AMPS RBR vs Other Providers

AMPS’ Reference Based Reimbursement (RBR) was created to provide a RBP solution that is fair to both the payer and the provider alike. AMPS Reference Based Reimbursement solution is built on the following pillars:

Responsibility

Being a named fiduciary enables AMPS to have responsibility for payment determinations on hospital and physician claims while protecting Health Plan and employee/member assets.

 

 

Defensibility

 

The RBR program is based on Fairness, Transparency, and Reasonability. Through a consistent application of our industry-accepted repricing analysis and decision process, AMPS can create a valid and defensible payment recommendation.

 

 

Reasonability

Hospitals and physicians are incredibly important to the health care system, and AMPS Reference Based Reimbursement uses multiple reference points to ensure that providers are paid a reasonable amount for the services they render.

 

So, what makes AMPS RBR different from other RBP products?

 

1.  AMPS is a named fiduciary with full responsibility for all hospital & facility claims (no co-fiduciary for select claims).

 

2.  AMPS uses reimbursement methodology with multiple reference points to ensure fair and defensible payment to providers (not a scorched earth approach).

 

3. AMPS utilizes board-certified medical director audits to ensure appropriate payment/validate billed charges (line-by-line medical bill review).