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What is Virtual Examiner?

The Virtual Examiner®, developed by PCG Software, serves as a comprehensive tool for overseeing an organization’s internal claims process, efficiently tracking provider data to identify fraudulent or abusive billing practices while enhancing financial recovery. This advanced software enables healthcare organizations to optimize their claims adjudication systems, processing over 31 million edits per claim, which significantly streamlines operations. By meticulously monitoring the internal claims processes, it effectively pinpoints and mitigates payments made for incorrect or erroneous codes, ultimately preserving premium dollars. Beyond mere claims management, the Virtual Examiner® acts as a robust cost containment solution that analyzes claims for not only abusive billing patterns but also those that may require attention to third-party liability coordination, case management opportunities, physician billing education, and various other valuable cost recovery insights. Its multifaceted approach provides healthcare organizations with the tools they need to navigate complex billing landscapes and improve overall financial health.

What is PwC SMART?

PwC's Systematic Monitoring and Review Technology (SMART) significantly improves the efficiency and effectiveness of assessing the quality of both inpatient and outpatient coding processes while creating a robust framework for quality assurance and compliance evaluations. Supported by PwC Health Information Advisory, SMART strengthens your approach to monitoring coding accuracy and enhancing overall data quality. The inpatient module of SMART includes more than 1,000 predefined business rules aimed at identifying possible coding mistakes and opportunities for improving documentation, with flexibility to customize rules according to specific organizational needs. Its extensive reporting and data analysis features facilitate the evaluation of staff performance and highlight areas that require educational focus, such as Coding, Clinical Documentation Improvement (CDI), Quality, and Providers. Moreover, the outpatient module enhances claim accuracy and brings attention to issues concerning charge capture and the optimization of workflow processes. By addressing the risks associated with inaccurate coding, the system also promotes better regulatory compliance, ultimately leading to advantages for the entire healthcare organization. Furthermore, the combination of these modules effectively simplifies the coding review process, thereby ensuring elevated standards of care and improved operational efficiency, which can significantly impact the overall success of healthcare delivery. In this way, organizations can not only enhance their coding practices but also contribute to a higher quality of patient care.

Media

Media

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

API Availability

Has API

API Availability

Has API

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Company Facts

Organization Name

PCG Software

Date Founded

1984

Company Location

United States

Company Website

pcgsoftware.com/product-offerings/virtual-examiner/

Company Facts

Organization Name

PwC

Date Founded

1998

Company Location

United Kingdom

Company Website

www.pwc.com/us/en/products/smart.html

Categories and Features

Claims Processing

Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration

Medical Billing

Claims Processing
Claims Scrubbing
Code & Charge Entry
Compliance Tracking
Customizable Dashboard
Dunning Management
Invoice History
Patient Eligibility Checks
Practice Management
Quotes/Estimates
Remittance Advice

Categories and Features

Claims Processing

Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration

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