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Legal and Practical Implications of Reference-Based Pricing

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.

If you have questions concerning this Roundtable Webinar, e-mail

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.

Event Details

Date: July 26, 2018

Time: 1:00 pm (ET)

Attend This Event

Please register soon. You do not have to be a client to attend, and there is no charge.