REQUEST FOR PROPOSAL. Ambulance Billing Services

Transcription

1 REQUEST FOR PROPOSAL Ambulance Billing Services City of Calais (the City ) is requesting proposals from qualified Vendors ( Vendor ) to provide ambulance billing collection, financial reporting, and analytical services. This includes complete management of the billing process from receiving patient care reports for medical transport to account closure. This request for proposal ( RFP ) defines the scope of services and outlines the requirements that must be met by Vendors interested in providing such services. Vendors shall carefully examine the entire RFP and any addenda thereto, and all related materials and data referenced in performing the service. Vendors are advised to read all sections of this RFP before submitting a proposal. The City will receive sealed responses up to 12:00 p.m.(noon), MAY 17, 2016, addressed to City Clerk, 11 Church Street, P.O. Box 413, Calais, ME Responses received after this time will not be accepted. Responses will be publicly opened at 12:00 p.m. (noon), MAY 17, 2016, at City Clerk s Office, 11 Church Street, Calais. The offers will be identified, by name only, at that time. All interested parties are invited to attend. Questions concerning the scope of work, response submittal, or process should be submitted in writing to: Robert J Posick, Fire Chief Calais Fire - EMS P.O. Box 413 Calais, ME Office firechief@calaismaine.org The City reserves the right to reject any and all responses and to wave any irregularities and informalities. We look forward to receiving your response. The City of Calais is an Equal Opportunity Employer. 1

2 City of Calais Request for Proposal EMS Billing and Collections Services 1. INTRODUCTION Calais Fire EMS is a rural municipal run combination organization providing service to 5 communities surrounding the city and 11 communities in northern Washington and southern Aroostook counties. We respond to about 1800 calls for medical service annually out of two staffed bases which includes both emergency calls and inter-facility patient transfers. Calais Fire EMS medical billing service has been performed by the City of Caribou since inception. The City, in the interest of due diligence, is seeking bids from any interested vendor who would be capable of providing medical billing services similar to our current service provider. 2. PROPOSAL TIMELINES Release and advertise the RFP: April 22, 2016 Sealed Proposal due: May 17, 2016 Opening of RFP: May 17, 2016 Vendor Selection: May 26, 2016 Contract effective Date: July 1, SCOPE OF SERVICES This Section outlines the minimum contract requirements for billing, collection, financial reporting and analytical services. The City desires to pursue partnerships to build an optimal revenue cycle. The minimal requirements may or may not be described below. 1. Retrieve the electronic billing file and other billing related information from the City via Maine EMS web-based program supported by Image Trend. MEMSRR. 2. Prepare and submit accurate and complete insurance claims according to the rates established by the City, guidelines and procedures established by the Vendor and the City, and all applicable laws and regulations including those for Medicare, Medicaid, MaineCare, and any other applicable carriers including both commercial and private insurances. The first contract shall include submittal and any further action required for collection of retro-active billing still active with City s current medical billing service provider. 3. Verification and Missing Information Follow-up: The Vendor will provide all 2

3 labor, materials and equipment for verification of the downloaded transport information and patient information. The Vendor will promptly notify Calais Fire - EMS, regarding the missing information required to complete the billing process. The Vendor will work with Calais Fire EMS staff to ensure all required information is obtained so as to complete the billing process starting from the initial patient care report and ending when the individual payer account is considered paid in full or uncollectable. The Vendor will file any claim reviews and represent the City in Medicare/Medicaid appeals. The Vendor will also respond to any billing and collections questions. 4. Prepare and mail invoices to patients/parties responsible for co-pays and/or deductibles, private pay, and uninsured patients, or as directed by Calais Fire - EMS. 5. Post payments to the appropriate accounts and provide payment posting and revenue reports to the City as described in Section 6 below. Vendor will ensure that all checks are scanned and sent electronically to the bank of City s choice. As Remote deposits are made into the City s specified bank, Vendor shall send via fax a Confirmation Page for this transaction to City s Finance Director. 6. At a minimum, the following reports are required to be furnished to Calais Fire EMS on a monthly basis. These reports must have content and formatting similar to what Calais Fire EMS currently uses in house so as to ensure continuity of our processes. A. Monthly Invoice B. Call Summary C. Charge Detail D. Charge Summary E. Credit Detail F. Credit Summary G. Charge Schedule and Event Summary H. Aging Call Detail I. Aging Patient Detail J. Aging Summary 7. Provide the City with additional reports regarding uncollectable accounts and payment plan status as requested by and in a format required by the City. 8. The Vendor will act as a consultant regarding medical billing and collection services. 9. Customer Service: The Vendor will provide a staff of Customer Service Representatives ready to assist City s patients and Calais Fire EMS staff with patient account information Monday through Friday, during normal business hours, excluding holidays recognized by the Vendor. These hours shall be 8 a.m. to 4 p.m. 3

