Blog
2024 Federal Poverty Guidelines Released
Payors and Providers wait for the release of the poverty guidelines each year to update patient financial assistance and eligibility information within their forms and systems. The 2024 Poverty Guidelines are now effective and posted HERE. Poverty guidelines are issued each year in the Federal Register by the Department of Health and Human Services (HHS). The federal poverty guidelines (FPG) are…
Reducing Uncompensated Care Using the Three C’s: Communication, Collaboration, and Compensation
Even a cursory review of the latest healthcare news reveals that hospitals and health systems across the United States are looking to improve their financial outlook. With media headlines touting another round of layoffs at many health systems, the question becomes: Where and how can revenue cycle vendor partners step up to the plate and…
Is Strategic Pricing a Luxury or a Necessity for Hospitals Today?
Hospitals are operating in a world where they are being crushed by labor costs. I talk to CFOs daily that describe unsustainable labor models they have been forced into. As a result of this financial stressor, hospitals must scrutinize other costs, looking for savings. Hospitals must purchase sutures, oxygen, and other mission critical needs,…
Miskeying, Miscoding and Mismanagement: The Costly Mis-takes of Risk Adjustment
It has been a busy six months in the Medicare Advantage (MA) risk adjustment space, with plenty to keep the industry’s best and brightest thinking about what changes are in store for PY 2024 and beyond related to the risk model transition from v24 to v28, and the RADV Final Rule. Much of this prodigious…
Core Tenets for Monitoring and Improving Referring Relationships with Providers
Every hospital relies on a network of relationships with a variety of partners, including their patients and their support networks, local independent and employed physicians, state and federal organizations, payors, and many others. One of the most important relationships in driving growth, as opposed to other facility goals, is that with the local referring physician…
Price Standardization For Hospitals
Hospitals have a rational interest in standardizing prices across facilities. This interest has only intensified with the introduction of Price Transparency requirements. The goal of standard pricing must be considered simultaneously with other goals such as price stability and changes in gross and net revenue. There are several complexities in this analysis that must be…
Federal Poverty Guidelines 2023 Release and the “Unwinding” of Medicaid Continuous Enrollment Period
Payors and Providers wait for the release of the poverty guidelines each year to update patient financial assistance and eligibility information within their forms and systems. The 2023 Poverty Guidelines are effective January 16, 2023, and are now posted HERE. Poverty guidelines are issued each year in the Federal Register by the Department of Health and Human Services…
New ESRD 2023 Payment Model and Dual Status Impact
Starting with the January 2023 payment month, health plans will see the impact of dual status on their End-Stage Renal Disease (ESRD) members change from prior years. In 2023, CMS implements the changes to the ESRD payment models that were announced in the 2023 advance notice. The revised ESRD payment model is calibrated on more…
ACA RA Transfer Report – 2021 Benefit Year
CLICK TO VIEW INTERACTIVE VISUALIZATION Once again, the U.S. Department of Health and Human Services (HHS) reported that the risk adjustment program operated smoothly for the 2021 benefit year. For the seventh year, the risk adjustment program is working as intended by more evenly spreading the financial risk carried by issuers that enrolled higher-risk individuals…
Dual Eligible Renewal Strategies
The U.S. Department of Health and Human Services (HHS) first declared a Public Health Emergency (PHE) in January 2020. Section 6008 of the Families First Coronavirus Response Act (FFCRA) as amended by the Coronavirus Aid, Relief, and Economic Security (CARES) Act provides states with a temporary 6.2 percentage point increase in their federal medical assistance…