Alter current procedures to reduce silent PPO activity

Silent PPOs, as their name indicates, can be difficult to identify. To avoid falling prey to these sneaky imposters-and correct the situation if you do-follow these steps:

  • Begin with audits. Sort out individual plans and their contracted payers' payment practices by auditing samples of the organizations' explanations of benefits (EOB). The PPO's name/identification number should match that found on the patient's identification card. The payer listed on the EOB should appear on the list of payers belonging to the PPO.
  • Tackle silent PPO issues in your contract. Attach a complete payer list to the contract and require the plan to provide a notice of changes to the list. Include a provision that requires forfeiture of all discounts that fail to comply with the PPO agreement.
  • Implement a process. Look at your patient accounting processes and add steps that will help identify unauthorized discounts.

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