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.
 

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.

Have questions? I’m here to help.

Categories
Accounting and Tax Services Litigation Support Managed Care Consulting Managed Care Contract Negotiations Medical Practice and Healthcare Entity Valuation Medical Practice Assessment Medical Practice Brokerage Medical Practice Embezzlement Consulting Medical Practice Management Medical Practice Merger Advice Medical Strategic Planning Newsletter Personal Financial Planning Oversight Physician Compensation Models Physician Compliance Physician Financial Management Services Retirement Uncategorized
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 >

Reed Tinsley, CPA for Physicians