4 A local or toll free customer service number must be provided. (The number should be listed on all correspondence) 10. The Vendor acting on behalf of the City will remain respectful and mindful of the needs of the City s citizens and patients. Weekly and monthly installment payments can be made available. 11. The Vendor agrees to employ certified and continually qualified Ambulance coders/billers. They must stay current on billing practices and attend organized training regularly to ensure such an end. The Vendor also agrees to provide an account manager for Calais Fire - EMS. 12. The Vendor will provide collections services up to and including: representing the City when claims are denied or under paid. 13. The City reserves the right to recall accounts from the Vendor upon written notice. 14. Patients will receive a bill each month for three (3) months. If a bill has not been paid within 120 days, the patient and the City shall be notified of the delinquent amount. The Vendor will report which accounts have been determined to be uncollectible to the City, the criteria for uncollectible accounts will be approved by Calais Fire EMS prior to awarding any bid. 15. The City reserves the right to return accounts from the Vendor if the Vendor has failed to file proper insurance or follow up on outstanding insurance claims. 16. The Vendor is responsible for providing all materials and resources required for the performance of the contract including, but not limited to, facilities, equipment, statements, postage and personnel. 17. The Vendor will be required to provide, train, and retain staff who will work closely and candidly with Calais Fire EMS staff and its patients on a daily basis to ensure collection from every billable ambulance run as practical. 4. PROPOSAL INSTRUCTIONS: The proposal response must address the items included herein. Proposals should be prepared simply and economically, providing a straightforward, concise description of the capabilities of the Vendors offering. If no changes to service are proposed, City s current vendor may elect to only submit a Letter of Intent stating their wish to continue service as is, however such submittal shall only be considered as a response to this RFP and not considered approval or covenant between the City and its current vendor. Any and all proposed changes by current vendor, monetary or otherwise, must be submitted in detail and in writing within the timeframe of this RFP. Proposals should be organized in the order in which the requirements are presenting in the RFP. All pages of the proposal should be numbered. Each paragraph in the proposal should reference the paragraph number and sub-number, and repeat the text of the requirements as it 4

