Addressing Silent PPO and Rental Networks in Your Practice: 2 Hours

Presenter: Bridget Morehouse, MPT, MBA

Bridget Morehouse, PT, MBA is a practicing physical therapist and payer relations specialist in Bolingbrook, IL. She earned her Master of Physical Therapy and Masters in Business Administration in 2001 from Marquette University in Milwaukee, Wisconsin. She currently holds a position as adjunct faculty for Marquette University and the University of Wisconsin – Milwaukee, teaching healthcare policy, business administration, and professional issues. Ms. Morehouse is the owner of Morehouse Consulting where she serves as a payment consultant for many outpatient practices and rehab agencies. She also serves as the payer relations specialist for the Wisconsin Physical Therapy Association. She has held positions related to payer relations with the Private Practice Section of the American Physical Therapy Association.

Description:

As reimbursement becomes more complicated, the proliferation of Silent PPO Networks and Rental Networks has reached every practice billing claims to third party payers. These networks may be costing your practice precious revenue through unintended discounting of claims. This presentation will provide basic information on how these networks operate, and guide you in the decision-making needed to assess their potential benefit or harm to your practice. In addition, the presentation will provide a summary of state legislation that limits these networks’ activities in particular states. Highlights of third party payer contracting will also be provided.

This course is presented in an online PowerPoint® format with audio lecture for each slide. Approximate length to take the course, including audio lecture and all written material, is 2 hours.

State Approval Number: CE140022627, 55210TX, 686-5317

Objectives:

After completing this course, you will have a better understanding of the following:

1) Describe how to identify and avoid language in payer contracts that would subject the practice to these unintended discounts.
* Market information
* Terms of contract
* Applicable plans and products
* Contract fee schedule

2) Identify methods for billing staff to assure correct payments from third party payers and confirm payment accuracy over their next billing cycle.
* Fee schedules
* Explanation of benefits or payment from the payer
* Patient insurance card
* Remark codes
* Record or information requests

3) Demonstrate techniques and collection strategies to administrators and owners to immediately share with billing staff to address these unintended discounts.
* Contact the payer
* Inventory and maintain current and terminated contracts
* Process of appeals
* Review termination clause of contract

Target Audience: Physical Therapists, Physical Therapy Assistants
Instructional Level: Beginner/Intermediate


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