The medical expenses are getting higher every day and this actually leads many people to enroll under private insurance payers to avail of health benefits. Now you know, there’s always an issue between hospitals and the insurance companies regarding medical cost transparency. The CMS has implied many rules and policies to get control over the situation. As a result, we can see the CMS inpatient Pricer system.
In this system, a hospital is paid a fixed amount for each patient discharged in a particular treatment category or Diagnosis Related Group (DRG). That means the insurance payer will pay the hospital the medical bills based on a particular diagnosis and not based on the duration of the hospital stay. This is a very common scenario when you used to see the hospitals keep the patients for a long time in the hospital to increase the medical bill. This can bring a huge loss for the insurance payers. But with this system, the hospitals are now alert and they encourage their doctors to provide quality health service and the best treatment to the patient so that they can recover soon.
But it is important that health insurance payers keep themselves updated about the DRG modules and price rates. Using the CMS inpatient Pricer tool can help the payers to get all the latest updated details. This SaaS-based tool comes with cloud-based technology. It shows results within seconds and one can access it 24/7 from anywhere. It is a perfect tool and the users do not require to install additional software or sign any complex contracts. Healthcare service providers can check the details and compare different health plans. This tool helps them to make an accurate manual, batch, or EDI claims editing or processing.