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Alter current procedures to reduce silent PPO activity

Silent PPOs, as their name indicates, can be difficult to identify. To avoid falling prey to these sneaky imposters-and correct the situation if you do-you first must learn to identify silent PPOs. Regular PPOs connect providers contractually with insurance companies that send providers patients, thus increasing patient volume. In exchange, providers offer payers discounts on their billed charges. However, silent PPOs enjoy these discounted reimbursement rates without fulfilling any steerage obligations. A managed care organization sells or rents its PPO provider network to a third-party or broker, which then avoids paying higher out-of-network fees.

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