Wednesday, November 18, 2020 Cleverley Uncategorized No comments
How To Prepare for An Insurance Audit Insurance audits can be an intimidating prospect, but they’re necessary and, unfortunately, inevitable. Even if an insurer didn’t single your facility out for an audit, you may be part of a random selection. Whether you’re preparing for a pre-payment review or a post-payment review, the general purpose of an audit, from the insurer’s perspective, is to ...
Thursday, October 29, 2020 Cleverley Uncategorized No comments
Beckers recently published an article on how to gauge your hospital’s financial health, and they make excellent points. You can read the full article here. They cover many of the basics, including Aggregate Volume, Operating Ratios, Labor Costs Relative to Patient Volume, and Liquidity Ratios, but we believe there is another measurement that can shed light on your facility’s health and fina...
Thursday, September 17, 2020 Cleverley Uncategorized No comments
The FY21 IPPS Final Rule solidified a new requirement for hospitals to post the median payment (called the median “payer specific negotiated charge”) by MSDRG for Medicare Advantage (MA) plans. The plan is to use this information to establish weights for MSDRGs using hospital payments, as opposed to hospital costs via the current cost-to-charge ratio methodology. Per the rule, this transition ...
Tuesday, July 28, 2020 Cleverley Uncategorized No comments
On July 16, 2020 Cleverley + Associates presented a webinar on the final rule on hospital price transparency and the requirements for individual hospitals and systems. Content included a description of the price transparency guidelines effective 1/1/21, a list of important action items hospitals must implement, and a discussion of the two different ways prices must be published. A reco...
Tuesday, June 30, 2020 Cleverley Uncategorized No comments
Healthcare and hospital finance have changed dramatically over the last few years, and yet there are many things that seem slow to change. One of these is the continued reliance on Adjusted Discharges or Adjusted Patient Days. Adjusted Patient Days made perfect sense at one time. The percentage of outpatient revenue was less than 20 percent of total operating revenue, and many hospitals wer...
Thursday, June 18, 2020 Cleverley Uncategorized No comments
Shoppable services, and the issues of pricing transparency indelibly connected to them, are a hot topic in the hospital industry. In the past we’ve created several reports to help hospitals who are searching for strategies to reduce prices, by focusing on procedures where they are likely to have the most competition from free-standing providers. In that spirit, we created the Cleverley Consume...
Wednesday, June 03, 2020 Cleverley Uncategorized No comments
The 2021 Inpatient Prospective Payment Systems (IPPS) proposed rule is out and as data nerds, we could not wait to dig into it and see what changed. A comparison of Table 5 – listing of MS-DRGs and relative weights – is a great place to start. Quick refresher on terms: Medicare Severity-Diagnosis Related Group (MS-DRG) is a classification system for inpatient discharges that helps standa...
Tuesday, April 28, 2020 Cleverley Uncategorized No comments
COVID-19 has dramatically impacted the hospital industry. As hospitals adjust to new challenges, they must also face questions about new procedures and treatment requirements. Last week we took a close look at how hospitals are pricing COVID-19 lab tests. Now, let’s take a look at isolation rooms. We sent out a survey to assess how hospitals were approaching this new pricing challenge...
Wednesday, April 22, 2020 Cleverley Uncategorized No comments
COVID-19 has dramatically impacted the hospital industry. As hospitals adjust to new challenges, they must also face questions about new procedures and treatment requirements. In our next two blog posts, we’ll take a close look at how hospitals are pricing COVID-19 lab tests and isolations rooms. We sent out a survey to assess how hospitals were approaching this new pricing challenge and we...
Thursday, April 16, 2020 Cleverley Uncategorized No comments
Note: This post was updated on 4/16/20 to reflect the most current information. During this COVID-19 pandemic, we have received several questions on how facilities should be billing for telehealth services. As we continue to collect as much information as possible, we wanted to provide our findings so far:  Payment Guidance: Facility:Currently, billing for Medicare telehealth ser...
Wednesday, March 11, 2020 Cleverley Uncategorized No comments
Comprehensive APCs, aka C-APCs, are much like DRGs but on the Outpatient side. Comprehensive APCs expand CMS’s intentions of the Outpatient Prospective Payment System (OPPS) being a partially packaged system.   The official definition is: “A classification for the provision of a primary service and all adjunctive services provided to support the delivery of the primary ser...
Wednesday, March 11, 2020 Cleverley Uncategorized No comments
Laura Jacobson RHIA – Data Quality and Reimbursement Consultant Laura is an expert on data quality and compliance issues, making sure our clients receive accurate and immediately useful results. She works with managed care contracts, modeling reimbursement terms for pricing and payment work. Her work allows our consultants to give accurate advice to help our clients be financially stable an...
Wednesday, February 12, 2020 Cleverley Uncategorized No comments
Two areas that affect the impact of contract changes include how payers define categories and services and hierarchies of payment. A substantial provider-payer contract is nearing the renewal period. The payer initiates proposed changes to current payment terms, but the provider already has in mind specific outcomes desired for the upcoming contract year. The provider is faced with two choi...
Tuesday, February 11, 2020 Cleverley Uncategorized No comments
Healthcare figures to be a primary issue in the 2020 elections, with much of the focus on costs — especially hospital costs. A common concern among users of hospital services is the apparent lack of correlation between hospital charges and payment. Although some hospital managed care executives have suggested replacing percent-of-charge (POC) contract provisions with fixed-fee payment as a sol...
Friday, September 20, 2019 Cleverley Uncategorized No comments
“Big Data” is a buzz word in a lot of industries right now, so what do we mean when we talk about big data in healthcare? We know that big data is, well, big – usually very, very big. When we talk about big data in any context we’re usually discussing something that is more than a single person can analyze and parse. In fact, it might need a team or specialized equipment,and is assembled from ...
