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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.

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New FAQs Aim to Clarify 2019 CMS Price Transparency 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.

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CMS  |  Price Transparency

Examples of Online Patient Estimates to Help Your Hospital with Price Transparency

At a time when healthcare consumers expect greater personalization when it comes to receiving price estimates, providers are feeling the pressure to improve price transparency by providing an online patient estimation solution that is engaging, easy to use, and most of all, accurate.

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Key Metrics for Contract Management

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.

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CMS Price Transparency Final Rule - Hospitals Must Publish Charges in 2019

What is the CMS Price Transparency Final Rule? In an effort to increase price transparency for consumers, CMS has updated its guidelines under the Final Rule CMS-1694-F (which is part of FY 2019 IPPS/LTCH PPS) that requires hospitals to post standard charges online in a machine readable format. This will be required for all hospitals beginning January 1, 2019.

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Top 3 Trends in Denial Management

During our recent webinar session “Denial Management Essentials: The Metrics and Reporting Tools You Need to increase Revenue” we polled healthcare providers on several topics around denial management.

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How Prevalent are Narrow Networks In Healthcare Today?

During our recent webinar session “Winning Strategies for Contracting in Narrow Networks” we polled healthcare providers on several topics around narrow networks. These questions provide insight as to how well your organization is prepared to manage narrow network negotiations. How would your healthcare organization answer these questions? Here’s how the live webinar attendees responded…

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Almost Half of Healthcare Providers Not Confident in Payer Contract Modeling Tools

At a time where the healthcare industry is forced to adapt to new reimbursement models, providers are having a tough time adjusting to the contract negotiation process. Each reimbursement model comes with its own stipulations and understanding how to work with the payer to reach your organization’s financial goals comes with its own set of challenges.

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The 4 Components of Payer Negotiations

Laying the Foundation Generally speaking, the key to building and maintaining the success of any complex system is to establish a solid foundation, and the same holds true for healthcare providers modeling their contracts. The foundationmust be stable and flexible enough to allow for future growth as AI and other forms of big data work to cement itself as essential tools in the data analyzation process. As time progresses and more data gets collected and sorted, however, organizations will be able to utilize this big data to model future contracts with a greater understanding of their primary needs. Because contract modeling is only one component (a.k.a. “th

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How to Negotiate with Payers – Tips from a Managed Care Expert

Every profession has its set of experts. In the health industry’s managed care field, one of those experts is Susan Mego. Susan Mego Currently serving as the Executive Director - Managed Care for The MetroHealth System and ACO Executive of MetroHealth Care Partners, Susan Mego’s knowledge and extensive experience in the field of healthcare management makes her an invaluable asset to the organization, a clinically integrated delivery system in Northeast Ohio. Susan’s leadership spans over managed care strategies, payer performance, population health initiatives, and contract negotiations with health plans, employers, and providers. Over the course of her career, Susan has enjoyed 20 years in health insurance industry management and 10 years in community/tertiary health system administration as well as serving as teaching faculty at Baldwin Wallace University, each contributing ...

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Revenue, Cost, Productivity and Quality: The Four Modern Day Healthcare Directives Heard in Today’s Boardroom

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Revenue Cycle Consolidation Causes Heartburn For Hospitals

For hospitals contemplating revenue cycle solutions, it’s important to make sure your revenue cycle solutions aren’t half-baked. Have you ever bought a bunch of ingredients and gadgets to duplicate what the pros make on a cooking show?  They make it look easy…but it’s not.  There are nuanced skills with timing, technique, temperature, and other subtle variables related to sequence and presentation. Cooking shows are similar to industry consolidation; be it energy, automotive, or even healthcare. So, what do we get with consolidation? 

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