HEALTHCARE FINANCE, INTERNAL AUDITING AND COMPLIANCE CONSULTING SERVICES FOR UNIVERSITY HOSPITAL

Transcription

1 Purchasing Services REQUEST FOR PROPOSAL (RFP) TITLE: RFP NUMBER: HEALTHCARE FINANCE, INTERNAL AUDITING AND COMPLIANCE CONSULTING SERVICES FOR UNIVERSITY HOSPITAL UH DATE ISSUED: January 6, 2014 DUE DATE: January 21, 2014 TIME: LOCATION: 2:00 P.M. UNIVERSITY HOSPITAL DEPARTMENT OF PURCHASING SERVICES LIBERTY PLAZA 335 George Street, 2 nd Floor New Brunswick, New Jersey Important Note: Bidders should check Section 1.3 of this document to verify if attendance at a mandatory event (e.g., pre-bid conference, site visit, etc.) is required for this procurement. Failure to attend a mandatory event will result in the rejection of your proposal. In accordance with the requirements of this proposal, the undersigned offers and agrees, if their proposal is accepted, to furnish any and all services for which the prices are submitted in accordance with the attached conditions as specified in this proposal. BIDDER NAME: BIDDER REPRESENTATIVE: ADDRESS: NAME: TITLE: PHONE NO.: FAX NO.: FED. TAX ID: BIDDER S AUTHORIZED SIGNATURE - 1 -

2 PREVENTING DISQUALIFICATION WHEN BIDDING ON RFP UH CONSULTING SERVICES RFP A) First, always remain aware of the concept that this is a public sector bid, not private sector. The underlying premise of all public procurements is to keep a level playing field for all bidders so that competition will be fair among all that participate. This sometimes means that rules and requirements might seem arbitrary or even meaningless to a bidder experienced in the private sector. Those reactions, however valid, are not relevant to those evaluating the proposal submissions. There are parameters that must not be breached and the evaluators and Purchasing Services will be obligated to stay within them. Simply put, there are certain requirements that must be met for an award to be issued. Some examples: 1) The bid proposal must be signed 2) The bid proposal must have been submitted to Purchasing Services by the prescribed opening time and date. 3) Submit all required documents see Sections 1.0, 3.0, 5.0, 8.0, and ) Any changes in pricing written within the bid, (white outs, etc. must be initialed by the bidder. 5) Outside of procedural questions (e.g. directions to Liberty Plaza) all questions must be done by the protocol established within the RFP. Under the level playing field premise, all potential bidders must be made aware of any relevant information given to another bidder. 6) UH payment terms are 45-days. If a proposal takes exception to that aspect of the RFP, most often the proposal will be determined to be non-responsive. UH will accept shorter payment terms with additional discounts e.g. 2%/15 days. 7) Insurance requirements make any objections known immediately, before bid opening. 8) Bid submission - A submitted bid must be in a sealed package. 9) Identification of the Bid package - The package sent in must be labeled as stated in the RFP to prevent potential loss or accidental opening. 10) Bidder responsibility - Purchasing Services is not responsible for any bids that arrive late because of courier service errors. Send the bid for an arrival a day or two earlier than mandated and then track it! A late bid will be disqualified. B) Forms Problems with forms are a primary cause of bid rejection. The premise regarding them is relatively simple: if you have them completed, make sure that they are submitted with the proposal, if you don t have them, get them, complete them, and then submit them with the proposal. Section 9.0 of the RFP describes all of what is required but some problem areas are: - 2 -

3 1) Ownership Disclosure must be submitted with the bid. Purchasing Services is trying to get that changed but as for now, that is the requirement. 2) The New Jersey State Business Registration it does not have to be submitted with the bid but the bidder MUST have registered with the state of New Jersey BEFORE the bid opening date. Registration often takes some time. If you are not registered, start the process immediately! 3) The Affirmative Action (AA) Certificate Up until three years ago, the AA 302 form which provided racial and ethnic hiring and working statistics was the only AA document that was required to be submitted with a bid proposal. Currently AA requires, along with the AA 302 Form, certification of its submission to the state. That certification requires a $ to be sent to the state. Without certification you won t necessarily be disqualified but you will not be eligible for award until UH receives evidence that the certification has been granted by the state. Links to AA for to obtain certification are in Section 9.0 of the RFP. 4) Two Year Chapter 51 Forms These forms establish whether the bidder s firm or its principle ownership have made any political contributions. If these forms are not submitted your firm will unequivocally NOT be able to have a contract with a state entity in NJ. 5) Business Associates Agreement - Any deviation from the UH Business Associates Agreement may be accepted but because of the process and legal review, any potential award will be delayed significantly. C) Exceptions Exceptions to the specifications contained within the RFP are the most serious form of non-compliance/non-responsiveness. Whereas some of the above are mistakes for which potential cures may be offered, material exceptions have one cure withdrawal of the exception. Evaluators will look at all exceptions to see if any may be determined to be non-material deviations which would give no advantage to the bidder. Usually exceptions give advantage to the bidder over its competitors and without withdrawal the bidder will ultimately be disqualified. REVIEW: 1) Read and understand the entire RFP 2) Follow instructions as presented in the RFP 3) Sign everything that requires signing 4) Enclose all required documents and forms in your bid package 5) Label the bid package correctly 6) Submit the bid package ahead of time 7) Take no exception - 3 -

