Contracting With a Preferred Provider Network Toolkit
Physicians are constantly solicited to participate in preferred provider networks (PPNs) via participating provider agreements. But how do you know if the agreement is beneficial for your practice? In today’s market of rental networks, understanding who you are contracting with and what the agreement should contain is imperative. These agreements often include provisions that allow the PPN to sublease the network to other PPNs, with which you may or may not hold a contract. While subleasing can lead to greater patient steerage, it can also increase confusion and make tracking the payment difficult for your practice staff. Problems occur when the payer's relationship to the PPN is not clearly identified, both prior to the time services are rendered and at the time payment is made.
Learn what a PPN should include in the agreement, what kinds of questions you should ask and how to determine whether signing is in the best interest of your practice. The AMA and the American Association of Preferred Provider Organizations (AAPPO) have created an educational toolkit for physicians and PPNs, “Physician and other health care provider contracting toolkit,” to equip both physicians and PPNs to ensure fair participating provider agreements. Additionally, some states have laws regulating PPNs. Contact your state medical association for specific laws in your state and to report unfair discounting practices.
If you believe a PPN is not complying with applicable regulations, you can easily register a complaint. The AMA Practice Management Center has created an interactive map that provides each of the avenues through which you can submit a payer complaint in your state—through your state insurance commissioner, your state medical association or the AMA.
Learn more about the AMA’s work to regulate the rental network industry.
Related resources
Chart of rental network state laws
Read your contracts: Is your practice losing money through rental network PPOs?
