Reimbursement & Payor Relations

Medicare Wage Index

  • Healthcare Council continues to lead strategies for improvement of the Pittsburgh and other Pennsylvania Urban Wage Index levels. This initiative includes an annual review process which is designed to improve each hospitals’ reporting that generates the Pittsburgh Wage Index.
  • Similarly, Healthcare Council initiated a statewide PA Rural Wage Index review in 2013 that has continued annually resulting in a substantial increase in reimbursement for these hospitals.
  • The Pittsburgh CBSA, despite significant efforts, has the lowest wage index of any metropolitan CBSA with a population in excess of 2 Million people. HCWP continues to focus on methods to establish a minimum wage index level that would benefit this region through legislation and collaboration with other regions of the country.

Medical Assistance

  • Healthcare Council reviews payments levels within the state of Pennsylvania for consistency and appropriateness and has identified areas needing focus and improvement.
  • Healthcare Council has led initiatives for the reform of Inpatient, Outpatient and Observation payments by Medical Assistance in Pennsylvania, and over the past several years provided particular focus on the excessively low payment for outpatient services ranging from 30-40% of cost.
  • Healthcare Council has also worked with state agencies to appropriately maximize the level of Federal Matching dollars available to fund more reasonable levels of Outpatient payments.

 Commercial and Managed Care

  • Healthcare Council has provided focus on payor behaviors that negatively impact the payment levels received from these payors. Areas such as inappropriate denials, underpayment of contracted rates, inappropriate application of Medicare Sequestration, and other contract related issues, have resulted in substantial increase to hospitals’ Net Patient Revenues.

Patient Responsibility Amounts

  • Healthcare Council has initiated a complete focus on the level of Patient Financial Responsibility, particularly related to the ever-increasing level of deductibles being employed by payors and employers that effectively result in a substantial reduction of the effective rate paid to providers. Healthcare Council is working to educate the region on this issue and provide effective strategies for hospitals to implement.