PayerParity Releases Accuracy Test Results for Medicare Pricing Software
PayerParity has published the results of a 5,000-claim test comparing its pricing software against the federal CMS Web Pricer, with all results falling within a one-dollar margin of error.
Texas-based software firm PayerParity has released an accuracy report detailing the performance of its independent Medicare and Medicaid claims pricer. The study evaluated 5,000 synthetic inpatient claims against the Centers for Medicare & Medicaid Services (CMS) official pricing program, finding that every claim matched within $1.00, with a maximum variance of 22 cents.
The test spanned roughly $89 million in Medicare inpatient payments across 60 hospital provider records. It specifically included challenging billing scenarios, such as per-diem transfers and cost outliers, to assess the robustness of the system. The company has made the full dataset and methodology public to allow for independent verification.
Chief Technology Officer Sanju Chand stated that the transparency of the calculations is intended to provide health plans with a defendable basis for provider contracting and payment integrity. By providing a line-by-line breakdown of each factor, the company aims to move away from the 'black box' approach common in some legacy pricing software.