Product (RFP/RFQ/RFI/Solicitation/Tender/Bid Etc.) ID: MB-6526

Government Authority located in Virginia; USA based organization looking for expert vendor for EMS compliance claims audit specialist services.

[A] Budget: Looking for Proposals

[B] Scope of Service:

(1) Vendor needs to provide EMS compliance claims audit specialist services
- Compliance Program Assessment
• Review EMS practice compared to applicable statutes, regulations, and other program requirements.
• Review a variety of practices and factors as described by Office of Inspector General (OIG), Health and Human Services (HHS) Compliance Program Guidance for Ambulance Suppliers including policies and procedures, employee training and education, employee knowledge and understanding, claims submission process, International and Classification of Diseases (ICD) and Healthcare Common Procedure Coding System (HCPCS) coding, accounts receivable management documentation practices, management structure, contractual arrangements, changes in reimbursement policies, and payor expectations.
- Ambulance Claims Review
• Review a sample of EMS claims to determine if the agency codes and codes are correctly applied for both EMS emergency and nonemergency transports allowable by Medicare and the state Medicaid rules.
• Identify opportunities to improve Medicare, Medicaid, and commercial reimbursements for EMS emergency and nonemergency transports and treatment for non-transports.
- Clinical Documentation Review
• Review a sample of clinical documentation and EMS Field Medical Officer processes to determine if there are opportunities to enhance the efficiency and effectiveness of those processes.
(2) All question must be submitted no later than June 14, 2022.

[C] Eligibility:

- Onshore (USA Organization Only);

[D] Work Performance:

Performance of the work will be Offsite. Vendor needs to carry work in their office location.

Expiry Date : Saturday, 23 July, 2022

Question Answer Deadline : Tuesday, 14 June, 2022

Category : Medical Billing and Coding

Country : USA

State : Virginia

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