The term "healthcare Reference Pricing," or RBP, refers to a pricing system that bases a claim or bill's price on a benchmark or reference price rather than a discount taken from the originally billed charges (as typical networks do). Common and customary prices are examples of traditional pricing strategies.
How does such a pricing strategy work?
When a claim is priced using Medicare pricing as well as other benchmark pricing approaches, this is known as reference-based pricing. Sometimes, before the services are provided, a deal is reached with the provider on payment for such claims. For practitioner and auxiliary services, employers may provide reference-based pricing services to their staff in addition to a conventional PPO network or in place of a conventional PPO network. Referencing-based pricing services consequently commonly encourage usage "with or without a network."
Benefits of Adopting a Reference-Based Pricing System
● Encourages members to choose healthcare providers who offer affordable costs for non-emergency "shoppable" surgical procedures, medical tests, and prescription drugs.
● Might be used to replace or supplement annual health insurance deductibles.
● Can encourage service providers to engage in price and quality competition.
● Can encourage providers to seek out cost-cutting innovations.
● Access to information about value and quality is necessary for it to work.
Surgical implications covered by reference-based pricing
Based on the state's price dispersion, the available quality data, and the geographic accessibility of services, the California Public Employees' Retirement System (CalPERS) created reference pricing for five high-cost procedures beginning in 2010 and 2011. These procedures include arthroscopic surgery, colonoscopy, cataract surgery, hip and knee replacement surgery, and arthroscopic surgery.
Final words
Reference pricing and medical claim repricing offered by CMS Pricer can spur service providers to explore cost-cutting technologies and price-quality competition.
Visit for more info: https://cmspricer.com/