Reference-based pricing webinar recording available

Posted on: 6/13/18

If you missed OHA’s May 16 webinar, “Reference-Based Pricing: The Rise of Non-Network Health Plans in Oklahoma,” a replay is available.

An increasing number of employer-sponsored health plans in Oklahoma are electing not to enter into contractual agreements with hospitals through an established provider network. These plans seek to limit payment for hospital services provided to plan beneficiaries by repricing the services at a plan-determined amount, typically based upon a percentage of Medicare reimbursement, an amount far below traditional commercial payment for the same services. This payment determination method is known as reference-based pricing.

Braum’s Ice Cream and Dairy Stores and the Oklahoma State Medical Association’s OSMA Health Plan are among a growing number of groups in Oklahoma now using reference-based pricing rather than provider network contracts to determine hospital payment amounts. It is important for hospitals to understand their legal rights and procedural requirements for dealing with these patients and plans.

In addition to this one-hour webinar recording, participating OHA member hospitals receive a “toolkit” to help formulate a strategy for responding to these non-network plans. The toolkit includes model patient financial responsibility language, templates for notice to non-network health plans, template letters rejecting conditional payment from a non-network plan, template notices to beneficiaries of non-network plans, lists of known bill repricing consultants and non-network plans operating in Oklahoma, FAQs, and more.

The speaker for the webinar is Angela M. Smith, attorney with Hall, Render, Killian, Heath & Lyman in Indianapolis, Ind. Smith regularly assists health systems, hospitals and other providers in the review and negotiation of managed care and commercial payer contracts, and she assists clients in developing strategies for navigating and adapting to the changing landscape of commercial payment and reimbursement. She is a seasoned appellate litigator who has assisted a variety of health care providers in resolving a wide range of disputes involving accreditation, business, commercial reimbursement, Medicare reimbursement and risk management issues.  She has successfully resolved appeals before both state and federal courts and state and federal agencies, including the Provider Reimbursement Review Board, commercial utilization review boards and The Joint Commission.  

The webinar recording is priced at $200 for OHA members, and $400 for non-members. To purchase the recording, contact Shelly Bush at OHA, [email protected]. (Rick Snyder)