Medicare 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 the arrival of Medicare claims automation tools, the procedures are now enabled to look up these repricing guidelines and seamlessly streamlined to process the Medicare claims for an almost error-free output. The payers, employers, or auditing firms can automate the financial comments of a provider contract, automate tasks after contract feature exclusions, and apply rule-based decisions on a claim. 

With all such solutions available on a Medicare claims automation platform like the SaaS-based Medicare claims system, CMSPricer, payers now experience increased effectiveness and noticeable cost reduction in the volume of Medicare claims repricing that would require manual interventions. 

Medicare claims automation is a breakthrough ROI in compliance adherence, decreased provider abrasion, etc. 

Compliance Adherence:

Staying compliant with the latest CMS rules is mandatory. Payers often struggle to do it for repricing Medicare claims. That said, there lies a clear need for a solution that can ensure accuracy and compliance. CMSPricer, a web browser-based Medicare claims automation solution, ensures an end-to-end process that addresses all touchpoints of complex Medicare claims repricing, to avoid costly rework and reputation-damaging penalties. 

Improved Operations:

Medicare claims repricing is highly repeatable, error-prone, and costly when handled manually. Automation is a good choice for them.

Decreased Provider Abrasion:

The slow and error-prone manual method of Medicare repricing tends to strain payer-provider relations to the breaking point, resulting in revenue loss. With faster repricing, the tasks that follow it will get accelerated, with fewer escalations. Undoubtedly, Medicare claims repricing automation has been the key to drive today’s payer-provider relationship while staying compliant with the latest CMS rules.

EDI Services Automation

Medicare claims automation systems can perform the tasks faster, with results returned in seconds priced at 100% of Medicare rates. Batching claims into the system is easy to do and also importing and exporting of claim files for re-pricing so easily. CMSPricer can meet the stringent CMS Medicare claims’ requirements accurately for auditing claims and it can do the task from over 50 Medicare Advantage plans. By using the CMSPricer SaaS-based tool and interface, you can effectively process the batches with ease and precision. 

In Conclusion:

The traditional way of Medicare claims repricing loses favor. For health plans feeling the financial pinch of today’s rising claim economy, gaining control of overpayments is their top priority. Many of them have been using manual methods that have fallen short of results that they would expect. As a result, payers have found Medicare claims automation as the best solution now to maximize revenue. 

CMSPricer – the top-choice SaaS-based Medicare claims repricing platform – proves as the best value-making solution for payers, TPAs, auditing firms, healthcare BPOs, and employers. Get details here.