Wednesday, April 06, 2022 Cleverley Blog No comments
How Do We Compare Payment Rates Across Health Plans and Hospitals? Recently we were asked by a hospital client to address three common questions they hear from the public regarding price transparency. We’ve already answered “Why do Hospitals Offer Lower rates to Some Payers?” and “What Is The Relationship Between Insurance Contracts and What Members Pay?” so let’s look at “Why do Hospital...
Tuesday, May 10, 2022 Cleverley Blog No comments
What Is The Relationship Between Insurance Contracts and What Members Pay? Recently we were asked by a hospital client to address three common questions they hear from the public regarding price transparency. Last time we answered “Why do Hospitals Offer Lower rates to Some Payers?” Now we’ll look at “What Is The Relationship Between Insurance Contracts and What Members Pay?” and next we’ll inv...
Friday, April 01, 2022 Cleverley Blog No comments
We Answer Questions About Hospital Payer Rates Recently we were asked by a hospital client to address three common questions they hear from the public regarding price transparency. So, in our next three blog posts we’ll answer the following questions: Why do Hospitals Offer Lower rates to Some Payers? What Is The Relationship Between Insurance Contracts and What Members Pay? Why Do Hospitals C...
Wednesday, February 23, 2022 Cleverley Blog , Hospital Finance Research No comments
A Response to the CY20 Opps Proposed Rule (CMS-1717-P) For Increased Price & Payment Disclosures 1) BACKGROUND The CY20 OPPS Proposed Rule contains additional information and requirements regarding hospital price transparency. The proposal, which can be traced to guidelines provided in the Affordable Care Act, primarily follows several recent important government communications regarding th...
Thursday, February 17, 2022 Cleverley Blog No comments
Die Hard Cost John McClane Is Die Hard a Christmas movie? Obviously. Is it the greatest Christmas movie? Well, that’s up for debate. We’ll let your holiday dinner table take up that one. But we at Cleverley + Associates can weigh in where we’re experts, which is hospital pricing data! Action movies, especially one as hard core as Die Hard, mean injuries and injuries mean hospitals. Sure, John M...
Thursday, February 17, 2022 Cleverley Blog No comments
About Price Transparency CMS did everything they proposed on transparency…including the very large increase in fines! CMS has remained focused on the importance of Price Transparency, consistently stressing that their goal is to empower patients to make informed decisions regarding their health care. In their recent fact sheet, CMS called out what they called “sub-optimal compliance.” We’ve cov...
Wednesday, March 30, 2022 Cleverley Blog No comments
Standard Machine-Readable File Recommendations for Hospitals The CY22 proposed rule covered many topics, but, in our opinion, the guidelines and clarifications surrounding machine-readable files were some of the most critical. The Proposed Rule’s observation that there was a “lack of uniformity in the way that hospitals display their standard charges (84 FR 65556)” wasn’t a great surp...
Thursday, March 17, 2022 Cleverley Blog No comments
Are Hospitals Really Flouting Federal Requirements? A new report by PatientRightsAdvocate.org claims that only 5% of US hospitals are fully compliant with disclosing their prices as required by the CMS. A summary of their report was featured in The Washington Post and has brought several questions from hospitals around the country.  You can read The Washington Post article here.  The ...
Tuesday, February 22, 2022 Cleverley Blog , Price Transparency No comments
CMS Price Transparency Requirements As we continue our research into Price Transparency (you can see our full Spring Summit on the topic here), one of the things we wanted to know is are hospitals complying and, if so, how? We conducted a survey of hospitals and took a close look at their approaches to the new Price Transparency requirements. Here’s what we found. Our Methodolo...
Friday, April 08, 2022 Cleverley Blog No comments
CY22 Proposed Rule Change  As new Price Transparency regulations went into effect this year, most hospitals quickly adjusted to become compliant under the new rules. However, many were confused on some points, and some decided not to post their prices, choosing instead to see how CMS would approach enforcement and what, exactly, it regarded as compliance. The new proposed CMS rule (CY 2022 Me...
Wednesday, February 23, 2022 Cleverley Blog No comments
Price Transparency Warnings Since the passage of the ACA, Price Transparency has largely been a bipartisan issue, meaning that new rules and regulations have appeared, regardless of administration. CMS’ goal is to make it easier for patients to compare prices between hospitals. However, their final rule, which went into effect January 1st, had not yet been followed up by enforcement. CMS’ we...
Thursday, March 17, 2022 Cleverley Blog No comments
How do Hospitals Compete with Free Standing Clinics? The continued pressure on shoppable services has heightened the competition between hospitals and freestanding facilities. But what effect does this have on their day to day business? We analyzed the rate at which hospitals and their freestanding competitors have increased charges in four key groups from 2015 to 2019: imaging, procedures, ...
Wednesday, February 16, 2022 Cleverley CMS Rule , CMS Updates , Price Transparency No comments
Last year the hospital industry faced major changes to the availability and accessibility of their prices. Now that 2021 is here, and the new CMS rules are officially in effect, CMS plans to audit how successfully the industry achieved compliance. According to the CMS website they have already selected hospitals for their initial audits. We’re not sure how hospitals were selected for a...
Wednesday, February 16, 2022 Cleverley Blog 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 create for ourselves, especially around the holidays. What really matters is what brings us together and make us feel happy...
Thursday, March 17, 2022 Cleverley Blog 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, i...
Friday, April 08, 2022 Cleverley Blog No comments
Another Way to Gauge Your Hospital’s Financial Health 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 t...
Wednesday, February 23, 2022 Cleverley Blog 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...
Thursday, March 17, 2022 Cleverley Blog No comments
About Hospital Pricing Transparency 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 ...
Friday, April 08, 2022 Cleverley Blog No comments
Why We Need To Rethink Adjusted Discharges 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 o...
Wednesday, February 16, 2022 Cleverley Blog No comments
Cleverley + Associates Introduces the Consumer Shoppable Report! 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-s...
Wednesday, February 23, 2022 Cleverley Blog No comments
CMS Proposed MSDRG Changes for 2021 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 s...
Wednesday, March 30, 2022 Cleverley Blog No comments
How Do Hospitals Set Prices for COVID-19 Isolation Rooms? 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 ...
Tuesday, May 10, 2022 Cleverley Blog No comments
Hospitals Set Prices for COVID-19 Lab Tests 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 ...
Wednesday, March 30, 2022 Cleverley Blog No comments
COVID-19 Telehealth – What You Need To Know 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: ...
Wednesday, February 23, 2022 Cleverley Blog No comments
A Quick Guide to Comprehensive APCs 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 ...
Wednesday, February 16, 2022 Cleverley Blog No comments
4 Key Areas of Managed Care Contracts 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 ...
Thursday, February 17, 2022 Cleverley Blog 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...
Wednesday, February 16, 2022 Cleverley Blog 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...
Thursday, February 17, 2022 Cleverley Blog No comments
How We Look at Big Data and Bundled Payments “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 ...
Thursday, February 17, 2022 Cleverley Blog No comments
Die Hard Cost John McClane (and His Hospital) 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 a...

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