The vendor is required to provide audit services for zero balance accounts, which a contract was awarded for in 2021.
- In addition to payments from commercial payers, contractor shall review payments from governmental payers, such as, but not limited to; medicare, Medicaid, Tricare, workers compensation, as well as medicare advantage and Medicaid managed care plans.
- Claims payments shall be reviewed by the contractor for hospital‐owned physician clinic services as well as hospital services
- The hospital uses third‐ party software such as 3m and SSI.
- The hospital will provide the contractor access to all claims with a zero‐balance during the period under review
- The contractor shall compare the payments received on those claims against our payer contract terms.
- The contractor shall review claims in chronological order, beginning with the oldest claim.
- The hospital anticipates the review of a year’s claims is to be completed between four and six months.
- The claims have been audited, hospital and contractor will evaluate the need to audit the subsequent year’s claims.
- The contractor shall re‐process all claims that are found to have been paid incorrectly and work with the payers and the business office to obtain payment.
- Payments by 3rd party payers will be remitted to the hospital and a contingency fee will be paid by the hospital to contractor on a monthly basis, based upon cash received by hospital from 3rd party payers on accounts reprocessed by contractor
- Hospital and contractor will work together to establish the necessary access to MedTech and payer contracts to enable the contractor to perform under the terms of this agreement.
- The contractor shall work with the hospital’s business office staff to ensure a knowledge transfer surrounding the claims paid improperly.
- The goal is to ensure that the hospital’s business office staff implement a review process to ensure that claims are paid properly going forward.
- The contractor shall work with the hospital’s business office staff to ensure a knowledge transfer surrounding the claims paid improperly
- The goal is to ensure that the hospital’s business office staff implement a review process to ensure that claims are paid properly going forward.
- Contract Period/Term: 1 year
- Questions/Inquires Deadline: March 19, 2025