Debt Collection Services

Transcription

1 NORTHWEST RURAL EMERGENCY MEDICAL SERVICES ASSOCIATION, INC QUINN ROAD TOMBALL, TX REQUEST FOR PROPOSALS For Debt Collection Services for Northwest EMS Proposals are due by 3:00 PM (CDT) on Friday, May 22, 2015

2 (THIS PAGE INTENTIONALLY LEFT BLANK) Page 2 of 21

3 Contents Intent... 6 Background... 6 Calendar of Events... 6 Future Agenda... 6 Northwest EMS Points of Contact... 7 Scope of Work... 7 Contractor Minimum Work Performance Percentage... 7 The Scope of Work includes but is not limited to the following:... 7 Multilingual Capability... 7 Early-Out Collection... 7 Bad Debt Collection... 8 Contractor Staff Assignment to Northwest EMS... 8 Receipt of Accounts... 8 Reports... 8 Proposal Content... 8 Company Info... 8 Collections... 9 Administrative... 9 Compliance/Security Technology Fees Contract Term Proposal Package Requirements Content and Layout Section 1 Requirements Section 2: Requirements; Project Experience & References (per Attachment B) Section 3 Requirements; Section 4 Requirements; Exceptions Section 5 Requirements; Appendix Appendices: Additional Requirements Submittal Instructions & Conditions Submittal Identification Requirements Page 3 of 21

4 Mailing Address Due Date Acceptance Ownership Compliance Selection Criteria Contract Awards Sequential Contract Negotiation Agreement to Terms and Conditions Collusion Rights to Pertinent Materials Attachment A: General Firm Information Attachment B: Project Experience Signature Page Page 4 of 21

5 SOLICITATION DETAILS SECTION Page 5 of 21

6 Intent The Northwest Rural Emergency Medical Services Association (Northwest EMS) Board of Directors has identified the need to enhance Debt Collection Services for the Northwest EMS and would like to partner with Best in Class vendor(s) that can provide these services, capitalizing on best practice models the vendor(s) has developed. It is the intent of Northwest EMS to solicit proposals from qualified CONTRACTORS, through the Request for Proposal (RFP) process. These proposals will be evaluated to select the Vendor (hereinafter referred to as CONTRACTOR) to negotiate an agreement with Northwest EMS. The contract period of performance will be for three (3) years with the option to renew for two (2) additional one year periods. Fixed prices for the contract period will be established as part of the initial contract. Costs for any enhancements in service will be negotiated. Background Northwest EMS provides emergency and non-emergency ambulance and medical transportation services in the Tomball (Harris County), Texas, area. The day-to-day operations of the organization are managed by the Chief of EMS. The Chief is appointed by a volunteer Board of Directors. The organization is partially subsidized by tax dollars as a contractor for Harris County Emergency Services District No. 8. The remainder of operating funds are derived from patient revenues. Northwest EMS is a 501(c)(3) public charity committed to reducing the incidence and impact and injury, illness, and catastrophic events in our communities through superior coordinated clinical care, prevention programs, and education. Calendar of Events Issue RFP Friday, April 24, 2015 Deadline for Written Questions Friday, May 15, 2015 Proposal Submittal Deadline Friday, May 22, 2015 Estimated Notification of Selection Friday, June 26, 2015 Estimated AGREEMENT Board of Thursday, July 23, 2015 Directors Approval Date This schedule is subject to change as necessary. Future Agenda CONTRACTORS, who received notification of this solicitation by means other than through Northwest EMS direct , shall contact the person designated in the NORTHWEST EMS POINTS OF CONTACT herein to request to be added to the mailing list. Inclusion on the mailing list is the only way to ensure timely notification of any addenda and/or information that may be issued prior to the solicitation submittal date. IT IS THE CONTRACTORS SOLE REPONSIBILITY TO ENSURE THAT THEY RECEIVE ANY AND ALL ANDDENDA FOR THIS RFP by either informing Northwest EMS of their address. Addenda will be distributed by the day they are released. Page 6 of 21

