MS HB81

Department of Corrections shall implement state-of-the-art clinical code editing technology to automate claims resolution and prevent overbilling based on American Medical Association and Centers for Medicare and Medicaid Services protocols.

Department shall implement correctional health care claims audit and recovery services to identify improper payments and recover overpayments through post-payment reviews of coding compliance, transfers, readmissions, and billing errors.

Savings achieved through these services shall cover the cost of implementation and administration, with reimbursement to contractors potentially structured as percentage of savings, per beneficiary per month, per transaction, case-rate, or blended models.

Performance guarantees may be included in contractor agreements to ensure identified savings exceed program costs.

Effective date: July 1, 2013.