Revolutionize Your Medicare Advantage Claims Repricing Business with CMSPricer
If you’re in the Medicare Advantage claims repricing business, you know that pricing can be a challenge. With the ever-changing landscape of healthcare, it can be difficult to keep up with the latest pricing trends and regulations. That’s where CMSPricer comes in – an innovative SaaS-based Medicare repricing platform that empowers Medicare Advantage claims repricers…
Read MoreWhy Healthcare Providers Should Utilize a Repricing Medicare Claims Tool for Greater Pricing Transparency
The healthcare industry has long struggled with pricing transparency and accuracy, leading to confusion and frustration for patients. However, the recent CMS report highlights the efforts of hospitals and health systems to implement price transparency policies to help patients understand their costs. According to CMS, a higher percentage of hospitals in 2022 (70%) complied with…
Read MoreTransforming Your Claims Repricing Process: The Top Benefits of a SaaS-Based System
As the Medicare enrollee population is going to increase from 35% to between 45-55% by 2025, the relationship between payers and providers is often put to the test when addressing Medicare claims from different ends of the payment continuum. A more flexible approach than traditional fee-for-service is needed to meet the new healthcare market requirements,…
Read MoreSave Time & Money While Optimizing Price Transparency With a SaaS-based CMS Repricing Tool
A SaaS-based CMS repricing tool works by analyzing Medicare claims submitted by healthcare providers and comparing them to Medicare’s fee schedule. The fee schedule is a list of prices that Medicare has established for different medical procedures and services. If the provider’s claim is higher than the fee schedule price, the tool will re-price it…
Read MoreStay Ahead of the Curve: Use An Intuitive Medicare Repricing SaaS Tool for Quick Configuration
By analyzing Medicare reimbursement data at the claim line level, CMSPricer provides Medicare fee-for-service (FFS) rate-based claims summaries. A common practice in the healthcare industry is to compare medical claim allowed amounts with Medicare FFS rates to gauge payers’ data and payment practices. By using CMSPricer, you can compare payment rates across several categories, locations,…
Read MoreReduce Denials & Redundancy in Medicare Billing with a SaaS Repricing & Editing Tool!
Payers often struggle to ensure zero-error in putting across Medicare claims. However, it is very common to them to receive reports of claim errors from the Medicare Administrative Contractors (MACs). Below are a few common types of errors committed by payers. In the message from MAC, it may appear that payment or processing of the…
Read MoreReduce Your Company’s Healthcare Costs by Adopting a Reference-based Pricing Model
Medicare repricing can help companies reduce their healthcare costs by utilizing a reference-based pricing model. In this model, the reference price is set by Medicare, and the provider is reimbursed at the lower of the billed amount or the reference price. This can help reduce the cost of care for companies, as Medicare reimbursement rates…
Read MoreMedicare Claims Editing Module Increases Revenue by 25%
When health plans have finalized claims, they don’t want to retroactively fix them. It is vital to a health plan’s success to improve claim accuracy and reduce errors. An IT ecosystem that can integrate easily and exchange data in real-time is essential for health insurance companies to improve claim accuracy. With real-time data, payors can…
Read MoreIs Reference-Based Pricing a Cost-Cutting Tool for Employers?