7 Northwest EMS Points of Contact Questions and correspondence regarding this solicitation shall be directed to: Primary Contact for Northwest EMS Brian Bayani Chief, Northwest EMS All questions regarding this solicitation shall be submitted by . The questions will be researched and the answers will be communicated to all known interested CONTRACTORS after the deadline for receipt of questions. CONTRACTORS must notify Northwest EMS of current contact information to receive updates. The deadline for submitting written questions regarding this solicitation is indicated in the CALENDAR OF EVENTS herein. Questions submitted after the deadline will not be answered. Only answers to questions communicated by formal written addenda will be binding. Prospective CONTRACTORS shall not contact Northwest EMS officers or employees with questions or suggestions regarding this solicitation except through the primary contact person listed above. Any unauthorized contact may be considered undue pressure and cause for disqualification of the CONTRACTOR. Scope of Work Contractor Minimum Work Performance Percentage CONTRACTOR shall perform with his own organization contract work amounting to not less than 50 percent of the original total contract price, except that any designated Specialty Items may be performed by subcontract and the amount of any such Specialty Items so performed may be deducted from the original total contract price before computing the amount of work required to be performed by the Contractor with his own organization. The Scope of Work includes but is not limited to the following: Contractor will perform Early-Out Collections Services, as well as Bad Debt Collections Services for recovery of monies owed for non-payment of patient accounts, including but not limited to fines, penalties and fees. Multilingual Capability Contractor must be able to service accounts in both English in Spanish. Early-Out Collection Provide Early-Out Collection for 90 days Provide notice (by letter) to Patient Account Debtor on behalf of Northwest EMS prior to assigning the account to collections Letter will reflect that payment is to be made to Northwest EMS during the 90 day Early-Out Collection period Page 7 of 21

8 Make one phone call per month to Patient Account Debtor during the Early-Out Collection period Bad Debt Collection Bad Debt Collection process to begin after 150 days for Medicare accounts, and 90 days for all other accounts Additional legal actions will be taken only after reasonable collection efforts have been made Contractor Staff Assignment to Northwest EMS Contractor shall provide a staff person to Northwest EMS, knowledgeable with current Northwest EMS collection accounts as a primary contact for collection preparation services between contractor and Northwest EMS Contractor and Northwest EMS to mutually determine and agree on best time(s) for primary contact to perform collection preparation services. Receipt of Accounts Contractor shall furnish Northwest EMS with an acknowledgment of assigned accounts within 48 hours following receipt of accounts. Acknowledgement shall include: o An ALPHA-listing by name of Patient Account Debtor o Northwest EMS assigned patient account number o Amount assigned o Total number of accounts o Total dollars assigned for collection Reports Contractor shall furnish Northwest EMS a monthly report indicating all accounts with payments received by the 25 th of the month. Report shall include: o Northwest EMS assigned account number o Dollar amount assigned o Any payments, including date(s) received o Current balance due o A summary of collection efforts o Current status of each account o The Report shall also include an overall summary of the items listed above by account status and include the percentage of dollars collected on behalf of Northwest EMS o The Monthly Report must coincide and include payment to Northwest EMS for all cash received during the month. Proposal Content All proposals must have a response to the following questions per Attachments A and B, attached herein. Company Info 1. Headquarters 2. Contact Name Page 8 of 21

