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 make undesirable decisions related to how to operate in a decentralized nature and whether to lay off employees. It means patients — who are also often employees and parents — are facing the same economic risks and fears as the providers who care for them. 

Providers’ patient liability programs are a necessary link between their healthcare plans and the clients. Through proactive communication programs, they can help reduce the near- and long-term impact of this health crisis. That being said, it is now providers’ prerogative to evaluate their communications and outreach program to help ensure their communication is made through a compassionate, empathetic and respectful tone. This may help a bit more to mitigate patients’ new and often stressful situation.

Providers are also taking several proactive steps to help everyone involved in the healthcare ecosystem navigate the crisis. They are especially focused on mitigating overall revenue risk and establishing fair and reasonable payments.

The role of a medical claims repricing system is significant in this regard for both providers and self-funded employers. Look into the features and functionalities of CMSPricer, a self-service Medicare claims repricing system.

This SaaS-based Medicare repricing system complies with the latest CMS policies and rates to ensure accurate claims pricing and takes medical costs datasets from Medicare along with proprietary data to establish cost by procedure and facility to establish a fair price for services. Self-funded employers leverage this system to make reference-based pricing (RBP) plans for their employees and dependents. As a result, employers can lower plan costs, improve predictability and reduce uncertainty around claims. 

CMSPricer’s integrated payer platform delivers the competitive edge that you need for cost-effective benefit administration. This SaaS-based system not only helps TPAs cut manual workloads, but it also includes responsive portal capabilities to allow members, providers, and administrators to connect, communicate, and share data in real-time.

CMSPricer’s self-service Medicare claims repricing platform enables you to:

Create Significant Savings:

CMSPricer enables effective medical cost reduction through advanced PPO repricing, Medicare claims repricing, meaningful pricing of all PPS types of institutional and professional claims including claim editing for Referenced Based pricing.

Simplify Workflows:

CMSPricer’s powerful hand key entry or auto batch/EDI uploads, easy imports/exports hub delivers enterprise-wide efficiencies with end-to-end workflows for claims, encounter data, and more. This SaaS-based platform provides a quick solution at 100% of Medicare rates and helps reduce your administrative costs and improves pricing accuracy.

Easy to Connect & Communicate:

CMSPricer SaaS-based platform enables its users to connect to members, providers, and all essential stakeholders on the fly. With CMSPricer self-service Medicare and Medicaid claims repricing solution, you can securely access eligibility, provider information, claims history, and other configurable data fields, from any device, anytime and anywhere!

Final Verdict:

CMSPricer has a history of continuous development and improvement to allow its user members to be able to calculate high adjudication rates through an automated process and ensure all Medicare claims payments are made accurately. Payers  recover significant savings and reduce utilization by leveraging CMSPricer’s accurate SaaS claims processing, easy manual, batch or EDI claims entry, and automatic audits. 

Schedule a digital discussion with a representative of CMSPricer who can elaborate what more advantages you can achieve and solutions for protecting healthcare interest for everyone in this time of Covid-19 crisis.