Fund for Public Health in New York 291 Broadway, 17th Floor, New York, NY 10007 Phone: (212) 266-7821 Fax: (212) 693-1856 www.fphny.org Medical Billing and Coding Training Program Request for Proposals Due Wednesday, June 15, 2011 at 5:00 p.m.
INTRODUCTION The Fund for Public Health in New York, Inc. (FPHNY) is a 501c3 not-for-profit organization incorporated in 2002. FPHNY is the closely affiliated, non-profit partner to the New York City Department of Health and Mental Hygiene (DOHMH), responsible for soliciting, administrating and receiving funds, and using such funds to further assist the work of DOHMH. Through this partnership, DOHMH and FPHNY work to advance the health and well-being of all New York City residents by supporting innovation, increasing efficiency, and leveraging DOHMH program capacity and reach. FPHNY is partnering with DOHMH, Workforce Development Corporation (WDC), and New York City Department of Small Business Services (SBS) to provide medical billing and coding training to low-income employees of small primary care physicians offices in order to increase administrative efficiencies and maximize reimbursements for medical practices, while also providing employees with the opportunity to build their skill set and professionally advance. The six-month program will enroll up to 50 incumbent healthcare workers at physician practices enrolled with the DOHMH s Primary Care Information Project (PCIP) and other small physician practices that meet PCIP s membership criteria, which requires that practices are primary care practices with 10 or fewer physicians and with a minimum of 10% of Medicaid and/or uninsured patients. The Bureau of PCIP was established in 2005 to assist small primary care practices in underserved communities with the adoption and effective use of health information technology. Towards this aim, FPHNY is seeking a provider to deliver training in medical billing and coding to selected healthcare workers. 1 STATEMENT OF PURPOSE The Fund for Public Health in New York, in collaboration with the Workforce Development Corporation, NYC Small Business Solutions, and NYC Department of Health and Mental Hygiene is requesting proposals from qualified vendors to deliver training in medical billing and coding for up to 50 health care workers employed by primary care physicians offices. The selected vendor will provide comprehensive instruction that prepares trainees for the National Healthcareer Association s (NHA) or the American Academy of Professional Coders (AAPC) certification examinations. Participating physicians offices will sign a Letter of Agreement committing to pay employees during training and to give wage increases of at least 5% within three months after the successful completion of training. The program will target low-income healthcare workers (no enrolled participant may earn greater than $60,838) in the billing/coding function, understood to have inadequate formal training to do the job effectively and efficiently. The program will offer physicians offices a solution to increase efficiencies and decrease losses in revenue while also providing their staff increased wages and the opportunity to pursue a broader career path. 1.1 SUMMARY SCOPE OF SERVICE AND PROJECT TIMELINE The selected training provider must propose and deliver a complete curriculum, including goals and objectives, instructional plan, and performance assessments, for an intermediate to advanced level course in medical billing and coding. The provider should assume that participants have basic experience in medical billing and coding. The provider may propose a complete curriculum for an existing course offering in medical billing and coding, if appropriate, or propose a customized curriculum based on the guidelines provided below. If the provider proposes a customized curriculum, the budget should reflect the time and effort required to develop a new curriculum. The training provider must be familiar with health information technology and propose a curriculum that integrates current electronic health record technologies designed to increase administrative efficiencies, improve revenue cycle management, and reduce claims denials. It is strongly preferred that the selected training provider have knowledge of reimbursement regulations. The curriculum 2
must include instruction for using current coding systems such as ICD-9 and CPT-4, electronic claims, and knowledge of HIPAA and insurance requirements. Upon completion of training, participants will be prepared to obtain industry-recognized billing and/or coding certifications, and knowledgeable of: Different types of medical insurance coverage and requirements to ensure that patient claims are directed to correct insurance company with adequate documentation to avoid denials Medical, anatomy and physiology terminology in order to determine whether the provider s documentation (medical notes) corresponds with patient charges Medical coding CPT, ICD-9, HCPCS and modifiers, in order to correctly create medical billing claims, including appropriate codes and other documentation/forms Billing workflows and documentation in an EHR-enabled environment Electronic Remittance Advice and EOB in order to advise practices in correct charge reconciliation The role of clearinghouses in medical billing The credentials process in order to understand how providers are enrolled with health plans A/R management, including collection and appeals, in order to incorporate workflows into the practice in order to sustain practice income EHR Meaningful Use, PQRI, and e-prescribing financial incentive programs The above goals are the minimum of