PORTLAND, Ore.--(BUSINESS WIRE)--WellRithms, the industry leading payment integrity firm, today released a provocative white paper, revealing the startling, inherent flaws of reference-based pricing (RBP) and introducing Sustainable Claims Pricing™ (SCP) as a superior alternative. “Why Reference-Based Pricing has been Leapfrogged” unwraps the failures of RBP to deliver on its promise for transparent and predictable healthcare costs.
“Once hailed as a viable market solution for providing fair-market value for medical services, RBP has not only proven to be unsustainable and ineffective, it has also resulted in inconsistencies, underpayments and regional complexities that hinder provider negotiations,” says Ira Weintraub, M.D., CMO, WellRithms. “Readers will discover the inherent weaknesses in RBP's arbitrary methodology, understand why RBP has fallen short of its initial promise and learn how it has become a source of friction, litigation and dissatisfaction among both payors and providers.”
Recognizing the urgent need for a more effective approach, WellRithms developed SCP to address these shortcomings and deliver greater payment integrity. SCP utilizes a proprietary medical pricing database to reprice medical bills line-by-line, incorporating factors such as hospital cost-to-charge ratios, geographical cost variations and inflationary adjustments. By leveraging the expertise of physicians and surgeons – not simply coders or ancillary personnel – the WellRithms proprietary SCP ensures precision in claims payment accuracy, prevents overbilling and eliminates fraud, waste and abuse.
“SCP offers payors a solution that guarantees savings while promoting transparency and reducing the risk of litigation,” continues Dr. Weintraub. “This white paper advances greater appreciation of the historical roots of RBP, its limitations and the evolving landscape of healthcare payment strategies. Detailed analyses and case studies shed light on the challenges facing self-insured plan sponsors and explore the pressing need for a more sustainable, equitable reimbursement model.”
About WellRithms
WellRithms saves money for health plan sponsors by Leveling the Paying Field™ between healthcare purchasers and providers. The company serves group health and workers’ compensation payors who seek the most advanced medical bill review system available, the most precise repricing, and unsurpassed plan savings. WellRithms Shield Indemnification™, backed by our insurance captive, sets WellRithms apart by transferring full legal and financial liability from the payor and participant to WellRithms, rendering balance billing tactics, collections, and pressures to overpay ineffective and unenforceable.