5 appears in this RFP. (Eg. 5.1 The Vendor must provide a history of the company ) Information that the Vendor wishes to present that does not fall within any of the requirements of the RFP should be inserted at the end of the proposal and designated as additional materials. Each copy of the proposal should be bound or contained in a single volume where practical. All documentation submitted with the proposal should be contained in that single volume. Proposals should be as thorough and as detailed as possible so that Calais Fire EMS can properly evaluate your capabilities. The City reserves the right to contact references other than, and/or in addition to, those furnished by the Vendor. 5. REQUIRED INFORMATION: 1. The Vendor must provide a brief history of the Company, qualifications and years of experience in Ambulance billing. 2. The Vendor must describe their capability to provide automated claims submission to applicable insurance carriers. 3. The Vendor must also provide references from Two (2) current EMS Service providers who submit their runs to the Vendor via Maine EMS web-based program supported by Image Trend (MEMSRR). These references will include the name, address and telephone number of billable transports submitted electronically. 4. The Vendor shall provide examples of the Minimum number and type of reports as described above to City. If these reports are to be provided to City electronically, Vendor shall provide City with secure access to Vendor s website so as to obtain and review applicable reports prior to awarding any bid. If applicable, please also indicate whether said reports can be saved to a variety of formats (MS Word, Excel, PDF format) and provide samples. 5. The Vendor should confirm that they have developed and implemented a compliance plan to ensure billing procedures comply with all local, state and federal laws, rules and regulations. 6. The Vendor shall confirm that, to the best of their knowledge, they are not presently the subject of any federal or state investigation involving fraudulent or abusive billing practices, and if such investigations are ongoing or have occurred within the past five (5) years, the Vendor shall provide the nature and outcome of such investigations with the response to this RFP. Failure to comply may result in refusal of bid. 7. Indicate whether or not you as a Vendor has had a contract terminated in the last five (5) years, and describe the nature and circumstances. Termination for default is defined as notice to stop performance due to the vendor s non- performance or poor performance and the issue of performance was either (a) not litigated due to inaction 5

6 on the part of the vendor, or (b) litigated, and such litigation determined that the vendor was in default. 8. Please list the software used, how often it is updated, and method of training staff. 9. The Vendor, by virtue of the proposal, agrees to hold City harmless from liability incurred in the performance of the contract. Additionally, Vendors agree to comply with all laws as applicable for work with a City government. 10. A certificate of General Liability coverage not less than $1,000, The Vendor shall describe their staff and their credentials and training. 12. A Non-Collusion Affidavit, by which the signer of the proposal declares that all persons, companies or parties interested in the contact as principals are named therein; that the proposal is made without collusion with any other person, persons, company or parties submitting a proposal; that it is in all respects fair and in good faith without collusion or fraud; and that the signer of the proposal has authority to contractually bind the Vendor. 13. The contract shall be for a period of one (1) year from the initial date of signing with the option to renew at the discretion of the City for a two (2) additional year term. 14. Describe any value added services provided by the Vendor that are not covered by the RFP, but would assist the City in enhancing its collections. Include examples of these services. 15. A written fee structure to provide services required in this RFP 16. Vendors must include a step by step flow chart detailing how medical billing claims are processed in their entirety. Include statistical information on collections success and how those numbers were obtained. 6. CONTRACT PERFORMANCE STANDARDS: The City will evaluate all proposals in accordance with the Evaluation Criteria contained herein. Should the City determine that only one Vendor is fully qualified, or that one Vendor is clearly more qualified and suitable than the others under consideration, a contract may be awarded to that Vendor. This request does not commit the City to pay any costs incurred in the preparation and submission of proposals or in making necessary studies or designs for the preparation thereof, nor to procure or contract for services. The Vendor will be considered the sole point of contact with regard to all stipulations, including payments of all charges and the meeting of all requirements. The City will authorize payment to the Vendor on the basis of satisfactory performance and 6

7 receipt of Vendor s correct invoice for services rendered. All invoices shall be sent to: Calais Fire - EMS P.O. Box 413 Calais ME, It is the City s expectation that the contract between the Vendor and the City will be a performance based contract. During the contract development, the City will work with the chosen Vendor to establish these standards. 7. SELECTION PROCESS Qualification and experience of the Vendor Ability to comply with the RFP Use of technology Reference checks and evidence of collections rates History of compliance with accepted billing practices 8. QUESTIONS AND ADDENDUMS Vendors shall carefully examine this RFP and any addenda. Vendors should seek clarification of any ambiguity, conflict, omission or other error in this RFP in writing. All questions and responses will be shared with other known Vendors submitting RFPs. For information regarding RFP contact: Robert J Posick, Fire Chief, Calais Fire - EMS, P.O. Box 413 Calais, Maine firechief@calaismaine.org. If the answer to any question materially affects the RFP, the information will be incorporated into an addendum and distributed to other vendors. Oral comments do not form a part of this RFP. 7