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…

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Why 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…

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Stay 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,…

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Medicare 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…

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Is 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,…

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Enhance 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…

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CMSPricer 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,…

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Adapting 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…

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Improve 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,…

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5 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…

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SaaS-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…

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Worried 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…

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How 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…

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Medicare 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…

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Why 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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