How 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 can now navigate market trends, such as the rise of consumerism and value-based care, embarking on a medicare claims repricing system to address their strategic and operational priorities. It helps them manage medical costs and collaborate with the ecosystem for better outcomes. 

Drive Cost Control

Adoption of a SaaS based medicare repricing system can enable the healthcare providers and payers to balance cost. Self Service medicare and medicaid repricing system equips them to better manage utilization and unit cost, help health plans optimize provider networks, streamline payment efficiency, improve payment accuracy and revenue performance, and facilitate value-based care and payments.

Drive Operational Efficiency

Implementation of a medicare claims repricing system enables the payers to connect to the largest EDI network in the US health system, reduces the claims processing costs through its payment accuracy, and helps scale efficiency for core payer operations through integrated TPA services. 

Scaled Capacity:

Retrieving a large quantity of high-quality data can be challenging if using free CMS PC Pricer. If you evaluate the cost of a repricing solution, it’s critical to look at the total cost of ownership. Studies have shown that SaaS solutions provide the best overall economics while PC Pricers typically provide the worst. 

Reference-based Pricing:

Pricing all Prospective Payment System (PPS) types of Institutional and Professional claims including claim editing for Referenced Based pricing is made efficient, eliminating accuracy issues while ensuring compliance with the latest CMS policies and rates. 

24/7 Availability for Increased Productivity

The top advantage of SaaS based technology for repricing Medicare claims is a solution accessible for 24/7, ensuring almost zero business downtime. As long as you have access to the Internet, you can run the system for your requirements excluding short windows for system maintenance. Healthcare payers, thus, needn’t to lose time to productivity.

How does CMSPricer Enable Providers to Achieve Their Goals & Save Millions?

Built on a SaaS-based model,” CMSPricer enables its users to accomplish their entire process of repricing Medicare and Medicaid claims effortlessly, without having to waste their time on doing things repeatedly, manually! It’s a kind of plug-and-play workflow. 

CMSPricer has seamless compliance with the CMS website database and the database is manually updated to streamline the pricing rules 10X faster than the CMS PC Pricer tool. By using this system, a health plan or auditing company can reprice medicare claims “accurately,” which is most often unavailable with the government’s system. 

Advantages of Using CMSPricer:

  • No software to install
  • No complicated contract to sign
  • Assured accuracy in claim processing
  • Easy manual, batch, and EDI claims entry
  • No obligation contract
  • 5 Claims Processing for FREE for first-time users
  • In order to ensure no PHI data is stored, CMSPricer utilizes contemporary cloud-based security, including EV SSL Certificate, 5HA2, and 2048 bit encryption. CMSPricer also stands out for streamlining the ‘batch’ claims process into the system easily and accomplishes import/export of a claim file for repricing with its custom interface faster.