Part 2: The Silent PPO Detective – How to Spot Leased Networks Before They Drain Your Wallet
Your contract might look squeaky clean, but hidden inside could be language that invites silent PPOs to the party. These stealthy clauses let strangers crash your network and swipe your discounts. Here’s how to play detective and catch them before they strike.
Red Flags to Watch For
- Network Leasing Language: Words like “affiliates,” “partners,” or “extended networks” are silent PPO magnets
- Discount Program Mentions: If you see “repricing services” or “discount arrangements,” sound the alarm
- Broad Access Clauses: Phrases like “any payer under agreement” are code for “open season on your rates.”
Why It Matters
Silent PPOs and leased networks:
- Slash your reimbursement without boosting patient volume
- Make revenue forecasting a nightmare
- Put you at risk for compliance violations under transparency laws
How to Protect Yourself
- Demand Full Disclosure: Get a list of every entity that can access your rates
- Ban Unauthorized Leasing: Add language that forbids sharing your negotiated fees
- Audit Like a Hawk: Check EOBs for mystery payers and unexplained discounts
Don’t let hidden networks hijack your revenue. NIHC keeps your contracts clean and your bottom line safe.
Download our Guide: Understanding Payor Enrollment vs. Credentialing: Essential Guide for Healthcare Practices
The Contract Clarity Series: How to Outsmart Hidden Revenue Killers (Part 2)