Managed Care Contract Negotiations
Feb 26

Add clause to your physician provider contracts protect yourself

If you give a plan you’re contracted with unfettered access to your peer review records, you can jeopardize your right to keep them confidential from third parties, including patients and attorneys who want to sue you, your facility, or your organization for malpractice.

The best way to protect yourself is to add a clause to your plan contracts that gives plans the limited access they need without jeopardizing the confidentiality of your records. The clause should

  • Give the plan access to quality assurance (QA)/utilization review (UR) information. The first part of the clause should say that you’ll cooperate with plan QA/UR programs and provide access to records relevant to those programs, subject to confidentiality requirements. For example, be prepared to let a plan see utilization data, such as the number of readmissions, but not investigations of disruptive physicians.
  • Give the plan limited access to peer review records. The clause should also say that the plan can’t make the provider grant access to peer review information, including records, files, proceedings, or other material prepared or maintained by a medical or peer review committee, unless access is required by law or court order.
  • Require the plan to keep all information confidential. The clause should require the plan to keep all of the information provided for QA/UR activities—including peer review information—classified. The clause should also state that the plan cannot disclose this information to a third party without either the provider’s advance written consent, or as required by law or a court order.
About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →