Claims Accuracy is Ensured with CMSPricer’s Edit-Only Approach
Medicare third-party administrators can eliminate manual data entry and centralize workflows to reduce costs. They can re-price all commercial claims based on Medicare rates (Reference Basis Pricing) and rate all Medicare claims based on the Medicare cap. CMSPricer, a software-as-a-service (SaaS) solution, offers payers and third-party administrators a competitive edge by streamlining clinical, financial, and…
Read MoreMedicare Contract Claims Can Be Configured To Your Specific Rate Now
CMSPricer provides Medicare claims repricing information at claim line level and claims summaries based on Medicare fee-for-service (FFS) rates using a SaaS platform. In the healthcare industry, comparing medical claim allowed amounts with Medicare FFS rates is a common practice, since it provides payers with a useful benchmark to gauge their data and payment practices.…
Read MoreMedicare Claims Editing Module Designed to Increase Revenue Up to 25%
Health plans don’t want to fix claims retroactively once they have finalized a claim. A health plan’s claim accuracy rate improves productivity, reduces errors, and is crucial to its success. To improve claim accuracy, health insurance companies need a technology that can integrate easily with all the systems in their IT ecosystem and exchange data…
Read MoreCMSPricer Editing Feature Allows Rebilling of Incorrect Medicare Claims without Redundancy
Medicare repricing systems are designed to enable healthcare payers and auditing firms besides others to streamline the Medicare claims repricing processes. These systems offer a number of advantages, including increased efficiency and improved data accuracy. CMSPricer is one of those Medicare repricing systems that healthcare payers, auditing firms, PPOs, TPA’s, BPO’s, self-funded employers among others…
Read MoreImprove Healthcare Decisions With Medicare Claims Repricing
Healthcare costs are on the rise, and employers are struggling to keep up by finding high medical claims, minimizing them, and understanding how they affect the health plan. As a result of low transparency and complicated relationships among employers, brokers, and bidders, it is increasingly difficult to accurately compare costs across health plans and networks.…
Read MorePayers Can Avoid Redundancy in Rebilling Error-ridden Medicare Claims By Using CMSPricer
The Medicare Administrative Contractors (MACs) report periodically the most common claims errors they encounter. A few examples of the error-driven Medicare claims that occur on claims are as follows that MACs send to the payers. The claim is duplicate in nature. The primary identifier of the referring physician is missing or incorrect. Invalid or inconsistent…
Read MoreSelf-Funding: What Does Medicare Claims Data Have To Do With It?
It is typical for small employers to pay 8% to 18% more for the same plan than their larger counterparts. To reduce some of these costs, employers have moved to a self-funded model for benefits. Because of this, it is becoming more and more important to have accurate claims data in order to create a…
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…
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