Managed Care Contract Negotiations
Jun 20

Protecting your physician practice from Silent PPOs

Continuing efforts to identify and stop Silent PPO arrangements is essential. At a minimum, physicians signing PPO contracts should ensure the following:

  1. That discounts will be extended only to enrollees of the PPO who have cards identifying them as such;
  2. That all PPO members eligible for discounts will be subject to steerage rnechanisms; contract language that promises "best efforts” by the PPO to steer enrollees usually is of minimal value under most state law;
  3. That the types of entities that can be added to the network are identified in advance, and that providers receive timely notice when payors or employers are added;
  4. That all members added to the PPO be subject to the same steerage mechanisms;
  5. That any discounts applicable to a PPO enrollee be disclosed at the time coverage is verified; and
  6. That the sale or other unauthorized use of contract rate information is specifically prohibited.
About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →