Adapting Medicare Claims Repricing to Changing Markets

1. Medicare Claims Repricing: Adapting to Changing Markets When it comes to healthcare expenses, people are always terrified because it is high on the rise. Medicare advantage claims processing plans are in high demand. Medicare Advantage premium increases have generally been slower than those of the marketplaces. Currently, it represents around one-third of Medicare enrollment. Let us understand some of the parameters that influence the changing market influence on Medicare claims. Size of the Market: In 2019, 22 million people, or 34% of all Medicare recipients, were enrolled in Medicare Advantage plans. The potential market is still larger and more driven to sign up for comprehensive coverage with coordinated care (compared to the growth rate of 19 million in 2017) because healthcare risks tend to increase with age. Few people who are enrolled in Medicare Advantage change plans; this enrollment is constant. Payers may benefit from managing the healthcare requirements of their enrollees.

2. Challenges: As a result of the development of Medicare Advantage, healthcare payers that deal with the pricing of Medicaid and Medicare claims processing systems are increasingly being forced to optimize and modernize their basic administrative operations. Due to manual procedures and antiquated administrative systems, they have encountered erroneous and expensive results. Solutions: Increasingly, more payers (TPAs, BPOs, self-funded employers, and auditing firms) are using automated processes as solutions. Systems for processing Medicare claims, repricing duties and obtaining precise results have now been established as the best option. They can maintain CMS policy and rate compliance, cut down or completely eradicate duplication errors, and guarantee proper claims pricing for increased ROI. Repricing System: CMSPricer, a SaaS-based Medicare claims processing system, enables its users to provide coordinated, standardised, and cost-efficient Medicare and Medicaid care while meeting changing regulatory compliance criteria. Due to the growing and ageing U.S. population as well as the advancement of CMS's delivery models, policies, and rates, CMSPricer continues to expand their SaaS-based platform with solutions to accommodate CMS initiatives and automate workflows for Medicare and Medicaid payer communities. Medicare advantage claims processing Payers can get the performance they require with CMSPricer and incur much lower operational costs.