DAWSON COUNTY GOVERNMENT REQUEST FOR PROPOSALS FOR AMBULANCE TRANSPORT BILLING FOR DAWSON COUNTY EMERGENCY SERVICES

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1 DAWSON COUNTY GOVERNMENT REQUEST FOR PROPOSALS FOR AMBULANCE TRANSPORT BILLING FOR DAWSON COUNTY EMERGENCY SERVICES SUBMISSIONS ARE DUE AT THE ADDRESS SHOWN BELOW NO LATER THAN FRIDAY, DECEMBER 13, 2013, AT 10:30AM, EST DAWSON COUNTY BOARD OF COMMISSIONERS ATTENTION: PURCHASING DIRECTOR 25 JUSTICE WAY, SUITE 2223 DAWSONVILLE, GA RFP # THE RESPONSIBILITY FOR SUBMITTING A RESPONSE TO THIS RFP ON OR BEFORE THE STATED DATE AND TIME WILL BE SOLELY AND STRICTLY THE RESPONSIBILITY OF THE OFFEROR. ISSUE DATE: NOVEMBER 13, 2013 Bid # RFP Ambulance Transport Billing for Page 1

2 DAWSON COUNTY, GEORGIA REQUEST FOR PROPOSAL FOR AMBULANCE TRANSPORT BILLING FOR DAWSON COUNTY EMERGENCY SERVICES SECTION I GENERAL OVERVIEW A. PURPOSE Dawson County Board of Commissioners is issuing this Request for Proposals (RFP) to solicit sealed proposals from qualified vendors that specialize in and that can provide ambulance billing, collection from insurance carriers, financial reporting, and analytical services related to Ambulance Transport Billing. This includes complete management of the billing process from patient transport to account closure. The County does not guarantee a minimum value for this contract. B. INFORMATION TO VENDORS 1. RFP TIMETABLE The anticipated schedule for the RFP is as follows: RFP Released November 13, 2013 Pre-Bid Conference Meeting None Deadline for questions to Dawson County to Monday, November 25, 2013 at dsimpson@dawsoncounty.org 1:00PM, EST Deadline for Addenda posted on Thursday, December 5, 2013 at under Bids & RFPs 5:00PM, EST Submittal deadline Friday, December 13, 2013 at 10:30AM, EST Interviews (if needed) December 17-18, Times are TBD Tentative Award Date Thursday, January 16, 2014 at 6:00PM, EST 2. BID SUBMISSION One (1) original and five (5) copies of the complete signed submittal must be received FRIDAY, DECEMBER 13, 2013 AT 10:30AM, EASTERN STANDARD TIME. Proposals must be submitted in a sealed envelope stating on the outside, the vendor's name, address, Bid # RFP AMBULANCE TRANSPORT BILLING FOR DAWSON COUNTY EMERGENCY SERVICES to: Dawson County Board of Commissioners Attention: Purchasing Director 25 Justice Way, Suite 2223 Dawsonville, GA Bid # RFP Ambulance Transport Billing for Page 2

3 Hand delivered copies may be delivered to the above address ONLY between the hours of 8: 00AM and 5:00PM EST, Monday through Friday, excluding holidays observed by the Dawson County Government. For a complete listing of holidays please visit Vendors are responsible for informing any commercial delivery service, if used, of all delivery requirements and for ensuring that the required address information appears on the outer wrapper or envelope used by such service. NOTE: Many express mail and delivery services do not guarantee overnight by noon to Dawson County. Submission by US Mail must be sent to the below address: Dawson County Board of Commissioners Attention: Purchasing Director 25 Justice Way, Suite 2223 Dawsonville, GA The Submittal must be signed by a company officer who is legally authorized to enter into a contractual relationship in the name of the vendor. 3. CONTACT PERSON Vendors are encouraged to contact Davida Simpson, Purchasing Director at (706) , by fax at (706) or dsimpson@dawsoncounty.org to clarify any part of the RFP requirements. All questions that arise prior to the DEADLINE FOR QUESTIONS due date shall be directed to the contact person in writing via facsimile or . Any unauthorized contact shall not be used as a basis for responding to this RFP and also may result in the disqualification of the vendor's submittal. Vendors may not contact any elected official or other county employee to discuss the bid process or bid opportunities except: 1.) through the Purchasing Director named herein, or 2.) as provided by existing work agreement(s). This policy shall be strictly enforced and the County reserves the right to reject the submittal of any vendor violating this provision. 4. ADDITIONAL INFORMATION/ADDENDA Dawson County will issue responses to inquiries and any other corrections or amendments it deems necessary in written addenda issued prior to the due date posted on the county s website under the bid information. Vendors should not rely on any representations, statements or explanations other than those made in this RFP or in any addendum to this RFP. Where there appears to be a conflict between the RFP and any addenda issued, the last addendum issued will prevail. Vendors are advised to check the website for addenda before submitting their bids. Vendors must acknowledge any issued addenda by including Attachment B- Addenda Acknowledgement with the submittal. Proposals which fail to Bid # RFP Ambulance Transport Billing for Page 3

