Bay Area Preferred Physicians Q & A for Physicians
Q: What is BAPP?
A: BAPP is a messenger model organization which helps physicians contract with preferred provider organizations and health plans by communicating physicians' fee-for-service reimbursement rate desires to health plans and health plan contract offers to physicians. BAPP acts as attorney-in-fact for its member physicians so it can execute PPO contracts on their behalf. BAPP credentials its members so they need not fill out multiple forms and participate in multiple processes. BAPP provides analytical services which help physicians understand their contracts. BAPP also handles claims and utilization appeals on physician members' behalf. In summary, BAPP's mission is to communicate and facilitate contract administration.
Q: How does BAPP work?
A: Physician members will submit to BAPP a confidential list of the top 10 CPT codes in their practices, along with the fees they would accept for each service. BAPP stores that information in a secure computer system. When BAPP receives a PPO offer, it will compare it to each member's list and acceptable fees. If it meets or exceeds at least 5 of those fees the member will be notified and offered an opportunity to opt out of that contract. If the member chooses not to opt out, acting as his/her attorney-in-fact, BAPP will execute the contract between the member and the PPO. If the contract does not meet or exceed at least 5 of those fees, but does meet the fees of at least 50% of BAPP's member physicians, a notice is sent that the contract will be administered by BAPP and the member will be given an opportunity to opt in. If the member chooses to opt in, BAPP will, acting as his/her attorney-in-fact, execute the contract with the PPO. Members remain in complete control of which contracts they participate in and which they decline. And members may, of course, update their schedules and acceptable fees at any time.
Q: Doesn't anti-trust law limit what BAPP can do?
A: Yes. While independently practicing physicians can negotiate in groups for contracts in which they share financial risk, they cannot negotiate as a group for PPO contracts without violating anti-trust laws. Therefore, BAPP has taken several steps to ensure that it operates within legal boundaries and provides real value to its members:
First, BAPP has obtained a letter from the Federal Trade Commission which outlines its business operational plan and states that if BAPP operates as described; its operations do not violate the law.
Second, we have contracted with a longstanding, successful third-party administrator, First Choice Administrators in Los Angeles, which has many years of experience designing and operating effective messenger model organizations. First Choice will provide all the back-office work BAPP requires—collecting fee information, managing the computer system, analyzing contract terms and conditions, and communicating with physicians, PPOs and health plans.
Third, we are engaging in an educational marketing effort to make sure physicians understand what BAPP can do and what it is prohibited from doing.
We believe BAPP can provide a significant service to physicians, patients and third-party payers well within the constraints of anti-trust law.
Q: Can BAPP help its members understand the terms and conditions of the contracts they are considering or that they currently participate in?
A: Yes, this is a key benefit of being a BAPP member. BAPP has developed a set of “standard terms and conditions” which it uses as a benchmark to evaluate every PPO contract. These standard terms are included in the physician agreement with BAPP. When a PPO contract is materially different from these terms, BAPP will alert its members to those differences so they can easily identify how such terms would affect them. Additionally, as a service, a member may request BAPP to perform an analysis of the non-financial terms and conditions of any health plan contract that is not administered through BAPP.
Q: Is BAPP like an IPA? Does BAPP take an administrative fee from the payments physicians receive from PPOs?
A: BAPP does not take any administrative fees from the payments its members receive. BAPP does not bill for members, or receive and process any PPO payments. A member's entire financial obligation to BAPP is an annual membership fee, and a one-time fee to cover the credentialing and set up process. BAPP is not in any way involved in risk (HMO capitated) contracts.
Q: How is BAPP organized and funded? Who can join BAPP?
A: BAPP is an independent, non-profit 501©(6) mutual benefit organization sponsored by seven Bay Area medical associations (Alameda-Contra Costa, San Francisco, San Mateo, Santa Clara, Sonoma, Napa, Solano). Each sponsoring medical association has designated two physician representatives to form the BAPP board of directors. Its operational funds come from annual membership dues paid by participating physicians. BAPP was created as a member benefit, and as such is open to all physicians who are members of the Bay Area county medical associations.
Q: Why should I join?
A: BAPP will greatly simplify the administration and management of members' contracts, allowing them to participate in more agreements without additional overhead to their practices. BAPP will credential its members for all PPOs whose contracts are administered through BAPP, and will handle claims and utilization appeals under those contracts. If a member would prefer to transfer these tasks to a membership organization formed to solely serve physicians, BAPP is an excellent value.
