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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.
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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