Reference Based Pricing
a critical component of the next generation health plan
- What is Medicare Reference Based Pricing?
- Why Medicare Reference Based Pricing?
- 30% Savings
- Health Plan Renewal Comparison
- RBP Claims Example
- Savings Report
- Balanced Billing: Fear Meets Reality
Referenced Based Pricing (RBP)- a reimbursement calculation utilizing the
Medicare allowance and mark up value; a reasonable level of reimbursement to
• Comparing prices for healthcare services and supplies is difficult given
- The variation in billing practices from office to office
- The difference in the charges for the SAME medical service can be intimidating and confusing.
• In order to find a universal standard, a common reference was needed to determine geography and risk adjusted price
• Why are we using Medicare as a reference?
- Medicare allows for a relative consistent standard to compare hospitals to physician’s and other medical services (or locations).
- Medicare’s calculation process is publically available
- Medicare is the largest healthcare payer in the country
- Medicare is adjusted for case mix and geography rather than on individual hospital charge masters
What if you could save 30% on the cost of your healthcare benefit,
while at the same time increase benefits and reduce payroll
deductions for your employees?