4 1.0 INFORMATION FOR BIDDERS 1.1 Purpose and Intent of the Procurement Purpose This Request for Proposal (RFP) is being issued by the University Hospital (UH), Department of Purchasing Services on behalf of various departments, such as Healthcare Finance, Compliance and Internal Audit throughout University Hospital. The purpose of this RFP is to enter into contracts for consulting services in the categories detailed in Section 3.0, Scope of Work, of this RFP. The contracts will be awarded for three (3) years, commencing from the date of award. The contracts may be extended for two (2) one year periods Intent The general intent of this RFP is to establish a list of firms in each of the consulting categories from which the departments throughout University Hospital may solicit proposals for various types of projects. Specifically, it is the intent of UH to select consulting firms most qualified in each category and thereafter establish a list of firms capable of providing consulting services for UH. It is University Hospital s intent to select multiple firms for each defined category depending on the fee range. Meaning that it is the intent of UH to select, at minimum and if possible, seven (7) firms that offer proposals in the lowest fee range which is less than $36,000 for any one project for each defined category. It will then select, if possible seven (7) firms in the next low fee range (from $36,001 to $100,000) for each of those defined categories. After that, if possible, at least five (5) firms will be selected in the middle fee range from $100,001 to $250,000 for any one project for each defined category and then, if possible, at least five (5) firms will be selected in the high fee range from $250,001 to $500,000 for any one project. Consulting projects over $500,000 shall be part of an advertised-bid procurement although UH reserves the right to use any of the contractors in the last category for procurements over $500,000 if deemed necessary by UH. The lowest fee range in each category is reserved for those firms that qualify as New Jersey Small Business Enterprises (SBE s). Contracts shall be awarded to bidders that meet all of the required criteria in the order of evaluation. After award, a Date of Commencement shall be established. During a period of at least three (3) but up to five (5) years starting from the Date of Commencement, University Hospital intends to solicit proposals from and award Purchase Orders for various consulting services to firms on the list of awarded firms

5 The University reserves the right to re-issue a Request for Proposal for consulting firms during the contract period if significant changes render an awarded firm non-responsive or unqualified. One criteria by which a category, at the discretion of UH, may be deemed non-responsive would be if, after the UH request, three (3) or more separate project fee proposals in any one category are not submitted. The maintenance of a list of awarded firms in no way limits the University Hospital s ability to award work to firms not on the awarded list if, in the opinion of UH, the particular project merits an advertised bid, a waiver of the advertised bidding statutes or any other legal method of procurement. University Hospital reserves the right to bid any specific project requiring consulting services, following established University Hospital/NJ State policies and procedures. A single firm may not be engaged through this selection process in more than three (3) active projects at any one time within a given project category and fee range. If only one eligible firm is remaining in a project category, University Hospital reserves the right to utilize the pool of candidates from any other category in addition to the one remaining firm for the basis of selection. Bidders responding to this RFP must clearly demonstrate, through their written Statement of Qualifications and demonstrated experience on similar projects, the capacity, capability, and experience to successfully perform the required services described in this Request for Proposals. (See Section 7.0) 1.2 Background University Hospital The New Jersey Medical and Health Sciences Education Restructuring Act of 2012 transitioned most of the schools and units of the University of Medicine and Dentistry of New Jersey (UMDNJ) into Rutgers, The State University of New Jersey, separated University Hospital from UMDNJ and made the hospital a separate, stand-alone entity as of July 1, A statewide healthcare asset for New Jersey, University Hospital, with over 3,000 employees, is home to Northern New Jersey s Level 1 Trauma Center and to specialty programs such as the Center for Liver Diseases, which attracts patients from across the state. University Hospital is a model venue for the integration of education and research to promote breakthrough discoveries in healthcare. As the primary teaching hospital for Rutgers New Jersey Medical School, New Jersey Dental School and other Newark based healthcare programs, University Hospital is uniquely positioned to help advance extraordinary scientific discoveries in Newark, NJ. University Hospital is New Jersey s largest Graduate Medical Education site for students studying to become physicians and for graduate students pursuing other healthcare professions. The success as an academic health center is strongly related to the affiliations with schools and programs on campus

