Reference-Based Pricing gives our clients the opportunity to treat their medical costs
in the same manner they would any other business cost.
Health plan reimbursement based on the fair market
value of the services rendered.
Reduces your current health plan spending by 20-35%
Improves operating margins
Lowers out of pocket expenses for employees
What is Reference-Based Pricing?
The current medical services reimbursement system uses a discount (50%) off of some negotiated dollar amount agreed to by the provider of medical services (hospitals, doctors) and a PPO network of providers.
Reference-Based Pricing is a way for employers & employees to combat this highly flawed pricing model and to reduce the increasing cost of healthcare.
Reference-Based Pricing establishes a maximum amount that an employer/plan sponsor will pay providers (hospitals, doctors, etc.) for hospital, specified medical or prescription services.
It is not uncommon for medical services to have drastic cost variations between providers with no discernible differentiation in quality.
RBP provides the employee with health care choices, saves the employer money and provides quality care. RBP eliminates the need for a PPO.
RBP provides the employer with pricing designed to follow MEDICARE PRICING. There will be no inflated medical pricing and PPO over payment. Ruscitti Associates, together with AMPS, will have the responsibility to manage your health dollars.
We audit each claim to weed out exorbitant charges from health care facilities.
Ruscitti Associates offers a Referenced Based Pricing solution uniquely effective in the medical market as part of a comprehensive cost management solution.
We provide legal defense if balance billing or a collection attempt occurs. AMPS is the co-fiduciary of your health plan.
Under ERISA Law, the employer has the fiduciary responsibility to manage its health care plan.
With Ruscitti Associates and AMPS as co-fiduciary the “Prudent Man Standard” is enforced. Supporters of their strategy often present RBP as a more rational, transparent, and cost effective method of paying for healthcare.
Our RBP plan have been in been in business since 2003, we are averaging savings of $150,000-$200,000 annually per 100 covered lives. We average 25-30% reductions in overall healthcare spending.
How It Works
Reference-Based Pricing reimbursement rates are established as a multiple of what Medicare pays based on the Medicare Fee Schedule. A traditional PPO network marks up healthcare services just so they can be marked down, usually to a 40-50% discount. Reference-Based Pricing is a more transparent and fair pricing system. An employer can see significant savings over a PPO plan while the provider is still receiving more than they would normally receive from Medicare. Under RBP you will reduce your medical costs by 20-35% over your current PPO plan, with no change in benefits.
Data Driven Pricing
What are the Benefits?
COST SAVINGS – Both employers and employees can save significantly with Reference-Based Pricing strategies. By basing reimbursements on actual costs of facility services, payments with RBP verses a traditional PPO plan are consistently lower, often times as little as half the cost. We see discounts of 20-35% over your current PPO costs.
TRANSPARENCY – With RBP, patients know the costs of procedures in advance, giving them a chance to evaluate and select the facility that best suits their needs. By empowering consumers, overall employer costs for healthcare is driven down and the cost to the patient is dramatically reduced.
PATIENT SUPPORT – We offer member service teams to help members navigate their RBP plan. We are experts at dealing with balance billing and are able to help reduce or eliminate unnecessary member expenses.
PLAN BENEFITS – We duplicate your current plan of benefits that you offer your employees. Your employees can choose any hospital, doctor, or other medical providers, we don’t use a PPO network. We use Medicare based rates- the lowest rates in America.
