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 the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.