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Aspects to Consider When Taking Advantage of Medicare’s Prospective Payment System (PPS)
In a time when healthcare costs are rising at an alarming rate, prospective payment systems (PPS) are one of the most important policy tools. Using a methodology that shapes providers’ incentives, PPS has gained traction in health policy-making in relation to the government’s effort to expand health coverage.How does PPS Work?Patient care is delivered efficiently,…
CMSPricer Can Help Payers Avoid Rebilling Error-Rigged Medicare Claims
In terms of Medicare claims errors, Medicare Administrative Contractors (MACs) provide a periodic report on the ones they encounter most frequently. These are some examples of error-driven Medicare claims that MACs send to payers. If there is missing information, the payment or processing of the claim is not possible. Since this claim cannot be processed,…
Adapting Medicare Claims Repricing to Evolving Markets
There is a strong demand for Medicare Advantage plans. On average, Medicare advantage premiums have grown less than those in the marketplaces. It now accounts for about one-third of Medicare enrolment Size of the Market: Approximately one-third (34%) of all Medicare beneficiaries, or 22 million people, are enrolled in Medicare Advantage plans in 2019. Since…