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.