9 3. Contact Number 4. How many years of experience does your firm have collecting ambulance-related bad debt? 5. What percentage of placements to your organization are Healthcare Organizations? 6. What percentage of placements to your organization are Early-Out Accounts? 7. What are your average net recovery percentages for similar organizations (non-profit firms serving government contracts, for example)? Net recovery percentages are equal to collections divided by net placements. Please define the criteria you used to select "similar organizations". 8. Do you have experience collecting ambulance bad debt in Texas? 9. If you answered "Yes" to Question #8, how many years? 10. Please provide one or more references we may contact. 11. Do you have experience collecting healthcare bad debt in this region (Southeast Texas)? 12. If you answered "Yes" to Question #11, where (i.e. which organizations)? 13. If you answered "Yes" to Question #11, please provide one or more references we may contact. 14. Do you have experience collecting bad debt for non-profit EMS organizations in Texas? 15. If you answered "Yes" to Question #14, where (i.e. which organizations)? 16. If you answered "Yes" to Question #14, please provide one or more references we may contact. Collections 1. Describe your approach for collections i.e. communication to the patient, letters to the patient, legal action, etc. 2. Describe your approach for working Early-Out Accounts. 3. Do you assign specific collectors to Northwest EMS or would collectors working Northwest EMS accounts also perform collections for other clients? 4. Please describe your procedures for handling a patient complaint. 5. How would your collectors handle patients who may qualify for charity under Northwest EMS s policy? 6. Are pre-collect letters available as part of a standard letter series? If yes, please include examples. 7. Please describe your collector training program in detail (provide supporting documentation). 8. Do you have a formal process for auditing collector telephone calls? If yes, please describe and provide documentation. 9. Please explain how you provide a customer service focused approach while also attempting to collect on the early out population? 10. As you obtain new or updated patient demographic information, how do you communicate it back to your client? How often? 11. Do you provide a grace period for accounts that you have identified as having insurance and/or where the patient pays the balance within a certain number of days of consignment? 12. If you answered "Yes" to Question #11, how many days is the grace period from consignment? Administrative 1. What processes are in place to ensure invoice accuracy and appropriate and timely remittance to Northwest EMS? 2. What are the collection/customer service hours where a patient can reach a live representative? 3. Please provide samples of reports that can be provided to Northwest EMS. Page 9 of 21

10 4. Are there charges associated with custom reports? 5. Please describe the inventory reconciliation process preferred by your agency. 6. How often do you typically complete full inventory reconciliation? 7. Do you have any clients that review accounts to ensure contract compliance - If yes, how many do they review and how often? 8. Describe your current policies of insurance and coverage limits, including but not limited to: commercial general liability, business automobile liability, Workers Compensation, Professional Liability, and Errors and Omissions. Compliance/Security 1. Describe the processes you have in place to ensure HIPPA compliance. 2. What processes are in place to ensure that collectors recognize and protect PHI? 3. Describe the processes in place to ensure PCI compliance for all credit cards / debit card payments. 4. Provide an overview of your agency s approach to data security. 5. Does your organization maintain any data security related certifications (ISO27001; 2005, SAS16, etc.) 6. Is your agency PPMS certified through the ACA International? 7. Does your organization staff Compliance or Security Officer that does not fulfill other duties? 8. What role based controls do you have for users? 9. Describe your process for conducting criminal history checks for employees as well as verifying employees are not listed on exclusion lists for federal healthcare payors. Technology 1. Please provide a copy of your disaster recovery plan. 2. When accounts are returned or cancelled, do you provide a reason for return - Are your reason codes customizable by client or are they a standard set? Fees 1. Describe your company s fees for Primary Early Out Placement Accounts / 0-30 days 2. Describe your company s fees for Primary Early Out Placement Accounts / > 30 days 3. Describe your company s fees for Primary Early Out Placement Accounts / Legal Accounts 4. Describe your company s fees for Early Out Accounts returned to Northwest EMS deemed to have insurance coverage or are eligible for coverage 5. Describe your company s fees for Primary Bad Debt Placement Accounts / 0-30 days 6. Describe your company s fees for Primary Bad Debt Placement Accounts / > 30 days 7. Describe your company s fees for Primary Bad Debt Placement Accounts / Legal Accounts 8. Describe your company s fees for Bad Debt Accounts returned to NMC deemed to have insurance coverage or are eligible for coverage 9. Describe your company s fees for custom reports 10. Describe your company s incidental fees for Primary Early Out Placement Accounts Contract Term The initial term of the AGREEMENT(s) will be for a period of three (3) years with the option to extend the AGREEMENT(S) two (2) additional one (1) year periods. Page 10 of 21

