Employers continue to search for ways to control healthcare costs. In the self-funding market there is an alternative model emerging as a creative option to traditional discount pricing through provider networks. Reference Based Pricing (RBP) is based on the Center for Medicare and Medicaid Services (CMS) costs, which is regularly accepted by providers for the services provided to patients. Medicare pricing is significantly less than what insurance companies pay.
For example, in 2015 the national average charge by providers for a Carotid Artery Stent was $73,220 but the average Medicare payment was $14,047 according to CMS. Under a RBP plan, employers set an amount, percentage, or range of payment for services provided. An employer plan that sets reimbursements at 140%...Read More