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.
MedAssets will implement a range of solutions spanning the revenue cycle including: consulting on patient access processes, accounts receivable valuation, third-party billing and collection services, enhanced automation for cash and allowance posting and managed care recovery services, including Silent PPO
and underpayment recovery.
The white paper provides additional clarity regarding the role of PPOs within the health care system, and better defines what constitutes a silent PPO.
A silent PPO is a business entity that applies discounts to payments for provider services without a contractual right to do so, without having honored the obligations to the provider and without appropriate notice to the provider.
AAPPO's white paper on silent PPOs provides clear explanations of what constitutes a PPO versus a silent PPO, the fundamentals of the contract between providers, payors, and/or preferred provider networks (PPNs), what some of the common misperceptions are about silent PPOs, as well as what AAPPO has done and is continuing to do to minimize - and hopefully eliminate - the negative impact of silent PPOs on the health care industry as a whole.
This affiliation also equips AzHHA with access to MedAssets' suite of revenue management solutions, designed to help with all aspects of the hospital revenue cycle workflow including the unique linkage of the supply item file to the chargemaster, patient bill estimation and point-of-service collection programs, claims, remittance and contract management, silent PPO
recovery, concurrent and retrospective denial management, accounts receivable services, charge capture, defensible pricing, and decision support technology.
These solutions include revenue cycle technology and consulting, charge integrity and pricing services, claims, remittance and denial management, silent PPO
recovery, concurrent and retrospective denial management, accounts receivable services and decision support technology.