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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.
Business Insights | Contract Modeling
Leveraging Medicare Benchmarks in Contract Negotiations
When it comes to hospital reimbursement, one statistic often dominates the conversation—on average, hospital commercial reimbursement is coming in at approximately two to three times Medicare reimbursement. It’s critical to understand how your organization stacks up against industry benchmarks since this can significantly affect preparations for contract negotiations and your bottom line. Through analysis, we've found reimbursements to be approximately 200%-215% of Medicare. But here's the big question—how do you use this data strategically to enhance contract negotiations, improve financial planning and analysis (FP&A), and maximize net revenue?
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Why a Safety-Net Review could save you millions
Denials and underpayments are a constant challenge for hospitals, putting significant pressure on financial teams to recover lost revenue. With continual market shifts and inconsistencies in payor behavior, staying on top of these issues can feel like a moving target. That’s where having a safety-net review comes in—leveraging analytics, AI technologies, and decades of expertise to help hospital teams recover cash, minimize false variances, and optimize reimbursement processes.
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Keeping Accounts Receivable Under Control and Ensuring Financial Health
With a 21% increase in Accounts Receivable (AR) trends, is your team preparing for impacts on your organization's financial health? We're taking a closer look at aging Accounts Receivable (AR) – a vital indicator often influenced by external factors, like changes in payer behaviors and increasing denials.
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Protecting Yourself & Your Team from Phishing Attacks
In today's digital age, avoiding online scams has become more crucial than ever. With the growing prevalence of digital platforms for communication, shopping, and banking, cybercriminals continually develop new techniques to exploit unsuspecting users. Falling victim to online scams can lead to financial losses, identity theft, and compromised personal information—consequences that can be both costly and life-disrupting. By staying informed and adopting proactive measures, individuals and organizations can safeguard themselves against these threats and foster a safer online environment.
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Insurance Payments Continue to be Delayed Year over Year—What It Means for You
The healthcare revenue cycle is facing new challenges that can’t be ignored. Analysis of industry data reveals a concerning trend—payors took approximately 42% longer to pay in Q3 2024 compared to Q3 2023. This means cash flow disruptions, extended recovery times, and potentially significant financial impacts on your organization. Payment delays not only strains healthcare organizations but also fuels public frustration, as individuals grow increasingly discontent with the financial tactics affecting their access to timely and quality care.
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As We Approach 2025, Healthcare Organizations Need to be Prepared
As we bid farewell to 2024 and step into the new year, it's the perfect time to reflect on the past year and prepare for what lies ahead in 2025. In this article, we examine five significant takeaways from 2024, weighing their impact on the healthcare industry and offering valuable lessons for the future. Explore the key trends, challenges, and opportunities shaping 2025, and gain valuable information to navigate the coming year.
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Navigating the Rising Tide of Prior Authorization Denials
Prior authorization denials are a major headache for many healthcare organizations. As hospitals and healthcare organizations grapple with this persistent issue, it's crucial to grasp its implications and devise smart strategies to curb revenue losses. By tapping into analytics and insights, organizations can boost their operations and enhance overall performance. This article delves into the challenges posed by these denials, the ongoing rise in numbers, and practical ways to tackle them head-on.
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Transforming Data into Actionable Insights for Informed Decisions
Efficient contract management is increasingly becoming a linchpin for organizations aiming to leverage data for strategic advantage. Understanding how to turn raw data into actionable insights is crucial for maintaining business continuity in a dynamic environment. Explore how mature organizations can harness data for effective contract management, ensuring they remain competitive in the fast-paced world of healthcare finance.
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Business Insights | Strategic Pricing & Chargemaster
Hospital Finance: Decoding Lesser of Charges Insights
Lesser-of charge hits are increasingly eating into hospital’s revenue and have increased 30% year over year. Out of the health systems included in this survey, 43% saw an increase in lost revenue specifically due to lesser-of charges. These often-overlooked cost adjustments can greatly affect a hospital's financial health. Mastering these adjustments is vital for boosting financial performance and requires strategic complexity of balancing market position, price transparency, patient affordability, and the effects of lesser charges. Understanding the intricate relationship between these factors is essential for optimizing net revenue and remaining financially secure. A comprehensive, data-driven approach to decoding these nuances helps ensure that hospitals can continue to provide quality care while navigating challenging financial landscapes.
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Navigating the Future of Cybersecurity after the Change Healthcare Breach
In today's rapidly evolving digital landscape, cybersecurity isn't just an IT issue—it's a business imperative that affects every department. The recent Change Healthcare breach serves as a stark reminder of this reality, especially for those in the financial sector. This incident has highlighted the vulnerabilities within healthcare data security, urging organizations to reassess their protective measures. Understanding the implications of robust cybersecurity practices is not just about safeguarding sensitive information, but also about maintaining trust and compliance in an increasingly interconnected world.
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