Scrubs & Suits: Mitigate the Impact of Silent PPOs
“Silent PPO” is the term used to describe when a non-contracted payer or plan administrator applies a contracted payer’s fee schedule to services rendered by a provider, without the provider’s prior knowledge or consent,” said NAB president Cynthia Stewart, CPC, CPC-H, CPMA, CPC-I, CGS-P in a recent article.
Additionally, she gives readers several tips to reduce the blow to your practice’s bottom line:
- Using a contracted network affiliated payer list, review each explanation of benefit and honor only authorized payer fee adjustments.
- Request updated contracted network affiliated payer list every three to six months.
- Employ “when in doubt, check it out” mentality by contacting the contracted payer network for updated affiliated payer information.
- Be wary of “valid agreement language” used by non-contracted payers. Who is the valid agreement with—the provider or the contracted payer?
- When contracting with new payers, stipulate that discounted rates will only be applied if patient steerage and provider promotion is employed.
- Consider contracting directly with the non-contracted payer. By contracting directly, the provider should receive the benefits expected through network contracting (e.g., patient steerage and provider promotion).
- Know your contract termination date(s), and inform the staff responsible for payment posting of termination date(s) to prevent ineligible discounts from being taken
Read the full article here.