Riverside Medical Clinic Selects PCG Software's Virtual Examiner®

Business Wire, July 8, 2008

Multi-specialty group utilizes Virtual Examiner software to identify unclean claims, which is improving cost containment and staff efficiency

MALIBU, Calif. -- PCG Software, a leading provider of innovative software solutions designed to increase profitability for healthcare payer and provider organizations, today announced that Riverside Medical Clinic (Riverside, Calif.) has selected the company's Virtual Examiner claims evaluation software to improve cost containment and enhance staff efficiency. Since installing the software in April 2008, the multi-specialty group is already retaining thousands of dollars by identifying unclean claims immediately upon submission.

"Prior to implementing Virtual Examiner, we had to rely on completely manual claims adjudication and auditing processes, which entailed significant inefficiencies and limitations," says Becky Pelkey, manager of prepaid business services, Riverside Medical Clinic. "We knew we were losing revenue, but we had no idea of the magnitude of those losses until PCG Software performed a claims data run that showed us how we had lost more than $400,000 by paying noncompliant claims in 2006 alone. That served as a major eye-opener, and the results we've achieved since deploying the software continue to impress us."

Since implementing Virtual Examiner, Riverside Medical Clinic has identified and retained thousands of dollars that otherwise would have been paid in unclean claims. Riverside expects that it will have recouped its investment in Virtual Examiner within 90 to 120 days of implementation. Deploying Virtual Examiner has also enabled Riverside to improve the efficiency and effectiveness of its staff, and since employees are no longer manually monitoring claims, they are being reassigned to more productive tasks.

Established in 1935, Riverside Medical Clinic is a multi-specialty group of more than 115 physicians serving more than 200,000 patients in the community of Riverside, Calif., and surrounding areas.

Virtual Examiner is a cost containment solution that evaluates claims for fraudulent and abusive billing practices; identifies claims that may involve third-party liability/coordination of benefits, case management opportunities and physician billing education; and provides many other cost recovery possibilities. Virtual Examiner also helps providers become aware of claims that may be out of compliance with state and federal regulations.

About PCG Software

Established in 1984, PCG Software is a leading provider of innovative software solutions designed to slow the escalating costs of healthcare. The company works with healthcare payer organizations to increase profitability and maximize financial recoveries, while assisting their provider partners to improve the accuracy of billing processes.

The company's flagship software solution enhances claims adjudication systems with more than 30 million edits per claim and uses investigative profiling reports to graphically indicate patterns of fraud and abuse. Through more accurate and efficient claims adjudication, this fraud and abuse prevention software acts as an automated cost containment system for national and regional health insurance plans, independent practice associations and third party administrators. More information about PCG Software can be found on the World Wide Web at www.pcgsoftware.com.