RIVER FALLS, WI. Jeff Rixmann, Association President REQUEST FOR PROPOSAL EMS BILLING SERVICES RFP # January 2, 2015

Transcription

1 RIVER FALLS, WI Jeff Rixmann, Association President REQUEST FOR PROPOSAL EMS BILLING SERVICES RFP # January 2, 2015 ADMINISTRATION 175 E. CEDAR ST. RIVER FALLS, WISCONSIN 54022

2 TRI COUNTY EMS ASSOCIATION REQUEST FOR PROPOSAL Table of Contents A. Summary of RFP... 3 Definitions:... 4 B. Government and Background... 4 C. Timeline for Procurement Process (brief)... 4 D. Minimum Qualifications for Proposing Companies... 5 Section 2 Scope of EMS Billing Services... 5 A. Minimum Services (required)... 5 B. Fee for Services (required)... 8 C. Lock Box Account (required)... 8 D. Terms of Contract (required)... 8 E. Additional Services (optional)... 8 Section 3 Bidding Instructions... 9 A. Timeline (detailed)... 9 B. Required Background Information C. Tri County EMS Association Standard Procurement Process Section 4 Proposal Submission & Evaluation A. Submission Process B. Evaluation Process Section 5 Other Attachments Tri County EMS Association: Request for Proposal EMS Billing Services

3 Section 1 Introduction A. Summary of RFP The Tri County EMS Association is currently seeking proposals from qualified EMS billing companies interested in providing comprehensive EMS billing and reporting services. The primary objective of requesting proposals is for the Association to determine which company can offer the highest quality of service at the most reasonable cost. This process also provides each individual agency or municipality the opportunity to explore alternative procedural methods that could improve its EMS billing and reporting capabilities. We encourage you to be creative and educational in your responses. Format must be consistent with the requirements of the RFP. If you believe that your proposed solution or services would be beneficial to the Association, we invite you to offer them. Please provide options that may create efficiencies, make improvements, and take advantage of new, applicable technologies. The Association intends to establish a three year contract, with an additional two year renewal option. Each individual agency or municipality will contract directly with the chosen vendor. The conditions of the proposal must remain valid for a minimum contract term of three years. Extensions will be considered based on the mutual agreement of both parties at the same terms as the original agreement. The Tri County EMS Association collaborates on service issues, training and other matters that affect EMS organizations. The Tri County EMS Association members may use this RFP and any EMS billing proposers responses in billing decisions for their organizations. A complete list of members is made part of this RFP as Appendix A. Written proposals will be accepted until 5:00 p.m. on January 16, 2015 at City Hall, 222 Lewis Street, River Falls, WI Responses must address all of the items listed in this request for proposal and ed, or submitted in a sealed envelope marked Tri County EMS Billing Services Proposal and submitted to: Lu Ann Hecht, City Clerk City of River Falls 222 Lewis Street River Falls, WI lhecht@rfcity.org Questions or request for clarification may be directed to Jeff Rixmann, Tri County EMS Association President, at (715) or address at jrixmann@rfcity.org. Questions and answers will be posted on the City s website no later than January 8, Tri County EMS Association: Request for Proposal EMS Billing Services

4 Definitions: Association Members means each individual EMS agency or municipality within the Association Agency/municipality means each individual EMS agency or municipality within the Association Proposing EMS Billing Company means a firm submitting a bid in response to this RFP Tri County EMS Association means the consortium of EMS services within Pierce, Polk and St. Croix Counties B. Government and Background The Tri County EMS Association is a consortium of EMS services established in The Association enlists members from six counties within the western WI and eastern MN area. The majority of the residents commute to the St. Paul Minneapolis region to work, as the Association is located very close to the Twin Cities. The Association and its members have worked together for fourteen years. The Association goal is to find consistent problems and work towards common goals and solutions. The Association consists of eighteen (18) ambulance services both private and municipal as well as four (4) first responder units. Together the Association members log over 15,000 calls annually. The Association is very well known in the State of Wisconsin due to our progressive nature and collaboration amongst departments. C. Timeline for Procurement Process (brief) The Association has made every effort to include enough information in this RFP for a EMS billing company to prepare a responsive proposal. A brief timeline is presented below: TIMELINE Distribution of RFP... January 2, 2015 Submission deadline for question... January 8, 2015 Proposal submission... January 16, 2015 Proposal review... January 21, 2015 First notification... January 26, 2015 Interviews with finalists... January 28, 2015 Final selection... February 2, 2015 Start of implementation activities... February 9, 2015 Implementation... March 1, Tri County EMS Association: Request for Proposal EMS Billing Services

