Medical Billing Services

The Vendor is required to provide administrative support, including billing and collections services (Medicaid, Medicare, and commercial payers) on behalf of the both homes.
- 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 pay or, 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/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.
•    Submit 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.
- Onsite Allowance and Meeting Participation
•    Provide onsite or virtual presence as requested by the facility as needed.
•    Response to facility billing or claim inquiries within 24 hours for urgent issues and within 48 hours for standard requests.
- Education and Consulting
•    Free phone and email access to consultants for MDS, billing, and clinical questions.
•    Conduct annual training updates on CMS/medicaid regulatory changes.
- RAC Audit Defense (RAD) Process
•    Minimum Data Set (MDS) consultant will review the claims, under PDPM for MDS accuracy.
•    Will review the therapy logs on the same set of claims to verify there are no "3-day breaks," check that the minutes and PDPM match, and to ensure the Primary Dx match the claim UB.
•    Consultant will contact the facility directly to report any discrepancies

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