Okaloosa County BOCC — May 20, 2014 — EMS Billing RFP 23-14 — reading text

The Okaloosa County Board of County Commissioners, hereinafter referred to as the "COUNTY", is seeking proposals from qualified firms, hereinafter refered to as the “CONTACTOR", fo PROVIDE EMS AMBULANCE BILLING SERVICES, for Okaloosa County Emergency Medical Services, hereinafter referred to as "OCEMS”, In accordance with the terms, conditions, and specifications contained in this Request for Proposals (RFP). 1. ELIGIBILITY To be eligible to respond to this RFP, the proposing firm must demonstrate that they, or the principals assigned to this project, have successfully completed services similar to those specified in the Scope of Services section of this RFP for at least three governmental entities within-the-State-of Herida and are licensed, insured, bondable and Health Insurance Portability and Accountabillty Act (HIPPA) and Emergency. Medical Services Tracking & Reporting System (EMSTARS) compliant In the State of Florida, The proposal should demonstrate at least three years of documented successful experience with and current knowledge of ambulance services billing. Experience must include filing claims with government programs such as Medicare and Medicaid, as well as, commercial health insurance programs (HMOs and PPOs} and the processing of at least 24,000 transports per year with a minimum of 85% documented collectlon percentage rate, VARIANCES While the County aliows CONTRACTORS to make variances to the RFP terms, conditions, and specifications, the number and extent of variances taken will be considered in determining proposal responsiveness and in allocating proposal evaluation points. ADDITIONAL ITEMS/SERVICES The COUNTY may require additional items or services of a similar nature, but not specifically listed in the contract. The CONTRACTOR agrees to provide such items or services, and shall provide the COUNTY prices on such additional iterns or services based upon a formula or method which is the same or similar to that used in establishing the prices in the proposal. If the price (s) offered are not acceptable to the COUNTY, and the situation cannot be resolved to the satisfaction of the COUNTY, the COUNTY reserves the tight to procure those items or services from other vendors or to cancel the contract ° upon giving the CONTRACTOR fhirly (30) days written notice, CONTRACTTERM The contract term will be as defined In the enclosed contract document. Any allowances requested due to Increase must be requested prior to renewal. Fees shall be based upon contractor performance and expressed as per claim price or as a percentage of actual collections remitted to the OCEMS. Medicaid clalms are the exception and must be expressed as a flat rate per claim. These fees shall be all-inclusive 22 of materials and personnel required for the performance of the final negotiated contract. SECURITY FOR FAITHFUL PERFORMANCE A bid bond, cashier's check or certified check representative of five percent (5%) for the first year's fofal bid price must be submitted with the bid package. A payment and performance bond in the amount of $25,000 made out to the Okaloosa Board of County Commissioners, issued by and institution approved by the Counly, will be due at the signing of the contract by the successful bidder. IV. SCOPE OF SERVICES BACKGROUND It Is the intent of the COUNTY to establish a contract with an established billing services provider for the purpose of collecting fees from EMS patients, and their insurance carriers, transported via ambulance to health facilities by OCEMS, This RFP is intended to cover all points of a contract from the reporting by OCEMS of the service to the satisfaction of the receivable, including potential future placement with the contracted Collection Agency after CONTRACTOR’s collection efforts have failed. The COUNTY, via OCEMS, will initiate providing Advanced Life Support (ALS) ambulance services, Basic Life Support (BLS) and non-emergency ambulance services, and on-scene medical iteatrnent (non-transport fees) to the citizens and visitors of the COUNTY, within OCEMS boundaries In Okaloosa County, Florida, The COUNTY wishes to obtain the services of a qualified service provider for the actual billing of funds due and Accounts Receivable posting of funds received by OCEMS for these services. At this time, charges for service are as follows: SERVICES FEE Non-Emergency Medical Transportation Service $175.00 (+Mileage) Base Rate for BLS $800.00 (+Mileage} Base Rate for ALS ~ 1 $800,00 (+Mileage) Base Rate for ALS -2 $800.00 (+Mileage} Specialty Care Transport $800.00 (+Mileage) Mileage $15.00 per mile Treatment / No Transport $250.00 Ambulance Standby $200.00 per hour Non-profit Organization Ambulance Standby $120.00 per hour Quick Response Vehicle Standby (with 1 Staff Member} $100.00 per hour EMT (No Vehicle) $75.00 per hour Paramedic [No Vehicle} $100.00 per hour Records reflect that OCMES has estimated the following number of transports, which would fall under the scope of services under this contract: YEAR NUMBER OF BILLABLE TRANSPORTS* 2010 17,268 2011 19,154 2012 19,349 *The number of patient transports in prior years are considered to be estimated, and there fs no warranty or guarantee that future service requirements will remain constant. SCOPE OF WORK The successful contractor, under this agreement, will provide all services necessary to collect for services provided by OCEMS. These services shall include, but are not limited to: 1 2 Receipt from OCEMS of the patient data necessary for billlng. This data will come from a department approved “Patient Care Report” (PCR) In computerized format. The CONTRACTOR will be furnished with these reports elther In a batch mode via mail or electronic transfer. The patient care reports will be electronically generated in a format approved by this department in ruggedized tablet devices capable of supporting electronic PCR and automated