decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 2 (February)
Orthopedic administrators turn to legislative option to fight silent PPOs
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Article Overview
This article examines how orthopedic practice administrators are responding to silent PPO-related underpayments through state legislative advocacy, payer contract language, and broader physician group coordination. It is relevant to practice administrators, medical office managers, and coding or reimbursement professionals who monitor payer behavior and contract compliance. The discussion focuses on the issue’s impact on physician reimbursement, examples of state-level responses, and general resources from medical associations.
Why This Topic Matters
Silent PPO arrangements can reduce reimbursement without a straightforward denial, so practices need to recognize the issue early and understand the kinds of administrative and legislative responses being used to address it.
What You Will Learn
- How orthopedic practices are responding to silent PPO-related underpayments
- Why explanation of benefits review is important in identifying reimbursement issues
- How state legislative efforts have been used to address payer network leasing concerns
- What types of contract language are being discussed by physician groups and medical associations
Who Should Read This
- Practice administrators
- Medical office managers
- Physician owners
- Revenue cycle professionals
- Reimbursement specialists
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