PMMC Healthcare Revenue Cycle Blog
Stay up to date on best practices for healthcare revenue cycle management with PMMC's blog.
Navigating the Future of Cybersecurity after the Change Healthcare Breach
In today's rapidly evolving digital landscape, cybersecurity isn't just an IT issue—it's a business imperative that affects every department. The recent Change Healthcare breach serves as a stark reminder of this reality, especially for those in the financial sector. This incident has highlighted the vulnerabilities within healthcare data security, urging organizations to reassess their protective measures. Understanding the implications of robust cybersecurity practices is not just about safeguarding sensitive information, but also about maintaining trust and compliance in an increasingly interconnected world.
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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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Shaping the Future of Healthcare Consumerism
Consumerism is shaking up the healthcare industry, and it's an exciting opportunity for CFOs, CEOs, and financial teams in hospitals to embrace change and plan ahead. In a recent conversation with Ryan Donohue, consumerism author and expert, we explored the evolving landscape of healthcare consumerism and its impact on hospital operations.
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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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The CFO's Predicament and Pathway to Innovation
With the days of 'business as usual' behind us, the role of an executive has changed. In an enlightening conversation with David Zerfoss, Master Chair at Vistage Worldwide and former President of Husqvarna Professional Products North America, David unveiled the intricate dance between strategy, growth, and continuous learning in fueling sustainable innovation.
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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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Co-sourcing as a Hybrid Approach to Financial Management
In the evolving landscape of healthcare finance, hospitals continuously face the dilemma of choosing between insourcing and outsourcing their financial administration tasks. This decision carries significant implications for operational efficiency, cost management, and overall patient care quality. In assessing these options, it's crucial to understand the advantages and challenges associated with each strategy.
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CMS & Transparency | Patient Estimates
CMS Price Transparency Updates for 2024: Navigating Compliance, Avoiding Fines
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.
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Consumerism in Healthcare: A Look to the Future
In the near future, hospitals will compete for business just like other service industries, i.e., restaurants and retailers, to name a few. For example, consider how someone finds the best speaker to buy on the market. They go online and compare prices, specs and quality. Knowing this information, they can then decide whether they will choose a certain speaker or not. For years, healthcare was immune to this level of consumerism, but since the push for stricter price transparency laws in healthcare, the consumer now has all the information they need to choose your hospital or not. The truth this change brings is that consumerism isn’t going anywhere. In fact, it is only going to get ramped up. As it will affect their bottom line, hospitals should take this seriously and plan to align with consumer demands and expectations.
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