What is the Big Deal About Reference Based Pricing?
With so many insurance options available today, it can be difficult to select the right policy. A fully insured health plan versus an employer-funded health plan is one of the biggest decisions you will have to make as an employer. Traditionally, companies pay premiums to their insurance companies for fully insured plans. Employers who operate…
Read MoreEdit-Only Approach in CMSPricer Prevents Overpayments & Underpayments While Ensuring Claim Accuracy
By replacing manual processes and centralizing their workflows, third-party administrators can save money by reducing costs. In turn, TPAs can re-price all commercial claims at Medicare rates (Reference Basis Pricing) and rate all Medicare claims based on the Medicare cap. SaaS-based Medicare claims repricing platform CMSPricer centralized clinical, financial, and administrative processes to provide TPAs,…
Read MoreWhat is the Big Deal About Reference Based Pricing?
With so many insurance options available today, it can be difficult to select the right policy. A fully insured health plan versus an employer-funded health plan is one of the biggest decisions you will have to make as an employer. Traditionally, companies pay premiums to their insurance companies for fully insured plans. Employers who operate…
Read MoreEmerging Considerations for Self-funded Plans and Employers
The self-funded industry has a long history of staying resilient in the face of unpredictable change. As such, the number of changes that have been required to address COVID-19 is not a shock to this sector. Now that we are in the throes of a global pandemic, the long-term consequences are only beginning to come…
Read MoreReference-Based Pricing: The Best Solution to Restrict Healthcare Spending of an Organization
Reference-based pricing has emerged as a tool self-insured organizations are utilizing to combat the growing financial burden of rising healthcare costs across the U.S. By 2022, healthcare costs are expected to rise by another 6%, largely because of rising prices. A recent study found this trend has been consistent since 2009. As a result of…
Read MoreTPA Medicare Claims Repricing System Enhances Administrative Efficiencies
Third-Party Administrators gain significant cost savings by replacing manual procedures and modernizing administrative processes through centralization of their workflows. As a result, TPA’s can re-price all Commercial claims at Medicare rates (Reference Based Pricing) at a percentage of Medicare allowable as well as price all Medicare based claims. CMSPricer’s SaaS-based Medicare claims repricing platform centralizes…
Read MoreCMSPricer Solution Can Reduce Claims Overpayment
he CMS PC Pricer tool used to estimate Medicare PPS payments. By using the PPS framework implemented into Medicare repricing systems, the TPAs, employers, or audit firms can manage the most complex Medicare repricing solutions. Medicare repricing systems can automate the process of accurate editing, grouping, and pricing across multiple care settings. It enhances Medicare…
Read MoreMedicare Claims Automation at Scale: Top 4 Benefits for Payers
Behind-the-scene machinations of Medicare claims procedures are now much more complex than those days when Medicare claims automation tools came on board. Today’s procedures are often so complicated that they tend to take a couple of weeks or even more due to the streamlining and standardization of critical processes such as claims repricing. Thanks to…
Read MoreEmpower Your Medicare Advantage Claims Repricing Business with CMSPricer
In order to sail your Medicare Advantage claims repricing processes through this current Medicare environment, you need a reliable system that can empower you with the right solutions to carry out the tasks efficiently. And for Medicare claims repricing, in particular, you need a customizable platform that allows automation processes and guarantees regulatory compliance through…
Read MoreReference-Based Pricing Approach Often Reduced Employers’ Healthcare Spending By 20% To 30%
Reference-based pricing in its simple terms is the concept that an employer or health plan may decide an exact dollar amount that a benefit plan might cover for a particular service or procedure. It is sort of the defined contribution approach around procedures or medicare care. So, for example, today if someone gets a test…
Read MoreAdopt Reference-Based Pricing Model to Contain Your Company’s Healthcare Costs
Employers can anticipate healthcare expenses once they adopt the reference-based pricing (RBP) model. With its implementation, they can determine reimbursements ahead of time, select the prices they are willing to pay for a healthcare service. RBP model saves employers from surprise healthcare expenses for their employees within their company. RBP can result in up to…
Read MorePreferred Provider Organization (PPO) & Facilities Now Can Price Any Claim at Any Specific Rate Automatically!
Healthcare prices set by fee-for-service have a direct impact on the prices paid by insurers throughout the health care system. But one of the most significant changes in the health care delivery system in the past few years has been the shift away from traditional FFS payment methods to managed care arrangements. It has been…
Read MoreMedicare Claims Editing Simplified and Streamlined to Save Your Time and Investment
Medicare claims repricing is the application of the contract terms to the billed charges between the hospital or the physician practice and the insurance network. And the bill charges are from the healthcare facility or the physician group. As the “claims” is received, it is sent for adjudication to verify certain claim criteria, and then…
Read MoreHow to Avoid Losing Money with Medicare Repricing System
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…
Read MoreHow Medicare Claims Editing Save You from Claims Denials?
When it comes to controlling healthcare costs, and keeping employers and providers satisfied, payers play an important role. They balance these competing objectives through processing of medicare claims as efficiently and precisely as possible. With rising healthcare and profits getting stagnant, payers need to make sure medicare claims processing is flawless. Any errors in claims…
Read MoreDesigned to Support TPAs For Today’s Complex Self-Funded Health Insurance Plans
Medicare claims repricing system is aimed at maximizing efficiencies through automation, enabling seamless transaction between providers, and members within employers’ self-funded plans, and delivering compliance. Advantages of Self-funded Plans: Flexible options Portability from one stop-loss carrier to another Avoidance of most premium tasks Potential for financial gain TPAs gain significant cost-savings and ROI by swapping…
Read MoreEmpowering Employers & Increasing Value For Self-funded Clients
Employers who choose to offer health insurance benefits to their employees have two options for paying or funding those benefits. Those two funding arrangements are self-funded benefits and partially self-funded benefits. Self-funded Arrangement: In the self-funded benefits arrangement, the employers guided by third party administrators (TPAs) creates, defines, and establishes a benefit plan for their…
Read MoreSelf-funded Employers are Leveraging Medicare Claims Repricing Tool to Cut Costs, Not Benefits
As the world deals with the impact of COVID-19, one of the most common issues we hear about healthcare today is the cost. The various healthcare studies indicate that the cost of providing medical and pharmacy benefits will rise 5 percent more for three consecutive years. As a result, the companies that use the best-in-class…
Read MoreWhat is Medicare Claims Repricing? Is Medicare Claims Repricing So Hard Anymore?
Medicare and Medicaid repricing system enables healthcare payers to efficiently manage healthcare provider data and automate claims pricing by leveraging its adaptive, rules-driven architecture. Medicare claims repricing can significantly lower, pre-negotiated rates which providers in the healthcare networks have already agreed. What is Medicare Claims Repricing? Medicare claims repricing is the application of the contract…
Read MoreReferenced Based Pricing: A Solution for Employers to Cut Health Plan Costs
Reference based pricing strategy in healthcare is revolutionary. It helps both employers and employees save money by paying reduced aggregate amounts based on a percentage of what Medicare reimburses these providers. It’s truly helpful for them to bend healthcare costs downward. Let’s Explain the Benefits of Reference Based Pricing Strategy. With the reference based pricing…
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