Let’s Take a Journey Through the World of Cost Containment By Leveraging Reference Based Pricing Model!

As healthcare costs continue to soar, employers are on a quest for innovative solutions to alleviate the burden without sacrificing quality care for their employees. In this pursuit, they have come across a rising star in the world of cost containment strategies – Reference Based Pricing.

But what exactly is this mysterious method? Reference Based Pricing (RBP) is a strategic alternative to traditional insurance systems, favored by self-funded employers looking to rein in their group benefit plan expenses.

Unlike traditional insurance plans, RBP does not involve a third-party insurance carrier or negotiated provider networks. Instead, employers set a fixed limit on the amount they will pay for certain healthcare services, based on Medicare rates or other reference points.

So how does this strategy work? There are various forms of RBP, with reimbursement amounts determined by Medicare-based rates, cost of charges, or percent of savings. Employers can set a fixed limit based on a multiplier or percentage of what Medicare would pay, with the goal of reducing reliance on provider network discounts.

The upside of RBP? Employers can see dramatic savings, up to 50-70%, compared to the average 20-40% from traditional network discounts. And employees can also benefit from these savings, as they can impact applicable deductibles, coinsurance, and copays.

The ultimate objective of RBP is to provide an effective tool for addressing healthcare costs and stabilizing the overall cost of care that TPAs, payers, auditors can achieve through leveraging SaaS RBP Systems like CMSPricer. However, it does come with its own set of challenges. Employers may face difficulties in managing RBP, such as working with stop-loss carriers, identifying and convincing providers to accept RBP rates, and considering variations in risk tolerance.

Is RBP the right option for every employer? The answer is not simple, as it depends on various factors. The employee base is a crucial consideration, as younger and healthier employees may not see as much benefit as older or less healthy individuals. Employee buy-in is also important, as RBP may require changes to plan costs, contributions, and potential balance-billing.

And what about the calculation of RBP? Medicare claims repricing tools, such as CMSPricer, are used by healthcare providers, TPAs, payers, auditors, etc. to ensure compliance with CMS policies and rates. These tools help streamline the repricing process, ensuring accuracy and efficiency.

CMSPricer stands out as a top choice in this field, with its cloud-based accessibility, user-friendly interface, and guaranteed accuracy. It can effectively handle claims processing for all types of institutional and professional claims, making it an invaluable tool for reference-based pricing.

In Conclusion Reference Based Pricing may not be the solution for all healthcare claims, but it is certainly a powerful tool that should not be overlooked. And with the right tools and strategies in place, employers can navigate this complex world of cost containment with ease and success. So why not take a closer look at Reference Based Pricing and see what it can do for your organization? Visit the website of CMSPricer to learn more about CMSPricer and how it can benefit your business.