Managed Care

Regs for Auditing Non-Contract Hospitals

  • 1.  Regs for Auditing Non-Contract Hospitals

    Posted 03-13-2014 02:57 PM
    This message has been cross posted to the following eGroups: Multi-Industry Auditing and Monitoring and Managed Care .
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    Hi,

    Does anyone know of regulations regarding a health plans' ability to audit NON-CONTRACTED hospitals regarding claims and reimbursements? Specifically; without a contract on what basis do we have the authority to request retrospective review of claims and reimbursement?

    For our contracted hospitals we ask that they "cooperate with and participate in compliance plans, including, cooperation with auditing and monitoring activities, participation in training and education, and implementation of compliance initiatives and programs as reasonably requested "

    Thanks,

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    Annmarie Rainford CHC,MBA
    Portland,OR
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    2019 HCCA Compliance Institute