Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management, recommends that hospitals and other providers ask payors these 11 questions regarding termination of managed care contracts during negotiations.
1. Is the term of the agreement acceptable?
2. Can the contract be terminated without cause?
3. If the contract cannot be terminated without cause, are the reasons for cause clearly defined?
4. Are the termination notice requirements reasonable (generally 60 days or less for PPOs)?
5. If the termination notice requirements are more than 60 days, can the provider terminate on short notice for non-payment of claims or breach of contract?
6. Are there any extended care requirements attached to the termination notice? If yes, may the provider bill at full charge?
7. May the provider initiate transfer of patients on termination of contract (hospital only)?
8. Does the contract include breach provisions? If yes, are the reasons constituting a breach clearly defined?
9. Under a breach, is the entire contract automatically terminated?
10. Does the contract allow the payor or the provider a means of curing a breach without resorting to contract termination?
11. Under a breach, can contract termination be accelerated over normal termination notice by either party?
1. Is the term of the agreement acceptable?
2. Can the contract be terminated without cause?
3. If the contract cannot be terminated without cause, are the reasons for cause clearly defined?
4. Are the termination notice requirements reasonable (generally 60 days or less for PPOs)?
5. If the termination notice requirements are more than 60 days, can the provider terminate on short notice for non-payment of claims or breach of contract?
6. Are there any extended care requirements attached to the termination notice? If yes, may the provider bill at full charge?
7. May the provider initiate transfer of patients on termination of contract (hospital only)?
8. Does the contract include breach provisions? If yes, are the reasons constituting a breach clearly defined?
9. Under a breach, is the entire contract automatically terminated?
10. Does the contract allow the payor or the provider a means of curing a breach without resorting to contract termination?
11. Under a breach, can contract termination be accelerated over normal termination notice by either party?
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