5 D. Minimum Qualifications for Proposing Companies The following is a list of the Tri County EMS Association minimum requirements in order for a EMS billing company to be considered: Authorized to bill for EMS services in the State of Wisconsin Ability to service all agencies within the Association with prompt billing, customer service and ongoing reporting using ImageTrend software Ability to offer electronic data access to designated staff members Compliance with federal, state and local regulations regarding confidentiality of data Ability to offer secure transmission of data Ability to process patient invoices with 10 days of receiving billing data Ability to safeguard revenues of the Association Members through disaster recovery planning and internal controls Ensuring all Association members are compliant with all local, state and federal regulations as it pertains to HIPAA and Red Flag rules, billing and collection procedures. Section 2 Scope of EMS Billing Services A. Minimum Services (required) To facilitate billing from reports generated by emergency services personnel, which include electronic run reports, ancillary documents, and hospital face sheet from the receiving hospitals. The Successful Bidder shall be responsible for obtaining all computer generated reports. Ancillary documents will be received, processed and stored on a secure server. Successful bidder shall have a minimum track record of eight (8) years of billing insurance companies, including Medicare, Medicaid, Third Party Insurances and HMO s, Commercial Insurances, Auto Insurances, Worker s Compensation and patients directly. Bidder must demonstrate at least five (5) years documented successful experience with and current knowledge of ambulance services billing. The Successful Bidder shall have or establish and maintain an office that operates, at a minimum, during normal business hours of 8:00 AM to 5:00PM Monday through Friday, excluding holidays. Bidder should have a toll free number for billing inquiries during this contract. The bidder must be capable of promptly addressing issues that may arise in connection with this agreement and/or day to day billing questions from Association Member s staff. Bidder shall have all the necessary equipment, such as dedicated phones lines, computer terminals, modems, and electronic storage facilities, sufficient personnel, materials, supplies and operate as the each agency/municipality s medical billing facility. Successful Bidder shall use the collected billing information as the basis for: Billing the transported individual s Medicare, Medicaid, Insurance Company, or any other appropriate third party responsible for payment for services provided. 5 Tri County EMS Association: Request for Proposal EMS Billing Services

6 Successful Bidder shall demonstrate the ability to submit and store all claims and related paperwork via electronic means, and shall use a clearinghouse to submit claims where feasible. The following minimum reports shall be submitted to the each Association Member on a monthly basis. Distribution of Charges and Collections This report will track the charges, payments and financial class mix of all patients for a given month or other specified period. Ages Receivable Report This report will have outstanding invoices sorted by date or account for thirty, sixty, ninety, one hundred twenty, and over one hundred twenty days. This report will also provide totals for these categories. Patient Alpha Listing This report lists all patients alphabetically by patient last name. Monthly Payment Listing This report lists payments, required charge offs (contractual adjustments), and refunds posted to each patient s account. Overpayment (refund request) Report This report lists all patients due refunds as a result of overpayment on account. Non Sufficient Funds (NSF) Report This report lists all non sufficient fund checks that have been returned. Total emergency and non emergency requests; total ALS and BLS requests, total non billable and patient refusal requests and total requests transported sorted by time of day and level of service. Bidder will submit state required information, on behalf of each Association Member. Services to be Provided: Successful bidders shall provide the following services: Mail an invoice to each patient transported, at the rates established by each agency/municipality for EMS transportation services. File all insurance claim forms for all patients based upon information received from the patient or obtained from successful bidder s research done at referring and/or receiving health care facilities. Send copies of patient care reports and Physician Certification Statements to Medicare, Medicaid, insurance companies, or any other third party payers (when requested) to obtain payment. 6 Tri County EMS Association: Request for Proposal EMS Billing Services

7 Comply with attorney requests for billing charges in a timely manner. Any claim denials for medically necessary transports shall be resubmitted properly and within the time frame provided and additional information provided within the resubmission to show validity of the claim for maximum benefit. Follow up on electronically submitted and mailed claims for which payment has not been received at thirty (30), sixty (60), and ninety (90) days following initial submittal. Follow up efforts and results must be documented and available to each agency/municipality for review. Record customer payments and refunds. The successful bidder will provide each agency/municipality with necessary refund request including all pertinent information relating to refund payments to patients and/or insurance companies, indicating the refund payee s name, address and reason for refund. Refunds will be sent to and approved by a specified person for each agency/municipality. Successful bidders will pay the approved refund and then will be reimbursed by each agency/municipality on the next billing cycle. Prepare monthly management/financial reports as stated above. When a billed account has become past due(an account older than the date of transport plus one hundred twenty days (120), that has a balance larger than zero), return the account to each agency/municipality by providing a listing of these past due accounts including all pertinent facts regarding attempted collection efforts. However, each agency/municipality at its option may leave selected accounts with the Successful Bidder for a longer period of time or turn the accounts over to a collection agency. Each agency/municipality may choose to use an independent collections agency. All accounts considered in write off status will be sent to each agency/municipality for review. All accounts must contain biller s notes showing reasonable attempts to collect and details of the claim progress, including noting conversations with patient, insurance company etc. The successful bidder shall also be responsible, for keeping up to date, all credentialing contracts with insurance providers. All credentialing contracts will be approved and signed by the EMS Director or equivalent for each agency/municipality. Any other services as agreed to by the parties in order to effectively collect transport fees. Vendor shall submit a proposed Scope of Service statement with the RFP response. 7 Tri County EMS Association: Request for Proposal EMS Billing Services

