It’s no secret that negotiating payer contracts has always been a challenge for healthcare providers. With the recent shift toward consumerism, changing patient behavior, and the revenue fallout from the COVID-19 pandemic, uncertainty is at an all-time high. To address this uncertainty, PMMC brought together three Managed Care experts. And we do mean experts – every panelist has had at least 25 years of experience. The panelists didn’t hold back from addressing the real challenges our hospitals face today in terms of revenue and reimbursement. It was shocking to learn that from March 1 to April 15, hospitals were losing $1 Billion per day due to the drop in elective procedures during the height of the COVID-19 outbreak. In just one hour, we covered everything including how to handle this revenue loss with payers, the impact of the rise in telehealth, and how to use predictive analytics and scorecards to manage and predict all these shifting dynamics in reimbursement.
As people across the country have shifted to working from home due to the COVID-19 outbreak, hospital revenue cycle leaders are doing their best to maintain "business as usual" while recognizing that they face unique challenges. PMMC recently hosted a virtual roundtable with two revenue cycle leaders at AnMed Health (based in Anderson, SC) and The Shepherd Center (based in Atlanta, GA). Our goal was to provide a forum for revenue cycle leaders to share their challenges and best practices for managing a team remotely and keeping up with payer collections. With over 100 healthcare providers in attendance, Samantha Evans from AnMed Health and Sheila Morris from the Shepherd Center offered some great advice and really spoke to what revenue cycle leaders are going through during this difficult time. Below you will find background on our revenue cycle panelists and their responses to the roundtable questions.
Key Metrics for Contract Management
The proper use of healthcare contract management software can make a difference of 2-3 percent net revenue. Thus, the proper use of a contract management system should be considered “mission critical,” from a financial perspective, but it often does not receive the attention it deserves. This whitepaper explains how applying metrics to healthcare contract management helps assure all accounts receive appropriate attention, thus ensuring revenue integrity.
For healthcare providers looking to make improvements to their revenue cycle, they should consider how they plan to manage their payer contracts and all of its data.
What are the Pros and Cons of contract modeling software versus using Excel for modeling and negotiating payer contracts? Negotiating payer contracts is one of the most important functions of Managed Care within hospitals and health systems. When done correctly, new contract terms can sometimes save healthcare organizations millions of dollars in reimbursement.
With over 400 hospitals and health systems nationwide equipped with the latest revenue cycle management (RCM) software through an integrated platform, PMMC is recognized as a leading provider of RCM software and services.
The healthcare revenue cycle is used by hospitals and health systems to manage all of the administrative and clinical data that comes into the hospital every day.
We live in a fast-paced digital world where literally every second, data is being shared from person to person across various networks. Because of this shift, businesses need to have access to the latest and greatest technology for not only serving their customers directly but also to allow their own employees to improve the financial performance of their company.
Just when we thought CMS was finished updating the requirements for the new price transparency ruling, they release another FAQ list that provides additional clarification to certain questions and includes new items to be added to your list of standard charges.
According to the CMS mandate (also referred to as FY 2019 IPPS/LTCH PPS), hospitals will be required to post their standard charges online via a machine-readable format for any given service by January 1, 2019. These prices must be updated at least annually and no hospitals are exempt from this mandate.
In August 2018, the Centers for Medicare and Medicaid Services (CMS) provided additional clarification to the new healthcare price transparency ruling (referred to as FY 2019 IPPS/LTCH PPS) that requires hospitals to post their standard charges online for any given service. The details of this mandate are spelled out in a series of frequently asked questions (FAQ) published on the CMS website.