Medical Billing Services

The vendor is required to provide medical billing administrative support, including billing and collections services (Medicaid, medicare, and commercial payers) on behalf of the agency.
- Medicare revenue management
•    Manage medicare part a, part b, and medicare advantage claims, including all billing, corrections, and follow-up.
•    Enter or import therapy codes monthly from therapy vendor files; cross-check against therapy logs for accuracy.
•    ensure all PDPM scores, hospital days, and dates of service are correctly aligned in claims.
•    Submit claims electronically to medicare, managed care payor, or other insurance companies for processing. 
•    The claims are to be checked in the appropriate systems for completion. 
•    If errors are present, they are to be resolved directly in the system for faster payment.
•    Monitor claim status and resolve rejections and denials within timely filing limits.
•    Collaborate with facility business office managers to reconcile missing information.
- Medicaid revenue management
•    Bill Medicaid monthly based on facility census and state requirements.
•    Reconcile Medicaid claims with monthly census reports, including hospital and leave days.
•    Claims directly to the state Medicaid system or appropriate managed care organization (MCO) portals.
•    Correct, appeal, or resubmit denied claims within timely filing guidelines.
•    Provide reconciliation with remittance advices to ensure accuracy.
- Commercial and co-insurance revenue management
•    Includes all primary commercial payors and all secondary co-insurance claims.
•    Retrieve and attach medicare remittance advices as necessary.
•    Perform eligibility verification and coordination of benefits prior to billing.

- Contract Period/Term: 4 years
- Questions/Inquires Deadline: November 14, 2025