4 acknowledge the vendor s receipt of any addendum will result in the rejection of the offer if the addendum contains information which substantively changes the Owner s requirements 5. LATE SUBMITTAL AND LATE MODIFICATIONS Submittals received after the due date and time will not be considered. Modifications received after the due date will not be considered. Dawson County Government assumes no responsibility for the premature opening of a proposal not properly addressed and identified, and/or delivered to the proper designation. 6. REJECTION OF PROPOSALS/CANCELLATION Dawson County Government reserves the right to reject any and all submittals and reserves the right to waive any irregularities or informalities in any submittal or in the submittal procedure, when to do so would be to the advantage of Dawson County. Dawson County reserves the right to cancel this RFP at any time. 7. MIMINUM RFP ACCEPTANCE PERIOD Submittals shall be valid and may not be withdrawn for a period of 90 days from the date specified for receipt of submittals. 8. NON-COLLUSION AFFIDAVIT By submitting a response to this RFP, the vendor represents and warrants that such proposal is genuine and not a sham or collusive or made in the interest or in behalf of any person not therein named and that the vendor has not directly or indirectly induced or solicited any other vendor to put in a sham proposal, or any other person, firm or corporation to refrain from submitting and that the vendor has not in any manner sought by collusion to secure to that vendor any advantage over any other vendor. By submitting a proposal, the vendor represents and warrants that no official or employee of Dawson County Government has, in any manner, an interest, directly or indirectly in the proposal or in the contract which may be made under it, or in any expected profits to arise there from. 9. COST INCURRED BY VENDORS All expenses involved with the preparation and submission of the RFP to the Dawson County Board of Commissioners, or any work performed in connection therewith is the responsibility of the vendor(s). 10. RFP OPENING Only the names of the firms responding to this RFP will be read aloud publicly due to the fact that the proposals will be subject to an evaluation review for accurate qualifications. A list of names of firms responding to the RFP may be obtained from the county s website after the RFP due date and time stated herein. Bid # RFP Ambulance Transport Billing for Page 4

5 11. OPEN RECORDS All materials submitted in connection with this RFP will be public documents and subject to the Open Records Act and all other laws of the State of Georgia, the United States of America and the open records policies of Dawson County Board of Commissioners. All such materials shall remain the property of Dawson County and will not be returned to the respondent. 12. TAXES Dawson County Government is tax exempt. No sales tax will be charged on any products or services. Dawson County cannot exempt any other person/vendor from applicable sales taxes that may be required of them in relations to this project. Selected vendor will be provided with Dawson County s Sales and Use Tax Certificate of Exemption number upon request. 13. VENDOR INFORMATION All submissions shall include a completed vendor information form, current copy of business license and current W-9. Failure to provide this information could result in the disqualification of the vendor from submitting a proposal. 14. INSURANCE Selected vendor will be required to provide a Certificate of Insurance as proof of liability and workman s compensation insurance while under contract with Dawson County. Workman s Compensation Insurance should be as required by the State of Georgia. General Liability at a minimum should cover $1,000,000 per incident. Dawson County Board of Commissioners shall be named as the certificate holder. 15. BONDS If required, under SECTION II SCOPE OF WORK of this document any combination of the following bonds may be requested by Dawson County. A five percent (5%) bid bond, a one hundred percent (100%) payment bond, and a one hundred percent (100%) performance bond. All bonds would be payable to Dawson County Board of Commissioners. Failure to submit appropriate bonding will result in automatic rejection of bid. Bonding company must be authorized to do business in Georgia by the Georgia Insurance Commission, listed in the Department of Treasury s publication of companies holding certificates of authority as acceptable surety on Federal bonds and as acceptable reinsuring companies, and have an A.M. Best rating. 16. ANTI-DISCRIMINATION Dawson County, in accordance with Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d to 2000d-4 and Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in Federally-assisted programs of the Department of Transportation issued pursuant to such Act, hereby notifies all bidders that it will affirmatively ensure that in any contract entered into pursuant to this advertisement, disadvantaged business Bid # RFP Ambulance Transport Billing for Page 5

6 enterprises as defined at 49 CFR Part 23 will be afforded full opportunity to submit bids in response to this Request for Proposal and will not be discriminated against on the grounds of race, color, national origin, sex, handicap/disability in consideration of an award. By submitting their bids, all bidders certify to Dawson County that they will conform to the provisions of the Federal Civil Rights Act of In every contract of over $10,000 the provisions in 1. and 2. below apply: 1. During the performance of this contract, the contractor agrees as follows: a. The contractor will not discriminate against any employee or applicant for employment because of race, religion, color, sex or national origin, except where religion, sex or national origin is a bona fide occupational qualification reasonably necessary to the normal operation of the contractor. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause. b. The contractor, in all solicitations or advertisements for employees placed by or on behalf of the contractor, will state that such contractor is an equal opportunity employer. c. Notices, advertisements and solicitations placed in accordance with federal law, rule or regulation shall be deemed sufficient for the purpose of meeting the requirements of this section. 2. The contractor will include the provisions of 1. above in every subcontract or purchase order of over $10,000 so that the provisions will be binding upon each subcontractor or vendor. 17. GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT Vendors submitting a Qualification package in response to this RFP must provide the following information in the package to indicate compliance with the Georgia Security and Immigration Compliance Act. The form is provided for completion. A. A statement that indicates the contractor will conduct itself in compliance with O.C.G.A and Rule in the execution of the contract. B. By completing the affidavit that is provided with this solicitation, the vendor is attesting to the following: a. The affiant has registered with and is authorized to use the federal work authorization program; b. The user identification number and date of authorization for the affiant; c. The affiant is using and will continue to use the federal work authorization program throughout the contract period; Bid # RFP Ambulance Transport Billing for Page 6