11 The AGREEMENT(s) shall contain a clause that provides that Northwest EMS reserves the right to cancel this AGREEMENT(s), or any extension of this AGREEMENT(s), without cause, with a thirty (30) day written notice, or immediately with cause. If the AGREEMENT(s) includes options for renewal or extension, CONTRACTOR must commence negotiations for any desired rate changes a minimum of ninety (90) days prior to the expiration of the AGREEMENT(s). Both parties shall agree upon rate extension(s) or changes in writing. Northwest EMS does not have to provide a reason if it elects not to renew. Proposal Package Requirements Content and Layout CONTRACTOR should provide the information as requested and as applicable to the proposed services. The proposal package shall be organized as per the table below; headings and section numbering utilized in the proposal package shall be the same as those identified in the table. Proposal packages shall include at a minimum, but not limited to, the following information in the format indicated. Organize and Number Sections as Follows: Section 1 Cover Letter (Including Contact Info) Receipt of Signed Addenda(s) (If Any) Signature Page Table of Contents Section 2 Project Experience (ATTACHMENT B) Section 3 General Firm Information and References (ATTACHMENT B) Section 4 Exceptions Section 5 Appendix Section 1 Requirements Cover Letter: All proposals must be accompanied by a cover letter not exceeding the equivalent of two (2) single-sided pages and should provide as follows: Signed Signature Page and Signed Addenda (if any addenda s were released for this solicitation). Proposal or qualifications packages submitted without this page will be deemed nonresponsive. All signatures must be manual and in BLUE ink. All prices and notations must be typed or written in BLUE ink. Errors may be crossed out and corrections printed in ink or typed adjacent, and must be initialed in BLUE ink by the person signing the proposal. Table of Contents Section 2: Requirements; Project Experience & References (per Attachment B) Key Staff Persons: CONTRACTOR shall identify key staff and their qualifications and experience proposed for the services identified herein. Page 11 of 21

12 Experience & References: CONTRACTOR shall complete and submit ATTACHMENT B attached hereto in which CONTRACTOR shall describe at least 3 similar projects for which it provided services similar to the scope of work described herein. Please include phone number and address if possible as Northwest EMS will conduct reference checks using this information. Section 3 Requirements; Please complete Attachment A Section 4 Requirements; Exceptions Submit any and all exceptions to this solicitation on separate pages, and clearly identify the top of each page with EXCEPTION TO NORTHWEST EMS SOLICITATION FOR DEBT COLLECTION SERVICES. Each Exception shall reference the page number and section number, as appropriate. CONTRACTOR should note that the submittal of an Exception does not obligate Northwest EMS to revise the terms of the RFP or AGREEMENT. Section 5 Requirements; Appendix Appendices: CONTRACTOR may provide any additional information that it believes to be applicable to this proposal package and include such information in an Appendix section. Additional Requirements To be considered responsive, submitted proposals or qualifications packages shall adhere to the following: Two (2) sets of the proposal package (one proposal marked Original plus one copy) shall be submitted in response to this solicitation. The copy shall include a cover indicating the company name submitting, and reference to, RFP: DEBT COLLECTION SERVICES FOR NORTHWEST EMS. In addition, submit one (1) electronic version of the entire proposal package on a CD, DVD, or USB memory stick. Additional copies may be requested by Northwest EMS at its discretion. Proposals or qualifications packages shall be prepared on 8-1/2 x 11 paper, preferably duplex printed and stapled together without binder or plastic enclosure (environmentally friendly). Fold out charts, tables, spreadsheets, brochures, pamphlets, and other pertinent information or work product examples may be included as Appendices. Reproductions of the Northwest EMS logo shall not be used in any documents submitted in response to this solicitation. CONTRACTOR shall not use white-out or a similar correction product to make late changes to their proposal or qualifications package but may instead line out and initial in BLUE ink any item which no longer is applicable or accurate. To validate your proposal or qualifications package, submit the SIGNATURE PAGE (contained herein) with your proposal. Proposals or qualifications packages submitted without that page will be deemed non-responsive. Proposal signature must be manual, in BLUE ink, and included with the original copy of the proposal. Photocopies of the Signature Page may be inserted into the remaining proposal copies. All prices and notations must be typed or written in BLUE ink in Page 12 of 21

