REQUEST FOR PROPOSALS. EMS BILLING AND COLLECTION SERVICES and ELECTRONIC PATIENT CARE REPORTING (epcr)

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1 REQUEST FOR PROPOSALS EMS BILLING AND COLLECTION SERVICES and ELECTRONIC PATIENT CARE REPORTING (epcr)

2 Page i Table of Contents 1.0 Background Proposal Submission Scope of Work General Information Overview EMS Billing and Collection Expectations EMS electronic Patient Care Reporting (epcr) system Evaluation Process Proposal Response Firm Background EMS Billing and Collection electronic Patient Care Reporting (epcr) System References Pricing... 9

3 Page Background The City of Port Aransas is soliciting proposal(s) for EMS Billing and Collection Services integrating hosted electronic patient care reporting (epcr). The initial term of this agreement will be three years. Upon completion of the initial contract term and mutual written agreement of both parties, the contract may be renewed for up to two additional one-year terms to be award one (1) year at a time. It is the intent of the City of Port Aransas to select a single firm to accomplish all the services outlined in this Request for Proposal. 2.0 Proposal Submission Action Date RFP released Questions due Questions responded Proposal due date :00 p.m. All proposals must be in a sealed envelope marked RFP for EMS Billing and Collection Services and Electronic Patient Care Reporting (epcr). Proposals are to be sent to: City of Port Aransas Darla Honea Director of Finance 710 W. Avenue A Port Aransas, TX No electronic or faxed proposals will be accepted and all proposals must be sealed and at City Hall by 2:00 p.m. on Monday July 7, Scope of Work 3.1 General Information The city is soliciting bids for a contract with a highly qualified provider for EMS Billing and Collections services with Electronic Patient Care Reporting (epcr). Unless otherwise stated, all specifications listed are minimum requirements. Proposals must provide all services: EMS Billing, EMS Claims Recovery, EMS Collections, and Electronic Patient Care Reporting (epcr). The City seeks a billing vendor that provides, or works in partnership with, hosted electronic patient care reporting software. The City seeks a vendor that primarily provides EMS billing and collections. Only one contract will be awarded. The City desires a Texas-based provider with significant EMS billing experience as well as offices in Texas for face-to-face meetings when desired.

4 Page Overview The City will award the Contract at a City Council meeting to be held on June 19, All services will be provided to the City of Port Aransas EMS Department. Following is the detail for the last three fiscal years and the current fiscal year to date giving information on call volume and amounts billed billable calls $288, billed billable calls $279, billed billable calls $368, billed (price increase ) billable calls $340, billed Below is the payor mix: Payor Mix Medicare 14.5% Medicaid 9.5% Insurance 19% Private Pay 56% The City s Fiscal Year is October 1 st through September 30 th of the following year. 3.3 EMS Billing and Collection Expectations The selected vendor is required to provide all necessary ambulance billing services meeting the following requirements: The contractor must currently have a software interface with the epcr Company and must have significant experience and knowledge of the data transfer with the respondent s billing software. Contractor must have a process for evaluating and addressing outstanding accounts receivable from previous years. The contractor will be required to generate and manage billing for a minimum of 800 calls a year. The system will be HIPAA compliant meeting all State and Federal confidentiality, security, and transaction coding requirements. The contractor must provide support during normal business hours by phone. Ability to allow agency access to patient account status, filing dates, insurance payment data information in real time online access. The contractor must be prepared with a seven (7) day notice to allow agency to conduct a complete on site financial / process review audit. 3.4 EMS electronic Patient Care Reporting (epcr) system The selected ambulance billing vendor is required to provide an electronic patient care reporting system meeting the following requirements:

5 Page 4 See Section 5.3 for this list 4.0 Evaluation Process The City will evaluate all proposals by evaluating all products reliability and ease of use, reference checks, and all federal and state compliance issues. The City will not award this proposal based solely on financial considerations all components will be evaluated. 5.0 Proposal Response In order to be considered responsive, the Bidder shall submit with their proposal such documentation as is necessary or required to attest to the company s capabilities and qualifications to perform the work as specified and all aspects of this contract in a competent and expeditious manner. Such documentation shall consist of no less than the following: 5.1 Firm Background Provide a brief profile of your company to include but not limited to personnel, years involved in the industry, other areas of expertise, and Texas EMS provider customers with the size of their service. Provide your specific experience in billing ambulance fees; include any information on billing for other similar government agencies. Include your length of time in the ambulance billing business. Provide your service offering, benefits, and specific knowledge related to Texas-based EMS billing and electronic patient records. 5.2 EMS Billing and Collection 1. Describe how you currently submit claims electronically to Medicare, Medicaid, and Major Private Insurance companies. 2. How many bills are generated by your company a year? 3. What is your turnaround time to process a bill for Medicare, Medicaid, Self-pay or Private insurance? 4. Discuss your quality assurance process and those firm processes that you feel generate increased collections. 5. Describe your process for evaluating and addressing outstanding accounts receivables from previous years, and anticipated outcomes and typical best practice results from your process. 6. What methods do you use to communicate with provider? Can custom reports be created based on specific criteria?

