Repricing Medicare Claims Tool Can Increase Pricing Transparency for Healthcare Providers
In the healthcare industry, pricing transparency and accuracy have long been problematic, causing confusion and frustration for patients. The recent CMS report, however, highlights the efforts hospitals and health systems are making to implement price transparency policies. Based on CMS data, 70% of hospitals in 2022 complied with both shoppable service information display requirements and…
Read MoreHow Effective is The SaaS-Based Medicare Repricing System, CMSPricer, at Empowering Healthcare Payers?
A growing healthcare cost environment demands providing consumers with the right information and tools to make informed healthcare decisions. CMSPricer, an tool that helps beneficiaries understand medical expenses, has received both praise and criticism. We explore here how CMSPricer empowers healthcare payers to make cost-conscious healthcare decisions, ultimately aiming for more transparent and patient-centered healthcare.…
Read MoreDoes Reference-Based Pricing in Healthcare Sacrifice Quality for Price?
Most network agreements establish discounts and billed charges in an arbitrary manner. There is not much relationship between them and the actual cost of the procedure, and they can vary widely by location, provider, and many other factors. Reference-Based Pricing (RBP) In order to control rapidly rising healthcare costs, self-insured companies use reference-based pricing (RBP).…
Read MoreThe 8 Most Common Medicare Billing Mistakes You Can Avoid By Leveraging CMSPricer – SaaS-based Medicare Repricing Tool!
In treating adults and Medicare-eligible beneficiaries, operating a private practice that provides occupational, physical, and/or speech language therapy has its own unique set of rules. The federal government continuously focuses on these three specialties, so it’s important for your practice to be up-to-date on Medicare policy. You can reduce the chances of Medicare repricing mistakes…
Read MoreAre You Prepared? Discover the Impact of the New Advanced Beneficiary Notice in Effect for Medicare!
A new Advanced Beneficiary Notice (ABN) is now in effect for Medicare. This ABN will help ensure that Medicare beneficiaries are informed of their rights and responsibilities regarding certain services or items requiring prior authorization. The ABN also outlines the potential financial liability associated with such services or items. It is important to review this…
Read MoreHow Reference-Based Pricing Impacts Healthcare Expenses: 6 Questions to Answer
Healthcare costs continue to rise as organizations strive to provide quality care to their employees while managing rising costs. Reference-based pricing (RBP) has received significant attention in recent years. With RBP, employers can regain control over their healthcare spending by challenging the traditional reimbursement model. To assess the potential impact of this pricing model on…
Read MoreUnlocking Hidden Revenue: Seizing the Reimbursement Opportunity of Transfer DRG Overpayments
The complex world of healthcare reimbursement poses numerous challenges for hospitals and healthcare organizations. Transfer Diagnosis Related Groups (DRG) overpayments are often overlooked. Healthcare providers can unlock hidden revenue streams by understanding the intricacies of Transfer DRG overpayments. To explore Transfer DRG overpayments, and learn how organizations can leverage this valuable reimbursement opportunity, we will…
Read MoreRevolutionize 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…
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