Meet growing needs for innovative insurance solutions while increasing operational health and improving compliance.
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Medicare pricing on demand
Milliman Medicare Reference Pricer
You need a pricing solution that meets provider contract requirements, but Medicare’s patchwork of fee schedules and groupers are complicated, and may not be appropriate for all scenarios. This can lead to delayed updates and the inability to trace pricing results back to current Medicare policies, costing additional resources and time.
The Medicare Reference Pricer provides complete and up-to-date Medicare payments with the flexibility to extend Medicare to commercial and individual claim pricing. Now, you can easily adjust payment components and relativities, as well as extend pricing to non-Medicare covered services and percent of Medicare reimbursement provisions. The software can be deployed as a web service or as a batch process, and is integrated into the web-based claims examiner support system.
Translate climate risks into specific impacts that can be used in financial modelling such as Own Risk and Solvency Assessments (ORSA) and business planning processes.
Access a dashboard of current and potential future risks, which can be combined into a single index to be tracked over time and translated into a medical inflation impact.
Drill down to the level of disease group and examine the effects of climate change on existing and future customer populations.
Receive timely updates with the latest information from Centers for Medicare and Medicaid Services (CMS) to keep payment systems up to date.
Choose the payment systems and components that are relevant to your network contracts and providers.
Reap the benefits of standardized payment structures and processes, including easy to understand provider reimbursement relationships and reduced administrative costs.
Use integrated groupers for Medicare-severity diagnosis-related group (MS-DRG) and ambulatory payment classification (APC) — plus code editor functionality — for accurate and efficient grouping.
Rely on pricing systems tested against Milliman’s full Medicare FFS fee-for-service (FFS) data feed from CMS.
Rely on high-touch support from experts in Medicare payment systems and provider reimbursement.
Identify areas of strength and gaps in performance with benchmarking reports that provide actionable advice.
Discover how Milliman assists provider organizations in navigating changing reimbursement models, patient expectations, and regulatory requirements.
Milliman’s Medicare Repricer software assigns Medicare-allowable fees to administrative claims data, allowing payers and providers to surface those fees in their enterprise data warehouse.
Analyse healthcare relative value units (RVUs) across all healthcare services and provider types, using any data set.