Employers can anticipate healthcare expenses once they adopt the reference-based pricing (RBP) model. With its implementation, they can determine reimbursements ahead of time, select the prices they are willing to pay for a healthcare service. RBP model saves employers from surprise healthcare expenses for their employees within their company.
RBP can result in up to four times savings on overall medical spending, as well as a reduction in fraud, abuse claims, waste, and stop-loss premiums, and claims.
How Reference-based Pricing Works?
Reference-based pricing works because it creates transparency. It is innovative in its ability to reduce certain costs while simultaneously promoting health market literacy. Independent third-party administrators create RBP plans complying with the employers’ health insurance budget allocation.
RBP can make a big difference for those organizations that are focused on saving money and that are sophisticated top-tier enterprises. The savings for reference-based pricing happens when employees choose procedures at the reference price, providers reduce their prices to the approved amount, and employees pay any difference between the allowed amount and the actual amount.
Advantages of Reference-Based Pricing:
RBP is a financing strategy for employer health plans, giving them benefits of reducing insurance claim costs significantly and allowing plan members to freely choose between providers and facilities rather than being restricted by a network.
Compared to traditional insurance network negotiated discounts, RBP offers much lower costs. All the more, employers and employees alike prefer it to others because healthcare allowed cost is predetermined, which means employers can anticipate the expenses and employees also are in the know that much amount is allowable to them and any extra they would have to pay from their own wallet. Those who obtain care from a provider with a price at or below the reference price have to pay only the normally required cost-sharing, for example, coinsurance, deductibles, etc.
How does CMSPrider Help TPAs to Custom Plan RBP?
RBP plans are typically administered by independent third-party administrators (TPAs). CMSPricer, a SaaS-based Medicare claims repricing system, supports TPAs to provide in-house RBP, based on CMS Medicare rates and provides their users with an option of Medicare allowable rates at 100% and configuration of any variance percentage of that rate.
CMSPricer streamlines the process of calculating the percentage of Medicare allowable fees for both providers and facilities. This one of the best web-based reference-based pricing tools enables the users to avoid over or underpayments hinging from accurate CMS Medicare allowable rates.
The bottom line is CMSPricer self-service interface that comes with custom configuration tools can lower healthcare costs of organizations significantly leveraging the RBP model.
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