Final answer:
The Silent PPO scheme follows a sequence where healthcare providers sign a contract with a PPO, rates get shared, third-party payers access discounts, healthcare services are rendered and billed at these rates, and the provider is paid without potentially knowing the involvement of a Silent PPO.
Step-by-step explanation:
The sequential order for a Silent PPO scheme can be outlined in several key steps. First, it's important to understand that a Silent PPO is a network that accesses discounted healthcare provider rates without the provider's explicit agreement. Below is a general sequence of how a Silent PPO operates:
- A healthcare provider signs a contract with a Preferred Provider Organization (PPO) to provide services at negotiated discount rates.
- The contract allows for sharing the discounted rates with other entities, often without clearly defining who these entities might be.
- Third-party payers access the provider's discounted rates through the PPO's network but might not adhere to the full contractual obligations of the PPO (like providing a certain volume of patients).
- Healthcare services are rendered to the patient, often with the patient and provider unaware of the actual payer’s network agreements.
- Claims are processed using the discounted rates, even though the PPO’s obligations may not be fulfilled.
- The provider receives payment at the discounted rate, sometimes without realising their services have been accessed via a Silent PPO arrangement.
It's crucial for providers to understand the terms of their contracts and to monitor which entities are accessing their discounted rates to prevent potential revenue loss associated with Silent PPOs.