Q3 2025 Newsletter
From the CEO
By Curt Hill
If you’ve been keeping up with the articles I’ve been writing for the past several quarterly newsletters, you know that I’ve been sharing aspects of the BluPrint work that Donna, Paula, Jana, and I created in the summer of 2023. The three days we spent together were an amazing time for us, and it gave us the necessary time away to gain a fresh perspective on our company and to re-imagine what we are committed to going forward. Out of that work, we invented our Ultimate Intent, or in other words, what our company is really about.
Yes, our primary line of business is and will remain revenue cycle management—or medical billing—for ophthalmologists, and I think we are quite good at it! However, while that is what we’re doing, it is not our ultimate intent, or said another way, what we are focused on delivering. We got very clear that what we’re committed to is Creating the Extraordinary, Together. So, by virtue of what we’re doing on a day to day, week after week, year in year out basis, we aim to create something truly extraordinary and to do it together with our clients, our vendors, and our staff. We hold ourselves to this every day!
In previous editions of this newsletter, which you can find here: PMRG Newsletters, we discussed our senior values of communication, partnership, and integrity. In this edition, I’ll review our senior value of courage. To create a bit of context, when the four of us did the hard work of re-imagining PMRG’s future, we aligned on five senior values. That’s of course not to say that there aren’t other attributes we value outside of the core five. It’s simply that the five we aligned on we say represent the senior values of PMRG and are consistent with our ultimate intent of creating the extraordinary, together.
When we say courage, what we mean is this: the willingness to take on the difficult, the challenging, and the uncomfortable. In acting with courage, we discover how big we truly are—our extraordinary nature. What does this mean in practice? As I’m sure we all know and appreciate, there are things that come along in the workday that are difficult, challenging, or uncomfortable. We don’t shy away from these things. In fact, stepping into these things and taking them on fully is an opportunity for us to grow and to fulfil our ultimate intent.
Curt Hill, CEO
PMRG, Inc
Understanding All-Payer Claims Databases (APCDs)
By Jana Holt
All-Payer Claims Databases (APCDs) are large state-managed databases that collect healthcare claims data from both public and private insurers. These databases include medical, pharmacy, and dental claims, as well as eligibility and provider files. APCDs are designed to improve healthcare affordability, efficiency, and cost transparency by providing comprehensive data on healthcare utilization and costs.
Purpose of APCDs
APCDs serve several key functions:
Price Transparency: They provide insights into healthcare costs, helping consumers make informed decisions.
Healthcare Policy & Research: Policymakers and researchers use APCD data to analyze healthcare trends, improve quality, and reduce costs.
Provider Performance Comparison: States can use APCD data to compare provider performance and healthcare outcomes.
Public Health Initiatives: APCDs support efforts to identify disparities in healthcare access and outcomes.
States with Publicly Available APCDs
Currently, 18 states have legislation mandating the creation and use of APCDs, while more than 30 states either maintain, are developing, or have a strong interest in establishing an APCD. Some states have launched public websites that provide price and cost information for consumers. Other states are still in the process of developing their APCD infrastructure. An interactive state map is available on the APCD Council’s website.
https://www.apcdcouncil.org/state/map
Here’s how the APCD in your state can help you make practice decisions:
Benchmarking Costs & Utilization: You can compare your practice’s costs and service utilization against statewide data to identify areas for improvement.
Negotiating with Payers: Access to claims data can strengthen your position when negotiating reimbursement rates with insurance companies.
Improving Patient Care: By analyzing trends in treatments and outcomes, you can make data-driven decisions to enhance patient care.
Understanding Market Trends: The database includes claims from Medicare, Medicaid, and private insurers, offering insights into broader health care trends in Colorado.
Policy & Compliance: Stay informed about regulatory changes and reimbursement policies that impact your practice.
APCDs play a crucial role in enhancing healthcare transparency and affordability. By collecting and analyzing claims data, states can improve healthcare decision-making for consumers, policymakers, and providers. As more states adopt APCDs, the potential for nationwide healthcare improvements continues to grow.
Employee Spotlight:
Noemi Guerrero
This quarter we’re proud to introduce you to COPC-Credentialed Team Lead Noemi Guerrero, who has worked for PMRG since 2016.
Noemi went to school for medical billing and coding at Everest College. Through an internship, she was “introduced to the medical world of the eye” and was later hired to work at that practice as an office coordinator. After that doctor retired, Noemi stayed on with the doctor who took over her practice as an ophthalmic technician. Several years later, one of the doctor's colleagues hired Noemi to do billing at her retina practice.
"I've basically worked from the front of the eye, starting with optometry, to the back of the eye—retina," she said.
Although Noemi worked her way up to practice manager, she found herself missing the billing aspect.
“I heard of PMRG through a good friend who worked here and for that I’m grateful—this is a company you want to be a part of!” Noemi said.
Although Noemi misses aspects of working in an office—including connecting in person with coworkers—she appreciates the work-life balance that working from home offers her.
“Time previously spent commuting can now be spent with the family,” she says.
And family is very important to Noemi.
“I’ve been married for 21 years to my best friend, Robert,” she says. “We have the most wonderful son ever, Rey. He will be starting college this fall and as his parents, we couldn’t be prouder!”
In addition to her husband and son, Noemi is close with her large family, including her three brothers and many cousins.
“Whether we are hanging at one of our homes, the beach, or just out enjoying the city, I love to make memories with them,” she says.
Noemi also enjoys hanging out with friends, video games, reading and being outdoors in the sun, including walks in nature and gardening.
Thank you, Noemi, for being one of our valued employees for the past nine years!