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A Deep Dive Into Medicare: Optimizing Pricing And Billing For Medicare Plans

posted by Oracle

on September 10, 2021

Medicare eligible recipients are growing in the U.S. and enrollments in Medicare  Advantage (MA) plans continue to rise

The demographic data of the United States demonstrates an aging population—1 in 5 Americans are baby boomers and this is expected to increase further over the years. This tsunami of baby boomers is disrupting many facets of USA economy and specifically the healthcare system. All stakeholders, be it CMS, private players, providers, PBMs and other suppliers—everyone is on a mission to manage the load to smoothen the healthcare delivery for baby boomers. On one side, where, CMS is working towards resolving concerns around price transparency, data interoperability and other privacy laws, payers are aiming to provide the best healthcare delivery experience by engaging patients over the entire care journey.

Resulting in payers heavily investing in attracting, educating and training the potential Medicare beneficiaries. The accelerated demand is eventually creating a need for reliable, scalable, and process intelligence enterprise grade systems that have the right provisions. Oracle Insurance Revenue Management and Billing for healthcare payers is a one-stop shop designed to help healthcare payer institutions achieve their goal of—unified operations, simplified processes and amplified experiences.

Disclaimer: This paper represents the views of the author, not AHIP. The publication, distribution or posting of this paper by AHIP does not constitute a guaranty of any product or service by AHIP.