The vendor is required to provide comprehensive, end-to-end revenue cycle management (RCM) services.
• Patient access services
o Eligibility verification, prior authorization, and benefits management
o Patient estimates and financial counseling (including point-of-service collections, charity care, and financial assistance)
o Insurance verification and registration accuracy
o Registration and scheduling functions.
o Clinical documentation integrity and health record maintenance
• Charge captures and coding
o Facility and professional coding (inpatient, outpatient, ed, surgery, and ancillary)
o Charge description master (CDM) management
o Clinical documentation integrity and charge capture audits
• Billing and claims management
o Insurance follow-up, including identifying, resolving, and preventing credit balance identification and recovery for professional and technical accounts receivable
o Timely and accurate claim submission (all payer types)
o Denial management and appeals
• Cash posting and reconciliation
o Payment posting, reconciliation, and refund processing
o Segregation of duties in cash handling
• Patient billing and customer service
o Patient statement generation, payment plans, and customer service
o Patient payment portal and self-service options
o Interest free financing
• Revenue integrity and compliance
o Provider credentialling, enrollment and onboarding
o Provider education
o Oversight of EMR and RCM system integration and optimization
o Regulatory compliance (HIPAA, no surprises act, price transparency, etc.)
o Root cause analysis for underpayments/overpayments and workflow improvement initiatives
• Analytics and reporting
o Real-time dashboards and KPI tracking
o Benchmarking and continuous improvement
• Technology enablement
o Implementation or integration of advanced RCM technologies (automation, ai, predictive analytics)
o Recommendations for system enhancements or replacements
o Data center solutions and capabilities.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: June 16, 2025
