Reference Based Pricing: A Detailed Guide

1. Reference Based Pricing: A Detailed Guide There is an evolution in health care by which providers can determine their own prices. There is a broad range of price variances from one provider to another! The price of a procedure may vary depending on where the procedure is taking place and who is performing it. The high cost of health care has many employers feeling limited in their options and they can provide quality benefits at a competitive cost. There are several options that exist beyond simply shifting costs to employees. One such popular option is reference-based pricing TPA (RBP). RBP helps to address the cost of care and it also addresses employer concerns about the affordability of health care benefits. What is reference-based pricing? Reference-based pricing is a health plan strategy where the employer sets a ceiling on the amount it will cover for a procedure rather than having the provider determine the cost. Providers then can accept the RBP payment, or provide the reasons as to why their fees exceed reasonable and customary charges.

2. For optimal results for both the employer and member, integrating RBP in health coverage needs administrative capabilities best served. The objective is easy – CMS web pricer address healthcare costs for individual employees and employers. The benefits of RBP however are many, ripple effects throughout the healthcare community. The purpose is to provide an effective tool to help stabilize the cost of healthcare. RBP eliminates guesswork and worry from employees about price – specifically, out of pocket costs. It even encourages members to engage proactively to manage their healthcare costs. Maintaining fair value pricing through RBP helps create a competitive market focusing on better results through quality performance at an affordable cost.