SaaS-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 database are mostly responsible factors for it. As a result, healthcare payers and employer groups suffer and struggle to transfer the exact health plan benefits to the people. 

In order to ensure that and improve health plan efficiencies, the payers, TPAs, employer groups, and auditing firms are leveraging the benefits of auto-adjudication Medicare repricing systems that play an invaluable role in managing value-based reimbursement, data aggregation, and interoperability.

How do Medicare Repricing Systems Benefit their Users?

Medicare claims repricing systems empower diverse health plans, such as Medicare Advantage Plans, Managed Medicaid, etc., to manage their multiple lines of business products. That enables payers to grow and innovate across these business product lines as they are leveraging the solutions of a centralized platform.

Take a quick rundown of the benefits of using a centralized SaaS-based Medicare claims repricing system.

Help Meet Cost Saving Goals:

The prime benefit of implementing such a system is it can automate the complex healthcare benefit calculations to drive high auto-adjudication rates and minimize the risk of paying claims incorrectly. Payers and TPAs can make significant savings and reduce utilization costs by leveraging automatic audits, responsive reporting and much more.

Configure Complex Healthcare Benefit Plans:

These systems can price all PPS types of institutional and professional claims including claim editing for Referenced Based pricing. Reference based pricing adds transparency to the health plan and produces significant cost savings for employers, with vendors or TPAs to negotiate the fixed payment with health plan providers. By using a Medicare claims repricing system, configurability of complex healthcare benefit plans becomes simplified and streamlined. 

Increased Transparency for Changing Compliance Requirements: 

CMS policies and rates are frequently updated and payers need to ensure accurate claims pricing with the latest CMS policies and rates. Manual processes involve risk of making mistakes and complying erroneously. The CMS.Gov typically has a 3-month lag time and incomplete pricing results. That means manual processes have a high chance of not staying compliant with the latest updates as following it. Contrarily, while leveraging SaaS-based Medicare claims repricing system, payers, TPAs, auditing firms are sure of their up-to-date CMS policy and rate compliance. Users get to see a holistic view of the compliance requirements and work accordingly to reduce or eliminate duplication errors for an accelerated ROI. It results in minimizing risks and challenges while accelerating growth for health plans. 

Actionable Cost Prediction Capability

Healthcare players can leverage the cost prediction functionality in a SaaS-based repricing system that integrates powerful business intelligence to deliver actionable insights. With this functionality, healthcare plan outcome and risk predictions can be made and can be configured accordingly, simplifying the repricing workflow of payers. 

In Conclusion:

Various reports indicate that health plans pay an additional $3 (approx) for every manual transaction, while that cost can be eliminated should healthcare businesses and payers access and leverage the benefits of a SaaS-based Medicare claims repricing platform.CMSPricer, a SaaS-based Medicare and Medicaid repricing platform, is built to simplify and streamline the healthcare claims repricing workflow that has to be performed by payers, TPAs, auditing firms, etc. To see and experience how it works, try CMSPricer for free upto first 5 claims.