13 the original proposal copy as well. Errors may be crossed out and corrections printed in BLUE ink or typed adjacent, and must be initialed in BLUE ink by the person signing the proposal. CONFIDENTIAL OR PROPRIETARY CONTENT: Any page of the proposal or qualifications package that is deemed by CONTRACTOR to be a trade secret by the CONTRACTOR shall be clearly marked CONFIDENTIAL INFORMATION or PROPRIETARY INFORMATION at the top of the page. Submittal Instructions & Conditions Submittal Identification Requirements ALL BOXES AND/OR ENVELOPES MAILED OR DELIVERED CONTAINING PROPOSAL OR QUALIFICATIONS PACKAGES MUST BE SEALED AND BEAR ON THE OUTSIDE, PROMINENTLY DISPLAYED IN THE LOWER LEFT CORNER: THE SOLICITATION TITLE AND CONTRACTOR S COMPANY NAME. Mailing Address Proposal or qualifications packages shall be mailed to Northwest EMS at the mailing address indicated on the signature page of this solicitation. Due Date Proposal or qualifications packages must be received by Northwest EMS ON OR BEFORE the time and date specified, at the location and to the person specified on the signature page of this solicitation. It is the sole responsibility of the CONTRACTOR to ensure that the proposal or qualifications package is received at or before the specified time. Postmarks and facsimiles are not acceptable. Proposals received after the deadline shall be rejected and returned unopened. Acceptance Proposals are subject to acceptance at any time within 90 days after opening. Northwest EMS reserves the right to reject any and all proposal or qualifications packages, or part of any proposal or qualifications package, to postpone the scheduled deadline date(s), to make an award in its own best interest, and to waive any informalities or technicalities that do not significantly affect or alter the substance of an otherwise responsible proposal or qualifications package that would not affect a CONTRACTOR s ability to perform the work as adequately specified. Ownership All submittals in response to this solicitation become the property of Northwest EMS. If a CONTRACTOR does not wish to submit a Proposal or qualifications package but wishes to acknowledge the receipt of the request, the reply envelope should be marked No Bid. Compliance Proposal or qualifications packages that do not follow the format, content and submittal requirements as described herein, or fail to provide the required documentation may receive lower evaluation scores or be deemed non-responsive. Selection Criteria The selection of COTNRACTOR and subsequent contract award(s) will be based on the criteria contained in this Solicitation, as demonstrated in the submitted proposal. CONTRACTOR should submit information Page 13 of 21

14 sufficient for Northwest EMS to easily evaluate proposals with respect to the selection criteria. The absence of required information may cause the Proposal to be deemed non-responsive and may be cause for rejection. The selection criteria include, but are not limited to the following: Quality and Responsiveness of Proposal Proven Ability to Perform Services Performed Technical Capabilities Security, Compliance, and Technology References Administrative Proposed Cost Northwest EMS reserves the right to give preference to local vendors. Contract Awards Northwest EMS has the option to award a portion or portions of this contract to multiple successful CONTRACTORs at the sole discretion and benefit to Northwest EMS. The award(s) made from this solicitation may be subject to approval by the Northwest EMS Board of Directors Northwest EMS reserves the right to interview selected CONTRACTOR before a contract is awarded. The costs of attending any interview are the CONTRACTOR S responsibility. Northwest EMS is not liable for any cost incurred by CONTRACTOR in response to this solicitation. Unsuccessful CONTRACTORS who have submitted a Proposal or Qualifications Package will be notified of the final decision as soon as it has been determined. The award(s) resulting from this solicitation will be made to the CONTRACTOR that submits a response that, in the sole opinion of Northwest EMS, best serves the overall interest of Northwest EMS. Northwest EMS does not guarantee a minimum or maximum dollar value for any AGREEMENT or AGREEMENTS resulting from this solicitation. Sequential Contract Negotiation Northwest EMS will pursue contract negotiations with the CONTRACTOR who submits the best Proposal or qualifications or is deemed the most qualified in the sole opinion of Northwest EMS, and which is in accordance with the criteria as described within this solicitation. If the contract negotiations are unsuccessful, in the opinion of Northwest EMS or CONTRACTOR, Northwest EMS may pursue contract negotiations with the entity that submitted Proposal which Northwest EMS deems to be the next best qualified to provide the services, or Northwest EMS may issue a new solicitation or take any other action which it deems to be in its best interest. Page 14 of 21

