At the Margins

Our latest insight into health care margin improvement efforts

You don't have to list your negotiated rates (yet): Our 3 key takeaways from the HOPPS final rule

By Eric Fontana, managing director, Revenue Cycle Advancement Center, and Rachel Hollander, senior analyst, Health Care Advisory Board November 4, 2019

On Friday evening, CMS released its latest set of finalized regulations for hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) in calendar year (CY) 2020. Our team is in the midst of breaking down the full implications of the rule, including new prior authorization requirements and ongoing cuts to the 340B drug program. We'll cover all of the details in our November 13th webinar.

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Curious about the impact of the Lower Drug Costs Now Act? Keep reading.

by Robin Brand and Sophia Duke-Mosier October 16, 2019

Amid all the buzz on the Hill about impeachment, you may have forgotten about House Speaker Nancy Pelosi's (D-Calif.) Lower Drug Costs Now Act proposal, but it's definitely worth your attention. If passed, this legislation will have a significant impact on provider finance.

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Surprise billing is still a problem. Here's how the legislative fixes compare.

by Lauren Robinson and Robin Brand October 9, 2019

Surprise billing continues to garner significant media scrutiny with stories of unexpected medical bills up to tens of thousands of dollars, exacerbating patients' fear and frustration. The attention has spurred debate around potential state and federal government solutions. Providers and insurers (and their respective lobbyists) are now squaring off, each advocating for different solutions, with patients stuck in the middle.

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Preview our 2019 Revenue Cycle Benchmarks

by Sophia Duke-Mosier and Rachel Matthews October 2, 2019

Later this month, we'll refresh our revenue cycle benchmarking tool with the latest data from 2019. In addition to the tool release, we'll detail key insights in a webconference on October 16. Want a sneak peek of our findings? Keep reading.

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Help us help you: Take our 5-minute survey to guide our research on charity care

by Sophia Duke-Mosier August 21, 2019

Struggles with patient collections and uncompensated care have increased, leaving hospitals scrambling for ways to collect on unpaid bills. But hospitals aren't the only ones scrambling—patients are continuously on the hook for more of their bills due to a shift from insurer to patient responsibility and rising out-of-pocket costs.

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Our take: This year's FY 2020 Inpatient Final Rule winners (and 2 other key insights)

Eric Fontana August 5, 2019

Late Friday, CMS continued the flurry of recent regulations by dropping the Inpatient Prospective Payment System Final Rule for Fiscal Year (FY) 2020. Unlike the headline-grabbing HOPPS proposal, this regulation was not expected to make major waves after a relatively tame inpatient proposal back in April. Nevertheless, our team will be scrubbing through the release over the next two weeks to examine the key provisions that will take effect on October 1, 2019.

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Make change a reality: How to gain stakeholder buy-in across the revenue cycle

by Robin Brand and Rachel Matthews July 31, 2019

Today's provider world moves at an impossibly rapid pace. Between mergers, EHR "go-lives," and staffing revamps, your revenue cycle has likely undergone significant change in the past year. In fact, research suggests that the average health care manager juggles five to 15 change initiatives at any one time.

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Medicare wants hospitals to disclose 'secret' prices, plus 2 other key takeaways from the 2020 HOPPS proposed rule

by Eric Fontana, Heather Bell, and Rachel Hollander July 30, 2019

Late yesterday, CMS released its proposed regulations for hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) in calendar year (CY) 2020.

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