MS HB1090

Division of Medicaid shall implement state-of-the-art clinical code editing technology to automate claims resolution and prevent billing errors in correctional health care based on protocols from the American Medical Association and Centers for Medicare and Medicaid Services.

Division of Medicaid shall establish correctional health care claims audit and recovery services to identify and recover improper payments through post-payment reviews of diagnosis codes, procedure codes, DRG coding, transfers, readmissions, cost outliers, and billing errors.

Division of Medicaid shall implement automated payment detection, prevention, and recovery solutions to ensure Medicaid is billed for eligible inpatient hospital and professional services in correctional settings.

Division of Medicaid may contract for audit and recovery services with reimbursement based on percentage of savings achieved, per beneficiary per month, per transaction, case-rate, or blended models, with contractor performance guarantees to ensure savings exceed program costs.

Act applies to state correctional health care systems and state-contracted managed correctional health care services, effective July 1, 2013.