15 Agreement to Terms and Conditions CONTRACTOR selected through the solicitation process will be expected to execute a formal AGREEMENT with Northwest EMS for the provision of requested service. The AGREEMENT shall be written by CONTRACTOR, subject to approval by Northwest EMS Legal Counsel. Submission of a signed bid/proposal and the signature page will be interpreted to mean CONTRACTOR HAS AGREED TO ALL THE TERMS AND CONDITIONS set forth in the pages of this solicitation. Collusion CONTRACTOR shall not conspire, attempt to conspire, or commit any other act of collusion with any other interested party for the purpose of secretly, or otherwise, establishing an understanding regarding rates or conditions to the solicitation that would bring about any unfair conditions. Rights to Pertinent Materials All responses, inquires, and correspondence related to this solicitation and all reports, charts, displays, schedules, exhibits, and other documentation produced by the CONTRACTOR that are submitted as part of the submittal will become the property of Northwest EMS when received by Northwest EMS and may be considered public information under applicable law. Any proprietary information in the submittal must be identified as such and marked CONFIDENTIAL INFORMATION or PROPRIETARY INFORMATION. Northwest EMS will not disclose any proprietary information to the public, unless required by law; however Northwest EMS cannot guarantee that such information will be held confidential. Page 15 of 21

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17 ATTACHEMENTS/EXHIBITS AND SIGNATURE PAGE Page 17 of 21

18 Attachment A: General Firm Information Please prepare a general information summary about your firm which includes the following: (This document should be prepared on separate 8 ½ x 11 sheets) 1. Firm Name, Address, Web Site URL 2. Headquarters 3. Contact Name 4. Contact Number 5. How many years of experience does your firm have collecting ambulance-related bad debt? 6. What percentage of placements to your organization are Healthcare Organizations? 7. What percentage of placements to your organization are Early-Out Accounts? 8. What are your average net recovery percentages for similar organizations (non-profit firms serving government contracts, for example)? Net recovery percentages are equal to collections divided by net placements. Please define the criteria you used to select "similar organizations". 9. Do you have experience collecting ambulance bad debt in Texas? 10. If you answered "Yes" to Question #9, how many years? 11. Please provide one or more references we may contact. 12. Do you have experience collecting healthcare bad debt in this region (Southeast Texas)? 13. If you answered "Yes" to Question #12, where (i.e. which organizations)? 14. If you answered "Yes" to Question #12, please provide one or more references we may contact. 15. Do you have experience collecting bad debt for non-profit EMS organizations in Texas? 16. If you answered "Yes" to Question #15, where (i.e. which organizations)? 17. If you answered "Yes" to Question #15, please provide one or more references we may contact. --End of Attachment A-- Page 18 of 21