Monday, September 30, 2019 Cleverley Uncategorized No comments
Every year, as the winter holiday season rolls around, the greatest debate of our time resurfaces – is Die Hard a Christmas movie? We at Cleverley + Associates believe that the answer to this question may be beside the point. What’s important are the traditions we make for ourselves, especially around the holidays, that bring us together and make us feel happy and fulfilled. But also, ye...
Friday, September 20, 2019 Cleverley Uncategorized No comments
Recently, NASA verified that they are investigating what might be the first crime in space. The short version is that Anne McClain accessed her ex-wife’s bank account while stationed aboard the International Space Station. It should be noted that Ms. McClain denies any wrongdoing, but the incident has raised some interesting questions about crime in space. Specifically, what do we do about ...
Friday, September 20, 2019 Cleverley Uncategorized No comments
The No-Surprises Act, currently under consideration, would prohibit providers from balance-billing. It would also establish rates for payments from commercial health plans, based on the local market. There is a process (added on July 17) that includes a third-party arbitration process for resolving certain disagreements.  The main focus of the bill, as with other recent surprise billin...
Wednesday, September 18, 2019 Cleverley Uncategorized No comments
As many hospitals are nearing the start of their next fiscal year, we thought it would be interesting to look at pricing strategies selected by a significant national sample during the first half of 2019. Hospitals may take one of two approaches when setting prices by following either an across-the-board (ATB) price change or a strategic approach. The ATB method assumes all prices in the ch...
Thursday, September 19, 2019 Cleverley Uncategorized No comments
COLUMBUS OH, SEPTEMBER 6 2019 – The CY20 OPPS Proposed Rule contains additional information and requirements regarding hospital price transparency. There are nine areas pertaining to the proposed requirements for hospitals to make public a list of their standard charges. Some of the areas represent further clarifications or definitions of terms outlined in the FY19 IPPS Final Rule a...
Monday, August 05, 2019 Cleverley Uncategorized No comments
A challenge exists in finding accurate comparative data for bundled-payment arrangements, such as total hip replacement. Cost advantage is necessary when a business is perceived as providing the same products or services as its competitors. In the eyes of many major healthcare payers, hospital services are not perceived as differentiated and are viewed as equally substitutable. While some p...
Friday, July 12, 2019 Cleverley Uncategorized No comments
On June 24th, President Donald Trump signed an executive order intended to lower healthcare costs through improved price transparency. The focus of the order is to provide patients access to pricing information for scheduled services and the out-of-pocket costs they may incur. It aims to eliminate barriers to price and quality transparency, to increase the availability of meaningful price and ...
Thursday, June 27, 2019 Cleverley Uncategorized No comments
Version 37 incorporates changes to our MSDRG list as well as associated relative weights.  From FY 2019 to FY 2020 two (2) MSDRGs are removed and two (2) MSDRGs have been created. To what extent is Relative Weight changing from FY 2019 to FY 2020? *Data Source: CMS, FY 2019 & 2020 Table 5 *Data Source: CMS, FY 2019 & 2020 Table 5 Based on the data presented, t...
Wednesday, June 05, 2019 Cleverley Uncategorized No comments
The FY 2020 IPPS Proposed rule introduces a new approach to the hospital wage index to address payment differences between low and high wage index hospitals.  CMS proposes to increase the wage index for hospitals with a wage index value below the 25thpercentile (.8482 for FY 2020) and decrease the wage index for hospitals with a wage index value above the 75thpercentile (1.0351 for F...
Friday, April 19, 2019 Cleverley Uncategorized No comments
What is the Transparency Fifty™? This report identifies the 50 most common outpatient procedures where hospitals compete with free-standing entities. This helps hospitals who are searching for strategies to reduce prices, by focusing on procedures where they are likely to have the most competition from free-standing providers.  Cleverley + Associates first released this report ...
Tuesday, April 09, 2019 Cleverley Uncategorized No comments
Pricing is certainly a hot topic right now with the disclosure requirement becoming effective on January 1, 2019.  The Hospital Charge Index® helps hospitals understand how high or low they are relative to peers for both inpatient and outpatient charges.  The metric utilizes total claim charges and is adjusted for resource intensity and cost of living.  Because the new requirement includes...
Tuesday, March 05, 2019 Cleverley Uncategorized No comments
Simply put, a provider based department is a location where hospitals provide services to their patients that is outside of the traditional main hospital. This year, there are a few changes to how these departments are defined and billed as prescribed in the CY19 Medicare Physician Fee Schedule Final Rule. The 4 types of Provider Based Departments (PBDs) remain unchanged. On Campus ̵...
Tuesday, February 12, 2019 Cleverley Uncategorized No comments
A clear sense of current market trends, cost of care, and demonstrated efficiencies that reduce cost are essential elements of contract negotiation preparations. Negotiation leverage, in terms of hospital control, comes from several sources. The most recognized driver is market power based on geographical area or demographic factors. However, hospital/payer relationships, service offerings ...
Friday, January 25, 2019 Cleverley Uncategorized No comments
Obtaining an accurate perspective on the meaning and relative impacts of cost and payment increases in the healthcare industry depends on the specific metrics that provide the basis for the analysis. To no one’s surprise, health care was a primary political issue in the Fall midterm elections. Everyone knows that our country spends more on health care as a percentage of GDP than other dev...
Monday, January 07, 2019 Cleverley Uncategorized No comments
Earlier this month, the CMS issued another responses to frequently asked questions on its website.  Knowledge of – and access to – this latest posting have been limited, however, there is important information administrators have been learning from this latest update.  The information in this latest update were largely not part of the original final rule language, nor part of the first response...

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