Reference-based pricing is one way self-insured payors have increasingly turned to in order to cut costs, particularly through the use of third-party administrators (TPA) where the price for a service is set not by a party agreement, but instead, solely on the reference pricer’s own price list. This self-set pricing can be based on a number of sources varying from the use of a percent of Medicare rates, to RBRVS, to the use of a proprietary fee schedule. The use of reference-based pricing can result in significant amounts due from patients, because the amounts paid under reference pricing schemes are always significantly below a provider's billed charges. This Roundtable will address the legal implications of reference pricing including:
- What is reference-based pricing;
- Strategies for providers to identify reference-based pricing;
- Options for how providers can respond to reference-based pricing; and
- Best practices to limit the damages caused by use of reference pricing.
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CLE credit will be applied for in CA, GA, IL, NY, TX and, if needed, NC and VA. Attendees will receive a Uniform Certificate of Attendance via email approximately 30 days after the program to seek CLE credit in other jurisdictions. New York lawyers: This program is considered transitional and non-transitional in content. The interactive webinar format is synchronous and approved for all lawyers. King & Spalding LLP / 1180 Peachtree Street, Atlanta, GA 30309 | CA Provider # 10947.