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.
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.
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.
Contract modeling software can help healthcare decision-makers look beyond their revenue cycles and adapt to industry trends to maximize profitability. Partnering with an experienced contract modeling system provider like PMMC is also helpful for evaluating payer contracts and ensuring that they’re being fully maximized. Let’s further examine contract modeling software, including why hospitals need them and the benefits they provide.
Over the last several years, hospitals and healthcare groups have been ravaged by pandemic-related revenue losses. According to the American Hospital Association, in 2021 alone, U.S. hospitals lost approximately $54B in net income. Despite that, hospital leaders strive to achieve an economic resurgence by reducing operating expenses, streamlining operations, and perhaps most importantly, restructuring payer proposals to maximize their returns.
Most hospitals have been feeling the effects of ongoing staffing challenges. Hospitals across the nation are struggling to hire and retain both frontline care providers and administrative talent like accounting personnel.
Since early 2020, hospitals have been contending with unprecedented challenges that have negatively impacted their revenue and profitability. Throughout 2022, 53% of hospitals had negative margins, according to the American Hospital Association, and even those projected to end the year with positive margins are still recouping from the financial hurdles of the last few years.
A revolutionary new AI tool is poised to change how healthcare organizations manage revenue recovery and protect cash flow.
We would like to congratulate April Miller, Director of Contracting and Payor Relations at PMHA, as PMMC's Star of the Month!
We would like to congratulate Sheila Morris, Revenue Cycle Director at Shepherd Center as PMMC's Star of the Month!