Q1 2024 Newsletter
A Letter from Curt Hill
We at PMRG envision a world where everyone involved in the process of medical reimbursement is collaborating in partnership–a new model for doing business. We know we aren’t currently living in that world, and we aren’t naïve about the challenges involved in having that world come about. Nonetheless, we see the possibility of that kind of collaboration. To be clear, when we say everyone, this includes the insurance companies!
As you know, in our work on your behalf, we engage with insurance companies daily, and often that is difficult and challenging. From an outsider’s perspective, one might even say that private commercial carriers are out to avoid paying for the services, you—a professional health care provider—are providing. There is plenty of evidence to support this view.
However, looking at it that way does not empower us! We are actively working to create relationships within the large commercial carriers who are willing to work in partnership with us to best serve you, which ultimately best serves your patients. This may seem quixotic, but it is the world we see as possible!
We’re working every day to bring those possibilities to light. One way we’re bringing our vision to life is with a newly renovated website. I invite you to visit! You can find us at www.medicalpmrg.com.
Finally, a few reminders:
For custom reports, please send an email to reports@medicalpmrg.com.
For technical issues such as working with e-bridge, or for most things with AdvancedMD, please contact our support team at support@medicalpmrg.com.
If you have consulting needs outside of the normal billing we do, Jana is brilliant for that! She can be reached at jholt@medicalpmrg.com.
And, lastly, if you have colleagues that you think could use our services, please send them my way at chill@medicalpmrg.com. Your referrals speak volumes!
Documenting and Coding
for Social Determinants of Health
by Jana Holt
Social Determinants of Health (SDoH) are economic or social conditions in the environment that can affect individuals’ health and quality-of-life outcomes.
Social determinants of health can be broken out into five groups:
Economic Stability
Education Access and Quality
Health Care Access and Quality
Neighborhood and Built Environment
Social and Community Context
Examples of SDoH:
Safe housing, transportation, and neighborhoods
Racism, discrimination, and violence
Education, job opportunities, and income
Access to nutritious foods and physical activity opportunities
Polluted air and water
Language and literacy skills
The above Social Determinants result in a patient whose care management is considered Moderate Risk, 99204/99214. You medical record must contain the documentation to support and SDoH.
CMS and the CDC have established ICD-10 codes to help track patients who are affected by one (or more) of the five groups of Social Determinants of health in an effort to produce better outcomes.
The following links contain helpful information for documenting and choosing a diagnosis code for patients affected by Social Determinants of Health.
Using Z Codes: The Social Determinants of Health from CMS.gov
Improving the Collection of Social Determinants of Health (SDOH) Data with ICD-10-CM Z Codes
If you need any additional information or guidance regarding Social Determinants of Health as it relates to your practice, please contact Jana Holt at jholt@medicalpmrg.com.
Employee Spotlight:
Amber Rohead
This quarter we’re proud to spotlight Team Lead Amber Rohead. Amber started at PMRG in 2015, working her way up from biller to her current position.
Amber started her career in medical billing and coding in 2010. Shortly thereafter, she moved into ophthalmology when she started working for a local practice in the area. Two years later she began to work at PMRG. In 2016, she got assigned to Eye Care Institute when they became a PMRG client; she has managed their account since. Currently she and her team also manage HINES and ECOA.
Amber has enjoyed working at PMRG. She loves the laid-back work environment, the friendships she’s made with her coworkers, and she enjoys the flexibility of working from home since PMRG switched to that model.
Amber describes herself as “A busy mother of four daughters,” ages 18, 20, 23, and 26. Although her two oldest daughters no longer live at home, Amber said, “I was lucky enough to expand my family in the last year to include my fiancé and his two daughters (ages 13 and 15). I am really enjoying having a household of six to care for and cook for once again.”
Amber is also an accomplished athlete and loves to run. She has completed four marathons (26.2 miles of running each) and a half ironman race (70.3 miles total, made up of a 1.2-mile swim, 56-mile bike ride and a 13.1-mile run).
Amber considers it her calling to “Help people realize that anything can be accomplished when you set your mind to it. I carry this with me every day, throughout every facet of my life."
“Whether I am facing a challenge of my own with my sport, my profession, or my family, if I am trying to support a friend, family or co-worker—or even a stranger on the street—this is what drives me every day. I want to share as much positivity as I can to get people excited about the things that I am excited about as it works for me."
“When I accomplish a goal, I feel so much personal pride and it drives me so much that I want everyone else to experience the same feeling!"
Thank you, Amber, for being one of our valued team members!
