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Third Party Billing Application

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PMRNC:

--- Quote ---One of the things I was told that was missing was  in my standard contract it should include the responsibilities of the third party billing service to the provider with respect to maintenance of back-up systems against loss of records
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This is something you will want to get directly from your compliance plan. Yes most providers want this info and it's one I learned early on which was when I realized a compliance plan was necessary before the contract. Most billing company's don't even have a compliance plan despite its importance. If there is ever any violation, your compliance plan can go a long way to reduce or eliminate fines/penalties and to show lack of "willfull neglect" under HIPAA and HITECH. With that said, information on your backup system will be in that compliance plan. YES absolutely clients want to know what happens if you were to be flooded, become ill, or god forbid worse, where is their data? This is especially important if you are licensing your own PM system to which a client isn't accessing. Some billing companies have the capability of having providers create and maintain your own backups. In my contract, the provider is responsible for any/alll backups because I do not license or utilize my own system, ALL clients data resides within their system/program and that is also in my compliance plan in two areas "disaster recovery" and "client responsibilities".


--- Quote ---AND responsibilities of the third party billing service with the client with respect to maintenance of insurance coverage by the third party billing service against risk of loss.

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Yes this also would be in your compliance plan. If you have Errors and Omissions the carriers name, address, policy number and rep (if given one) should be there.  It is not required to have E/O, however it is strongly reccomended.  Whether you offer it or not it should be in your contract that you have it or you don't. This is one of reasons I like NJ Registration, because they are such sticklers your contract will be a good one to meet areas most other billing companies don't even address. For example, I can tell you most billers include a hold harmless clause because maybe their attorney said they should. In this business a hold harmless clause is completely useless and will be tossed out in court because as the billing company and business associate you are responsible for what you bill out. If you have  hold harmless clause IT COULD serve as substitute for the insurance info for the sake of the NJ registration but i would ask them first. I've had E/O from the beginning so it was always in my contract so I am not exactly sure NJ is saying here you must have it. I'm thinking you would either have to have it and mention it or not have it and assume liability, but again I would verify this with NJ first.


--- Quote ---They also did state that the third party billing service does not have to provide any of these but the contract must make it clear whether or not the third party billing service is providing these items to its client. Are you familiar with this and what would you suggest I put on my contract? And would this be under the BAA? Do most medical billing services provide these to their clients?
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Right, you don't have to put those in your contract but like they said it has to be "addressed" so you want to consult with an attorney on how you should word that. A provider may see the hold harmless clause and no reference to or a reference to not carrying insurance and it will look unfavorable.

IF you have a compliance plan, those things mentioned will or should be in there. I always advise billing company owners to have that in place meeting all elements before their contract so that your contract reflects the items in your compliance plan and as I mentioned, NOT having one could be harmful to your business and your personal assets depending on how your business is structured.

The BAA is completely separate and apart and the client is responsible for making sure they have you sign one, but I always advise to have it ready in case they don't have you sign one. Under HITECH a BA is still REQUIRED to perform Risk Anlalysis, (Most billing companies don't even realize this is mandatory),  so you really need to be sure to take the lead on these things even if the client never brings them up. It's why a compliance plan is so important as it really is your road map to being and maintaining compliance not to mention to cover your !@* if needed.   Most E/O carriers require it also to obtain the proper insurance.

AKA:
Thank you so much Linda! You have been very helpful!  :)

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