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I learned something new today about how PFFS plans are accepted by providers.
While they do not need to be contracted, they are deemed to accepting the payment terms.
Example: This plan will pay 100% of the Medicare allowable rate for test A,B, and C. However, test D is paid out at 90% of the Medicare allowable amount
That is why some doctors are not taking PFFS plans.
But, most of the time it is an education issue, and in that case I will fax them a copy of the provider info that the carriers put out.
While they do not need to be contracted, they are deemed to accepting the payment terms.
Example: This plan will pay 100% of the Medicare allowable rate for test A,B, and C. However, test D is paid out at 90% of the Medicare allowable amount
That is why some doctors are not taking PFFS plans.
But, most of the time it is an education issue, and in that case I will fax them a copy of the provider info that the carriers put out.