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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.
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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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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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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Combatting High Dollar Account Denials by Payors
Have you noticed a trend of higher dollar account denials by payors? If not, let’s get you caught up on what others are experiencing. The growing trend of payors denying high dollar accounts is a pressing issue for healthcare finance. It’s not just about the dollars—it’s about ensuring that nothing is left unchecked.
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Understanding the Impact of the Change Healthcare Breach and the Role of Analytics in Response
The recent cyberattack on Change Healthcare has highlighted critical issues in data management and financial stability within the healthcare industry. This breach has disrupted revenue cycles and exposed significant vulnerabilities. This article delves into the immediate and prolonged effects of the breach and explains how advanced analytics can play a crucial role in managing the aftermath.
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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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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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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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