Case Study: State Facility Consulting

The Client:
State of North Carolina, Department of Health and Human Services Division of Mental Health, Developmental Disability and Substance Abuse Services

The Project:
Come-behind billing services and additional technical/operational support to enhance revenue for North Carolina’s state-operated mental health facilities.

The Opportunity:
The North Carolina Department of Health and Human services (DHHS) currently has 12 state-operated facilities to serve some of the neediest clients within the state system. PCG set out to maximize claim collections for these 12 facilities through the aggressive pursuit of liable third parties, including Medicaid, Medicare, Medicare Part D, TRICARE, and other commercial carriers.

The PCG Approach:
Since 1997, PCG has supplemented state staff to optimize revenue and improve cash-flow for the state by working on some of the more difficult accounts for which collections had not yet been realized. These accounts typically require extensive work with facility staff to provide the needed information to resubmit claims to the liable third party carriers. PCG’s understanding of the significant differences between mental health and physical medicine billing allow our diverse staff to provide expertise in solutions for all phases of the billing process, from patient intake third party liability identification to compliance monitoring, patient billing/information systems, claim coding, and process improvement.

The Result:
To date, PCG has collected more than $37 million for North Carolina, including more than $10 million in FY 2006-2007.