Comments on: SALUS Medical Solutions new software detects Silent PPO activity http://publishersnewswire.com:/2009/06/03/PNW1178_074813.php News about books, entertainment, music and software Tue, 13 Mar 2012 18:37:04 +0000 hourly 1 By: Joe http://publishersnewswire.com:/2009/06/03/PNW1178_074813.php/comment-page-1#comment-579 Joe Thu, 28 Jan 2010 20:32:16 +0000 http://publishersnewswire.com/?p=1178#comment-579 I am encouraged to find companies beginning to take an interest in stopping silent PPO theft. I have 20 years experience in the healthcare payor field with some of that involving patient account audits at various hospitals. Recently, I left one of these 'repricing companies' after I witnessed time and time again the lengths that owners of these companies go to to secure their portion of the 'shared savings'. Off the bat, I am skeptical to a software program being relied on for the vast majority of silent PPO theft. Taking the belief that silent PPOs are confined to merely taking a physician's contract and applying a discount through a "rented" or "local" PPO and passing it off as merely a contract dispute between the provider & PPO is only scratching the surface. Can this software detect a fraudulent ID card? Oh yes! They are out there! How about the callas made ahead from the silent PPOs to have an unsuspecting receptionist or billing poster change the patient's NEW coverage so that the incoming discount matches?? There is much much more. This really takes knowledge of the field from all angles and the willingness to do the phone work. Having a software program is a step in the right direction, though. :) I am encouraged to find companies beginning to take an interest in stopping silent PPO theft. I have 20 years experience in the healthcare payor field with some of that involving patient account audits at various hospitals. Recently, I left one of these ‘repricing companies’ after I witnessed time and time again the lengths that owners of these companies go to to secure their portion of the ‘shared savings’. Off the bat, I am skeptical to a software program being relied on for the vast majority of silent PPO theft. Taking the belief that silent PPOs are confined to merely taking a physician’s contract and applying a discount through a “rented” or “local” PPO and passing it off as merely a contract dispute between the provider & PPO is only scratching the surface. Can this software detect a fraudulent ID card? Oh yes! They are out there! How about the callas made ahead from the silent PPOs to have an unsuspecting receptionist or billing poster change the patient’s NEW coverage so that the incoming discount matches??

There is much much more. This really takes knowledge of the field from all angles and the willingness to do the phone work. Having a software program is a step in the right direction, though. :)

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