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>>"Reference-based pricing applies that to all providers, including out-of-network providers." RBP is a multiple of standard Medicare rates, say 140%, often is
by ecommerceguy 3y ago
>>"Reference-based pricing applies that to all providers, including out-of-network providers."
RBP is a multiple of standard Medicare rates, say 140%, often is substantially less than a negotiated rate from a Carrier, hence balance billing and not so happy provider. Basically a take it or leave it option for the provider, many of which simply take it and move on. Not claiming right or wrong, just stating facts.
RBP uses the Medicare "network".
- chimeracoder 3y ago> RBP is a multiple of standard Medicare rates, say 140%, often is substantially less than a negotiated rate from a Carrier, hence balance billing and not so happy provider. Negotiated rates are also themselves set as multiples of the Medicare Allowable Rate. Both are set as multiples of Medicare rates; that's not something unique to reference-based pricing.
- ecommerceguy 3y ago>>Negotiated rates are also themselves set as multiples of the Medicare Allowable Rate. Care to provide proof of that statement? "...instead of negotiating prices with providers." From the American Hospital Association: https://www.aha.org/fact-sheets/2021-06-08-fact-sheet-reference-based-pricing https://www.aha.org/fact-sheets/2021-06-08-fact-sheet-refere...