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PMMC Healthcare Revenue Cycle Blog
Stay up to date on best practices for healthcare revenue cycle management with PMMC's blog.
BI Insights: A Growing Challenge for ER Downgrades
Discreet ER Downgrades: A Growing Issue for Hospitals Discreet Emergency Room (ER) downgrades are an increasingly pressing issue for hospital financial teams. Unlike traditional ER downgrades where the emergency room level on the remit is lower than the ER level on the claim, discreet downgrades present a unique challenge. In these downgrades, the ER levels on the claim and remit match, but the reimbursement is still based on the lower ER level negotiated rates and charges. This discrepancy results in lower reimbursements and necessitates more effort to recover revenue.
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The CFO's Predicament and Pathway to Innovation
With the days of 'business as usual' behind us, the role of an executive has changed. In an enlightening conversation with David Zerfoss, Master Chair at Vistage Worldwide and former President of Husqvarna Professional Products North America, David unveiled the intricate dance between strategy, growth, and continuous learning in fueling sustainable innovation.
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Uncovering Hidden Revenue: The Low-Balance Account Opportunity
For years, the conventional wisdom in the finance and healthcare sectors has been that low-balance accounts represent negligible value — they're seen as more trouble than they're worth, consuming resources that could be otherwise directed to higher-yield pursuits. That sentiment is precisely where many of us have been getting it wrong. In the labyrinth of the revenue cycle, low balance accounts often hide opportunities for incremental, sometimes substantial, returns that can significantly impact a hospital's financial health. Here's why you shouldn't glaze over these seemingly small accounts, and how to transform them into a robust source of revenue.
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Co-sourcing as a Hybrid Approach to Financial Management
In the evolving landscape of healthcare finance, hospitals continuously face the dilemma of choosing between insourcing and outsourcing their financial administration tasks. This decision carries significant implications for operational efficiency, cost management, and overall patient care quality. In assessing these options, it's crucial to understand the advantages and challenges associated with each strategy.
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CMS | CMS & Transparency | Patient Estimates
CMS Price Transparency Updates for 2024: Navigating Compliance, Avoiding Fines
The Centers for Medicare & Medicaid Services’ (CMS’s) initial price transparency rule went into effect on January 1, 2021. While January 1st, 2024, marks the three-year anniversary of this sweeping regulation, the rule is still evolving, and compliance is proving to be an ongoing challenge for many organizations. If your organization hasn’t yet achieved full compliance, fines are avoidable. However, you can mitigate the scope and severity of fines by prioritizing key updates to your pricing strategy. CMS regulators will be evaluating your organization to determine whether it has made a good-faith effort to achieve price transparency. They will also be evaluating your website to ensure it has the appropriate text file and footer link. Join us as we further explore these requirements, the fining process, and what you can do to protect your organization’s revenue in 2024. We’ll also highlight what changes go into force in 2024, what key deadlines to look out for, and what they mean for you.
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CMS & Transparency | defensible pricing | strategic pricing
Consumerism in Healthcare: A Look to the Future
In the near future, hospitals will compete for business just like other service industries, i.e., restaurants and retailers, to name a few. For example, consider how someone finds the best speaker to buy on the market. They go online and compare prices, specs and quality. Knowing this information, they can then decide whether they will choose a certain speaker or not. For years, healthcare was immune to this level of consumerism, but since the push for stricter price transparency laws in healthcare, the consumer now has all the information they need to choose your hospital or not. The truth this change brings is that consumerism isn’t going anywhere. In fact, it is only going to get ramped up. As it will affect their bottom line, hospitals should take this seriously and plan to align with consumer demands and expectations.
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From Dollars to Sense: Strategic Pricing Key Challenges and Solutions
Of the various factors that impact your healthcare organization’s profitability, pricing is an often overlooked lever that you have control over. Even those healthcare organizations that do address pricing sometimes undermine their strategic pricing strategies by failing to address lesser-of-charge clauses or skipping the charge description master (CDM) modeling process, which can wreak havoc on their bottom line. The price transparency mandate added another layer of complexity, as raising prices to eliminate lower reimbursement may have adverse effects.
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Reimbursements & Recovery | revenue cycle analytics
Quarterly Business Intelligence Report: Navigating the Denial Storm
During the height of the COVID-19 pandemic, patient volume declined by 60%, overall claims volume decreased, and revenue plummeted for healthcare organizations and hospitals nationwide. However, insurers were paying for virus treatment and testing services, which helped offset some of the financial impacts of the epidemic.
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Pricing Transparency Evolves: Ensuring Hospital Compliance Amidst New Regulations
In July 2023, CMS proposed some major price transparency changes with the release of the 2024 OPPS rules. Most notably, the proposed rule changes move to standardize the formatting of the machine-readable files (MRF), increase data accessibility and greater accountability. This can lead to a significant impact on hospitals that are not completely compliant with existing regulations. Even if you believe your organization is 100% compliant today, the proposed changes may expose your hospital to penalties. Let’s examine the proposed price transparency changes and highlight how PMMC is quickly moving to incorporate these changes to help our clients remain compliant.
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Pricing Transparency Laws and the Need for Reliable Estimator Software
The CMS’ hospital price transparency laws are in full effect. In addition to requiring hospitals to post pricing data online, these regulations also make it mandatory for facilities to provide estimates to patients upon request and include estimates for ancillary providers as well.
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