Certified Revenue Cycle Representative (CRCR) Practice Exam

What is a silent PPO?

1. A network of non-contracted providers

2. A discount scheme used by health plans

3. A provider organization that doesn't participate in Medicare

4. A necessary certification for treatment

The correct answer is: A discount scheme used by health plans

A silent PPO refers to a situation where a health plan negotiates discounted rates with providers, but members of the plan are not made aware that these arrangements exist. As such, option B accurately captures the essence of a silent PPO, as it involves a discount scheme that can result in providers receiving lower reimbursements without a formal contracting process in place. Members may inadvertently access services from out-of-network providers who carry discounted rates, which can create confusion regarding the costs of care and the true network available to them. The other options do not accurately describe a silent PPO. For instance, a network of non-contracted providers (option A) may imply that providers are part of the plan without patients being aware of it, but it doesn't encompass the concept of "silent" in terms of rates negotiation. Similarly, a provider organization that doesn't participate in Medicare (option C) differs fundamentally from the silent PPO idea, as it addresses Medicare participation rather than the dynamics of contracting and discounts. Lastly, a necessary certification for treatment (option D) is unrelated to the concept of a silent PPO, which revolves around the financial arrangements between providers and health plans rather than credentialing or certification processes for treatment. Understanding the definition of silent PPOs helps manage expectations around healthcare costs and