Bill Text: MS HB81 | 2013 | Regular Session | Introduced
Bill Title: Corrections; department shall implement technology solutions to automate claims resolution and enhance cost containment.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2013-02-05 - Died In Committee [HB81 Detail]
Download: Mississippi-2013-HB81-Introduced.html
MISSISSIPPI LEGISLATURE
2013 Regular Session
To: Corrections
By: Representative Baker
House Bill 81
AN ACT TO PROVIDE THAT THE DEPARTMENT OF CORRECTIONS SHALL IMPLEMENT STATE-OF-THE-ART CLINICAL CODE EDITING TECHNOLOGY SOLUTIONS TO FURTHER AUTOMATE CLAIMS RESOLUTION AND ENHANCE COST CONTAINMENT THROUGH IMPROVED CLAIM ACCURACY AND APPROPRIATE CODE CORRECTION; TO PROVIDE THAT THE DEPARTMENT SHALL IMPLEMENT CORRECTIONAL HEALTH CARE CLAIMS AUDIT AND RECOVERY SERVICES TO IDENTIFY IMPROPER PAYMENTS; TO EXPRESS THE INTENT OF THE LEGISLATURE THAT THE DEPARTMENT CONTRACT FOR THESE SERVICES AND THAT THE SAVINGS ACHIEVED SHALL MORE THAN COVER THE COST OF IMPLEMENTATION AND ADMINISTRATION; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1.
(1) Unless otherwise stated, this section specifically applies to:
(a) State correctional health care systems and services; and
(b) State contracted managed correctional health care services.
(2) The Department of Corrections shall implement state-of-the-art
clinical code editing technology solutions to further automate claims
resolution and enhance cost containment through improved claim accuracy and
appropriate code correction. The technology shall identify and prevent errors
or potential overbilling based on widely accepted and referenceable protocols
such as the American Medical Association and the Centers for Medicare and
Medicaid Services. The department shall apply the edits automatically before
claims are adjudicated to speed processing and reduce the number of pended or
rejected claims and help ensure a smoother, more consistent and more open
adjudication process and fewer delays in provider reimbursement.
(3) The department shall implement correctional health care claims audit and recovery services to identify improper payments due to nonfraudulent issues, audit claims, obtain provider sign-off on the audit results and recover validated overpayments. Post-payment reviews shall ensure that the diagnoses and procedure codes are accurate and valid based on the supporting physician documentation within the medical records. Core categories of reviews may include: Coding Compliance Diagnosis Related Group (DRG) Reviews, Transfers, Readmissions, Cost Outlier Reviews, Outpatient 72-Hour Rule Reviews, Payment Errors, Billing Errors and others.
(4) It is the intent of the Legislature that the department contract for these services and that the savings achieved through this section shall more than cover the cost of implementation and administration. Therefore, to the extent possible, the department shall secure technology services used in carrying out this section by using the savings generated by the program, so that the department's only direct cost will be funded through the actual savings achieved. Further, to enable this model, reimbursement to the contractor may be contracted on the basis of a percentage of achieved savings model, a per beneficiary per month model, a per transaction model, a case-rate model, or any blended model of the aforementioned methodologies. Reimbursement models with the contractor also may include performance guarantees of the contractor to ensure savings identified exceeds program costs.
SECTION 2. This act shall take effect and be in force from and after July 1, 2013.
