How 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…
Read MoreSolution to Drive Compliant and Cost-efficient Medicare Reimbursement Rates Easily and Accurately
Medicare billing can be arduous and Medicare claims repricing can be challenging. If they are put together and one works on them without proper training, the result can be a loss of revenue. With the use of an easy-to-use, SaaS-based medicare claims repricing tool, an organization can mitigate the entire claims repricing process and optimize…
Read MoreValue Based Healthcare
The state of US healthcare concerns us all. The rising costs are the principal concern and many of us wonder why do we spend more than other industrialized nations. Leaving aside the assertion that the “other industrialized nations” provide the same level of care, the rising costs are definitely a problem. Many “sophisticated” schemes were…
Read More3 Ways Our Software Can Streamline Your Medicare Claims Repricing
Any business that handles Medicare and Medicaid claims repricing regularly knows the pain, the labor, and the enormous time the task tends to take. Ensuring that those who are involved with the task have up-to-date and accurate information and that every person knows what needs to be done next. It is especially true for those…
Read MoreWhy Healthcare Payers Can’t Get Ahead With Yesterday’s Technology?
Many healthcare insurers are still working on rigid legacy systems that hold them back from enjoying the advantages of today’s innovative systems. As a result, they keep languishing in several fronts, such as flawed compliance capability, inefficient policy management, poor customer data privacy, and lack of visibility, among others. However, there are many insurers who…
Read MoreTop Secrets to Making Reference Based Pricing Work in the Covid-19 World
The US spends $ 3.6tn a year on health. Post Covid-19 times, this spending is breaking all previous records and people are really concerned about high out-of-pocket costs. In times of the Covid-19 pandemic, healthcare experts anticipate healthcare costs will continue to rise. In April 2020, a health report estimated that $163.4 billion in direct…
Read MoreWhat 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…
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