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Medicare PPS

Implement Medicare rules to support Medicare Advantage and other contracts based on Medicare PPS methodologies. More accurately reimburse out-of-network (OON) claims at Medicare rates, rather than paying uncontrollable percent-of-charge rates.

Several payers have realized savings of more than 60% on Medicare Advantage OON encounters using PPS.


Improve Your Bottom Line

If you're a payer organization seeking to benefit from the increased premiums afforded for Medicare Advantage programs, you're in good company. Numerous payers are expanding existing programs or offering new ones in order to take full advantage of this opportunity to enhance their services while improving their bottom lines.

Highlights

  • Automated regulatory content updates
  • Over 20 state- and payer-specific payment systems
  • Modules for long-term care, inpatient psychiatric and rehabilitation facilities
  • More than 60 Medicare Advantage plans using the solution

The Right Tools for the Job

Without the right tools, PPS can be extremely difficult to manage because regulatory changes are frequent and complex. With the Medicare PPS solution, you benefit from automated regulatory content updates to more accurately process claims.

Experience

Ingenix is a leading provider of PPS solutions that empower payers to control costs and manage risk using PPS, with more than 160 payer customers, including over 60 Medicare Advantage plans.

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