Patient Business Office and Denial Management Services - Phoenix Indian Medical Center

Background
The Indian Health Service (IHS) is issuing this contract for Patient Business Office and Denial Management Services at the Phoenix Indian Medical Center (PIMC), one of the largest IHS facilities in Arizona. The center has an estimated account receivable aging total exceeding $28 million.

The goal of this contract is to enhance revenue capture by addressing the backlog of aged accounts and improving patient access and denial management processes in accordance with IHS policies and guidelines.

Work Details
The contractor will provide Accounts Receivable, Collections, Denial Management, and Patient Access services. Specific tasks include:

1. **Patient Business Office**: Conduct quarterly training for current staff on patient demographics, referrals, and payer types; assist in maintaining annual certifications; train new staff onsite; create and maintain a Patient Business Office dashboard with updated metrics; develop tracking mechanisms for productivity; clean up patient registration backlog by verifying Indian Blood quantum and obtaining proof of tribal membership.

2. **Denial Management**: Research rejected claims for Medicare, Medicaid, and Commercial/Private Insurance over 60 days old (approximately 15,000 claims annually); categorize aging reports by payer, visit type, clinic, and dollar amount; verify patient eligibility; resubmit corrected claims until payments are received or claim statuses are updated; identify denial reasons and trends for management reporting.

Period of Performance
The contract will be performed over a period of one year.

Place of Performance
Phoenix Indian Medical Center, 5212 N. 16th St., Phoenix, AZ 85016-5319