7 d. Any employee, contractor, or subcontractor of such contractor or subcontractor shall also be required to satisfy the requirements set forth in this paragraph; and e. Upon contracting with a new subcontractor, a contractor or subcontractor shall notify Dawson County and shall deliver a completed Subcontractor Affidavit to Dawson County within five (5) working days of entering into a contract or agreement of hire with the subcontractor before the new subcontractor begins any work. C. Failure to provide the completed and notarized affidavit with the contractor s proposal will result in immediate disqualification as required by the Georgia Security and Immigration Compliance Act. Bid # RFP Ambulance Transport Billing for Page 7

8 SECTION II GENERAL CONDITIONS A. PURPOSE Dawson County Board of Commissioners is issuing this Request for Proposals (RFP) to solicit sealed proposals from qualified Firms that specialize in and that can provide ambulance transport billing, collection from insurance carriers, financial reporting, and analytical services. This includes complete management of the billing process from patient transport to account closure. B. CONTRACT PERIOD The initial term of a contract awarded as a result of this RFP shall be from date of award through December 31, The contract may be renewed according to the terms stated herein for five (5) additional one (1) year periods. The contract shall terminate absolutely and without further obligation at such time as appropriated and otherwise unobligated funds are no longer available to satisfy the obligations of the County under this contract. The County does not guarantee a minimum value for this contract. If, at any time, the County determines it is in its best interest to discontinue use of these services the County reserves the right to cancel this Agreement by giving thirty (30) days advance written notice. No fees will be due by Dawson County Board of Commissioners or the Dawson County Emergency Services (DCES) Department as a result of this RFP or contract. C. SCOPE OF WORK 1. Background Dawson County operates an Emergency Services department that utilizes three (3) Advanced Life Support (ALS) transport units for the sole purpose of providing prehospital emergency medical care and patient transports. currently documents patient care through the use of electronic PCR software. Patient care reports are submitted electronically to the billing department of the vendor and the State Office of Emergency Medical Service. After daily review of each submitted patient care report (PCR), Dawson County Emergency Services electronically transfers each PCR to the current billing and collections vendor via a secure Virtual Private Network (VPN). The vendor subsequently identifies and bills the appropriate guarantor for services provided. Yearly History transported 1430 patients in the prior FY2012 and collected $507, during the same period. Medicare: 48.6% Medicaid: 11.3% Bid # RFP Ambulance Transport Billing for Page 8

9 Primary Insurance: 24.1% Secondary Insurance: 4.7% Auto Insurance1.8% Workers Compensation 0.9% Private Pay: 8.3% transported 1355 patients in the prior FY2011 and collected $534, during the same period. Medicare: 46.9% Medicaid: 11.8% Primary Insurance: 28.3% Secondary Insurance: 4.8% Auto Insurance1.6% Workers Compensation 0.8% Private Pay: 5.4% transported 1175 patients in the prior FY2010 and collected $448, during the same period. Medicare: 45.0% Medicaid: 10.9% Primary Insurance: 27.7% Secondary Insurance: 5.2% Auto Insurance 2.3% Workers Compensation 0.7% Private Pay: 7.9% transported 1210 patients in the prior FY2009 and collected $531, during the same period. Medicare: 39.8% Medicaid: 8.2% Primary Insurance: 36.5% Secondary Insurance: 5.9% Auto Insurance 1.4% Workers Compensation 0.4% Private Pay: 7.5% 2. Specifications This section outlines the minimum contract requirements for ambulance billing, collection, financial reporting, and analytical services. The County desires to pursue a partnership to build an optimal revenue cycle. The minimal requirements are listed here, however, the County is open to alternatives to meet the requirements that may or may not be described below. Bid # RFP Ambulance Transport Billing for Page 9

