PMMC Healthcare Revenue Cycle Blog
Stay up to date on best practices for healthcare revenue cycle management with PMMC's blog.
Price Transparency Still Failing In Most States - Here's Why
Despite efforts to improve price transparency, 43 states received an "F" grade according to the Health Care Incentives Improvement Institute (HCI3 ) – Catalyst for Payment Reform (CPR) Report Card on State Price Transparency Laws.
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Visit Us In Vegas! PMMC to Reveal Revenue Cycle Solutions at HFMA ANI
Las Vegas is the place to be next week (June 26-29) for healthcare finance and the revenue cycle at the annual HFMA National Institute (ANI). PMMC will be front and center in the exhibit hall, so be sure to visit us at Booth 123.
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Win Payer Negotiations With Contract Modeling
It’s a disadvantageous situation from the beginning: It’s time to renegotiate payer contracts, but your hospital has a high volume of commercial contracts and payers are shifting to new reimbursement methodologies. Not to mention the contract language is open to interpretation.This is a situation Managed Care is placed in more and more often these days. These factors give leverage to commercial payers and make it difficult for hospitals to determine how the new contract terms impact net reimbursement revenue, especially when using tools like Microsoft Excel.
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Why Denial Management For State Medicaid Is So Frustrating
It's estimated that nearly 7% of healthcare providers claims are denied by payers. The good news is that nearly 75% of these items can be successfully appealed and collected. However, this process is tedious and, more importantly, extremely time consuming for staff. Some payers are notorious for denying claims more frequently and are slower to pay than others. State Medicaid programs are known to be one of them. Medicaid state programs are among the slowest paying and least transparent payers, with an overall average denial rate of 18.5 percent (compared with 6.8 percent for all payers) and an average of 44 days spent in Accounts Receivable (compared to 26 days for all payers).
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[Webinar] How To Create A Friendly Patient Estimation Process
Did you know that 80 percent of patients find a patient estimate to be helpful, but only about 25 percent of patients actually receive one?
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No Joke: CJR Ruling Starts Today
No April Fools joke here. Medicare's Comprehensive Care for Joint Replacement (CJR) ruling officially goes into effect TODAY in 67 markets leaving many hospitals accountable for the total cost of services across the entire episode of care for hip and knee replacements. The financial risk for hospitals is between $500,000 and $3 Million in payback penalties over the next five years. That's a lot of money.
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CJR Is Here: How To Prepare for The Financial Impact [Webinar]
This is not an early April Fools joke. Medicare's Comprehensive Care for Joint Replacement (CJR) officially goes into effect on April 1st in 67 markets (the specific MSA's can be found at the bottom of this post), leaving many hospitals accountable for the total cost of services across the entire episode of care for hip and knee replacements. That's why we're partnering with Healthcare Business Insights (HBI) on March 15th for a webinar to help hospitals prepare for the financial impact of the CJR model.
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Healthcare Price Transparency Tested In 6 Cities - How Did They Do?
From New York to Los Angeles and in between, researchers found it difficult, frustrating, and sometimes impossible to obtain patient estimates for routine medical procedures, according to a new study from the Pioneer Institute Policy Brief. Here's the scenario: Researchers called into 54 hospitals in six metropolitan areas (Des Moines, IA, Raleigh-Durham, NC, Orlando, FL, Dallas-Ft. Worth, TX, New York, NY and Los Angeles, CA) asking for the price of an MRI of the left knee. Generally speaking, this is a pulse check of how far healthcare providers have advanced in adapting price transparency.
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CMS & Transparency | Strategic Pricing & Chargemaster
Why Hospitals Should Stop Automatic Chargemaster Increases
Hopefully your hospital's pricing strategy doesn't sound like this: “Prices were set in cement a long time ago and just keep going up almost automatically.” This was one Chief Financial Officer’s explanation of Chargemaster prices from the controversial 2013 Time Magazine article “Bitter Pill: Why Medical Bills Are Killing Us.” The article highlighted the extreme cases of high prices at hospitals and even called several hospitals (by name) into question. Although some of the findings in the report were later disputed, the article placed hospital pricing under a microscope and reinforced the need for defensible pricing. Automatic price increases might be the traditional route, but the strategy opens itself up to scrutiny, inefficiencies, and a potential loss in net revenue. Because of these factors and the recent emphasis on increased price transparency and defensible pricing, hospitals are moving away from the "across the board" annual gross price increase and towards a modeling approach to predict how charge adjustments impact net revenue. Not only does this give finance a clearer picture of future net revenue, it creates a defensible pricing strategy if prices ever come into question.
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Hospitals Face Up to $3 Million Financial Loss from CJR Ruling
We now have a better understanding of the financial implications of the Comprehensive Care for Joint Replacement (CJR) model, the new CMS rule that requires bundled payments for hip and knee replacements.
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