the curricular fundamentals. Successful proposals will encompass the purpose stated above as well as any additional curricular elements appropriate for the topic and level of instruction. The selected training provider must maintain ongoing communication with FPHNY. The training provider must monitor trainee attendance and report presence and grades to FPHNY on a monthly basis. In order to ensure that trainees are eligible to partake in the program and that they are compensated for their time spent in class, the training provider must manage the collection of payroll from trainees and submit to FPHNY. The training provider will schedule classes at varying times in order to provide maximum access to staff working unusual hours. Online instruction is not allowed, however, submission of assignments via an online system is permitted. Instruction should be conducted during the period of September 2011 April 2012. 2 SCHEDULE OF EVENTS The deadline for this proposal is June 15, 2011 by 5:00 p.m. Late proposals will not be accepted. The following schedule of events represents the best estimate of the schedule that will be followed. Unless otherwise specified, the time of day for the following events will be between 9:00am and 5:00pm EST. EVENT DATE Release of RFP. 5/9/11 Inquiry Period. 5/9/11 5/23/11 Letter of Intent Due (non-binding). 5/18/11 Questions Due (questions received after this date will not be 5/23/11 answered). Questions Answered- all questions and the answers to them will be 6/1/11 released to all candidates via email and posted on FPHNY s website. Proposal Deadline (late proposals not accepted). 6/15/11 Estimated Notice of Award. 7/15/11 3
3 RFP COMMUNICATIONS Potential vendors may submit questions about this RFP electronically to: Megann Strajcher, Grants Administrator E-mail: mstrajcher@fphny.org All questions must be received by May 23, 2011 at 5:00 p.m. No other contact with FPHNY, WDC, SBS, and DOHMH personnel regarding this project is permitted in the period between the release of this RFP and the notice of award. Any oral communication shall be considered unofficial and non-binding with regard to this RFP and subsequent award. 4 PROPOSAL APPLICATION AND SUBMISSION REQUIREMENTS 4.1 APPLICATION REQUIREMENTS 4.1.1 LETTER OF INTENT To allow staff to plan the review of proposals, prospective applicants are strongly encouraged to submit a letter of intent that includes an acknowledgement of interest in applying for this opportunity, the name of the applying institution, as well as the name and e-mail address for the primary contact person. The letter of intent is not binding and is not considered in the review of the application. However, these letters are administratively very helpful, and as indicated above, strongly encouraged. Please submit a letter of intent electronically to Megann Strajcher at mstrajcher @ fphny.org by May 18, 2011 at 5:00 p.m. 4.1.2 APPLICATION Each response to this RFP must consist of: Completed Proposal Transmission Sheet (Attachment 1) Section A: Qualifications and Experience (Maximum 3 pages) o Provide a statement that the provider organization is adequately staffed and trained to perform the required services. Provide the name and title of the contact for day-today operations. Attach an organizational chart highlighting the key personnel who will be assigned to accomplish the work required by this RFP, illustrating the lines of authority. Attach the curriculum vitae of key personnel. o Describe criteria provider uses to hire trainers and how provider evaluates individual trainer performance. Attach the curriculum vitae of current trainers. o Describe provider s prior experience developing and implementing medical coding and billing curricula integrating the utilization of health information technology. Experience examples include: Minimum of 3 years experience working with medical billing and coding subject matter Prior experience providing training to businesses or professional audiences for the purpose of improved workplace performance Knowledge of relevant regulations Prior experience and knowledge of electronic health records and functionalities o Provide as attachments: Training provider organizational chart Curriculum vitae for key personnel and trainers 4
Client references - Provide three (3) Client references that can verify the vendor s claims and quality of service rendered. Section B: Project Management and Innovation (Maximum 5 pages) o Describe how project will be managed o Describe the mode of training (i.e., classroom-based, bookwork, online submission of assignments, combination), frequency and time of day of course installments, suggested class size, student-teacher ratio, description and locations of rooms, and in which languages training will be offered. o Describe how issues or problems will be identified and resolved during the course of the project. o Describe how EHR-related training will be integrated in the curriculum (e.g., which EHR systems will be used, how will systems be available to students) o Describe mechanisms to maintain ongoing communication with FPHNY. Topics that must be addressed include: How provider will monitor trainee attendance and report presence monthly to FPHNY How provider will manage the collection of payroll from trainees and submit to FPHNY How provider will report grades to FPHNY o Provide a statement that the provider does not have any commitments or potential commitments, which may impact ability to perform the services described. o Provide as an attachment a complete description of the proposed course. Please include the following components: Goals and objectives Instructional plan