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

billing process and new requirements for data gathering as they occur. In addition, the contractor 26 must apply up to 3 hours tralning annually on the use of the read-only version of the software to be provided under this contract for OCEMS-based use. 17, The CONTRACTOR also agrees to provide: d, b. All invoices and related Insurance forms with remitiance advice. Return envelope with the address to be designated and approved by OCEMS. Window envelopes are acceptable for satisfying this requirement. Postage for the mallling of all said invoices and forms for the billing operation. Patient statement with a message stating “all checks must be made payable to Okaloosa County EMS". Sample of jnyoice to be provided. Reasonable effort to locate and correct any incorrect billing address for billable patients. A working arrangerment with all OCEMS service hospitals, Areconciliation report on the 15'* and the last day of the month that will show all patients that have been billed for the previous 15 days. The invoice will display the PCR number, date of service, level of care (BLS, ASL< ALS-2, SCT, etc.), miles transported, patient billing code assignment, and the total amount of the invoice, A reconciliation report on the 15th and the last day of the month that will show a breakdown of BLS/ALS/ALA-2 patients and the mileage charges for each category. It will be broken down per category to ensure all PCRs processed and forwarded to the CONTRACTOR have been processed within approved time line. The CONTRACTOR must provide OCEMS with a refund request including all patient information relating to refund payments to patients and/or Insurance company indicating the refund payee's name, address, and reason for refund, The CONTRACTOR shall follow up on electronically submitted claims for which payment has net been received belween 30 and 45 days following Initial submittal. Follow-up shall be accomplished on all unpaid paper claims between 45 & 60 days after Initial submittal. Follow-up efforts and results must be documented and avallable to the COUNTY. Follow-up efforts subsequent to the initial effort must also be documented and retrievable, The CONTRACTOR agrees to provide the COUNTY with information necessary for OCEMS to pursue collection of non-sufficient fund checks. 27 20, 1, Glven reasonable notifications, OCEMS has the right to aucit all financial records pertaining to the billing and collection for OCEMS m. Subpoenas: Any subpoena request processed through OCEMS and sent to the individual names on the subpoena requesting the medical records, n. The CONTRACTOR will keep a log of the medical records sent out in compliance with subpoenas or other legal and HIPPA compliant request and will send a copy of the PHI log electronically fo the Privacy Officer of HIPPA on a monthly basis, A copy of the request will also be placed in the medical records. oO, The CONTRACTOR will comply with any special report request in reference to transport locations and response modes to specific locations on a case by case basis. Reports: qa, 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 perlod. (Pravide sample of this report.) Aged Recelvable 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 provide totals for these categories, (Provide sample of this report.) Patient Alpha Listing — This report lists all patients alohabetically by patient name. (Provide Sample of this report.) Monthly Payment Listing ~ This report lists payments, required charge offs (adjustments), and refunds posted to each patient's account, (Provide sample of this report.} Overpayment (Refund Request) Reports ~ This report lists all patients due refunds as a result of overpayment of account. (Provide sample of this report.) NSF Check Reports ~ This report lists all patients that have made payment with checks that have been returned for non sufficient funds of an account. (Provide sample of this report.) Additionally, any other mutually agreed upon report (s) as may be required. Responsibllity of OCEMS: OCEMS will provide the necessary patient and insurance information to the CONTRACTOR on a twice weekly basis for those patients that have been recently transported or freated at scene. (Period may be adjusted dependent upon volume.) 28 OCEMS will comply wiih all Federal, State and local laws, rule and regulations as applicable to the services being contracted for. OCEMS will agree to use the successful firm for all medical billings exclusively for the service specified herein as long as the contract agréement is in force, except for accounts past due six (4) months or more that have been deemed uncollectible by the CONTRACTOR and OCEMS., 21, Performance Schedule: Patient statements shall be at maximum intervals of 35 days with no patient receiving a statement until their insurance has had ample opportunity to act on the claim. Ample opportunity is defined as at least 60 days, Initial bills to insurance carriers are to be sent within fiffeen (15) business days of the Date of Service of five (5) days of the CONTRACTOR receiving all necessary information to enable the bliling process, The Proposer shall include sample bills forms and sample messages that can be used on patient