What are the Benefits of Using a SaaS-based Medicare Repricing Solution and Their Impacts?
Every Medicare repricing solution might be different, but almost every single one makes the same mistake by putting the company in jeopardy: it delays in complying with the CMS updates. As a result of delayed CMS update compliance: Inaccurate payment or overpayment risks Claims re-working or readjusting Strained provider relations or increased provider inquiries Holding…
Read MoreBest 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…
Read MoreHow Can Employers Cut Health Plan Costs with Reference-Based Pricing?
Capping health plan expenses is gaining attention. Employers and advisers alike have been buzzing about Medicare reference-based pricing (RBP), which is a relatively new solution for controlling health plan expenses set outside traditional insurance carriers. With Medicare reference-based pricing, employers can get in on the savings too, enabling them to control the costs of medical…
Read MoreGaining Competitive Advantage through Medicare Prospective Payment System (PPS)
Prospective Payment System (PPS) is one of the most important policy tools in controlling ever-increasing healthcare costs. Built on a methodology that plays a crucial role in shaping providers’ incentive, PPS is gaining traction in health policy-making vis-a-vis the government’s efforts to expand health coverage to wider populations. What is the Purpose of PPS? Prospective…
Read MoreHow Leading Healthcare Insurers are Saving Millions While Ensuring Compliance
Many leading healthcare insurers used to spend too much time doing a lot of paperwork to fix billing errors, and complying with medicare regulations. That process had been too complex and labor-intensive, requiring manual collation taking weeks to finish. The outcomes were confusion, non-compliance, and errors with huge expenses. Technology as a Saviour Healthcare insurers…
Read MoreMedicare 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…
Read MoreSaaS-Based Medicare Claims Repricing System: Simplifying the Business of Healthcare
The U.S. spends over $2.8 trillion on healthcare and an estimated 30% is waste! Along with the rapidly-rising healthcare expenses in the country comes a surprising level of inefficiency and waste. Total waste of healthcare expenses tends to cross over $840 billion each year. Inefficient claims processes, administration plans, and non-compliance with the latest CMS…
Read More3 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.…
Read MoreModernizing 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…
Read MoreReference 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…
Read MoreSee 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.…
Read MoreIs 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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