Performance assessments Credentials expected as a result of training completion, if any o Provide an estimate, based on historical averages or professional experience, of the demand for Medical Billing and Coding courses among business owners in New York City. Please cite sources. o Provide a breakdown of the number and type of businesses who are common customers for this type of training, specifying: business size; business sector or industry (including, where available NAICS); and business location (at minimum by borough). Please also include any other factors that significantly influence demand. If no such data is maintained, industry statistics on demand for the proposed type of training are acceptable but not preferred. Section C: Itemized Budget Proposal o Cost-effective proposals will be given greater consideration. The final award amount depends on the availability and apportionment of funds and is subject to change. FPHNY reserves the right to award more or less than the full amount of funding requested by the proposers. o Payment will be based on successful completion of activities described below. o FPHNY will reimburse the Vendor for 30% of eligible costs once a student enrolls in the course. Enrollment will be defined as completed customer information forms, payroll stub, and employer commitment to wage gains. FPHNY will reimburse the Vendor for 30% of eligible costs upon 60% completion of course and will reimburse the remaining 40% after the student completes the full course (contingent upon receipt of final attendance report and grades.) Payment will be remitted within 30 5
o o o days upon receipt of required records including enrollment, training activity, and expenditure documentation and valid invoice. Providers that are proposing to develop a new curriculum should account for this in the budget proposal. Provide as attachments a proposed budget (in excel format) and narrative justification for resource allocations. Failure to submit any of these elements may cause the application to be considered non-responsive and rejected. Vendors will not be reimbursed for any costs incurred in preparing proposals 4.2 SUBMISSION REQUIREMENTS Each vendor must submit an electronic copy of the application. The format should be Microsoft Professional Office 2000 or compatible format. All Proposals in response to this RFP must be e-mailed to the following address, no later than June 15, 2011 at 5:00 pm: Megann Strajcher, Grants Administrator E-mail: mstrajcher@fphny.org Late proposals will NOT be considered. 4.3 METHOD OF AWARD A contract may be awarded to the successful vendor whose proposal is determined to be the most advantageous to FPHNY, DOHMH, WDC, and SBS. Proposals will be evaluated based on the factors described in Section 6, proposal evaluation. Please note that any awards made pursuant to this RFP are made contingent upon the availability of such funds and the successful negotiation of a formal contract between FPHNY and the recipient and the execution of such a contract by an authorized officer or agent of such applicant. All contracts entered into pursuant to this RFP shall incorporate all terms and conditions as are necessary to accommodate the grant-related, contract-related, statutory and regulatory restrictions that affect FPHNY, DOHMH, WDC, and SBS in relation to the funding activities and programs referred to herein. Subject to availability of funding and successful completion of the initial term of the awarded contract, FPHNY and the selected vendor may have the option to renew the contract for an additional one year period subject to mutually agreed upon terms and conditions. 5 EVALUATION PROCESS Evaluation Categories and Maximum Points Awarded The proposal evaluation process is designed to award the contract not necessarily to the vendor of least cost, but rather to the vendor with the best combination of attributes based upon the evaluation criteria. FPHNY reserves the right to conduct interviews, visit proposers place of business and/or place of instruction, and/or to request that proposers make presentations and/or demonstrations, as FPHNY deems applicable and appropriate. Although discussions may be conducted prior to award, FPHNY reserves the right to award a contract based on the initial proposal received, without discussions; therefore, the proposer s initial proposal should contain its best programmatic offering. An evaluation team will be made up of at least three (3) individuals. Section A: Qualification and Experience 6
Each Proposal will be evaluated on the provider s ability to: Demonstrate adequate staffing and capacity to complete the required scope of services Demonstrate three years of experience with providing medical billing and coding training to businesses or professional audiences for the purpose of improved workplace performance Demonstrate experience with EHR technologies and electronic claims Ability to effectively facilitate the discussion and learning of participants Provide references/recommendations from businesses verifying the vendor s capacity and experience providing instruction in similar subject matter to that proposed Proposals will be scored higher in this section if documentation of experience and qualifications can be provided for actual instructors for this course Section B: Project Management and Innovation Each proposal will be evaluated on the vendor s ability to: Propose an effective and efficient curriculum that reflects an understanding of the topic, the audience, and includes performance assessment tools and metrics that effectively gauge participant skill gain and likelihood to achieve proposed outcomes