statements, as part of the response, Alliext, format, color or printing and stock subject to approval by OCEMS. V. PROPOSAL FORMAT The Proposal must name all persons or entities interested in the proposal as principals. The proposal must be declared that It is made without collusion with any other person or entity suomitting a proposal pursuant to this Request for Proposal. Proposer shall prepare their proposals using the following format with each section clearly labeled and shall include the following: qa. b, Letter of Transmitial. Statement acknowledging receipt of each addendum Issued by the COUNTY. Qualifications and experience of the firms(s} /Individual{s) who will provide the services which shall include documentation of the firm's experience In similar work, List at least two (2) current and pertinent professional and financial references (name, address, and phone number} that the COUNTY may contact in relations to the Proposer’s qualifications, experience and stability. Scope of Work - This section of the proposal should explain the Scope of Work as understood by the Proposer and detail the approach activities and work products, The proposal shall Include: 1} A rationale for the approach taken for schedule of deliverables. 2) A list of work product which the Proposer will provide. 29 3) 5) 8) ?) 8) 9) 10) 11) A list of any assistance OCMES may be requested to provide the Proposer. Provide completed cost proposal (Attachment “A”). Provide evidence of current levels of Insurance In areas of General Liaiollity and Professional Liability or evidence of insurability. Provide a statement of Proposer's financial stability, including information as fo current or prior bankruptcy proceedings. Provide a summary of any litigation filed against the proposer in the past three years which Is related to the services that Proposer provides in the regular course of the business, The summary shall state the nature of litigation, a brief description of the case, the outcome or projected outcome, and the monetary amount invoived, Identify the type of business entify involved {i.e., sole proprietorship, partnership, corporation, etc,). Identify whether the business entity is incorporated in Florida, another state, or a foreign country. In the case of a sole proprietorship or partnership, provide Social Security numbers for all owners or partners. If proposer Is a corporation, provide certification from the Florida Secretary of State verifying Proposer's corporate status and good standing, and in the case of out-of-state corporations, evidence of authority to co business in the State of Florida. Any additional information that the Proposer considers pertinent for consideration should be Included in separate sections of the proposal. The COUNTY solicits a statement about why the Proposer feels Its approach would be the most cost effective to the COUNTY. 30 ATTACHMENT A (Format for Pricing) Overall contract fee or percentage for providing Billing & Receivable services as outlined in the attached Scope of Services for all billings EXCEPT FOR MEDICAID CLAIMS. ESTIMATED CLAIMS X AVERAGE EXPECTED COLLECTIONS X PERCENTAGE FEE PER AMOUNT COLLECTED ~ ALL COSTS INCLUDED Claims x $ Estimated average collection per claim x Vendor percentage = Total County Cost. OR x Claims x $ Estimated average collection per claim x % =F (Insert Count's estimate where the x appears above,} Are the above costs fixed for the three year duration of the contract? Yes {} / No ()} lf no, quantify any and all factors that will Influence the cost of the service with a guaranteed percentage yearly maximum for each year of the contract. Year I % Year 2 % Year 3 % * MEDICAID CLAIMS must be shown as a flat rate for performing any billing. This shall be per billing and shall not percentage. The COUNTY estimates there will be approximately such claims annually based on past experience or projections. This is an estimate only and does not In any way guarantee’ the CONTRACTOR will be paid this amount. A "billing" is defined as a separate and Inijial paper or electronic transaction to recover costs from Medicare of Florida Medicaid and any and all follow-up or secondary filing associated with an ambulance run on that specific date of service, $ /Billing x bills = $ per yeor. (Insert county's estimate where x appears above.) What fee does the proposer pay for the processing of the following credit card transactions? This assumes that the Vendor will only pass along the vendor's cost of this service — additional vendor fees are not allowed. The COUNTY recognized that these fees are adjusted periodically by Credit Card service providers and expects these fees to be adjusted accordingly, however, the COUNTY must receive a copy of the notification t 31 provided to the Vendor by the Credit Card processor prior to the vendor adjusting these fees: Master Card: Visa: American Express: Vendor Name Address Phone/Contact Person 32 REFERENCE SHEET Refer to Proposal Specification NAME OF CUSTOMER ADDRESS PHONE NUMBER PERSON TO CONTACT NAME OF CUSTOMER ADDRESS PHONE NUMBER PERSON TO CONTACT NAME OF CUSTOMER ADDRESS PHONE NUMBER PERSON TO CONTACT NAME OF CUSTOMER ADDRESS PHONE NUMBER PERSON TO CONTACT NAME OF CUSTOMER ADDRESS PHONE NUMBER PERSON TO CONTACT 33