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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.
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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Modernizing Revenue Recovery Through the Power of AI
A revolutionary new AI tool is poised to change how healthcare organizations manage revenue recovery and protect cash flow.
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