Coding and Other Revenue Cycle Services

The Vendor is required to provide coding and other revenue cycle services
- Coding services
•    Provide detail description of all KPIs that will be utilized while providing coding services to university, along with methods for measurement of expected targets.
•    Perform medical coding by accessing medical record documentation located in epic EHR for university and university health system with an accuracy rate of > 95%.
•    Audit coders at regular intervals, preferably quarterly, and provide audit results to university.
•    Provide comprehensive provider education program that is readily accessible and addresses the educational needs identified from documentation quality assessments.
•    Claims submission for professional services within four (4) business days following the receipt of complete clinical information. 
•    Handle patient inquiries regarding account balances, claims processing, insurance, etc. using based personnel in collaboration with university customer service team to ensure a high-quality patient experience.
•    Insurance accounts receivable follow up and denial management. 
•    Provide data interface for patient statement delivery by existing university vendor.
•    Provide reporting and analytics for all requested revenue cycle KPIs on monthly basis and per special request. 
•    Provide detailed plans with timeline for correction if KPI performance metric drops below minimum standard. 
•    Identify uncollectable account balances to allow for timely submission to the collection agency in use by university. 
•    Support payment posting function performed by university. 
•    Provide all requested data and support necessary for all audit requests received from CMS, other governmental entities and contracted payers.
•    Provide viable options for business continuity or disaster recovery for all revenue cycle functions. 
•    Provide a detailed 90-day implementation plan, including data migration, staff training, and knowledge transfer from incumbent team. 
•    Reconcile all charts to be coded against the electronic registration log and immediately notify university of any missing records or records that require additional documentation to be considered complete for coding.
- Revenue cycle function
•    Assign a designated manager and back-up to be point of contact with university. 
•    Provide alternate coverage for workers needed to always ensure proper staffing and workflow. 
•    Provide all required hardware for remote workers as well as upkeep of hardware. 
•    Adhere to all CMS guidelines and procedures. 
•    Demonstrate staff is compliant with HIPAA law and regulations.