Doctors and hospitals that accept Medicare reimbursement agree to fixed prices for the services and treatments they provide to Medicare patients. The Centers for Medicare and Medicaid Services (CMS) base these prices on the provider's costs, not on what they bill. Consequently, these prices are typically a fraction of the amount that insurance companies or private-pay patients pay and while those higher prices continue to increase at an average of more than three times the rate of inflation every year Medicare based prices increase much more slowly.
With Medicare Reference-Based Pricing (RBP), payers (self-funded employers, health plans, etc.) of all sizes can get in on the savings, enabling them to control their healthcare related costs short and long-term.LEARN MORE
Every payer's needs and situations are unique. For some, switching to a RBP based plan that reimburses payers based on a multiple of the Medicare rate makes the most sense. For others paying their out of network claims or for specific claims types based on a multiple of the Medicare rate works best. H.H.C. Group offers Reference Based (RBP) solutions to fit each client's unique needs.
Operationally, some payers want help with everything from plan document assistance to claim repricing, provider appeal resolution, patient education and balance bill support/patient advocacy. Others only need some of these services. That's why H.H.C. offers its RBP services on an ala carte basis.
Medical claims are not getting any less complex. Often out of necessity, claims are frequently processed without the detailed scrutiny that would be required for financial optimization and billing accuracy. The claim volumes can be just too massive inside of the limited processing time windows.