6 University Hospital s high performance and innovation in specialties such as cardiology, orthopedics, stroke care and trauma have earned broad recognition by the national hospital accrediting agency, and, likewise, by monitors of quality of care in academic health centers nationally. Approximately one-third of the patients emanate from outside Essex County and the U.S., reflecting the breadth of services and expertise patients find at University Hospital. 1.3 Key Events Questions and Inquiries It is the policy of the UH, Purchasing Services to accept questions and inquiries from all potential bidders receiving this RFP. Written questions should be mailed or faxed to the UH, Purchasing Services to the attention of the assigned buyer at the following address: UH, DEPARTMENT OF PURCHASING SERVICES 335 GEORGE STREET, 2 ND FLOOR NEW BRUNSWICK, NEW JERSEY ATTN: John Belkewitch Jr Buyer s Phone Number: (732) Buyer s Fax Number: (732) Buyer s Address: belkewjo@uhnj.org Cut-Off Date for Questions and Inquiries A mandatory Pre-Bid Conference has been scheduled for this procurement; therefore, the cut-off date for submission of questions will be the conclusion of the mandatory Pre-Bid Conference. While all questions will be entertained at the mandatory Pre-Bid Conference, it is strongly urged that questions be submitted in writing prior to the mandatory Pre-bid Conference. Written questions must be delivered to the Department of Purchasing Services Buyer. It is requested that bidders having long, complex or multiple part questions submit them in writing as far in advance of the mandatory Pre-Bid Conference as possible. This request is made so that answers can be prepared prior to the mandatory Pre-Bid Conference Question Protocol Questions should be submitted in writing to the attention of the assigned UH, Purchasing Services buyer. Written questions should be directly tied to the RFP by the writer. Questions should be asked in consecutive order, from beginning to end, following the organization of the RFP. Each question should begin by referencing the RFP page number and section number to which it relates

7 Short procedural inquiries may be accepted by telephone by the buyer; however, oral explanations or instructions given over the telephone shall not be binding upon the University Hospital. Bidders shall not contact any person within the University Hospital directly, in person, or by telephone, other than the assigned buyer, concerning this RFP Mandatory Pre-Bid Conference A mandatory Pre-Bid Conference has been scheduled for this procurement. The purpose of the mandatory Pre-Bid Conference is to provide a structured and formal opportunity for bidders to raise questions and clarify any of the proposal requirements. The date, time and location are provided as follows: DATE: January 13, 2014 TIME: 9:00 A.M. LOCATION: UNIVERSITY HOSPITAL, H-LEVEL CONFERENCE ROOM #H-349, 150 BERGEN STREET NEWARK, NEW JERSEY CAUTION: At the discretion of the Executive Director of Supply Chain Management bids will be automatically rejected from any bidder that was not represented or failed to properly register at the Mandatory Pre-Bid Conference. It is the responsibility of the bidder to identify and address any additional requirements or information needed to submit a proposal. No special consideration shall be given to any bidder, because of the bidder's failure to be knowledgeable of all the requirements of the proposal after the Pre-Bid Conference date. 1.4 Additional Information for Bidders Revisions to this RFP In the event that it becomes necessary to clarify or revise this RFP, such clarification or revision will be by addendum. Any RFP addendum will be distributed as follows: Since a mandatory Pre-Bid Conference has been scheduled for this procurement, any addendum issued before the mandatory Pre-Bid Conference will be distributed to all bidders who were sent the initial RFP. Any addendum issued at the time of or after the mandatory Pre-Bid Conference will be distributed only to those bidders represented and properly registered at the mandatory Pre-Bid Conference

8 1.4.2 Addendum as a Part of this RFP Any addendum to this RFP shall become part of this RFP and part of any contract resulting from this RFP. Notice to Bidders: It is the responsibility of all potential bidders to check UH s web site regularly and obtain all addenda that may be issued to bid specifications. UH is not responsible for direct distribution of addenda posted on the web site to all vendors who desire to submit a proposal Issuing Office This RFP is issued by the UH, Department of Purchasing Services. The buyer noted in Section is the sole point of contact between the bidder and the UH for purposes of this RFP Bidder Responsibility The bidder assumes sole responsibility for the complete effort required in this RFP. No special consideration shall be given after bids are opened because of a bidder s failure to be knowledgeable of all the requirements of this RFP. By submitting a proposal in response to this RFP, the bidder represents that it has satisfied itself, from its own investigation, of all the requirements of this RFP Cost Liability UH assumes no responsibility and bears no liability for costs incurred by bidders in the preparation and submittal of proposals in response to this RFP Contents of Bid Proposal All information submitted by bidders in response to a bid solicitation is considered public information, except as may be exempted from disclosure by the Open Public Records Act, N.J.S.A. 47:1A-1 et seq., and the common law. All bid proposals as public records, with the exception of information determined by the courts or UH to be proprietary, are available for public inspection after contract award. A bidder may designate specific information as not subject to disclosure when the bidder has a good faith legal/factual basis for such assertion. UH reserves the right to make the determination and will advise the bidder accordingly. The location in the bid proposal of any such designation should be clearly stated in a cover letter. UH will not honor any attempt by a bidder either to designate its entire bid proposal as proprietary and/or to claim copyright protection for its entire proposal. The bidder will be required to withdraw such designation before the bid proposal will be considered for contract award

