The Centers for Medicare & Medicaid Services’ (CMS’s) initial price transparency rule went into effect on January 1, 2021. While January 1st, 2024, marks the three-year anniversary of this sweeping regulation, the rule is still evolving, and compliance is proving to be an ongoing challenge for many organizations. If your organization hasn’t yet achieved full compliance, fines are avoidable. However, you can mitigate the scope and severity of fines by prioritizing key updates to your pricing strategy. CMS regulators will be evaluating your organization to determine whether it has made a good-faith effort to achieve price transparency. They will also be evaluating your website to ensure it has the appropriate text file and footer link. Join us as we further explore these requirements, the fining process, and what you can do to protect your organization’s revenue in 2024. We’ll also highlight what changes go into force in 2024, what key deadlines to look out for, and what they mean for you.
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.
Insurers are swimming in data that gives them a steady stream of insights into their markets and the healthcare providers with whom they contract. Unfortunately, most providers don’t have access to the same level of business intelligence. That lack of reliable information on payer performance puts healthcare organizations at a disadvantage.
As people across the country have shifted to working from home due to the COVID-19 outbreak, hospital revenue cycle leaders are doing their best to maintain "business as usual" while recognizing that they face unique challenges. PMMC recently hosted a virtual roundtable with two revenue cycle leaders at AnMed Health (based in Anderson, SC) and The Shepherd Center (based in Atlanta, GA). Our goal was to provide a forum for revenue cycle leaders to share their challenges and best practices for managing a team remotely and keeping up with payer collections. With over 100 healthcare providers in attendance, Samantha Evans from AnMed Health and Sheila Morris from the Shepherd Center offered some great advice and really spoke to what revenue cycle leaders are going through during this difficult time. Below you will find background on our revenue cycle panelists and their responses to the roundtable questions.
The healthcare revenue cycle is used by hospitals and health systems to manage all of the administrative and clinical data that comes into the hospital every day.
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.
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… 1. Is your organization currently part of a narrow network?
Laying the Foundation
This webinar has taught us a lot about a program in the healthcare industry commonly referred to as narrow networks. We learned about the pros and cons for adopting this type of system, the growing trend of employers offering this to their employees, and most importantly, the value of knowing the contracted terms before entering into these agreements. So, with that being said, what’s the biggest piece of advice we can take away from this presentation?:
During our recent webinar session “Intro to Narrow Networks: What’s the Impact on Healthcare Providers?” we polled healthcare providers on several topics around narrow networks.