Q1 2026 Newsletter
From the CEO
By Curt Hill
If you have been keeping on top of our quarterly newsletters, you know that I have been sharing the work Donna, Paula, Jana, and I did in the summer of 2023 when we re-imagined PMRG and who we say we are for our clients, our staff, and the medical billing industry in general. The work we did was enlightening for us and articulated a future that heretofore was at best murky. If you missed any of those newsletters, you can find them all here: PMRG Quarterly Newsletters.
In this edition, I’ll share the four aspects of the declared future we created. You can imagine this as four corners of a canvas that defines the arena in which we do our work where we are creating the extraordinary together.
1. Who We Are
We are a company that people want to be a part of.
We are a team that doesn’t back down or give up in our commitment to produce extraordinary results.
With deep compassion, we hear, acknowledge and appreciate each other.
2. What We Stand For
We say people matter and have unlimited potential for growth, development and fulfillment.
We stand for physicians being free to practice medicine unconstrained by the hassle of reimbursement.
3. What We See
We see everyone involved in the process of medical reimbursement collaborating in partnership – a new model for doing business.
We see the possibility of people working remotely being nurtured and having a real sense of belonging and being part of a team.
4. What We Promise
We promise to honor our values and to work in service of the best interests of our clients and our staff.
These four aspects of the future we declared are not simply words on a page, or something to be framed and hung up in a lobby somewhere. No, this is what we reference ourselves against. We keep this in front of us as a sort of north star. We review it on every all-staff call we have. Going forward on the newsletters, I’ll highlight one of these aspects or one of our values with an example that illustrates it.
Strengthening Revenue Cycle Performance in Today’s Ophthalmology Practice
By Jana Holt
In our December newsletter, I shared an outline of strategic goals for ophthalmology practice administrators to focus on in the year ahead. Throughout this year, each quarterly newsletter will take a deeper dive into these priorities, providing practical guidance and actionable strategies to support successful implementation. The goal is to help practices strengthen operations, improve financial performance, and build sustainable processes that support long-term growth.
In today’s evolving healthcare environment, ophthalmology practices must balance exceptional clinical care with strong financial performance. As reimbursement models grow more complex and patient responsibility continues to rise, optimizing Revenue Cycle Management (RCM) is essential to maintaining profitability, compliance, and long-term sustainability.
Three key areas have the greatest impact on revenue performance: payer mix and contract analysis, billing and coding accuracy, and proactive management of accounts receivable (A/R). Focusing on these areas allows practices to reduce revenue leakage, improve cash flow, and strengthen operational accountability.
1. Analyze Payer Mix and Contract Performance
Not all payers contribute equally to a practice’s financial health. While patient volume may appear strong, reimbursement rates, denial trends, and payment timeliness ultimately determine profitability.
A thorough analysis of payer mix helps identify high-performing contracts and those that underperform due to low reimbursement, frequent denials, or slow payment cycles. Understanding this data supports smarter contract negotiations, strategic scheduling decisions, and service line growth planning.
Key reports to monitor:
• Payer mix by charges and collections
• Reimbursement per encounter by payer
• Denial rates by payer
• Contractual adjustment trends
Important KPIs:
• Net collection rate by payer
• Average payment per visit
• Denial rate
• Underpayment rate
• Average days to payment
When reviewed consistently, this data empowers leadership to make informed financial and operational decisions rather than relying on volume alone.
2. Audit Billing and Coding Practices
Accurate coding is both a financial driver and a compliance safeguard. Ophthalmology practices manage a complex mix of E/M services, diagnostic testing, procedures, and injections—all of which are subject to payer scrutiny.
Coding inaccuracies can result in lost revenue through undercoding, increased denials, delayed payments, or compliance exposure due to overcoding. Expanding the number of charts audited each month provides a more accurate representation of provider coding patterns and documentation quality.
Recommended reporting includes:
• Coding distribution by provider
• CPT utilization trends
• Modifier usage analysis
• Denied claims by CPT
• Audit findings summaries
KPIs to track:
• Coding accuracy rate
• Undercoding and overcoding percentages
• Coding-related denial rate
• Documentation deficiency rate
• Charge lag days
Routine auditing not only improves revenue capture but also strengthens documentation integrity and reduces long-term audit risk.
3. Address Accounts Receivable (A/R) Aging
A/R performance is one of the clearest indicators of revenue cycle health. When balances age beyond 90 days, the likelihood of collection decreases significantly. Delays often stem from claim errors, denial backlogs, incomplete documentation, or unstructured patient collection processes.
PMRG’s strong RCM management approach helps practices strengthen this critical area. A healthy revenue cycle begins with clean claim submission and continues with proactive denial management and early follow-up on unpaid claims. Equally important are well-defined internal patient financial policies and structured payment plan options, which significantly improve patient A/R performance and overall collection success.
Essential reports include:
• A/R aging summaries
• A/R by payer
• Denial aging
• Patient balance aging
• Bad debt write-off trends
Core KPIs:
• Days in A/R
• Percentage of A/R over 90 days
• Clean claim rate
• First-pass resolution rate
• Patient collection rate
• Bad debt as a percentage of charges
PMRG can intervene early and monitor these indicators monthly so that your practice can experience stronger cash flow, reduced write-offs, and improved financial stability.
Moving from Monitoring to Action
Optimizing revenue cycle performance requires consistent reporting, defined accountability, and timely action. Establishing a monthly dashboard that tracks payer performance, coding accuracy, and A/R trends ensures leadership can quickly identify negative patterns and implement corrective measures.
When these areas are proactively managed, an ophthalmology practice is better positioned to reinvest in staff, technology, and patient care — ultimately strengthening both clinical excellence and financial performance.
Employee Spotlight:
Andrea James
Andrea James serves as a Credentialing Specialist within our Client Services team, bringing decades of hands-on healthcare administrative experience to PMRG. She began her career in medical billing in 1998 and expanded into credentialing in 2011. Her path reflects true professional growth—starting at the front desk, advancing into billing, and ultimately building deep expertise in credentialing.
Throughout her career, Andrea has worked in private practices, surgery centers, management companies, and independently. This diverse background gives her a comprehensive understanding of healthcare operations from multiple angles, allowing her to anticipate challenges and support clients proactively.
Her experience spans a wide range of specialties, including ophthalmology, optometry, endocrinology, pain management, PT/OT, infertility, orthopedics, sports medicine, rheumatology, family practice, internal medicine, podiatry, neurology, nephrology, and infectious disease. This breadth of knowledge enables her to navigate payer requirements confidently and efficiently across specialty lines.
Andrea joined PMRG in March 2022 and is an integral part of the Client Services team. She values being part of a collaborative group that is “small but mighty,” and appreciates leadership’s genuine investment in supporting employees and fostering a strong team culture.
Originally from Los Angeles, California, Andrea now resides in Las Vegas, Nevada. Outside of work, she enjoys spending time with her family, cheering on football, caring for her dogs, and gardening.