Cost-caps for health plans are gaining popularity. A relatively new solution to controlling health plan expenses, Medicare reference-based pricing (RBP), has been buzzing among employers and advisers alike. Referral-based pricing from Medicare lets employers save too, allowing them to control short- and long-term health care costs. In spite of all the buzz about reference-based pricing,…
Read MoreEnhance Administrative Efficiency with TPA Medicare Claims Repricing
With the centralization of their workflows, third-party administrators can save significant amounts by replacing manual procedures with automated ones. So, TPAs can re-price all commercial claims at Medicare rates (Reference Based Pricing) at a percentage of Medicare allowable, as well as price all Medicare claims. SaaS-based CMSPricer’s Medicare claims repricing platform optimizes clinical, financial, and…
Read MoreAspects to Consider When Taking Advantage of Medicare’s Prospective Payment System (PPS)
In a time when healthcare costs are rising at an alarming rate, prospective payment systems (PPS) are one of the most important policy tools. Using a methodology that shapes providers’ incentives, PPS has gained traction in health policy-making in relation to the government’s effort to expand health coverage. How does PPS Work? Patient care is…
Read MoreCMSPricer Can Help Payers Avoid Rebilling Error-Rigged Medicare Claims
In terms of Medicare claims errors, Medicare Administrative Contractors (MACs) provide a periodic report on the ones they encounter most frequently. These are some examples of error-driven Medicare claims that MACs send to payers. If there is missing information, the payment or processing of the claim is not possible. Since this claim cannot be processed,…
Read MoreAdapting Medicare Claims Repricing to Evolving Markets
There is a strong demand for Medicare Advantage plans. On average, Medicare advantage premiums have grown less than those in the marketplaces. It now accounts for about one-third of Medicare enrolment Size of the Market: Approximately one-third (34%) of all Medicare beneficiaries, or 22 million people, are enrolled in Medicare Advantage plans in 2019. Since…
Read MoreImprove Your Claims Accuracy Today with CMSPricer’s Edit-Only Approach
Administrators of Medicare can reduce costs by eliminating manual data entry and centralizing workflows. They can also save money by re-pricing all commercial claims based on Medicare rates (Reference Basis Pricing) and rating all Medicare claims according to the Medicare cap. Providing payers and third-party administrators with a competitive edge through a software-as-a-service (SaaS) solution,…
Read More5 Easy & Quick Ways You Can Control Medicare Contract Claim Costs
CMSPricer provides instant Medicare claim repricing information and claims summaries based on the latest Medicare fee-for-service (FFS) rates. With CMSPricer, you can compare payment rates across multiple business lines, service categories, and locations – giving you a valuable benchmark to gauge your data and payment practices against. Paying for Medicare FFS can be confusing and…
Read MoreSaaS-based CMSPricer Can Be Your Valuable Administrative Tool For Medicare Claim Repricing
As a SaaS-based platform, CMSPricer’s Medicare claims repricing platform centralizes clinical, financial, and administrative processes to enable the optimization and delivery of the competitive edge that Third Party Administrators and payers require for cost-effective benefit administrations. This is a web-based application that facilitates the electronic transmission of one of the best medical claims processes by…
Read MoreWorried About Medicare Claim Denials? Check Out How Our SaaS Medicare Claims Editing Tool Can Assist You
In order to control healthcare costs and ensure satisfaction among employers and providers, payers are crucial. Their goal is to process medicare claims as precisely and efficiently as possible to balance these competing objectives. Increasing healthcare costs and stagnant profits mean payers have to make sure medicare claims processing is smooth. If you make any…
Read MoreHow You Can Avoid Rebilling Errors in Medicare Claims?
Are you looking for a Medicare repricing tool that can eliminate your rebilling errors in Medicare claims? Looking for such a tool to provide claim line level detail and summaries of Medicare claims repriced to Medicare rates, easily, quickly, and flawlessly? The Medicare Administrative Contractors (MACs) complain that they often see Medicare claim reports replete…
Read MoreMedicare Claims Repricing Based on Medicare Rates
Physicians and hospitals that accept Medicare reimbursement agree to fixed prices for the services and treatments they provide to Medicare patients. These prices are established by CMS (the Centers for Medicare and Medicaid Services). Prices for those services are typically a fraction of what insurance companies or privately insured patients pay, and they increase by…
Read MoreWhy Do TPAs Need Medicare Repricing Software?
As our medical technologies advance, it’s not surprising why rates for healthcare services are also rising. Therefore, employers are becoming more interested in self-funded insurance programs, such as reference-based pricing models. Self-funded programs are now primarily used by companies with 200 to 400 employees. By taking care of these expenses themselves, smaller companies are now…
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