Medicare 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. With CMSPricer, you can compare payment rates across multiple business lines, service categories, and locations.

Medicaid Claims Systems

Payments for Medicare FFS are based on complex rules that change frequently. The logic and outcomes can be nuanced. In addition to helping you determine how your medical claims payments compare to Medicare FFS rates and to identify areas of improvement, CMSPricer will assist you with creating pricing assumptions, negotiating more competitive provider contracts, validating internal payment procedures, and setting up new capitation arrangements. Discrepancies between contracted rates and actual rates, for example, can be discovered by uncovering services with unfavorable payment rates. CMSPricer can help you decode the Medicare FFS benchmarks that are hidden inside the “black box.”

By leveraging the Contract Configuration feature of CMSPricer, you can be able to configure any contract claims at any specific rate. Its automated pricing-based solution on the predetermined fee-for-service (FFS) will load the contract schedule to your specifications. You can save time by generating and exporting claim reports, and processes can be accelerated three times faster. With this new feature, you can:

  • Organize and customize contract claims from beginning to end
  • Manage and maintain multiple fee schedules and networks
  • Identify providers and provider organizations easily
  • Automate your contracts with accurate pricing and editing capabilities in your CMS, 
  • Manage a rate payment increase on any given day (usually once per year)

Repricing Medicare FFS rates is streamlined by this feature of CMSPricer, which extends beyond client data. By repricing these data sets with CMSPricer, you can conduct an end-to-end benchmarking to understand how your payment practices compare.

Leverage a significant control over costs by using CMSPricer Medicare repricing tool, easily and quickly, by following these simple five steps on the intuitive dashboard of this medicare repricing system:

  1. Input your contract information or RBP rate
  2. Check your loaded rules
  3. Configure any sophisticated rule-based set to provide settings for different providers/facilities, individual services, and specific dates. Adapt the rules to your specific needs.
  4. Create a claims group by type and then apply the parameters according to your specific needs.
  5. Use the CMSPricer’s FeeForService module for FFS and PPO networks if all claims are not Medicare. CMSPricer always selects the correct fee schedule for providers within your network regardless of how their PPO’s change.

In addition to providing time-saving and cost-saving solutions, CMSPricer’s contract configuration module provides flexibility too. The module’s management control feature also helps reduce costs considerably.

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