9 In the event of a challenge to the bidder s designation of confidentiality/proprietary materials, the bidder shall have be solely responsible for defending its designation and UH shall have no responsibility therefore Price Alterations Bid prices must be typed or written in ink. Any price changes (including "white-outs") must be initialed. Failure to initial price changes may preclude an award being made to the bidder Joint Venture If a joint venture is submitting a bid, the agreement between the parties relating to such joint venture should be submitted with the joint venture s proposal. Authorized signatories from each party comprising the joint venture must sign the bid proposal. A separate Ownership Disclosure Form, Affirmative Action Employee Information Report, MacBride Principles Certification and, if applicable, foreign (out of State) corporate registration must be supplied for each party to the joint venture HIPAA Compliance As a State Agency, New Jersey State regulations require that we obtain documentation regarding our vendor HIPAA Compliance status. In order to be in compliance and conduct business with your company for the procurements of goods and/or services, it will be necessary for your company to complete a Business Associate Agreement. This agreement involves the access to protected health information that is considered protected pursuant to federal, state and/or local laws and regulations in accordance with the privacy requirements of the HIPAA Health Insurance Portability and Accountability Act of The requirement is a precondition of entering into a valid and binding contract Business Registration Notice All New Jersey and out of State business organizations must obtain a Business Registration Certificate (BRC) from the Department of the Treasury, Division of Revenue, prior to conducting business with the State of New Jersey. Proof of valid business registration should be submitted by a bidder with its bid proposal. The business registration form (Form NJ-REG) can be found online at: Definitions For the purpose of the section, the following shall be defined as follows: Affiliate means any entity that (1) directly, indirectly, or constructively controls another entity, (2) is directly, indirectly, or constructively controlled by another entity, or (3) is subject to the control of a common entity. An entity controls another entity if it owns, directly or individually, more than 50% of the ownership in that entity

10 Business organization means an individual, partnership, association, joint stock company, trust, corporation, or other legal business entity or successor thereof. Business registration means a business registration certificate issued by the Department of the Treasury or such other form or verification that a contractor or subcontractor is registered with the Department of Treasury. Contractor means a business organization that seeks to enter, or has entered into, a contract to provide goods or services with a contracting agency. Contracting agency means the principal departments in the Executive Branch of the State Government, and any division, board, bureau, office, commission or other instrumentality within or created by such department, or any independent State authority, commission, instrumentality or agency, or any State college or University Hospital, any county college, or any local unit. Subcontractor means any business organization that is not a contractor that knowingly provides goods or performs services for a contractor or another subcontractor in the fulfillment of a contract Requirements Regarding Business Registration Form A contractor should submit a copy of its business registration at the time of submission of its bid proposal in response to this RFP. A subcontractor shall provide a copy of its business registration to any contractor who shall forward it to the contracting agency. No contract with a subcontractor shall be entered into by any contractor unless the subcontractor first provides proof of valid business registrations. The contractor shall provide written notice to all subcontractors that they are required to submit a copy of their business registration to the contractor. The contractor shall maintain a list of the names of any subcontractors and their current addresses, updated as necessary during the course of the contract performance. The contractor shall submit to the contracting agency a copy of the list of subcontractors, updated as necessary during the course of performance of the contract. The contractor shall submit a complete and accurate list of the subcontractors to the contracting agency before a request for final payment is made to the using agency. The contractor and any subcontractor providing goods or performing services under the contract, and each of their affiliates, shall, during the term of the contract, collect and remit to the Executive Director of the Division of Taxation in the Department of Treasury the use tax due pursuant to the Sales and Use Tax Act, P.L. 1966, c. 30 (N.J.S.A. 54:32B-1 et seq.) on all their sales of tangible personal property delivered into the State

11 Deficit Reduction Act The University Hospital is committed to the prevention and detection of any fraud, waste, and abuse within the University Hospital related to all health care programs, including Federal and State programs. To this end, UH maintains a vigorous compliance program geared in part to educating our community on the range of fraud and abuse laws, including the importance of submitting accurate claims and reports to the Federal and State governments. Our policies prohibit the knowing submission of a false claim for payment in relation to any health care program, including a Federal or State funded health care program. Such a submission is a violation of Federal and State law and can result in significant administrative and civil penalties under the Federal and State False Claims Acts. To assist UH in meeting its legal and ethical obligations, any employee, contractor or agent who is aware of the preparation or submission of a false claim or report or reasonably suspects any other potential fraud, waste, or abuse in relation to a Federal or State funded health care program is required to report such information to his or her supervisor and UH s Office of Ethics and Compliance. Any employee of UH who in good faith reports such information will be protected against retaliation for coming forward with such information both under UH s internal compliance policies and procedures and United States and New Jersey law. As an organization, UH obligates itself to investigate any such information swiftly and thoroughly through its internal compliance programs and mechanisms. Nonetheless, if an employee, contractor or agent believes that the organization s response is deficient and unresponsive, the employee shall bring these concerns to UH s Office of Ethics and Compliance. If such follow-up still does not trigger an investigation, after a reasonable period of time, the employee, contractor or agent has the ability to bring his/her concerns to the appropriate government agency under the relevant Federal and/or State laws. This information shall be provided to all UH employees and all contractors and agents of UH

