Why Healthcare Payers Can’t Get Ahead With Yesterday’s Technology?

Many healthcare insurers are still working on rigid legacy systems that hold them back from enjoying the advantages of today’s innovative systems. As a result, they keep languishing in several fronts, such as flawed compliance capability, inefficient policy management, poor customer data privacy, and lack of visibility, among others. 

However, there are many insurers who are embracing digital transformation and keeping up with the changes to improve efficiencies, reduce operating costs, and improve the experience for them and their clients. 

Simply put, the legacy infrastructure for repricing Medicare Advantage and Medicaid managed care programs is not well equipped to stand up to the huge rigors of today’s modern payer market. This market is now knee-deep in new levels of complexity and controls. So, quick transformation is the only way to scuttle that. 

How to Survive Today’s Complex Payer Market?

Modernization is the key. Payers now realize it and have been modernizing their approach to Medicare repricing and related operations. They are entering into the strategic partnership with self-service medicare and medicaid solutions like CMSPricer to embrace transformation and leverage the advantages of automation.

The result? They achieve the agility to quickly configure, reprice, and deliver new benefits to their clients. It also helps them stay compliant with the latest CMS policies and rates and to ensure accurate claims pricing. They can also price all PPS types of Institutional and Professional claims, including claim editing for Referenced Based pricing (RBP) while optimizing costs and margin considerations.  

Uses of Medicare Repricing System:

As you explore the market, you will come across numerous market players. But only a few of them can provide you with the capability that actually serves the purposes. Of those few, CMSPricer is the one that has that capability, featuring highly flexible and rule-based policy administration and offering a wide variety of solutions

Contrary to the hard-coded legacy systems, the SaaS-based medicare repricing system CMSPricer offers the following applications. 

Reference Based Pricing:

Percentage of Medicare pricing provides easy-to-understand price relationships.

Standardized Fee Schedules:

Providers can calculate current percentages and switch to Medicare-based fee schedules.

Fee-for-service Equivalents:

Payers and providers can understand the value of the service delivered under a contract by repricing data to medicare-allowed amounts. 

Payment Integrity:

SaaS based, modern Medicare repricing solutions like CMSPricer enable plans to check actual payment amounts and adjudication results. 

What are the Key Features of CMSPricer – Self Service Medicare Repricing System?

Built on the SaaS based model, CMSPricer is a one-of-a-kind Medicare claims repricing platform for healthcare payers, PPOs, TPA’s, BPO’s, self-funded employers and auditing firms. See all those advantages that can make Medicare repricing a simple and streamlined workflow. 

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.

To Conclude: The legacy system that supports a few solutions prevents payers from taking their business to the next level with ease and precision. The implementation of a modern, SaaS based Medicare claims processing system like CMSPricer can help payers achieve greater return on investment (ROI) and eliminate errors and the costs associated with them while improving the member experience. 

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