10 A Billing The Firm will commence billing the patient care reports with the start-up date established by the Firm and Dawson County. The Firm shall maintain certified ambulance coders on staff. B Invoicing The Firm shall be able to prepare invoices and bill in the following manner: 1. All invoicing must be in accordance to the correct rates established by the County. See attached ordinance. 2. All invoicing must be in accordance with the guidelines and procedures established by the firm and the County. 3. All invoicing must be in accordance with all applicable laws and regulation including those from Medicare and Medicaid services Centers for Medicare and Medicaid Services or CMS. 4. All invoices shall also be billed in compliance with the Fair Debt Collection Practices Act. 5. Electronic filing is the required method of filing primary Medicare and Medicaid claims. Electronic filing is the preferred method of filing to all other guarantors, if applicable. Otherwise, paper invoices may be issued directly to appropriate patient guarantors. 6. The Firm shall pre-screen all claims to confirm compliance with guarantors guidelines. (i.e. physician certification statements, assignment of benefit signature forms, medical necessity documentation) 7. The Firm shall verify insurance eligibility utilizing available resources and commercial databases prior to the submission of any patient claim for reimbursement. 8. The expectation of the County is that the initial invoices will be processed within three (3) days of the electronic posting of the billing file on the Firm s secure server, according to the agreed upon process for various claim types. 9. ART epcr (proprietary) is the current data collection software utilized by. The billing software of the Firm must configure billing export and import setup. 10. Upon awarding of the bid, the Firm shall evaluate the current data collection configuration of the County and shall be responsible to make recommendations to the County any reconfiguration that might be required to assure minimal interruption of the data stream. C Collections The Firm shall process all claims according to timelines agreed upon between the County and the Firm. The claims shall be divided into multiple revenue categories: Medicare, Medicaid, Primary Insurance, Secondary Insurance, Auto Insurance, Worker s Compensation and Private Pay. Bid # RFP Ambulance Transport Billing for Page 10

11 Claims shall be appropriately re-categorized after receiving payment from the primary guarantor. All denials shall be processed according to the timeline defined by the firm and the county. Customer service will be provided using a toll-free phone number. Firms shall provide Customer Service hours on the Financial Proposal Form. The telephone systems utilized by the Firm must be able to accept voice mail messages and route incoming calls to the appropriate persons. The Firm must make a good faith effort to make return contact to all customers within 24 business hours after initial contact from any customer has been received. The Firm will treat all debtors fairly with professionalism, honesty, courtesy and integrity while obtaining the maximum results. The County will be the final arbitrator of disputes between the successful Firm and customers. The County s decision shall be final. Dawson County will be the only agency accepting payments. All checks should come to Dawson County for processing and only then will copies be sent via to the billing Firm. Medicare and Medicaid are electronically deposited to Dawson County accounts. Fees charged by the Firm for billing and collections services will be based upon net cash collections. Refunds shall be processed by the County only. The County will make payment of all refund requests upon receipt of the appropriate documentation from the Firm. Dawson County regards net cash collections as total funds collected less refunds issued as a result of overpayments or erroneous payments. An active Quality Assurance and Internal Auditing Controls program for detecting, correcting and avoiding process errors shall be maintained. D Accounting and Reporting Accounting for all billing pursuant to Generally Accepted Accounting Principles shall be provided on a daily, monthly, quarterly and annual basis, or as requested by the County. Such reports and all supporting documentation shall be submitted to the County within ten (10) business days after the end of the month. Detailed below are reports required by the County to monitor the billing process. The list is not allinclusive. The reports noted below must be provided to the appointed Dawson County Emergency Services billing contact by the time period specified. Reports should be submitted electronically either via or secure server. Reports should be provided in MS Excel and/or as a PDF document as required or when requested. Additional reports may be requested on an as needed basis. Any report may require modification periodically on specific issues or other needs that might arise. Any report modification shall be the responsibility of the Firm. Other reports relating to the accounting and reporting of the billing and collections component of the County Emergency Services Operations may be requested or required by the County. Bid # RFP Ambulance Transport Billing for Page 11

12 Monthly Reports shall include, at minimum, the following: 1. A revenue report showing all transports billed. At a minimum, the report shall include the date of service, incident number, patient name, origin, destination, procedure code and gross charges. 2. An outstanding aged accounts receivable report sorted by payer including a total outstanding aged report. The report should show four (4) categories of outstanding accounts: 30, 60, 90 and more than 120 days outstanding. The report shall also show the last date of activity on the account. The report shall break down the categories into the current financial class of the account (where the next dollar payment is expected from). 3. A monthly listing of all refund requests processed for the month. 4. Report of all claims written off during the month. Any write-off shall be authorized by the County prior to removing any outstanding balance. The County may elect to set a monetary threshold of accounts that may be written off without advanced approval. 5. Any report deemed required on an as needed basis that would be useful to the County in monitoring and evaluating the County s ambulance service and/or accounts receivable process. The County reserves the right to audit the records of the Firm related to the County s billing and collection efforts. The Firm shall make and keep full and complete records and books of accounts or revenue and income, costs and expenses that specifically relate to performance under this contract. Records and books of accounts, together with any of all other memoranda pertaining thereto that may be kept, maintained or possessed by the Firm, shall be open to examination during regular business hours by the County or its representatives for the purpose of inspection, auditing, verifying, or copying the same or making extracts therefrom. The Firm shall make and keep said records and books of account in accordance with generally accepted accounting principles. E Analytical Services The Firm shall be required to provide analysis and expertise in all issues related to ambulance billing and operations. This analysis shall include developing trends within the Emergency Services Operations and other pertinent issues that may develop. The Firm shall provide other analytical services as requested or required by the County. The Firm shall schedule regular meetings with the County to review performance. Also, at a minimum, a written report reviewing the performance of the accounts receivable shall be prepared, identifying among other issues, the strengths, weaknesses and opportunities of the performance. Also, key issues that might arise in the future should be identified, along with strategies to address the issues. This report should be prepared quarterly or as deemed necessary by the County. Bid # RFP Ambulance Transport Billing for Page 12

