NYC Health + Hospitals Seeks Billing and Coding Audit Services

NYC Health + Hospitals ( the System ) is seeking the services of a qualified vendor or vendors to conduct prospective and retrospective billing and coding auditing services for inpatient, outpatient, Federally Qualified Health Centers (FQHCs), home care and skilled nursing facility accounts.

The selected vendor(s) will provide data analysis to identify areas of risk, conduct prioritized chart reviews as determined by the risk analyses, work with operating areas to develop and monitor corrective action plans if needed, conduct or coordinate training where deficiencies are noted, train staff on billing and coding auditing, and prepare ongoing reporting and analysis for management review.

The selected vendor(s) will work with the Offices of Corporate Compliance and Revenue Cycle Services in performing the Scopes of Work for this project.

The auditing functions included in the Scopes of Work must be conducted by personnel with Certified Coding Specialist (CCS) and/or Certified Professional Coder (CCP) certifications, and include, but not be limited to, audits of Inpatient coding and billing Outpatient coding and billing, including FQHCs, including Risk Adjustment coding such as International Classification of Diseases (ICD) / Hierarchical Condition Category (HCC) / Clinical Risk Groups (CRG) coding Skilled Nursing Facility coding and billing Home Health Care coding and billing Health Home coding and billing In addition, the qualified vendor(s) will conduct periodic risk assessments to determine areas of risks, threats, and opportunities related to documentation, coding, and billing of services provided, prepare a multi-year audit plan based on the risk assessments, and conduct or assist in conducting audits of risk areas identified in the risk assessments.

Agency: NYC Health + Hospitals Status: Solicitation