12 2.0 DEFINITIONS The following definitions shall be part of any contract awarded or order placed as a result of this RFP: Addendum Written clarification or revision to this RFP issued by UH, Purchasing Services. Amendment A change in scope of work to be performed by the contractor. An amendment is not effective until it is signed by the Executive Director of Supply Chain Management or Chief Financial Officer. Bidder An individual or business entity submitting a bid in response to this RFP. CFO University Hospital, Chief Financial Officer. Contract This RFP, any addendum to this RFP, and the bidder s proposal submitted in response to this RFP and UH s Contract Term Sheet. Contractor The contractor is the bidder awarded a contract. Evaluation Committee A committee established to review and evaluate bid proposals submitted in response to this RFP and to recommend a contract award to the Executive Director of Supply Chain Management. Executive Director The Executive Director of Supply Chain Management; the contracting officer for UH. HIPAA or HITECH Act Health Insurance Portability and Accountability Act of 1996, 1996 ( HIPAA ), the Health Information Technology for Economic and Clinical Health Act (Title XIII of the American Recovery and Reinvestment Act of 2009) (the HITECH Act ), and regulations promulgated by the U.S. Department of Health and Human Services (the HHS ) (hereinafter the HIPAA Regulations and the HITECH Regulations, respectively) and/or applicable state and/or local laws and regulations.. Loaded Hourly Rates - All inclusive rates for each project requested. May Denotes that which is permissible, not mandatory. President University Hospital, President. Project The undertaking of services that are the subject of this RFP

13 Request for Proposal (RFP) This document, which establishes the bidding and contract requirements and solicits proposals to meet the purchase needs as identified herein. Shall or Must or Will Denotes that which is a mandatory requirement. Failure to meet a mandatory requirement will result in the rejection of a bid proposal as materially non-responsive. Should Denotes that which is recommended, not mandatory. Subtasks Detailed activities that comprise the actual performance of a task. Task A discrete unit of work to be performed. UH The University Hospital, Newark, New Jersey

14 3.0 SCOPE OF WORK Beneath each specification is a line stating: WE HAVE READ AND SHALL FULFILL THE REQUIREMENTS OF SECTION. The bidder must indicate by putting a check mark in the appropriate box marked Y (Yes) N (No). If any requirements cannot be fulfilled the bidder must explain why on a separate sheet identifying the Section # and Name. (See Section 7.5) The bidder must recognize that the inability to fulfill a required specification may possibly result in the proposal being deemed non-responsive and thereby disqualify the proposal from evaluation. 3.1 Required Services- General The consulting firms will be evaluated for their abilities to provide various consulting services to University Hospital. The criteria of evaluation are to demonstrate the ability to provide consultation for the Departments of Healthcare Finance, Ethics and Compliance and Internal Auditing. The scope of services may vary according to individual project requirements as determined by University Hospital. WE HAVE READ AND SHALL FULFILL THE REQUIREMENTS OF SECTION 3.1. Y (Yes) N (No) 3.2 Categories The categories are not intended to be formal, narrowly-defined categories, but are intended to generally describe the types of projects UH would want aid from a consulting contractor. Awarded firms are not limited to any single category; a firm may be awarded in one, all or any number of categories Healthcare Finance University Hospital is seeking multiple consulting Contractors to provide counsel for a broad scope of financial services concerning a variety of financial and reimbursement issues. The Contractor shall have available and/or develop an appropriate data base that would enable them to deal with the issues that are presented in an expeditious/reasonable timeframe Internal Audit University Hospital is seeking multiple consulting Contractors for the purpose of providing counsel for a broad spectrum of internal auditing, auditing staffing and educational consulting services

