Contracting with a Preferred Provider Network Toolkit

Physicians are regularly 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 separate contract. While subleasing can lead to greater patient steerage, it can also increase confusion and make tracking payments more 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. Read your contracts: Is your practice losing money through rental network PPOs?

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. The guide includes information on the following topics:

• Identifying information that PPNs and payers should include in participating provider agreements and additional documents and communications that physicians need to support the contracting process
• Understanding key differences in the types of networks and the implications for PPNs, payers and physicians
• Identifying information that physicians should know prior to executing a participating provider agreement with a PPN or payer
• Defining a “silent PPO”

These joint educational documents provide a common ground for discussions between PPNs, payers and physicians. Advice from experienced counsel should be sought in the event of uncertainty or for assistance in negotiation.

Contact your state medical association for specific laws in your state and to report unfair discounting practices. Chart of rental network state laws.

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.

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