13 F Technology Requirements The Firm shall provide all necessary software associated with the epcr, billing, and collections process. The Firm shall provide a system that will ensure complete and uninterrupted flow of service via back-up systems and a data recovery project plan/system should a disaster occur. Upon awarding of the bid, the Firm shall provide a copy of a written plan for review by the County s Information Technology Division. Records shall be retained according to an agreed upon record retention plan. The Firm shall have the ability to utilize a secure FTP platform via VPN for extract file transfer. If the Firm recommends an alternative method for file transfer, the Firm shall provide a detailed description of the recommended process. The Firm shall provide sufficient HIPAA compliance training to all employees dealing with applicable information. G Training of EMS Personnel The Firm shall provide, at no additional cost, in-depth documentation compliance training of the complex Medicare and Medicaid regulations as they relate to the prehospital delivery of emergency medical care. Additionally, like training shall be provided to Emergency Services personnel that are responsible for the delivery of non-emergency convalescent transports to include in-depth training on all supporting documentation to meet the strict medical necessity requirements of CMS. The training shall include all necessary visual training aids and handout materials that personnel may reference at the conclusion of any training session. The Firm shall provide, at a minimum, an initial training of County Emergency Services personnel three (3) Compliance and Documentation sessions. One session each for A, B, and C shift. The training sessions shall be at least two (2) weeks prior to the firm commencing billing services on behalf of the County. A follow up, supplemental training session for each shift shall be provided within one month after the completion of the first quarter. Training sessions shall be provided at a time and place designated by the County. The Firm shall provide any additional training as requested by the County and may include training sessions for any group or individual, at no additional cost to the County. H epcr and Panasonic Tough Book Computer System The Firm shall provide, at no additional cost, an epcr system and either Panasonic Tough Book computers or similar entry method. Due to the number of epcr systems and various configurations, would like to have various options proposed in each firm s proposal. The requirements for this system Bid # RFP Ambulance Transport Billing for Page 13

14 are that the system or firm submit data to GEMSIS on a daily basis, the system be simple to use for crews, and that data must be stored and backed-up offsite. D STATEMENT OF QUALIFICATIONS This section identifies all information which must be submitted in each proposal. Company background and Structure The Proposer will provide a general history and description of its company including, but not limited to the number of years in business and number of employees. Include the legal form of the business organization, the state in which incorporated (if corporation), the types of business ventures in which the organization is involved, and the office location that will be the point of contact during the term of any resulting contract. Company Experience and Staff Proposers are encouraged to list years of experience in medical billing; and, if possible, show a proven effectiveness in administering contracts with County governments. Proposers must have qualified and trained staff with sufficient back-up personnel to successfully complete the contract requirements. Approach to Scope of Work Referencing the Scope of Work listed under Section C and Specifications listed under Section D, provide a detailed approach to fulfill the requirements of this RFP. References Proposers must submit at least three (3) references on the Bidder s Reference Form provided within this RFP. Additionally, Proposers must also list ALL Georgia City/County Government accounts held and or lost within the last five (5) years. Disclose any services terminated and the reason(s) for termination of contract, either voluntary or other. This information will be used to determine experience with Georgia local governments. Financial Stability Provide financial information that would allow proposal evaluators to ascertain the financial stability of the Proposer. If a public company, include a recap of the most recent audited financial report. If a private company, provide a recap of the most recent internal financial statement and a letter, on the financial institution s letterhead, stating financial stability. Bid # RFP Ambulance Transport Billing for Page 14

15 Business Litigation Disclose any involvement by the organization or any officer or principle in any material business litigation within the last five (5) years. The disclosure will include an explanation, as well as the current status and/or disposition of the case. Financial Proposal Proposers are to use the Financial Proposal Forms provided within this RFP. Firm to provide percentage of total receipts to be paid for services rendered. Dawson County to issue checks monthly to Firm. E. EVALUATION PROCESS Proposals will be reviewed by the Review Committee for quality and completeness. These proposals will then be scored in each of the following categories using the maximum point values listed below. Experience of Firm & Qualifications of Staff 20 Approach to Scope of Work 15 Requirements Questionnaire 15 References 10 Financial Stability & Business Litigation 15 Financial Proposal 25 TOTAL POINTS 100 Proposals will be reviewed and evaluated by the review committee to determine whether the Respondent has met the experience and staff qualifications described in this RFP. The short list will consist of no more than three (3) firms with the highest ranking scores after the initial scores are tabulated. Presentations: The top ranking three (3) firms may be invited to conduct oral interviews. If required, these presentations will be scheduled in advance and limited in time. Presentations will be conducted in Dawson County at a location to be determined. Dawson County shall be the sole judge of the provider s ability to meet the requirements set forth. Their decision in determining responsible and responsive provider(s) will be final. Dawson County reserves the right to act in its best interest in this determinations process, to waive all technicalities, and to select the most responsible and responsive treatment provider. F. ADMINISTRATION The project will be administered by the Dawson County Board of Commissioners with the and Finance Departments being the main point of contact for all questions during the term of the contract. Bid # RFP Ambulance Transport Billing for Page 15

