Specifications include, but are not limited to: 1) Written assessment of existing system • Review API’s current billing and coding systems, including software, processes, and workflows. • Identify the strengths, weaknesses, and areas for improvement. • Evaluate documentation practices and compliance with relevant regulations. 2) Charge master development • The vendor shall collaboratively work with our organization's billing and coding team to develop a detailed and accurate Charge Master that encompasses all billable services, procedures, supplies, and other chargeable items related to psychiatric and medical services. This includes CPT codes, HCPCS (Healthcare Common Procedure Coding System) codes, revenue codes, descriptions, and associated pricing. 3) Compliance and regulatory analysis • Assess the hospital’s billing and coding practices against regulatory requirements, such as HIPAA and insurance provider guidelines. • Identify any compliance gaps and recommend corrective action. 4) Evaluation of Revenue Cycle Management • Review the hospital’s revenue cycle management processes, from patient registration to claims submission and reimbursement. • Identify opportunities for process optimization and streamlining to reduce billing errors and improve cash flow. 5) Review of coding accuracy • Analyze the accuracy of coding practices, including ICD and CPT codes. • Conduct audits of coded claims to identify discrepancies or coding errors. • Provide recommendations to enhance coding accuracy. 6) Development of customized coding manual • Create a comprehensive coding manual tailored to the psychiatric hospital’s services. • Ensure alignment with industry coding standards and guidelines. • Include coding instructions, documentation requirements, and coding examples specific to the hospital’s specialties. 7) Provide on-going training and education to API Staff • Develop and deliver training sessions for hospital staff involved in billing and coding processes. • Cover topics such as proper coding techniques, documentation guidelines, and assistance with compliance audits. 8) Provide on-going support and consultation • Provide continued support and consultation to address questions, concerns, and challenges during implementation. • Offer remote support, clarification on coding guidelines and assistance with compliance audits. 9) Provide on-going reporting and monitoring. • Generate detailed reports summarizing findings, including identified gaps, recommendations, and action plans. • Establish mechanisms to monitor progress and provide feedback on implementation. • Guide the hospital’s leadership in measuring and tracking key performance indicators related to billing and coding accuracy, compliance, and revenue cycle management.
