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Posts by pwsadmin

Top Secrets to Making Reference Based Pricing Work in the Covid-19 World

The US spends $ 3.6tn a year on health. Post Covid-19 times, this spending is breaking all previous records and people are really concerned about high out-of-pocket costs.  In times of the Covid-19 pandemic, healthcare experts anticipate healthcare costs will continue to rise. In April 2020, a health report estimated that $163.4 billion in direct…

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What are the Benefits of Using a SaaS-based Medicare Repricing Solution and Their Impacts?

Every Medicare repricing solution might be different, but almost every single one makes the same mistake by putting the company in jeopardy: it delays in complying with the CMS updates.  As a result of delayed CMS update compliance: Inaccurate payment or overpayment risks Claims re-working or readjusting Strained provider relations or increased provider inquiries Holding…

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Best Ways to Meet Payer’s Cost-Containment Goals and Protect Bottom-line During the COVID Crisis

In order to navigate the healthcare crisis and economic turmoil resulting from the coronavirus outbreak, many organizations are recalibrating their employee healthcare benefit programs. They are now more focused on finding solutions to keep their team members safe and healthy.  Yes, it is also true that many organizations across the country are being compelled to…

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How Can Employers Cut Health Plan Costs with Reference-Based Pricing?

Capping health plan expenses is gaining attention. Employers and advisers alike have been buzzing about Medicare reference-based pricing (RBP), which is a relatively new solution for controlling health plan expenses set outside traditional insurance carriers.  With Medicare reference-based pricing, employers can get in on the savings too, enabling them to control the costs of medical…

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Gaining Competitive Advantage through Medicare Prospective Payment System (PPS)

Prospective Payment System (PPS) is one of the most important policy tools in controlling ever-increasing healthcare costs. Built on a methodology that plays a crucial role in shaping providers’ incentive, PPS is gaining traction in health policy-making vis-a-vis the government’s efforts to expand health coverage to wider populations.  What is the Purpose of PPS? Prospective…

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How Leading Healthcare Insurers are Saving Millions While Ensuring Compliance

Many leading healthcare insurers used to spend too much time doing a lot of paperwork to fix billing errors, and complying with medicare regulations. That process had been too complex and labor-intensive, requiring manual collation taking weeks to finish. The outcomes were confusion, non-compliance, and errors with huge expenses.  Technology as a Saviour  Healthcare insurers…

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Medicare Claims Repricing Solution for Evolving Marketplace

The Medicare Advantage program seems to be thriving. Premium growth in Medicare advantage has been far lower on average than in the marketplaces. Enrolment has continued to increase, now accounting for about one-third of Medicare enrolment. Market Size: In 2019, one-third (34%) of all Medicare beneficiaries, which include 22 million populations, are enrolled in Medicare…

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3 Benefits of SaaS-Based Medicare Claims Repricing System

At times, the relationship between payers and providers turns hostile while addressing the Medicare claims from different ends of the payment continuum. Fee-for-service has been a solution, but today’s healthcare market requirements demand a more flexible approach to meet the needs of the growing Medicare enrollees from the current 35% to between 45-55% by 2025.…

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Modernizing and Innovating Medicare Claims Repricing Process

The Medicare Advantage market is expanding, giving out plenty of opportunities for insurers. Driven by an aging population and an increasing preference over fee-for-service plans, Medicare enrollment is on the rise. It is expected even more to grow from 35% of Medicare members to between 45-55% by 2025. And, this isn’t just growth in the…

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Reference Based Pricing Explained: Let’s Take a Look Around

With the continuous rise of healthcare costs, employers are searching for new ways to reduce those costs, without compromising healthcare quality for their employees. It drives them to explore and adopt viable strategies to mitigate the impact. One of those strategies, which is not so new but gaining in popularity as a cost containment strategy…

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See How a SaaS-Based Medicare Claims Re-Pricing Tool Can Save Payers Time and Money by Not Overpaying Claims

More than 17 million, or 31% of the rapidly growing group of Medicare recipients, have chosen to enroll in Medicare Advantage plans offered by private payers. Competition is, therefore, increasing among payers as they all endeavor to expand into new markets to capture a larger share of this growing population and the associated healthcare funding.…

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Is Reference Based Pricing Healthcare Truly Beneficial?

In the present day, the cost of healthcare services is rising continuously, making it harder for the common people to avail of the premium medical services. However, as it is said – where there is a problem, there is a solution as well, and in this case, the solution is healthcare insurance plans. By investing…

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