These days, employers struggle to keep up with the ever-rising healthcare costs, especially with high medical claims – how to fund them, mitigate them, and understand how they impact their plan. They face the lack of transparency issue when it comes to repricing Medicare and Medicaid costs across different health plans and networks based on the current CMS rates. The issue of complicated relationships between employers and preferred provider networks (PPOs) tends to overshadow the way to make a clear decision about choosing accurate healthcare plans that comply with their organization’s needs.
In order to improve medical cost transparency, the importance of SaaS-based self-service Medicare and Medicaid repricing tools like CMSPricer is beyond question. It has come as a veritable savior for the entire ecosystem, by using which payers, PPOs, TPA’s, BPO’s, self-funded employers, and auditing firms can accurately reprice claims, establish Medicare reference-based plans, and become able to make a fair decision through a rigorous data collection process and systematic, objective analysis.
What is Medicare Claims Repricing?
Medicare repricing enables clients to get a view of medicare claims cost, repriced based on actual claims data to help them pick the right network meeting their budget. The objective of repricing is clear, which is to choose the best network providing the desired provider coverage at the lowest available cost. This solution is especially useful for evaluating reference-based pricing (RBP) as well as more traditional networks.
Why Medicare Claims Repricing?
Medicare claims repricing helps payers, PPOs, TPA’s, BPO’s, self-funded employers, and auditing firms reprice health claims costs across different health plans or networks on the same basis. As a result, transparency is maintained and employers can avoid losing money in the crowd of so many plan conversations.
The primary benefit of the medicare repricing exercise is to provide an objective and fair analysis of claims cost.
CMSPricer Repricing Approach:
Built on a SaaS-based platform and designed to deliver the most accurate, highly secure, quick, and low-cost solutions, CMSPricer assists payers, PPOs, TPA’s, BPO’s, self-funded employers, and auditing firms to “reprice” Medicare and Medicaid claims based on the current CMS rates, “batch” claims into the system easily, and import/export a claim file for re-pricing so easily with its custom interface.
CMSPricer repricing tool also facilitates all network claims repricing. Their users can reprice the medicare claims to the significantly lower, pre-negotiated rates that network providers have already agreed to. For larger claims, the system double-checks with the network to confirm that the provider is currently contracted with them and that the discount taken is correct, lowering the potential for any reversals.
Quickview of User Benefits:
CMSPricer meets stringent CMS Medicare claims accuracy requirements for payers, PPOs, TPA’s, BPO’s, self-funded employers, and auditing firms from all Medicare Advantage plans. By using the CMSPricer SaaS-based tool and interface, you will be able to effectively batch process with ease and precision while maintaining cost transparency.
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