Manage trainee intake, screening to ensure that all trainees have the minimum knowledge to participate Incorporate courses that have been proven to lead to measurable outcomes and support wage gains of at least 5% Offer courses at times that are convenient for working participants and that are accessible throughout the five boroughs of NYC Demonstrate that effective processes will be in place to proactively identify and correct problems during the project period Demonstrate administrative capacity to collect documents such as registration and monitor attendance, report grades, track completion Deliver a curriculum that will achieve stated goals at a competitive per-trainee cost Maintain ongoing communication with FPHNY, and Demonstrate that provider does not have other commitments that would impact the provider s ability to perform the services described Section C: Budget Proposal Proposals will be evaluated on the vendor s ability to: Demonstrate and document a comprehensive understanding of the project resource requirements, Develop a budget based on costs for between 30 and 50 students, and Develop a budget that demonstrates an effective and efficient use of resources. If the provider proposes a customized curriculum, the budget should reflect the time and effort required to develop a new curriculum. All three proposal elements will be considered in the evaluation of proposals. The maximum points that shall be awarded for each of the categories are detailed below. CATEGORY Section A: Qualifications and Experience (Including, but not limited to items below) Instructor qualifications Organizational capacity Section B: Project Management and Innovation (Including, but not limited to items below) Curriculum 7 POINTS 25 45
Detailed explanation of how curriculum supports increases in business productivity and employee wages Accessibility Section C: Budget Proposal 30 MAXIMUM POINTS AWARDED 100 6. ADMINISTRATIVE CONDITIONS I. FPHNY reserves the right to change, postpone or cancel this solicitation, in whole or in part, to reject all submissions, or to award one or more or no awards off of this solicitation. This RFP may be unilaterally amended in writing at any time. If an RFP amendment is issued, such amendment will be conveyed to the bidders. II. Each proposal and material submitted in response to this RFP shall become the property of FPHNY. Selection or rejection of a proposal does not affect this right. All proposal information, including detailed cost information, shall be held in confidence during the evaluation process. This RFP document does not contain proprietary information; all information contained herein (or accumulated through other written or verbal communication), as well as all information describing this RFP process as a whole is not considered confidential. However, to the extent permitted by law, the information that a vendor provides in this RFI process will not be shared outside of relevant parties at DOHMH and FPHNY and members of the RFP Review Committee. III. Multi-year contracts are subject to modification or cancellation if adequate funds are not appropriated to FPHNY to support continuation of performance in any fiscal year succeeding the first fiscal year and/or if the contractor s performance is not satisfactory. FPHNY will notify the contractor as soon as is practicable that the funds are, or are not, available for the continuation of the multi-year contract for each succeeding fiscal year. In the event of cancellation, the contractor will be reimbursed for those costs, if any, which are so provided for in the contract that the contractor can show proof of work preformed under the agreement. IV. Prices proposed by the proposer shall be irrevocable until contract award, unless the proposal is withdrawn. Proposals may only be withdrawn by submitting a written request to FPHNY prior to contract award. This shall not limit the discretion of FPHNY to request proposers to revise proposed prices through the submission of best and final offers and/or the conduct of negotiations. V. Proposers will not be reimbursed for any costs incurred to prepare proposals. VI. A vendor shall not submit more that one proposal. VII. A vendor shall not submit multiple proposals in different forms, i.e., a vendor shall not submit one proposal as a prime contractor and permit a second vendor to submit another proposal with the first vendor offered as a subcontractor. This restriction does not prohibit different vendors from offering the same subcontractor as a part of their proposals, provided that the subcontractor does not also submit a proposal as a prime contractor. 7. RFP ATTACHMENTS Attachment 1: Proposal Transmittal Sheet 8
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[VENDOR PLEASE PRINT THIS ON OFFICIAL LETTERHEAD IF POSSIBLE] Medical Coding and Billing Training Program ATTACHMENT 1: PROPOSAL TRANSMITTAL SHEET PROPOSAL TRANSMITTAL The vendor must complete and sign this Technical Proposal Transmittal. It should be reproduced on the vendor s official letterhead if possible. It must be signed in the space below, by the individual empowered to bind the proposing entity to the provisions of this RFP and any contract awarded pursuant to it. If said individual is not the vendor s Chief Executive Officer, this document shall attach evidence showing the individual s authority to bind the proposing entity. Vendor s Legal Entity Name: Vendor Federal Employer Identification Number: Name and Title of Person Signing this Proposal Transmittal Sheet: Signature and Date: Project Director Name: Project Director Mailing Address: Contact E-Mail: Phone Number: Fax Number: