Summary of Specifications:
Genesee County Nursing Home (GCNH) is seeking a qualified billing agent/agency to review the Nursing Home’s physician visit/encounter information, research any obvious resident demographic errors, and process claims.
The selected agent should also facilitate third party credentialing requirements necessary for billing, as well as assist in identifying business process and system improvements within the GCNH third party health insurance billing. Credentialing will include approval for multiple physicians, physician’s assistants, and or nurse practitioners.
Respondents must have the capacity to provide GCNH with monthly reports inclusive of billing activity, as well as detail of receivables (unpaid claims). The agent/agency must work with GCNH to identify reasons for unpaid claims to maximize revenues. These reports must contain the following data elements:
1. Claim Aging – This report should contain all outstanding claims aged by date of service (30, 60, 90, 120 days). 2. Transaction Summary – This report should contain a summary of all write-offs with clear reasons for the write-offs, all charge for the month, insurance payments for the month, and resident payments. 3. Payer Summary – This report should reflect payers and amounts for the month. 4. Insurance Aging – This report should list all insurance with totals outstanding by age (30, 60, 90, 120 days).
Additional requirements: 1. The successful billing agent must demonstrate experience in physician billing in a long term residential health care facility setting. 2. The billing agent must be able to handle the billing volume for a 240 bed facility in a timely manner. Claim forms are expected to be billed on a weekly basis. 3. The billing agent must have the ability to handle automatic cross-over “co-insurance” billing. 4. The billing agent must have the ability to send claims electronically and to post remittances electronically. Billing is to be done weekly. All patient insurance forms and/or invoices to patients must be sent within one week of the date of receipt of charge and registration data by the agent. 5. The billing agent must be able to process all required demographic and insurance information from a “face sheet” supplied by GCNH. 6. The billing agent must be able to provide GCNH with an adequate year-end report for revenues and receivables for independent audit purposes. 7. The billing agent must be able to provide training on the completion of the encounter form, when necessary. The billing agency will provide a Registered Health Information employee to conduct such training. 8. The billing agent must demonstrate that it is HIPAA compliant and that its employees have been trained on HIPAA, BREACH, and RED FLAGS RULE. 9. Retrieve clinical/charge and patient registration data/forms from GCNH at times and frequencies mutually agreeable to both parties. 10. In the event that bills are not satisfied promptly after statements, the agent must prepare and send supplementary statements and letters of reminder to patients and/or the appropriate third-party payers; if necessary, contact the patient or appropriate third –party payer in an effort to collect the outstanding invoices. 11. With regard to delinquent accounts, the agent will obtain the Facility’s consent prior to forwarding any account to a collection agency.
