6 Managed Care Contract Questions Regarding Release and Audit of Records

Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management, recommends hospitals and other providers ask payors these six questions regarding the release of records and the right to audit and inspect within managed care contracts during negotiations.

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1. Are policies and procedures for record requests properly defined?

2. Are the requirements consistent with legal statutes and other standards, such as, federal, state or The Joint Commission?

3. Are record-retention requirements any different from those applying to the balance of patients?

4. Are the notification requirements reasonable?

5. Are reasonable reimbursement provisions included for duplicating and transmitting records?

6. Are any provisions included that indemnify the provider from liability for complying with a payor’s record request?

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