6 Page 5 7. Describe your process to stay current on Medicare/Medicaid changes. 8. Describe the city s capabilities to see financial data in real time, including the ability to allow the city access to patient account status and other similar information in real time online access. 9. How are you currently compliant with HIPAA and identity theft protection? 10. Explain the process if an epcr is missing information such as patient s demographics, Insurance, MOT, PCS, hospital face sheet and other related information needed to submit a bill. 11. How do you handle any discrepancies noted in an epcr? 12. Describe the policies and commitments you have in place to comply with all federal and state laws governing insurance billing requirements. 13. Describe your policy and commitment toward providing superior customer service; including training and monitoring of your employees performance. 14. Describe the training and certifications that are required for insurance coders in your company. 15. Do you provide support during normal business hours by phone and/or online? What are your hours of operation? 16. How many account representatives, coders and/or supervisors will be dedicated specifically to City accounts? 17. Describe the process used when your office is given a request for records by a lawyer or private citizen? 18. Has your company ever been investigated and found guilty in a fraud or abuse case? If yes, what was the outcome? 19. Have you provided billing services for a company that has been found guilty in a fraud or abuse case? If yes, what was the outcome? 20. Describe the process for remitting collections to the City and a typical schedule per month for remitting those collections. 5.3 electronic Patient Care Reporting (epcr) System Please respond either Yes or No to the following requirements, providing additional information below that may further describe the requirement or provide additional information that enhances the response to the City s benefit.

7 Page 6 1. Meets or exceeds the State s performance standards required data set. (Gold level certification preferred.) 2. Electronic exports of PCR to State. 3. Populates patient data for repeat clients. 4. Configurable data elements to meet Agency and State-specific EMS needs. 5. Easy data input and intuitive workflow, including auto-save functionality, multiple data input options, and quick navigation through drop-down lists. 6. Validation tools to help ensure that calls are complete and meet required data elements. 7. Electronic capture of patient signatures in the field no Internet connection required. 8. Interface capabilities data streaming to and from CAD and cardiac monitors, fire records, hospital medical records, and billing applications. 9. Include configurable Quick Treat lists for cardiac arrest, medications, and other functions, plus immediate time-stamping of vital signs and treatment events within the documentation flow and an instant note-taking surface. 10. Assessment tools to document initial and ongoing assessments, including pertinent positives and negatives. 11. Anatomical figures with 360-degree rotation and zoom-in capabilities. 12. Advanced vital signs documentation and auto-calculation of Glasgow Coma Scale, Revised Trauma Score, and Pediatric Trauma Score. 13. Specialty Patient forms for complete, rapid documentation of advanced airway, burns, stroke, STEMI, patient refusals, and cardiac arrest patients and more.

8 Page 7 Yes No 14. Customizable user roles, password management policies, validation routine, treatments. 15. Providing an easy way for administrators to send positive feedback, document errors, or request that information be added to an appended narrative. 16. Receiving hospitals have electronic access to patient care charts electronically. Authorized hospital users of the system can log in and download trips after permission has been granted by the EMS organization. The hospital only sees epcr s on which they are identified as the receiving facility. Multiple permitted users at the hospital are able to access the epcr. The EMS organization maintains access control to the hospitals. 17. Customize data searches for required quality improvements reports that are required by government agencies. 18. Must not require an internet connection to function. 19. Application must have an automatic update feature that allows software to be updated via internet without need to reinstall software. 20. Must not require Administrative rights on the local machine to operate and/or update. 21. A translation tool that enables EMS providers in the field to communicate with non-english speaking patients. Able to launch without leaving the epcr application (preferred) How many different languages will the software speak, please list languages? 22. Data is hosted at secure, Tier IV, SAS 70 Type II, PCI compliant hosting facility(ies). 23. Production equipment housed at a facility with 24-hour physical security, palm print and picture identification systems, redundant electrical generators, redundant data

9 Page 8 center air conditioners, and other backup equipment designed to keep servers continuously up-and-running. 24. The strongest encryption products to protect customer data and communications, including 128-bit SSL Certification and 1024-bit RSA public keys the lock icon in the browser indicates that data is fully shielded from access while in transit. 25. Software access only with a valid username and password combination, which is encrypted via SSL while in transmission. 26. A robust application security model that prevents clients from accessing another s data without authorization-- reapplied with every request and enforced for the entire duration of a user session. 27. Tight operating system-level security with a minimal number of access points to all production servers. Strong passwords for operating system accounts, with no master password database for production servers. Operating system maintenance at each vendor s recommended patch levels for security and hardened by disabling and/or removing any unnecessary users, protocols and processes. 28. Controls on database access at the operating system and database connection level for additional security. Restricted production database access to a limited number of points, with no master password database for production servers. 29. Vendor employees have no direct physical access to the production equipment. 30. Off-site, automatic client data backups are performed simultaneously or concurrently. 31. Servers housed in a Tier-IV Internet Data Center (IDC) equipped with redundant power, multi-layered security, effective environmental controls and cooling systems, and 24 7 monitoring. Built-in redundancy for each component of our hardware infrastructure, with multiple database servers with a Raid-5 configuration. 32. EMS providers utilizing a mobile epcr device and an available wireless network have the ability to transmit an alert while en route to the hospital providing the receiving facility with near real-time information for patients with suspected STEMI, stroke, cardiac, or trauma.

10 Page 9 Yes No 33. Maintain NEMSIS Gold compliance 34. Provides a bi-directional NEMSIS/HL7 transformation engine that is epcr and EMR vendor agnostic which enables EMS agencies and Hospitals to share vital patient information including EMS epcr data and Hospital outcomes and billing data in near-real time. The system has the capability to Populate EMR and other HIM systems with digital pre-hospital care records and discreet data and also includes data analysis tools that EMS can utilize for QI initiatives pertaining to patient outcomes. 35. Vendor costs must be inclusive without additional fees not otherwise mutually agreed on contract award, to include cost of additional users, faxing, training, software upgrades, reporting, and live support. 5.4 References A minimum of ten references, preferably located within the state of Texas, must be submitted with each bid. Each reference must be for projects providing billing, collection, and hosted electronic patient care reporting. Company name, contact and phone number must be included with each reference. 5.5 Pricing Please include details for the pricing model offered as well as a projection of revenue generated for three years and provide assumptions.

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