19 Attachment B: Project Experience Please provide a short response to the company s ability to provide the following services (This document should be prepared on separate 8 ½ x 11 sheets). Collections 1. Describe your approach for collections i.e. communication to the patient, letters to the patient, legal action, etc. 2. Describe your approach for working Early-Out Accounts. 3. Do you assign specific collectors to Northwest EMS or would collectors working Northwest EMS accounts also perform collections for other clients? 4. Please describe your procedures for handling a patient complaint. 5. How would your collectors handle patients who may qualify for charity under Northwest EMS s policy? 6. Are pre-collect letters available as part of a standard letter series? If yes, please include examples. 7. Please describe your collector training program in detail (provide supporting documentation). 8. Do you have a formal process for auditing collector telephone calls? If yes, please describe and provide documentation. 9. Please explain how you provide a customer service focused approach while also attempting to collect on the early out population? 10. As you obtain new or updated patient demographic information, how do you communicate it back to your client? How often? 11. Do you provide a grace period for accounts that you have identified as having insurance and/or where the patient pays the balance within a certain number of days of consignment? 12. If you answered "Yes" to Question #11, how many days is the grace period from consignment? Administrative 1. What processes are in place to ensure invoice accuracy and appropriate and timely remittance to Northwest EMS? 2. What are the collection/customer service hours where a patient can reach a live representative? 3. Please provide samples of reports that can be provided to Northwest EMS. 4. Are there charges associated with custom reports? 5. Please describe the inventory reconciliation process preferred by your agency. 6. How often do you typically complete full inventory reconciliation? 7. Do you have any clients that review accounts to ensure contract compliance - If yes, how many do they review and how often? 8. Describe your current policies of insurance and coverage limits, including but not limited to: commercial general liability, business automobile liability, Workers Compensation, Professional Liability, and Errors and Omissions. Compliance/Security 1. Describe the processes you have in place to ensure HIPPA compliance. 2. What processes are in place to ensure that collectors recognize and protect PHI? Page 19 of 21

20 3. Describe the processes in place to ensure PCI compliance for all credit cards / debit card payments. 4. Provide an overview of your agency s approach to data security. 5. Does your organization maintain any data security related certifications (ISO27001; 2005, SAS16, etc.) 6. Is your agency PPMS certified through the ACA International? 7. Does your organization staff Compliance or Security Officer that does not fulfill other duties? 8. What role based controls do you have for users? 9. Describe your process for conducting criminal history checks for employees as well as verifying employees are not listed on exclusion lists for federal healthcare payors. Technology Fees 1. Please provide a copy of your disaster recovery plan. 2. When accounts are returned or cancelled, do you provide a reason for return - Are your reason codes customizable by client or are they a standard set? 1. Describe your company s fees for Primary Early Out Placement Accounts / 0-30 days 2. Describe your company s fees for Primary Early Out Placement Accounts / > 30 days 3. Describe your company s fees for Primary Early Out Placement Accounts / Legal Accounts 4. Describe your company s fees for Early Out Accounts returned to Northwest EMS deemed to have insurance coverage or are eligible for coverage 5. Describe your company s fees for Primary Bad Debt Placement Accounts / 0-30 days 6. Describe your company s fees for Primary Bad Debt Placement Accounts / > 30 days 7. Describe your company s fees for Primary Bad Debt Placement Accounts / Legal Accounts 8. Describe your company s fees for Bad Debt Accounts returned to NMC deemed to have insurance coverage or are eligible for coverage 9. Describe your company s fees for custom reports 10. Describe your company s incidental fees for Primary Early Out Placement Accounts --End of Attachment B-- Page 20 of 21

21 Signature Page RFP: DEBT COLLECTION SERVICES DATE: April 24, 2015 PROPOSALS ARE DUE IN THE OFFICE OF THE CHIEF BY 3:00 P.M., LOCAL TIME, ON: Friday, May 22, 2015 MAILING ADDRESS: NORTHWEST EMS QUINN RD TOMBALL, TX QUESTIONS ABOUT THIS RFP SHOULD BE DIRECTED TO: Brian Bayani, Chief CONTRACTOR MUST INCLUDE THE FOLLOWING IN EACH PROPOSAL: (1 original, 1 copy plus 1 electronic) ALL REQUIRED CONTENT AS DEFINED PER PROPOSAL PACKAGE REQUIREMENTS HEREIN This Signature Page must be included with your submittal in order to validate your proposal. Proposals submitted without this completed page will be deemed non-responsive. CHECK HERE IF YOU HAVE ANY EXCEPTIONS TO THIS SOLICITATION. BIDDERS MUST COMPLETE THE FOLLOWING TO VALIDATE PROPOSAL: I hereby agree to furnish the articles and/or services stipulated in my proposal at the price quoted, subject to the instructions and conditions in the Request for Proposal package. I further attest that I am an official officer representing my firm and authorized with signatory authority to present this proposal package. Company Name: Date: Address: City: State: Zip: Signature: Phone: Fax: Printed Name: Title: Page 21 of 21