16 4. GENERAL CONTRACT REQUIREMENTS QUESTIONNAIRE This section will outline the minimum contract requirements for billing, collection, financial reporting, analytical services, and insurance coverage and liability. Dawson County desires to pursue a partnership to build an optimum revenue stream. A Billing: 1. The Firm will receive on a daily basis the electronic billing data and other related billing information by way of an encrypted FTP file or batch filing process. The Firm will be responsible for providing the appropriate software that will be compatible to interface with the Firm s software system. 2. The Firm will prepare invoices according to the rates, guidelines, and procedures established by Dawson County as well as meet all applicable laws and regulations including those for Medicare and Medicaid. 3. The Firm will be responsible for reviewing each Patient Contact Report (PCR) for content and accuracy for billing purposes. The Firm will be responsible for contacting the designated Dawson County ES employee to correct any discrepancies. 4. The Firm will be responsible for the initial collection of payments, generation of multiple collection attempts defined by Dawson County ES and generation of any and all insurance forms as well as filing and record maintenance. 5. Records and histories for services processed by the Firm shall be available and accessible by authorized Dawson County staff. 6. The Firm must have access to and will utilize all available resources and databases to obtain proper billing information on all serviced clients. 7. All client complaints concerning service rendered will be referred to the designated individual within Dawson County. Bid # RFP Ambulance Transport Billing for Page 16

17 B Collections: 1. Process all claims according to timelines defined by Dawson County and the Firm. 2. Re-categorize claims appropriately after receiving payment notification from Dawson County. Payments will be from the primary payer, and initiate any required secondary claims submission. 3. Act as the advocate for the client with Medicare, Medicaid and private insurance in an endeavor to optimize payment on behalf of the client. 4. Provide customer service at a minimum of a.m. until p.m. Monday thru Friday using a toll-free telephone number. 5. Record or credit all payments received by the Firms to the patient account within 24 business hours after the receipt of funds. 6. Process all refunds and overpayments within timelines defined by Dawson County and the Firm. 7. All funds received and collected by the Firm must be deposited by ACH transaction on a schedule that has been established Dawson County and the Firm. Corresponding reports must be provided with each deposit. C Reporting Requirements: Dawson County reserves the right to request additional reports as needed. 1. Monthly Information a. Date of Service performance monitoring and account reconciliation. Bid # RFP Ambulance Transport Billing for Page 17

18 b. Account Analysis by Month of all client accounts. c. Account Analysis by Month, by Payer. d. Aging Report by Current Payer and Aging Category. (Accounting Period Based) e. Accounts Receivables Reconciliation Report (Accounting Period Based) 2. Yearly Information A. Year End Accounts Receivable Report. D Analytical Services 1. Dawson County will expect the Firm to provide analysis and expertise in all issues related to ambulance billing. This includes analysis of trends and other pertinent issues that may develop. 2. At the beginning of the contract, the Firm will be expected to meet with Dawson County on a scheduled basis to review billing consistency, receivables performance, and other issues that have been encountered. Upon agreement of both entities these meetings may become less frequent, but will be held not less than once a year. Also, the Firm must prepare and deliver a written report reviewing the performance of the accounts receivables, identifying outstanding issues, and list any strengths, weaknesses, and opportunities for improved performance. Additionally, this written report must identify key issues that might arise in the future, accompanied by strategies, procedures, and timelines to address these issues. This report shall be due six (6) months after the original contract date. The report will then be due on a yearly basis unless Dawson County or the Firm request or determine the report is needed on a more frequent basis. E Technology Requirements 1. The Firm will provide all software/epcr associated with the billing and collection process. Bid # RFP Ambulance Transport Billing for Page 18

19 2. The Firm will provide a system that will ensure complete and uninterrupted flow of service via backup systems and a Data Recovery Project Plan/System should a disaster occur. 3. The Firm will retain records according to an agreed upon record retention plan. 4. The Firm shall provide sufficient HIPAA compliance training to all employees dealing with applicable information. F Insurance and Liability Requirements 1. The Firm shall maintain and provide Dawson County with evidence of the following described insurance, all on mutually-agreed terms and consistent with the custom in the area for similar collection contracts: a. General comprehensive liability insurance with aggregate of $1,000, b. An Errors and Omissions insurance policy covering itself and the services of its employees or contractors in the amount of $1,000, Coverage under the Errors and Omissions policy shall survive termination of this collection contract for a minimum of two (2) years. Does your bid comply with these requirements? Yes No c. To the extent available without significant surcharge, Dawson County will be named as additional named insured on all insurance policies specified in paragraph F.1. In all events, the insurance company will be required to provide Dawson County with prior written notice of cancellation, non-renewal or material amendment of each such policy. G Location of Operations All of the Firm s operations; including but not limited to; billing, collections, reporting, technology, compliance, customer service; shall be performed within the continental United States of America. In no case shall any of the services provided to Dawson County as part of this contract be performed outside of the continental Bid # RFP Ambulance Transport Billing for Page 19

