What are the Benefits of Using a SaaS-based Medicare Repricing Solution and Their Impacts?

Every Medicare repricing solution might be different, but almost every single one makes the same mistake by putting the company in jeopardy: it delays in complying with the CMS updates

As a result of delayed CMS update compliance:

  • Inaccurate payment or overpayment risks
  • Claims re-working or readjusting
  • Strained provider relations or increased provider inquiries
  • Holding claims risks prompt payment interest or penalties
  • What are the Problems of Legacy Systems?

    Legacy systems are a major bottleneck for businesses today. First of all, those are expensive as they require regular IT maintenance and patching, and often slow down the process of billing and enrolment, plus the claims operations and adjudications.

    Payers and providers bear the brunt, by overpaying and overspending, which is why the SaaS-based Medicare repricing model has gained mainstream attention. And, this model has aptly proven its worth and added value to their investment. 

    SaaS-based repricing system is fully capable of administering all types of health plans including Medicare, Medicaid, self-funded (TPA or first party payer) plans, PPOs, BPOs, and auditing firms. It is fully integrated with service capability and seamless compliance, allowing for the complete integration of member management and claims processing from claims receipt to claims payment. 

    Key Features:

  • Utilizes contemporary cloud-based security, including EV SSL Certificate, 5HA2, and 2048 bit encryption 
  • Fully integrated healthcare information technology services
  • Safe, secure and redundant data storage
  • Continually upgraded claims processing
  • Supports high auto-adjudication rates
  • Electronic EDI for claims, Encounters, HIPAA and ANSI 837 version 5010 ready
  • Integrated document management 
  • Batch claims into the system easily, no need to import/export a claim file for re-pricing
  • Flexibility is considered as the gold standard in today’s healthcare infrastructure. However, there are many health payers still sticking to yesterday’s technologies, as a result hampering their work process. 

    The bottom line is that the cloud has become essential. 

    Cloud-based repricing system provides a secure and cost-effective solution to legacy modernization. It offers scalability and the capability to adjust to rapid demands, providing faster deployments, greater employee productivity, and improved stakeholder collaboration. In addition, SaaS or cloud solutions allow for cost flexibility and cost optimization. 

    What Self-Service Medicare & Medicaid Repricing System does?

    Self-service medicare and medicaid repricing system is the best substitute for traditional health insurance planning solutions to organizations in the most economical way. Re-pricing involves entering into an agreement with a preferred provider organization by combining a fee schedule with a medical claim.

    The Preferred Provider Organization (PPO) networks working on medical repricing are always flooded with the claims repricing paperwork involved in the process. A considerable amount of operational cost and processing time is spent to carry out Medicare claims repricing jobs. 

    What SaaS-based CMSPricer does for You?

    Built on a SaaS-based model, CMSPricer can take away the pressure of the laborious process out of you, so that you can save your valuable human resources for other critical works. 

    No Set Up Required: Faster innovation, better member engagements, and better data analytics are all huge value drivers of cloud. CMSPricer returns results in seconds priced at 100% of Medicare rates, featuring hand key entry or auto batch/EDI uploads, and easy imports/exports.

    Accurate Repricing Results: It’s updated frequently and complies with the latest CMS policies and rates. This ensures accurate claims pricing. It prices all PPS types of institutional and professional claims including claim editing for Referenced Based pricing.

    Security: It doesn’t store PHI or claims data and utilizes contemporary cloud-based security, including EV SSL Certificate, 5HA2, and 2048 bit encryption (strongest on the market). CMSPricer is fully HIPAA and ANSI 837 version 5010 compliant and every user has their secure login and account. 

    In Conclusion:

    Moving to the SaaS-based platform will yield a considerable return on investment (ROI) for health insurers and payers and give them a competitive advantage in the market. In fact, the quantifiable returns from SaaS-based repricing solutions continue to dramatically outpace the returns from on-premise deployments. 

    Do you also want to leverage the modernization of medicare pricer software systems? Click here