vehicle location (AVL) functionality: a The CONTRACTOR shall be responsible for obtaining the appropriate software that will be compatible to interface with our computerized report wiiting system and to enter furnished data into their computerized billing system, The CONTRACTOR shall provide a GPS compatible AVL system that supports fleet management and real-time information sharing between field Units and dispatch. The CONTRACTOR will be responsible for reviewing each PCR for content to accomplish the following: a. Check for discrepancies to ensure the number of PCRs received match the number of patients transported as documented on the PCRs. This is particularly Important on multiple patents at one incident. Assign the appropriate biling code based on the documentation, ireatment and chief complaint of the patient. The CONTRACTOR will be responsible for sorting the PCRs In numerical/date order, as well as, sorting all the paperwork in a systematic order for billing organization and fuiure accessibility, To the extent possible, provide electronic claims processing and paper filings to all other insurance companies. The first invoice will be dated no later than fifteen (15) days after the date of service (DOS) or five (5) days after the contracted billing company has recelved the PCR, The second notice will be sent to the patient or responsible party thirty (30) days after the original invoice. The third notice (final notice) will be sent to the patient or responsible party atter 30 days 24 the second notice has been mailed. Services to be billed will include base fee, mileage, and hourly rate for ambulance/quick response vehicle standbys. 5. The contracted billing agency will be responsible for the initial collection generation of any and all insurance forms, fillings and record maintenance. The contracted billing agency will provide the contracted collection company with all accounts that have no payment activity for 180 days after the date of first billing. The CONTRACTOR will track the accounts turned over to the collection firm and will provide a monthly report to OCEMS listing the accounts surrendered to the collection firm. The CONTRACTOR will continue to work with the collection agency to assist with the following: . Information gathering Filing insurance claims for accounts in collections Review account status with collections firm and/or OCEMS, as required; ° Receive and handle phone calls for patients with accounts placed in collections; and . Receive, post and forward payments received on accounts placed in collections 6 Provision of all monthly finance, billing, recelvable and again reports as stated heraln. a, Collections profiles for each month, dating back to the beginning of said contract. b. Status of all accounts (payer max) for the current menth and total in system, c. Aging report. a. Monthly detail for current month reports. e Transport log. f, Month end Information for Finance. g. Monthly write off reports. h. Refund reports including refunds pending. I, HIPPA records release reports, J. Any additional reports that OCEMS may need or request will automatically be formatted fo thelr requirement and sent to the department. k, Dally payment logs with deposit confirmation attached, Month end payment logs to balance fo dailies. 25 ie 12. 13, 14, 15, 16. The CONTRACTOR will comply with the policles and procedures developed and Implemented by OCEMS in response to the Improvement of the department and the privacy act of HIPPA. The agency will enter into a business associates agreement with OCEMS to insure all HIPPA policies cre adhered to, Any violations of the HIPPA by contracted billing company will be grounds to terminate all contractual agreements. The CONTRACTOR will comply with HIPPA regarding protected health information (PH!) and guardian of all record sets and will maintain any and all documentation records and patient Information In a safe and secure manner allowing for Inspection and/or audit by the COUNTY. The CONTRACTOR will be required to store all record sets for a minimum of thirty- six (36) months and then turn them over to Okaloosa County for permanent storage, The CONTRACTOR will be In compliance with the Final Security Rule of HIPPA and remain under a business associates agreement during the duration of the contract, Provide sufficlent Customer Service Representative(s) to assist patients and/or other third party payees in alll billing inquiries in a timely manner, not to exceed three (3) business days. Conduct any follow-up required to obtain necessary Insurance information for payment processing. All payments received by the CONTRACTOR on behalf of OCEMS will be deposited to the COUNTY’s designated bank account within three (3) business days. Records of deposits will be correlated with database reports on a dally basis and this information will be faxed to the County on a daily basis, CONTRACTOR will follow-up with patient or patient's third party for collection of the receivable in increments of 30 days, 60 days and 90 days, after the Initial billing. OCEMS shall be provided information and a quarterly basis on those accounts deemed "non-collectlole except by further legal means" and OCEMS will decide the method in which it wishes to proceed, No such account will be reported as long as payments are being made In gocd faith. The CONTRACTOR agrees to negotiate and arrange a modified payment schedule for those individuals who are unable to pay the full amount when Invoiced. The CONTRACTOR is authorized to establish a monthly payment no less than $5.00 per month and ensure those individuals continue to pay at least the amount for the duration of the invoice, Collect remaining amounis after the patients insurance or other third party payments are made from the patient where permitted by law and provider agreement, The CONTRACTOR shall provide up to 4 hours training of EMS personnel annually, at the discretion of the EMS Division Chief, on changes in the