Reference-based pricing is gaining momentum — here’s why - Employee Benefit Adviser article

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Thursday, July 26, 2018 11:54:00 AM Categories: News and Views

This article makes a good case for billing and payment reform. Reference-based pricing using Medicare is a vast improvement over meaningless PPO “discounts” that currently dominate the self-funded market. Providers have completely co-opted PPO billing across the country. With the support of national payers, PPO provider agreements have become secret documents that self-funded plan fiduciaries are unable to see. The terms in those agreements determine how the self-funded plan’s money is spent, yet plan fiduciaries can’t see those terms: Talk about lack of transparency! Using Medicare payment levels puts the self-funded plan back in control of how provider bills get paid.

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