CMA has learned of a possible scam targeting physicians. Physicians report receiving via fax a request to confirm their participation in Three Rivers Provider Network (TRPN). The deceptive and misleading notice, formatted to mimic a HIPAA compliance document, implies that the physician has treated one or more TRPN patients and that in order to authorize the patients’ eligibility the physician must agree to the terms described in the document.

This is merely an underhanded attempt to get providers to join the TRPN network and agree to accept its discounted rates as payment in full. CMA urges physicians to alert their office staff about this solicitation and to be wary of requests for physician information from unknown payors.

Physicians are advised, before signing any new contract, to review it carefully. Among other things, physicians should ensure that the proposed compensation, including the payor’s payment policies and the rules it uses to adjudicate claims, will be sufficient to maintain the medical practice. Without doing this analysis, you cannot make an informed decision about signing the contract.

To help physicians negotiate and manage complex third-party payor agreements, CMA has published a contracting toolkit, Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting. The toolkit is available free to members at the members-only website. Nonmembers can purchase the toolkit for $100 in the CMA CMA bookstore

Contact: CMA’s reimbursement help line, 888/401-5911 or gfonseca@cmanet.org.