jonbrissman@verizon.net
Senior Member
Posts: 377
Joined: Oct 2003
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Friday September 26, 2008 9:17 PM
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Yes, LC Sect. 4603.2 governs along with its complement, 8 CCR Sect. 9792.5. But you need to analyze penalty and interest issues separately. The 15% penalty attaches only if defendant did not send an objection letter within 45 working days of its receipt of the itemized billing and any required reports. An EOB will often suffice as an objection letter, and it sounds as if you received EOBs contemporaneously with payments. Interest accrues from the time the bill became due, which is usually at the expiry of the 45-working-day period, until payment is received. A timely and adequate objection letter stops the penalty but it does not stop the interest. Any penalty and/or interest due is calculated on the unpaid or underpaid amount, which is likely only the PPO reduction in your example. Recognize that P+I on a relatively small amount is a miniscule amount, perhaps not worth the effort to collect.
General advice on PPO networks: It can be to a physician's benefit to join a PPO to get more business via referrals. But negotiate your contract with the PPO so that it will be entitled to a fee reduction only for charges on those patients it has referred to you. It makes little sense to allow a reduction to your charges on non-referred patients. If the PPO will not allow such a restriction, you may be better off not participating. Example: say you treat 50 new patients per month on average, and a PPO refers five of those. If your agreement is to give a 10% PPO discount on charges for all your patients, you're treating those five referrals for free. If the PPO sends you 25 new patients (half your workload) per month, then your participation in the PPO is beneficial. I have yet to see a PPO contract that, in practice, benefited the provider.
JCB
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