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Posts by pwsadmin

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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