Posts Tagged ‘Medicare Claims Repricing’
Decoding the Complexity of Medicare Repricing: Strategies, Players, and Innovations
Medicare repricing refers to the process by which the cost of medical claims is repriced to ensure that insurance providers can manage their payouts more efficiently while still covering the necessary medical procedures for insured individuals. This process is particularly relevant in the context of Medicare and preferred provider organization (PPO) plans. Given the backdrop…
Read MoreHow a SaaS Repricing & Editing Tool Can Minimize Redundancy & Denials in Medicare Billing?
Medicare claims are often difficult for payers to process error-free. They frequently receive reports of claim errors from Medicare Administrative Contractors (MACs). Payers Often Commit The Following Types Of Errors. It may appear in MAC messages that MAC cannot process a claim without missing information in their message. Your claim cannot be processed because of…
Read MoreUnlocking Hidden Revenue: Seizing the Reimbursement Opportunity of Transfer DRG Overpayments
The complex world of healthcare reimbursement poses numerous challenges for hospitals and healthcare organizations. Transfer Diagnosis Related Groups (DRG) overpayments are often overlooked. Healthcare providers can unlock hidden revenue streams by understanding the intricacies of Transfer DRG overpayments. To explore Transfer DRG overpayments, and learn how organizations can leverage this valuable reimbursement opportunity, we will…
Read MoreRevolutionize Your Medicare Advantage Claims Repricing Business with CMSPricer
If you’re in the Medicare Advantage claims repricing business, you know that pricing can be a challenge. With the ever-changing landscape of healthcare, it can be difficult to keep up with the latest pricing trends and regulations. That’s where CMSPricer comes in – an innovative SaaS-based Medicare repricing platform that empowers Medicare Advantage claims repricers…
Read MoreEnhance Administrative Efficiency with TPA Medicare Claims Repricing
With the centralization of their workflows, third-party administrators can save significant amounts by replacing manual procedures with automated ones. So, TPAs can re-price all commercial claims at Medicare rates (Reference Based Pricing) at a percentage of Medicare allowable, as well as price all Medicare claims. SaaS-based CMSPricer’s Medicare claims repricing platform optimizes clinical, financial, and…
Read MoreImprove Healthcare Decisions With Medicare Claims Repricing
Healthcare costs are on the rise, and employers are struggling to keep up by finding high medical claims, minimizing them, and understanding how they affect the health plan. As a result of low transparency and complicated relationships among employers, brokers, and bidders, it is increasingly difficult to accurately compare costs across health plans and networks.…
Read MoreSelf-Funding: What Does Medicare Claims Data Have To Do With It?
It is typical for small employers to pay 8% to 18% more for the same plan than their larger counterparts. To reduce some of these costs, employers have moved to a self-funded model for benefits. Because of this, it is becoming more and more important to have accurate claims data in order to create a…
Read MoreWhat is Medicare Claims Repricing? Is Medicare Claims Repricing So Hard Anymore?
Medicare and Medicaid repricing system enables healthcare payers to efficiently manage healthcare provider data and automate claims pricing by leveraging its adaptive, rules-driven architecture. Medicare claims repricing can significantly lower, pre-negotiated rates which providers in the healthcare networks have already agreed. What is Medicare Claims Repricing? Medicare claims repricing is the application of the contract…
Read More3 Ways Our Software Can Streamline Your Medicare Claims Repricing
Any business that handles Medicare and Medicaid claims repricing regularly knows the pain, the labor, and the enormous time the task tends to take. Ensuring that those who are involved with the task have up-to-date and accurate information and that every person knows what needs to be done next. It is especially true for those…
Read MoreBest Ways to Meet Payer’s Cost-Containment Goals and Protect Bottom-line During the COVID Crisis
In order to navigate the healthcare crisis and economic turmoil resulting from the coronavirus outbreak, many organizations are recalibrating their employee healthcare benefit programs. They are now more focused on finding solutions to keep their team members safe and healthy. Yes, it is also true that many organizations across the country are being compelled to…
Read MoreHow 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…
Read MoreMedicare Claims Repricing Solution for Evolving Marketplace
The Medicare Advantage program seems to be thriving. Premium growth in Medicare advantage has been far lower on average than in the marketplaces. Enrolment has continued to increase, now accounting for about one-third of Medicare enrolment. Market Size: In 2019, one-third (34%) of all Medicare beneficiaries, which include 22 million populations, are enrolled in Medicare…
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