Client Alert: What Do Your Third-Party Payor Agreements Actually Require?
How in-depth has your entity reviewed its third-party payor agreements? Have your billing team, Compliance Officer, Privacy Officer, and Legal team all been made aware of requirements or, better yet, were they involved in the agreements' approval? Navigating the “fine print” in payor agreements can be the difference between a smooth operation and a compliance nightmare. Here are five critical areas where providers often get tripped up—and what you should be asking your team right now. Breach Notification Requirements Some provider agreements require that entities notify the payor within 24 hours of a Health Insurance Portability and Accountability Act (HIPAA) breach . While often unrealistic, it's a standard clause that frequently lacks clarity as to whether an unsuccessful security penetration attempt must be reported. The Checkup: Have you determined what your reporting requirements are? Have you implemented a process to meet those requirements? Change of Ownership or Cont...