8 Required Use of Electronic Filing, Storage, and Billing System: The Successful Bidder must be currently filing, storing (both on and off site), and receiving Medicare and Medicaid claims and payments electronically and must transmit/receive Medicare claims via the required national format, or any future standard Medicare or Medicaid may require. The Successful Bidder must also be currently filing electronic claims with all Commercial Insurance Carriers that accept electronic claims. The Successful Bidder shall also submit a description of their billing software system and the length of time of its installation. The billing system must be proprietary in nature, and may not be off the shelf type programs. The Successful Bidder must also submit a system disaster recovery plan, as well as, a full description of system backup and recovery plans. B. Fee for Services (required) The Tri County EMS Association desires an all inclusive rate for performing the billing services consistent for any and all agency/municipality that chooses to use this RFP and the selected bidder. The successful bidder s fee for services to be provided will be a flat rate per claim billed during the contract period. The proposed rate shall cover all costs including but not limited to telephone and postage expenses, office supplies, and any other overhead expenses or administrative support. C. Lock Box Account (required) Each agency/municipality shall maintain a Lock Box or other method to facilitate receipt and deposit of all payments on customers accounts. The successful bidder will have online access to payment documents necessary to post collections to customers accounts. The EMS service company will pay all cost associated with the Lock Box Account. D. Terms of Contract (required) The initial contract term shall be for an initial three (3) year term. Fees quoted shall remain fixed for the initial three (3) year term. The Association reserves the right to extend the contract for an additional two (2) year term, providing both parties agrees with all term and conditions remaining the same. E. Additional Services It is highly encouraged for EMS billing proposers to provide information on the following services, if they are available to the Association Members. Availability of ImageTrend software for field users Ability of EMS billing company to host service bridge ImageTrend software Direct reporting to WARDS software 8 Tri County EMS Association: Request for Proposal EMS Billing Services

9 Customizable, online reporting Flat rate for up to 120 day billing cycle Enrollment into TRIP program Annual documentation training for department staff These services are not a requirement of contract by the Association, but the information allows River Falls to understand more about the EMS billing company s abilities. If a service is not provided, please mark Service Not Provided. Section 3 Bidding Instructions A. Timeline (detailed) The Association has made every effort to include enough information in this RFP for a billing company to prepare a responsive proposal. The Association encourages billing companies to submit the most comprehensive and competitive proposal possible. The Association reserves the right to retain all proposals submitted and to use any ideas in a proposal, unless protected by copyright, regardless of whether that proposal is selected. Submission of a proposal indicates acceptance by the firm of the conditions contained in the RFP, unless clearly and specifically noted in the proposal submitted, and confirmed in the contract between the Association Members and the billing company selected. The Association reserves the right to reject any and all proposals, cancel all or part of this RFP, waive any minor irregularities and request additional information from proposing billing companies. The Association will not reimburse the respondents to this RFP for any expenses incurred in preparing proposals, or for the attendance at interviews. This RFP does not obligate the Association to accept or contract for any services. TIMELINE The timing of the proposal process is as follows: Distribution of RFP The RFP will be ed and posted on the City of River Falls website on January 2, Proposal Submission Proposals must be received in the City Clerk s Office no later than 5:00 p.m., January 16, 2015, via fax, mail or . 9 Tri County EMS Association: Request for Proposal EMS Billing Services

10 Proposal Review Association staff will evaluate all proposals and summarize the findings. It is anticipated that the review process will be completed by January 21, Interview with the Finalists The Association reserves the right to schedule a telephone interview with one or more of the proposing firms. This would be scheduled for January 28, Proposals Accepted The Association will make the final selection by February 2, 2015, based on the recommendation of Association Members. Implementation The selected firm will be required to coordinate with Association Members all the activities necessary to ensure a smooth transition. Conversion activities will begin upon notification and projected completion date is March 1, Each agency/municipality may have separate transition dates depending on the current contracts with their current billing companies. The Association will make every effort to administer the proposal process in accordance with the terms and dates discussed in this RFP. However, the Association reserves the right to modify the proposal process and dates as deemed necessary. B. Required Background Information The following lists information that the proposing EMS billing company should include in their proposal: History of the EMS billing company, as well as financial information of the company, audited financial statements preferred. Information on key management and staff members that would be assigned to the account. Three (3) references of customers who have used services similar to those included in this request. Please provide name, address, telephone number and a contact person for each reference. Fee attachment listing pricing for required and optional services. Transition plan approach and timeline defining implementation periods and defined responsibilities. Reminder that there may be multiple transition plans for the Association Members (agencies/municipalities) depending on their current contractual ties with their existing billing companies. 10 Tri County EMS Association: Request for Proposal EMS Billing Services

