ProTeam Management (PTM)

Healthcare Quality measurement, reporting, improvement, compliance, and dispute resolution solutions.

Welcome to ProTeam Management (PTM)

ProTeam Management (PTM) is a healthcare professional services firm specializing in healthcare quality measurement and improvement services, reporting and compliance services, independent program auditing, and dispute resolution services.  PTM’s clients include Federal, State, and Local Government Healthcare Agencies, Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs), hospitals, physicians, and nursing homes across the United States. PTM’s services assist healthcare systems with tools to provide better care, access to coverage, and improved health.  Many of PTM’s services lead to increased reimbursement, eligibility for quality incentives and readiness for organizational surveys, credentialing, and licensing/certification.

Healthcare is life and death. With spending on healthcare approaching 20% of our Gross Domestic Product (GDP), healthcare is complicated, expensive and requires specialized reporting and compliance processes if we are to achieve the goal to provide “a high-quality health care system that ensures better care, access to coverage, and improved health”

Managed Care Organizations – PTM provides HEDIS Compliance Certified Auditors to validate the Healthcare Effectiveness Data and Information Set (HEDIS) reporting that is required of most managed care plans. Other MCO services include, but not limited to:

  • Utilization Management/Quality Management program assessments
  • Technical Assistance in program development, performance improvement design, outcome analysis and both member and provider satisfaction strategies
  • Provider education
  • Billing Compliance audits

Accountable Care Organizations (ACOs) – PTM can help reduce reporting and submission burdens, optimize outcomes, deliver high-quality care, and reduce health care spending so it’s providers can share in the savings it achieves from participating in the Medicare cost sharing programs.

Nursing Homes – PTM provides Informal Dispute Resolution (IDR) and Independent Informal Dispute Resolution (IIDR) to nursing homes.  The IDR/IIDR processes gives nursing facilities, assisted living facilities, intermediate care facilities, Home and Community-based Services the opportunity to informally dispute State or Federal regulatory survey findings. Assistance with quality provisions in state contracts.

State, Federal, and Local Governments – PTM provides consumer quality and compliance services such as:

  • Independent Informal Dispute Resolution (IIRD) and Independent Dispute Resolution (IDR)
  • State External Quality Review (EQR)
  • Secret Shopper – Customizable Survey Compliance Reporting
  • Coding compliance audits

Hospitals, Clinics and Providers – PTM provides clinical data abstraction services, on-site and electronically (remote). Licensed and credentialed nurses, physicians and other healthcare professionals conduct medical record data abstraction services with a 95% IRR reliability rating Medical record review can be utilized to meet multiple client needs such as, education, conducting focus audits and complying with a corrective action plan.