Meeting Archive:
Protecting your practice from rental networks


Meeting Description:

Protecting your practice from rental networks

 

Managed care contracts frequently permit managed care organizations (MCO) to rent their rights to negotiated physician discounts to third parties. These third parties may be payers other than the MCO. But these third parties may also be nonpayers such as “repricers,” network brokers, or rental network preferred provider organizations (PPO), which do not sponsor or administer health benefit plans but collect information concerning physician negotiated discounts. They then sell that information to MCOs with which the physician may, or may not, have a direct contractual relationship. When the physician submits a claim for payment to an MCO, the repricer, network broker, or rental network PPO reduces the claim payment by the deepest contractual discount to which the physician has agreed and to which the rental network PPO, repricer, or network broker has access. In many cases, the physician may not realize that a nonpayer has applied his or her negotiated discounts to claims payments until the practice receives an explanation of benefits or remittance advice listing unrecognized entities and payment rates representing the lowest discounts that the practice has agreed to accept. This webinar helps your practice identify contract language that allows MCOs to rent their discounts. The webinar discusses state laws that restrict rental network activity and tools your practice can use to counter discount rental activities.

Details
Date: Tue, Dec 11, 2012
Time: 12:00 PM CST
Duration: 1 hour
Host(s): AMA Practice Management Center
 Presenter Information
Wes Cleveland, JD
 

Wes Cleveland is an attorney in the AMA’s Private Sector Advocacy unit. Prior to joining the AMA, Mr. Cleveland served as assistant attorney general in the Office of the Texas Attorney General, an attorney in the Texas Medical Association’s Office of General Counsel, and in private practice in Austin, Texas, where he represented physicians, hospitals, and individual and institutional health care providers.


Mr. Cleveland advocates for physicians on a wide variety of issues related to federal fraud and abuse, antitrust, the Employee Retirement Income and Security Act, and state and federal managed care requirements.