11 A summary of what differentiates your products/services from other providers. A summary of new services or features the EMS billing company can offer, and within what time frame. Any additional information, which you believe to be relevant to this RFP, and your capabilities to provide the services requested. C. Tri County EMS Association Standard Procurement Process The Association Members (agencies or municipalities) intend to enter into a formal services agreement with the awarded EMS billing company that will incorporate all provisions of the RFP and the response from the selected vendor. The Association reserves the right to reject any or all bids, and select the best bid in the opinion of the Association and its Members. The Association reserves the right to eliminate any individual service contained in the proposal, if based on analysis, the fees for providing the service are excessive, or if the service proposed can be performed in an alternative manner. Unauthorized changes of the specifications, forms, or terms may not be made. Otherwise the response will be considered invalid. Failure to enter into a subsequent contract/agreement within 30 days of notification of award. A subsequent contract/agreement may be terminated by either party with written notice. 11 Tri County EMS Association: Request for Proposal EMS Billing Services

12 Section 4 Proposal Submission & Evaluation A. Submission Process All sealed proposals from interested billing companies must be received on or before 5:00 p.m. on the date noted previously, and addressed to: Lu Ann Hecht, City Clerk City of River Falls 222 Lewis Street River Falls, WI lhecht@rfcity.org Mailed or delivered proposals will be time stamped upon receipt and held in a secure place until the established due date. Proposals will not be opened publicly or disclosed to unauthorized persons, but will be opened in the presence of two or more Association Officers. A record of proposals will be established, which will include for every proposal: name of the entity submitting the proposal, a description sufficient to identify the services offered, and the date and time the proposals were opened. B. Evaluation Process Proposals will be evaluated by Association members based on the criteria set forth below. Association Members will make a recommendation to the Association Officers. All proposals submitted will be the primary document upon which each proposal will be evaluated. All proposals will first be screened to determine minimum institution qualifications as outlined in this RFP. It is the Association s desire to select the EMS billing company that will provide the best overall value to the Association and its Members. Best value is based not only on cost, but also includes the ability to provide quality desired services and support. Submitted proposals will be judged on the following evaluation criteria: Experience of the company in billing for EMS services Ability to meet the government s current and projected service requirements over the term of the agreement Cost of services as compared to service product as outlined in the proposal Capacity to provide a wide range of electronic billing and reporting services Quality of references Completeness of response to all required items on the standard forms provided The Association reserves the right to reject any and all proposals, to waive any information or irregularities in any proposal, and to use any idea in a proposal regardless of whether that proposal is selected. 12 Tri County EMS Association: Request for Proposal EMS Billing Services

13 Once a successful bidder is selected by the Association, each individual agency/municipality within the Association has the option to contract individually with the successful bidder per the approval of their respective boards or councils. Section 5 Other Attachments City of River Falls 2013 Annual Financial Report located on the City Website at Current and historical call volume is available on the River Falls EMS website Tri County EMS Association (Municipal) Members: o o o (Polk Co) Amery EMS, Osceola EMS, Northland Ambulance, Clear Lake Ambulance (St. Croix Co) Baldwin EMS, Hudson EMS, Glenwood City EMS, New Richmond EMS (Pierce Co) River Falls EMS, Ellsworth EMS, Maiden Rock/Plum City EMS, Elmwood EMS, Spring Valley EMS, Pepin Ambulance 13 Tri County EMS Association: Request for Proposal EMS Billing Services

14 SUBMITTED BY: (EMS Billing Company) (Address) (Authorized Signature) (Title) (Telephone) (E mail address) (Date) 14 Tri County EMS Association: Request for Proposal EMS Billing Services

15 Appendix A Tri County EMS Association (Municipal) Members: o o o (Polk Co) Amery EMS, Osceola EMS, Northland Ambulance, Clear Lake Ambulance (St. Croix Co) Baldwin EMS, Hudson EMS, Glenwood City EMS, New Richmond EMS (Pierce Co) River Falls EMS, Ellsworth EMS, Maiden Rock/Plum City EMS, Elmwood EMS, Spring Valley EMS, Pepin Ambulance 15 Tri County EMS Association: Request for Proposal EMS Billing Services