15 3.2.2 Ethics and Compliance University Hospital is seeking multiple consulting Contractors to provide counsel for numerous Ethics and Compliance issues. WE HAVE READ AND SHALL FULFILL THE REQUIREMENTS OF SECTION 3.2. Y (Yes) N (No) 3.3 Fee Ranges (Please see Section 8.0 and Attachment B) University Hospital has split each categorized type of project into an anticipated ranges of fees involving four (4) separate ranges. These ranges of fees are not intended to be exact, but rather are intended to give description to anticipated or estimated fees. Firms are not limited to any single range or category. A firm may be awarded one, all or any number of fee ranges. Fee ranges exclude reimbursable expenses. The fee ranges are: 1) Below $36,000 (for certified small Businesses only.) 2) Between $36,001 and $100,000. 3) Between $100,001 and $250,000 4) Between $250,001 and $500,000 At the discretion of University Hospital, the selection process and contracts for various consulting services for projects with fees greater than $500,000 will be handled separately under specific Request for Proposals processes. If necessary, UH reserves the right to use an awardee from this category for a project that may go over the $500,000 threshold. Such awards, would only take place under exceptional circumstances. WE HAVE READ AND SHALL FULFILL THE REQUIREMENTS OF SECTION 3.3. Y (Yes) N (No) 3.4 Healthcare Finance Consulting Services Requirements General Requirements For all Financial Consulting Services contracts, Contractors must be able to provide assistance to University Hospital regarding a variety of reimbursement related topics such as: Charity Care Special Relief Medicare DSH Medicare GME Shadow Billing Medicare Outlier Payments

16 Medicaid Payment Methodology LOS Benchmarking NJ Acute Care Hospital (SHARE) Cost Report Review/Preparation Medicare S-3 Statistics Medicare S-10 Statistics Profit & Loss Database and Analysis Charity Care Modeling Mental Health Subsidy Medicaid Fee- for-service GME subsidy Medicaid Upper Payment Limit Medicare Proposed Regulations, Impact Analysis P & L and Revenue Budget Projections Data Reporter Function Market Share Data/Analysis University Hospital, as defined by the NJ Department of Human Services, is a Critical Access Hospital and as such relays greatly on the subsidies that have been established by the State of New Jersey to assist such Hospitals in their healthcare mission. Since the majority of the Hospital s patients are classified as low income or uninsured, the Hospital does not have enough paying patients to defray the non-reimbursed expenses of the low-income patients making UH highly dependent on these special payments General Types of Deliverables: For the preponderance of contracts it may be necessary for the Contractor to perform some or all of the following in order to achieve the objectives of the request: Review all claims, data quality, formula calculations and other formula results, potential problems Monitor processes for identifying, documenting and submitting claims Make recommendations for improvements in the current processes Prepare written reports of the findings Review findings with UH personnel Provide education and training to UH personnel

17 3.5 Internal Audit, Auditing Staffing and Educational Services Requirements General: Internal Audit Assistance The Office of Internal Audit provides an independent and objective assurance service designed to add value and improve operations. To assist University Hospital management in providing the highest quality services in education, research, patient care and public service by promoting effective internal controls at a reasonable cost, the University Hospital Office of Internal Audit (IA) examines, evaluates, and reports on the adequacy and reliability of existing controls to ensure that: Revenues are accurately and completely captured and processed Expenses are reasonable, appropriate and properly approved Financial reporting is accurate and reliable Automated processing of financial and operating data is accurate, reliable and complete Laws, regulations, and internally developed policies and procedures are followed Assets are properly safeguarded. In addition, The Office of Internal Audit is also involved in systems development activities and application reviews to ensure that the applications are designed and implemented and/or maintained with appropriate types and levels of controls The Contractor may perform financial, performance, operational, contract, information systems, compliance-related and specialized healthcare auditing engagements for the University Hospital Office of Internal Audit. This may include identification of process and control gaps and areas of risk with recommendations leading to best practices that are compliant with federal, state, third party regulations and UH Policy and Procedures. Audits will be conducted in accordance with Generally Accepted Government Auditing Standards (GAGAS), or the auditing standards of the American Institute of Certified Public Accountants and the Institute of Internal Auditors, as applicable Engagement Services Required for the Internal Audit Department: Providing necessary services to support the Internal Audit department by conducting independent and objective reviews of University Hospital operations and procedures with Findings and Recommendations reported as appropriate. The scope of work encompasses

18 auditing assistance to the University Hospital Internal Audit (IA) Department in five areas of expertise: Financial Audit assistance Operational Audit assistance Healthcare Services Audit Assistance Information Systems Audit Assistance Construction Audit assistance Responding to auditing assistance projects that will be developed by University Hospital/IA for each area of expertise. Each response will be evaluated as to approach, methodology, personnel assigned and cost. For awarded projects, the Contractor will coordinate all phases of work with IA. All work is to be performed in accordance with Generally Accepted Government Auditing Standards For Healthcare Services Audit Assistance projects, the Contractor must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Public Law An assessment of the key business processes and procedures in place to manage the risks and to develop a prioritized audit plan for each project requested by IA. Once the key processes for an audit have been identified the focus shall be on the planning and executing of the audit to include: Testing the design effectiveness of the processes and Testing the compliance and effectiveness of the controls Realizing the objectives of each audit: Efficiently capture the information needed to assess all major aspects of the key business processes under review and the related controls Minimize the disruptions to normal operations; and Effectively communicate all findings to the IA department and area or unit under audit Phase I-Audit Planning The Contractor shall, conduct (or assist in conducting) audit planning activities. The Contractor shall work with IA and the audited department to understand the critical elements of the business and operating environment. Identify and document all critical business controls, processes and sub-processes and document business objectives including those significant areas of risk that must be managed

