a. RCM Services include: (a) providing billing and collection services for CUSTOMER, including notice of election (NOE) submissions for Medicare (b) submitting claims electronically to third party payers for and on behalf of CUSTOMER, and (c) following CUSTOMER’s claims through billing, adjudication, and
collections, (“RCM Services”).
b. Optima agrees to render the RCM Services in a professional manner and as follows: (a) Optima shall submit all CUSTOMER billings to the appropriate parties in a timely manner; and (b) Optima shall arrange for weekly communications between its billing coordinator and a single point of contact with CUSTOMER, to be identified and communicated to Optima. Each weekly communication from Optima to CUSTOMER shall cover the following topics: (i) patients billed for; and (ii) amounts billed and
amounts paid. CUSTOMER acknowledges and agrees that Optima’s performance of the RCM Services is contingent upon Optima receiving complete and accurate data from CUSTOMER. Accordingly, CUSTOMER represents that all data and information furnished to Optima is true and accurate in every material respect. In any case, the parties shall provide each other with any other reports or records that are determined through mutual consent of the parties. In addition to providing the foregoing information, CUSTOMER shall maintain proper patient medical records and books of record and account in which full, true and correct entries are made of all dealings and transactions in relation to its care to patients. CUSTOMER shall direct and permit Optima to invoice all accounts receivable of CUSTOMER. When RCM Services terminate, final RCM Services invoice from Optima to CUSTOMER will be processed no later than sixty (60) days after RCM Services end. Exclusions: Palliative care billing, authorizations, Medicare credit balance reports, cost report and cap report.
c. It is the responsibility of the CUSTOMER’S staff members to ensure NOE’s (notice of election) and NOTR’s (notice of transfer revocation) are changed from “referral stage” to “admission stage” within 24 hours of providing care for an incoming patient. All required documentation must be included prior to submission of NOE’s and NOTR’s, these include but are not limited to: Patient Name, Address with Zip Code, Date of Birth, Medicare Policy Number, Diagnosis Code, Physician Name and NPI (National
Provider Identification Number) and Admission Date or Revocation/Discharge Date. Optima RCM Services will not be held responsible for revenue loss due to late notice of election filings.
d. Eligibility verification prior to admission is the responsibility of CUSTOMER. Optima will perform a courtesy eligibility check upon submission of notice of election but will not be responsible for claims not paid due to incorrect insurance information.
e. Completion of forms and clinical audits are the responsibility of CUSTOMER.
f. EXISTING ACCOUNTS RECEIVABLE SERVICING. Upon commencement of the RCM Services by Optima, CUSTOMER may have existing outstanding accounts receivable due from insurers and patients. If requested by CUSTOMER and agreed to by Optima, Optima will attempt to resolve accounts receivable balances which precede the CUSTOMER relationship with Optima. Inheriting such account receivable balances requires significant research and effort without any guarantee of payment due to a myriad of circumstances beyond Optima’s control, including lack of proper authorization for services, unmet timely filing requirements, incomplete information necessary to research or resubmit claims, etc. For this reason, Optima will attempt to resolve existing account receivable balances only under the following conditions:
i. Access to Information. Optima will be provided timely and efficient access to all existing electronic and/or paper claims data in possession of CUSTOMER. Where possible, and if agreeable to Optima, CUSTOMER will provide access to existing databases which contain the information necessary to fully research existing account receivable balances. Optima will determine, in the exercise of reasonable discretion, whether the access provided is sufficient and will make possible the research of existing account receivable balances.
ii. Automatic Writeoffs. It is common for existing accounts receivable to contain large, unpayable balances. Balances which will not be paid must be addressed efficiently in order to limit any research efforts which will not generate additional monies to either CUSTOMER or Optima. For this reason, Optima will automatically write off balances which meet the following criteria:
a. Any claim which has been denied for timely filing.
b. Any non-Medicare claim over 90 days old which is missing patient or insurance information, including missing authorizations.
c. Any claim over 365 days old.
d. Any balance under $25.00.
g. To the extent that CUSTOMER utilizes billing software provided by Optima, the terms and conditions located at www.nethealth.com/CPT-End-User-Agreement also apply with regard to the CPT codes located within such billing software.
