Welcome to your daily briefing on healthcare developments in Maine. Today we're covering 4 key stories including updates on maine healthcare headlines, background & context. Let's dive in.
1 story
The Maine Department of Health and Human Services is dedicated to promoting health, safety, resilience, and opportunity for Maine people.
Healthcare professionals in ME should monitor DHHS initiatives to align care delivery with state health priorities and available resources.
Reach healthcare professionals
3 stories
A vendor is a business associate if they create, receive, maintain, or transmit PHI on behalf of the covered entity. They are NOT a business associate just because they happen to be in a building with PHI or could conceivably access it. The functional test matters, not the proximity test.
Forcing BAA execution on vendors who do not meet the functional test creates contractual bloat and weakens the negotiating position with vendors who actually do. Failing to execute BAAs with true business associates exposes the covered entity to OCR enforcement.
Three application defects routinely delay payor enrollment: incomplete work-history explanations for any gap over 30 days, a malpractice carrier-history that does not reconcile with the explanation, and CAQH attestation that has lapsed. Each forces a back-and-forth with the credentialing committee.
A new clinician without active payor enrollment cannot bill for covered services for most plans. Each month of delay is foregone revenue that does not retroactively recover.
The No Surprises Act good-faith-estimate requirement applies to all licensed providers offering services to self-pay or uninsured patients — not just hospitals or large groups. The estimate must be provided within timeframes that vary by how far in advance the appointment is scheduled.
Patient-provider dispute resolution under NSA typically defaults to the patient when the practice cannot produce a timely good-faith estimate. The penalty is the full disputed amount being struck.
Get Maine healthcare intelligence delivered to your inbox every morning.
Subscribe FreeView all past issues
Feature your brand across the U.S., Canada, and select international markets and 10 industry verticals.
Become a National Partner