Specifications include, but are not limited to: 3.1 Develop, implement, and operate all necessary administrative systems for handling private pay, Medicare, Medicaid and other Veteran home residency payments including, but not limited to, accounting (including billings, receivables, collections, payables, tracking of resident income, and personal funds), reporting, administrative records, etc., for all Veteran homes. Detailed, complete, and accurate fiscal records and other records pertinent to this Contract shall be maintained at the individual home level. Contractor shall maintain all fiscal records pursuant to accepted accounting standards and other records shall be maintained to the extent necessary to clearly reflect the extent of services furnished. Records of services and costs shall be made available to the SCDVA, any authorized representative of the State of South Carolina, and representatives of the federal government, including information requested by telephone. SCDVA has the right to, and may, photocopy any records, including personnel records, and financial records deemed by the SCDVA necessary to carry out state and federal statutes and rules. 3.2 Cooperate fully with SCDVA and other representatives of the State in any review, audit or copying of records, as well as with any inspection of any Veteran home or audit of its operation. 3.3 Obtain, maintain approval for, and account for appropriate Medicare, Medicaid, third-party, and other payments and have them remitted to SCDVA. Contractor shall do so in a manner consistent with federal and state law and generally accepted accounting principles and other applicable requirements, if any. Responsibility for payment of all payment plan deductibles, coinsurance requirements, and charges and fees for non-covered items and services shall remain with the Veteran homes’ residents. Contractor shall collaborate with each Veteran home’s operating contractor to consistently and appropriately communicate residents’ payment responsibilities. 3.4 Adopt and comply with the Medicare Reimbursement policy. Contractor also shall timely bill and have remitted to the State all resident, Medicare, Medicaid, and third-party payments. Maintain and provide copies of records to SCDVA or its designee as needed to complete annual Medicare Cost Reports. 3.5 Provide all services relating to the accounting of residents’ personal funds, including but not limited to accounting for funds received and deposited into the Resident Personal Fund; acting as a representative payee as elected by the resident; reconciling accounts; assigning interest accrued to the Resident Personal Fund to the appropriate resident account; releasing personal funds allowances to residents by the 10th of each month as required by law; applying monthly resident personal funds balances toward outstanding facility balances, such as room and board or pharmacy costs; providing quarterly fund balance reports to residents and authorized representatives; properly conveying funds as required upon a resident’s death under 38 CFR § 51.70 and 42 CFR 483.10; coordinating any audits as required by SCDHEC, the USDVA, the Social Security Administration, and any other regulatory authority; and processing any other premiums or purchases made by the resident