19 Typical Requirements: The Contractor shall analyze the key business processes and related risks that impact the operational and financial processes. For each key business process: The Contractor shall identify and understand the key inputs, outputs, activities and related business risks The Contractor shall identify the internal business and financial controls in place to reduce those risks to an acceptable level The Contractor shall compare the as is condition to detailed Internal Audit industry templates of controls and risks that are typically found in these processes The Contractor shall identify critical success factors and key performance indicators that measure the processes, integrity and reporting and assess the accuracy of these measurements and their effective use by management Phase II-Fieldwork The Contractor evaluates primary, secondary, and/or mitigating controls identified during the risk assessment phase and design appropriate audit tests. The Contractor may have to evaluate residual risk (which is the remaining risk, presuming identified controls are working as intended) If the residual risk is acceptable, tests of those controls are assessed to ensure that the controls are working as intended. If the residual risk is deemed unacceptable, appropriate recommendations shall be developed, so that the residual risk is reduced to an acceptable level The Contractor often will have to conduct (or assist in conducting) an assessment of each audit area to: Determine the impact and probability that the identified business risks are likely to occur; Measure and prioritize the identified business risks in quantitative and qualitative terms; Identify the critical controls and individuals accountable for managing these risks; Obtain management consensus with the process risk profile; and Develop a risk-based control and audit program for the selected processes, functions or systems that focus on optimizing risk management

20 3.5.5 Phase III-Report Preparation/Presentation Preparation The Contractor shall prepare (or assist in preparing) draft and final reports including all supporting documentation using University Hospital Office of Internal Audit formats. At the completion of all fieldwork and prior to issuing a draft report, a formal meeting will be held with the auditee(s) and University Hospital -IA to review all findings and to discuss alternatives for mitigating the risks associated with the identified control weaknesses. The final deliverables will usually include: Internal Audit lead sheets, which include the finding, criteria, condition, effect, cause, and recommendation Work program and supporting Work papers all of which are submitted for final approval to the Internal Audit Department Presentation The Contractor shall present (or assist in presentation) to the audited department the final audit results and all related information contained in the final report Fraud, Suspicion of Fraud or Un-auditable Conditions for IA Engagements The Contractor must immediately contact the Vice President, Internal Audit upon the suspicion of or recognition of fraud, major accounting system deficiencies or major misstatements of accounts. No further work shall be performed regarding the matter until instructed by the Vice President, Internal Audit The Contractor shall immediately contact the Vice President, Internal Audit if the Contractor determines at any time during an audit engagement that the records are un-auditable, or lacks sufficient documentation, which would result in a material effect on the financial statements and would lead to a disclaimer of opinion. The Contractor must issue a follow-up letter, which elaborates the reasons why the department is un-auditable or why a disclaimer of opinion is necessary. The Contractor must not perform any further work until advised by the Vice President, Internal Audit Meetings for IA Engagements Once a contractor is selected for a particular engagement an entrance meeting will be held with the Contractor and the designated individual from the Internal Audit Department to discuss in detail the scope and purpose of the audit. As a result of this engagement meeting and prior to the engagement the Contractor shall provide a letter of agreement that, at minimum, will include:

21 Scope of the Auditing Service Key Personnel with CV (Curriculum Vitae) Period of Performance Objective Methodology Fees: Senior Management at Meetings - Overhead Expenses The Contractor shall meet with the designated IA individual to discuss audit findings weekly or at any other time so designated by the designated IA individual, or deemed necessary by the Contractor Audit Reports for IA Engagements Preliminary Audit Report for IA Engagements For virtually all projects the Contractor shall prepare a preliminary draft audit report and shall be expected to attend a formal exit meeting with the designated IA individual prior to submittal to the final report to discuss any and all points of the preliminary draft audit report. Copies of the preliminary draft audit report must be provided to, and only to, the designated IA individual at least five working days prior to exit conference Final Audit Report for IA Engagements The Contractor shall deliver five (5) bound reports of the final report to the designated IA individual. The Contractor shall not provide any reports to the department under audit. If the Contractor is contacted by the department under audit and the department under audit requests any audit reports, the Contractor must have the department under audit contact the designated IA individual. The final report shall include but not be limited to: One (1) Page Executive Summary Explanation of the Regulatory Requirements related to the Audit Findings Benchmark Data against Peer and/or National Standards Recommendations The Contractor shall submit reports to: University Hospital Director, Internal Audit 65 Bergen Street Suite 1357 Newark, New Jersey

