The ideal time to incorporate such language is during contract negotiations. Choose language that defines precisely when a disaster or emergency is considered to have occurred. The usual description refers to an official declaration by a government agent or authority, but you should press for more limited situations in which an isolated incident, such as an explosion, destroys or seriously damages the building containing your practice.
Explore This IssueSeptember 2011
“Contract language shouldn’t be so specific that it can’t be flexible,” Fouassier said.
Contract language related to disasters should suspend specific time frames and formats for claims submission. You won’t have time to document during an emergency, so you’ll likely face problems coding those claims properly. A simple accommodation allows commercial plans to accept any government decree that affects Medicare or Medicaid, Fouassier suggested.
Seek relief from requirements for preauthorization or notification for admissions, treatment and discharge, he added, as well as suspension of concurrent utilization reviews. Although it’s reasonable for payers to ask for some evidence of medical necessity once the disaster has ended, seek language that allows alternatives, such as physicians’ affidavits or copies of X-rays.
Don’t be dissuaded by a payer’s claim of protection by a standard force majeure clause, which typically states that the contract doesn’t anticipate war, natural disasters and other “acts of God.” Given the lessons of 9/11 and Hurricane Katrina, combined with this year’s unusually severe blizzards, flooding, tornado outbreaks and fires, today’s practices are hard pressed to argue that they could not anticipate virtually any large-scale disaster.