20 United States. Violation of this condition shall result in the immediate termination of the contract. AWARD OF THIS CONTRACT WILL BE TO THE MOST RESPONSIVE, RESPONSIBLE BIDDER WITH PRICE BEING ONLY ONE OF THE FACTORS CONSIDERED. Bid # RFP Ambulance Transport Billing for Page 20

21 BIDDER S CHECKLIST REQUIRED FORMS Each proposal should be prepared simply and economically, avoiding the use of elaborate promotional materials beyond those sufficient to provide a complete presentation. The cost for developing the submittal is the sole responsibility of the respondent. The following documents are also required to be included in your proposal packet: 1. General Contract Requirements Questionnaire, completing all applicable pages. 2. A one-page statement of interest letter including the firm names, address, and telephone number. The respondent shall include the name, title, address and telephone and fax numbers, and addresses of each contact person for the duration of the proposal evaluation. 3. A brief (+-3-page) proposal summary that describes the Firm s understanding of the RFP and how it intends to meet the stated requirements. The respondent shall include any concerns regarding scheduling, concept or expectations. 4. Discussion of your Firm s specific abilities and expertise to provide the required professional services and qualifications related to the proposal requirements. 5. Provide some detail of the billing system and billing processes utilized as well as the identity of the software utilized and whether it is third-party or proprietary. 6. Identify key personnel proposed as project team members. 7. Provide references for at least three (3) clients for which your firm has provided similar professional services in the last three (3) years. Please include current contact information (name, address, telephone and address) for each reference. NOTE: First should list any and all Georgia local government contracts held within the last five (5) years. 8. Describe and discuss the firm s compliance program and how the program meets or exceeds the requirements of CMS and HIPAA. 9. Describe any services provided by the firm that are not covered by the RFP, but would assist Dawson County in enhancing its cash collections. 10. Provide a list detailing any and all variances to the scope of work detailed in this RFP. 11. Provide a copy of a completed SSAE16 Type II audit. REQUIRED FORMS Documentation that is required for a complete proposal includes: 1. Documentation listed under Section E: Statement of Qualifications 2. Vendor s Information Form 3. Vendor s Financial Proposal Form 4. Execution of Proposal Form 5. Vendor s Reference Form i. Three (3) References on Main Form ii. As described on page 14 under References, Vendor to include a list of ALL Georgia City/County Government accounts held and or lost within the last five (5) years. Disclose any services terminated and the reason(s) for termination of contract, either voluntary or other. Bid # RFP Ambulance Transport Billing for Page 21

22 6. Addenda Acknowledgment Form 7. Drug-Free Workplace Affidavit 8. Proposer s Certification and Non-Collusion Affidavit 9. Georgia Security and Immigration Compliance Act Affidavit i. Contractor Affidavit ii. Subcontractor Affidavit (if applicable) 10. SAVE Affidavit 11. Local Small Business Initiative Affidavit (if applicable) 12. Proof of Insurance 13. Completed W Copy of current business license If the Firm proposes to address a requirement in a manner different from the RFP specifications, the Firm shall provide an explanation of how that requirement will be met and demonstrate that the alternative is equal to or preferable to the requirement in the RFP. Before submitting a proposal, each Firm is required to make a careful study of these specifications, and fully assure itself of the quality of the service required. The consistent quality of the service provided is of profound importance to the County s on-going commitment to achieve fiscal objectives and maintain superior levels of customer service and satisfaction. The proposal shall be complete and require no further explanation. No contract will be awarded except to responsible organizations capable of providing the services outlined and achieving the identified expected results. Before the award of the contract, the Firm may be required to demonstrate any and/or all aspects of the Scope of Services. G. PROCEDURES AND MISCELLANEOUS ITEMS 1. All questions shall be submitted in writing ( is acceptable) and shall be communicated in the form of an addenda if the scope specifications are to be affected and posted on the County s website under the bid information, all firms responding to this RFP should check the website before responding to this RFP. 2. All respondents to this RFP shall indemnify and hold harmless the Dawson County Board of Commissioners, and any of their officers and employees from all suits and claims alleged to be a result of this RFP. The issuance of this RFP constitutes only an invitation to present a proposal. The Dawson County Board of Commissioners reserves the right to determine, at its sole discretion, whether any aspect of a respondent's submittal meets the criteria in this RFP. The Dawson County Board of Commissioners also reserves the right to seek clarifications, to negotiate with any vendor submitting a response, to reject any or all responses with or without cause, and to modify the procurement process and schedule. In the event that this RFP is withdrawn or the project canceled for any reason, the Dawson County Board Bid # RFP Ambulance Transport Billing for Page 22