22 3.5.7 Work Papers for IA Engagements The Contractor shall, at any given time during the course of the audit and at the conclusion thereof, make available to UH for its review, the working papers developed during the engagement. These papers shall include but not be limited to: The facts gathered and documents obtained/copies of documents Computations and analyses performed Other pertinent data relating to the audit Audit work papers shall be indexed in coherent manner and display evidence that each working paper or group of papers has been subjected to supervisory review. Working papers must show the name of the auditor who prepared the paper and must be clearly titled and dated The Contractor shall retain all work papers for a period of not less than three (3) years from date of receipt of Contractor s final payment for each engagement or three (3) years from end of contract and shall be made available to University Hospital when requested Audit Committee, Finance, Investment and Administration Committee or Board of Trustee Meetings The Contractor may be requested to attend and to present at meetings of the Audit Committee, the Finance, Investment and Administration Committee and the Board of Trustees, as deemed necessary by University Administration Proposal Submission After submission of proposals there are two distinct processes that University Hospital will initiate before a Contractor may begin any auditing services for the IA. These are: Award of Term Contracts Selection Procedure and Engagement Award Award of Term Contracts University Hospital will evaluate all proposals received in response to this RFP using criteria listed in Section 6. Award of a contract does not, in and of itself, guarantee any contractor the award of an engagement. Such a term contract binds a Contractor to provide auditing services at stipulated rates for a specified period of time

23 3.6 Engagement Services for the Office of Ethics and Compliance: The Contractor shall provide the necessary services to support the University Hospital Office of Ethics and Compliance. The scope of work encompasses auditing, training and counseling assistance to the University Hospital Office of Ethics and Compliance (OEC) Department in the following areas of expertise: a. The Contractor shall assist in the development of Compliance Work Plans for each University Hospital entity. b. The Contractor shall provide the necessary compliance audit services, written audit reports as well as follow up counseling/training that would address all key hospital, physician and research risk areas outlined in the two most recent OIG Work Plans. c. The Contractor shall provide the necessary audit services, written audit reports as well as follow up counseling/training that would address all key risk areas contained in the Office of Inspector General s compliance programs (and draft programs) for physicians, hospitals and recipients of PHS grants. d. The Contractor shall provide the necessary audit services, written audit reports as well as follow up counseling/training that would address all key risk areas relating to Medicare Conditions of Participation and all New Jersey Medicaid rules and regulations. e. The Contractor shall provide healthcare professionals and industry experts, including hospital executives, HIM specialists in coding, billing, and reimbursement, registered nurses, operations experts, physicians, and certified public accountants necessary to design/conduct a variety of compliance audits and to provide necessary follow-up reports and compliancerelated counseling and training, including f. The Contractor shall provide certified and experienced coders/auditors who can timely complete accurate audits of inpatient and outpatient physician documentation, coding and billing practices. g. The Contractor shall provide certified and experienced coders/auditors who can timely complete accurate audits of hospital coding and hospital billing practices. h. The Contractor shall provide experienced auditors who can timely complete accurate audits of pre and post award research policies and procedures, including reviews of proper billing in clinical trials. i. The Contractor shall provide interim, acting Compliance Officers when necessary. j. The Contractor shall provide audit and reporting services, where necessary, in accordance with the OIG s Provider Self-Disclosure Protocol

24 k. The Contractor shall provide a competent review of agreements for compliance with University Hospital policies and procedures, Stark exceptions, Anti-kickback staff harbors and other relevant laws, rules and regulations. l. The Contractor shall assist in the development/improvement of time and effort reporting systems within University Hospital. m. The Contractor shall work within University Hospital s audit policies and procedures, use certain software tools (Microsoft Office Suite, including PowerPoint and Microsoft Project) and a variety of third party audit automation tools. n. The Contractor shall demonstrate expertise and experience in auditing for compliance with HIPAA Security, HIPAA Privacy as well as other state and federal laws relating to patient privacy, FERPA. o. The Contractor shall demonstrate expertise and experience in EMTALA compliance and NJ DOH Hospital regulatory requirements. p. The Contractor shall work on special projects as requested. q. The Contractor must be familiar with waste stream audits that deal with the proper disposal of Protected Health Information. The Contractor shall complete on-going, scheduled HIPAA Privacy audits of shredding bins/other general waste containers to ensure that: (q1) original/source documents and original/source media that should be maintained in the medical record are not being improperly disposed of in the shredding bins; (q2) the shredding bins are only being used to dispose of documents/materials/media that contain Protected Health Information; and (q3) documents/materials/media containing PHI are not being included in other waste streams. r. The Contractor must conduct IRB audits to assure the integrity of clinical research and confirm adherence to institutional, state, and federal regulations governing research, including the adherence to Good Clinical Practices (GCP), safety and welfare of human subjects and Institutional Review Board (IRB) policies. The Contractor must conduct the audit through a process that is designed to be educational and collaborative. The Office of Ethics and Compliance will work with the Contractor and investigative research teams to identify the root of noncompliance and to develop a plan for remediation through on site monitoring, development of policies, and educational programs. The audit should normally include review of the following study documentation: IRB correspondence, subject records, data collection forms, subject s signed informed consents, and if applicable; interviews with relevant parties, sponsor s regulatory binder and/or test article accountability