Centralized Billing Office and Cost Report Services

The vendor is required to provide the operations of a centralized billing office (CBO), provide consulting services for revenue cycle management, and execute coding and billing functions for the state hospital.  
- These services shall be performed to optimize revenue opportunities while ensuring full compliance with federal and state regulations across all payor sources, including medicare, medicaid, managed care, and commercial insurers.
• Monthly coding and billing for all patient claims to appropriate payors
• Monthly coding and billing for all medicare part b claims for professional services, as applicable
• Denial management, follow-up, and account resolution
• Ensure appropriate application of adjusted rates
• Collaborate with local hospital staff to verify social security payeeship for patients
• Collaborate with local hospital staff to ensure payments from “patient banking” are correctly posted to hospital accounts
• Perform all provider enrollments and re-validations
• Perform all facility enrollments and re-validations
• Perform periodic chart reviews to ensure appropriate documentation for professional claims, and provide feedback and training to physicians and psychologists
• Identify and implement additional revenue opportunities with support from hospital superintendents
• Provide monthly revenue cycle dashboard reports
• Serve as an administrator for the state’s medicare portal
• Perform periodic chart reviews to ensure appropriate documentation for professional claims, and provide feedback and training to physicians and psychologists
• Identify and implement (with support from hospital superintendents) additional revenue opportunities
• Provide monthly revenue cycle dashboard reports
• Maintain charge master and current rates for all hospital facilities in the state’s electronic health record system
• Update all CPT codes annually and revise rates per the medicare physician fee schedule in the state’s electronic health record system
• Re-bill inpatient claims when there are fiscal year rate changes per medicaid.
• Monthly meeting with hospital facility business office staff
• Work with hospital business office and pertinent hospital administration staff to standardize processes as appropriate
• Develop policies and procedures for standardization.
- Contract Period/Term: 2 years
- Questions/Inquires Deadline: July 3, 2025