Silent PPO


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A PPO (Physician Provider Organisation) that utilizes the 'assignment' clause of the provider contract and sells or leases rights to the fee discounts to other health plans, which occurs without the provider’s knowledge or consent
References in periodicals archive ?
Blue Cross had created a silent PPO by selling its reduced provider rate to the workers' compensation fund, without the hospital's knowledge or consent.
Another benefit is the elimination of scams such as silent PPOs in which providers submit out-of-network claims to an insurer only to get the claim repriced at an in-network discount.
Yet another benefit is the elimination of seams such as silent PPOs (in which providers submit out-of-network claims to an insurer only to get the claim repriced at a steep in-network discount), and cherry picking (which occurs when a provider belongs to more than one PPO and a claim is shopped around for the lowest reimbursement rate accepted by a provider, regardless of the PPO identified on the patient's ID card).
There is one primary difference between a silent PPO situation and a repricing arrangement.
Silent PPOs are successful largely because physicians in most practices do not have the resources to verify that a patient is enrolled in the PPO that is listed on the EOB accompanying the discounted reimbursement.