23 of Commissioners shall have no liability to any respondent for any costs or expenses incurred in connection with this RFP or otherwise. 3. The RFP is subject to the provisions of the Dawson County Purchasing Policy and any revisions thereto, which are hereby incorporated into this RFP in their entirety except as amended or superseded herein. 4. Failure to submit all the mandatory forms from this RFP package shall be just cause for the rejection of the qualification package. However, Dawson County reserves the right to decide, on a case by case basis, in its sole discretion, whether or not to reject such a bid as non-responsive. 5. Any payment terms requiring payment in less than 30 days will be regarded as requiring payment 30 days after invoice or delivery, whichever occurs last. This shall not affect offers of discounts for payment less than 30 days, however. 6. In case of failure to deliver goods in accordance with the contract terms and conditions, Dawson County, after due oral or written notice, may procure substitute goods or services from other sources and hold the contractor responsible for any resulting additional purchasing and administrative costs. This remedy shall be in addition to any other remedies which Dawson County may have. 7. By submitting a qualification package, the vendor is certifying that they are not currently debarred from bidding on contracts by any agency of the State of Georgia, nor are they an agent of any person or entity that is currently debarred from submitting bids on contacts by any agency of the State of Georgia. 8. Any contract resulting from this RFP shall be governed in all respects by the laws of the State of Georgia and any litigation with respect thereto shall be brought in the courts of the State of Georgia. Then contractor shall comply with applicable federal, state, and local laws and regulations. 9. It is understood and agreed between the parties herein that Dawson County shall be bound hereunder only to the extent of the funds available or which may hereafter become available for the purpose of this agreement. H. BONDS Bid Bond not required Payment Bond not required Performance Bond not required I. FINAL SELECTION Following review of all qualified proposals, selection of a suitable vendor, and preliminary contract negotiations, a recommendation will be made to the Dawson County Board of Commissioners by the project representative. Following Commission approval, the County will complete contract negotiations. Bid # RFP Ambulance Transport Billing for Page 23

24 The Dawson County Board of Commissioners reserves the right to accept the response that is determined to be in the best interest of the County. The County reserves the right to reject any and or all proposals. Every vendor submitting a proposal must complete the forms showing compliance with the GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT OCGA The forms are provided with this RFP package. Bid # RFP Ambulance Transport Billing for Page 24

25 THIS PAGE LEFT INTENTIONALLY BLANK Bid # RFP Ambulance Transport Billing for Page 25

26 RFP # AMBULANCE TRANSPORT BILLING FOR DAWSON COUNTY EMERGENCY SERVICES VENDOR S INFORMATION FORM 1. Legal Business Name 2. Street Address 3. City, State & Zip 4. Type of Business: State of Registration: (Association, Corporation, Partnership, Limited Liability Company, etc) 5. Name & Title of Authorized Signer: 6. Primary Contact 7. Phone Fax Company Website 10. Has your company ever been debarred from doing business with any federal, state or local agency? Yes No If Yes, please state the agency name, dates and reason for debarment. ATTACH COPY OF BUSINESS LICENSE AND A COMPLETED W-9 FORM THIS PAGE MUST BE COMPLETED AND SUBMITTED WITH PROPOSAL Bid # RFP Ambulance Transport Billing for Page 26

27 RFP # AMBULANCE TRANSPORT BILLING FOR DAWSON COUNTY EMERGENCY SERVICES VENDOR S FINANCIAL PROPOSAL FORM Company Name: Customer Service Days and Hours Fee for Collections to be paid to Firm from Dawson County (% of Net Collections) Provide collection rate of top 5 Georgia Customers by customer Provide Accounts Receivable Aging Report for the top 5 Georgia Customers by customer Provide on Separate Sheet Provide on Separate Sheet Additional fees and charges (explain in detail): Authorized Signature Title Print Name Date THIS PAGE MUST BE COMPLETED AND SUBMITTED AS A PART OF YOUR PROPOSAL Bid # RFP Ambulance Transport Billing for Page 27

28 RFP # AMBULANCE TRANSPORT BILLING FOR DAWSON COUNTY EMERGENCY SERVICES VENDOR S REFERENCE FORM All references must be from customers for whom your company has completed work similar to the specifications of this bid. Attach additional page if necessary. References for: (Company Name) 1. Company Street Address City, State & Zip Contact Person Name Title Phone FAX Describe Scope of Work and dates of project/service: 2. Company Street Address City, State & Zip Contact Person Name Title Phone FAX Describe Scope of Work and dates of project/service: 3. Company Street Address City, State & Zip Contact Person Name Title Phone FAX Describe Scope of Work and dates of project/service: THIS PAGE MUST BE COMPLETED AND SUBMITTED AS A PART OF YOUR PROPOSAL Bid # RFP Ambulance Transport Billing for Page 28

29 RFP # AMBULANCE TRANSPORT BILLING FOR DAWSON COUNTY EMERGENCY SERVICES EXECUTION OF PROPOSAL DATE: The potential Contractor certifies the following by placing an "X" in all blank spaces: That this proposal was signed by an authorized representative of the firm. That the potential Contractor has determined the cost and availability of all materials and supplies associated with performing the services outlined herein. That all labor costs associated with this project have been determined, including all direct and indirect costs. That the potential Contractor agrees to the conditions as set forth in this Request for Proposal with no exceptions. Therefore, in compliance with the foregoing Request for Proposals, and subject to all terms and conditions thereof, the undersigned offers and agrees, if this proposal is accepted within sixty (60) days from the date of the opening, to furnish the services for the prices quoted within the timeframe required. Business Name Authorized Signature Date Typed Name & Title THIS PAGE MUST BE COMPLETED AND SUBMITTED AS A PART OF YOUR PROPOSAL Bid # RFP Ambulance Transport Billing for Page 29