Medical Billing Consultant Services

The Vendor is required medical billing consultant services to optimize the county’s specialty mental health and substance use disorder (SUD) medical billing system and maximize reimbursement opportunities.
• Services include, but is not limited to:
• Development of standardized best-practices, training materials, tools, technical assistance, and documented policies and procedures to support maximization and accuracy of Medi-Cal behavioral health billing. Update these materials as needed, at least quarterly, to align with changes in State and Federal regulations.
• Development of recommended strategies to optimize billing of various payor sources to ensure maximum reimbursement within County-operated and contracted programs.
• Provide ad hoc support related to billing improvement
• Implement an effective monitoring and continuous improvement process for all tools, guidance, technical assistance, and strategies to ensure they optimize billing, and strengthen compliance, audit readiness, operational efficiency, and use of local resources.
• Objectives:
• Identify and document best billing practices, processes, and procedures for Medi-Cal reimbursable Behavioral Health services by service type, including coverage rules, billing units/time, documentation requirements, claim data elements, and common compliance risks.
• Establish service-type-specific billing standards aligned with applicable Medi-Cal statutes, regulations, and Department of Health Care Services (DHCS) guidance to reduce errors and audit findings.
• Provide technical assistance to County BHS staff and contracted provider staff to support the development of billing expertise, implementation of best practices, and establishment of a billing infrastructure structured to optimize reimbursement leveraging certified coder expertise to validate coding accuracy and ensure compliance
• Develop reusable tools, embedded instructions, policies and procedures, and checklists to streamline processes, support internal controls, and facilitate external audits and DHCS inquiries.
• Develop training materials and train County staff and contracted providers on billing processes and tools to sustain improvements. Update these materials as needed, at least quarterly, to align with changes in State and Federal regulations.
• Assess and recommend technologies that would support more efficient, accurate, and effective billing
operations.
• Provide audit-ready documentation and guidance to support compliance monitoring and internal controls.
• Develop and support implementation of strategies to build and sustain County staff capacity in Medi-Cal billing and compliance by providing role-specific guidance, structured knowledge transfer, and ongoing support to ensure long-term operational resilience and audit readiness.
• Contract maximum amount for the one (1) year with four (4) one-year options is $4,250,000 to $5,000,000.