COUNTY OF NORTHAMPTON, VIRGINIA REQUEST FOR PROPOSALS FOR AUTOMATED AMBULANCE BILLING, INSURANCE SERVICES & COLLECTION SYSTEM

Transcription

1 COUNTY OF NORTHAMPTON, VIRGINIA REQUEST FOR PROPOSALS FOR AUTOMATED AMBULANCE BILLING, INSURANCE SERVICES & COLLECTION SYSTEM Date of Issue Monday, June 20, 2011 Due Date for Proposal Wednesday, July 6, 2:00 p.m. 1

2 Table of Contents PUBLIC NOTICE... 4 Instructions & Information... 5 I. INTRODUCTION... 7 II. SCOPE OF WORK TO BE PERFORMED... 7 A. Overview... 7 B. EMS Chart Processing... 7 C. Proper Patient Care/Medical Necessity Documentation... 8 D. Patient Authorization and Insurance Information... 8 E. Verification and Missing Information Follow-Up... 8 F. Customer Service... 9 G. Accounts Receivable and Transaction Posting... 9 H. Rejection Follow-Up I. Patient, Commercial, Entitlement Follow-up J. Billing Process K. Patient Refunds L. Term of Contract M. Project/Contract Description N. Sub-Contracting of Work O. County s Responsibility III. PROPOSAL PREPARATION AND SUBMISSION A. Format of the Proposal B. Contents of the Proposal IV. PROPOSAL EVALUATION CATEGORIES AND MAXIMUM POINTS V. PRICE PROPOSAL AND PAYMENT TERMS VI. GENERAL TERMS AND CONDITIONS FOR PROFESSIONAL SERVICES A. SUBMISSION OF PROPOSAL B. CLARIFICATION OF TERMS C. APPLICABLE LAWS AND COURTS D. ANTI-DISCRIMINATION E. ETHICS IN PUBLIC CONTRACTING F. IMMIGRATION REFORM AND CONTROL ACT OF G. QUALIFICATIONS OF PROSPECTIVE BIDDER

3 H. CHANGES TO THE CONTRACT I. DEFAULT J. CANCELING OR AMENDING A SOLICITATION K. PROTEST OF AWARD OR DECISION TO AWARD L. CLAIMS VII. SPECIAL TERMS AND CONDITIONS A. AVAILABILITY OF FUNDS B. CANCELLATION OF CONTRACT C. EXTENSION OF CONTRACT D. RETENTION OF WORKING PAPERS E. SUBCONTRACTS

4 COUNTY OF NORTHAMPTON, VA REQUEST FOR PROPOSALS FOR AUTOMATED AMBULANCE BILLING, INSURANCE SERVICES & COLLECTION SYSTEM PUBLIC NOTICE The Board of Supervisors of Northampton County, Virginia is requesting proposals from qualified entities to provide automated ambulance billing, insurance services and collection system for the Northampton County Department of Emergency Medical Services. A complete package providing more detailed information may be obtained at: Office of the County Administrator Katherine H. Nunez, County Administrator County of Northampton 7247 Young Street Machipongo, VA (757) Responses are due by 2:00 p.m., Wednesday, July 6, Place the original response along with five (5) copies in a sealed envelope or container clearly labeled Request for Proposals for Ambulance Billing, Insurance Services and Collection System. The proposal shall be signed by an authorized proposer or representative. Any response received after this date and time, whether hand-delivered, submitted via U.S. Postal Service, or submitted via any other delivery service, will not be accepted or considered. Any questions concerning this Request for Proposal should be directed to Hollye Carpenter, Emergency Services Coordinator, at (757) The County reserves the right to amend or cancel this Request for Proposals at any time if it is in the best interests of the County. The County reserves the right to reject any or any part of all responses and to waive informalities and technicalities. 4

5 County of Northampton Automated Ambulance Billing, Insurance Services & Collection System, with Four One year Renewals Instructions & Information A. Proposals must be submitted in a sealed package and received in accordance with the instructions detailed in the cover letter. All submittals shall be marked "Ambulance Billing. Proposal Offerors shall enclose all documents necessary to support their submittal. B. Offerors shall be responsible for the actual delivery of submittals during business hours to the address indicated in the cover letter. It shall not be sufficient to show that the submittal was mailed in time to be received before the scheduled closing time. C. Five complete sets of all required documents shall be submitted. D. The statement of qualifications shall contain all elements described in this request. Offeror may submit other information he feels may be important in the evaluation of his firm's capabilities. E. The County of Northampton reserves the right to reject any and all submittals and to request clarification of information from any Offerors. F. Offerors may be required to submit additional information that the County may deem necessary to further evaluate the Offeror's qualifications. G. The County of Northampton will not reimburse Offerors for any costs associated with the preparation and submittal of any statement of qualification, or for any travel and per diem costs that are incurred. H. All submittals, responses, inquiries, or correspondence relating to or in reference to this RFP, and all reports, charts, and other documentation submitted by Offerors shall become the property of the County of Northampton when received. I. The County shall be the sole judge as to the merits of qualifications submitted by Offerors. The decision of the County shall be final and only those Offerors considered to be qualified shall be interviewed. J. All statements of qualifications will be reviewed and ranked by the RFP Selection Committee (County Administrator, County Finance Director, County Treasurer, EMS Director) based upon the committee members' evaluation of suitability of each respondent to the requirements of the RFP. Selection shall be made of two or more Offerors deemed to be fully qualified and best suited among those submitting proposals, on the basis of the factors involved in the Request for Proposal, including price if so stated in the Request for Proposal. 5

6 Negotiations may then be conducted with each of the Offerors so selected. Price shall be considered, but need not be the sole determining factor. After negotiations have been conducted with each Offeror so selected, the RFP Selection Committee shall select the Offeror which, in its opinion, has made the best proposal, and shall make a recommendation to the Board of Supervisors to award the contract to that Offeror. Should the Selection Committee recommend and the Board of Supervisors determine in writing and in its sole discretion that only one Offeror is fully qualified, or that one Offeror is clearly more highly qualified than the others under consideration, a contract may be negotiated and awarded to that Offeror. 6

7 I. INTRODUCTION The Board of Supervisors of Northampton County requests qualified vendors to submit proposals to provide an automated ambulance billing, insurance services and collection system for the Northampton County Department of EMS. The attached scope of work defines the provision of a fully comprehensive and automated medical billing and collection system to include technical and administrative support for the Northampton County Department of EMS. The Northampton County Department of EMS provides pre-hospital medical evaluation, treatment and/or transportation to hospitals in the Tidewater area. In 2010, emergency medical services accounted for 2,760 calls with 1,385 patients transported to a hospital. Billable transports per year could be as few as 250 and as many as 1,500. II. SCOPE OF WORK TO BE PERFORMED A. Overview The County of Northampton plans to contract with a qualified firm for services regarding ambulance transport billing and third party billing including filing of insurance claims and collections. The following is a general outline of the type of work to be performed. The exact scope of work to be performed is subject to negotiation prior to acceptance. This outline is intended as a guide for consultants to analyze the scope of services sought and to demonstrate their qualifications for performing this work. Any questions concerning this Request for Proposals shall be submitted prior to submitting a proposal. The following guidelines will be included in a contract for services that will be required of the selected firm. B. EMS Chart Processing The contractor will provide all labor, material and equipment, to gather all essential information for generating and processing all EMS charts related to the Northampton County Department of EMS (NCEMS). Emergency medical services include, but are not limited to, the emergency treatment and/or transportation of patients, nonemergency treatment and/or transportation of patients, inter-facility patient transfers and patient refusals of treatment and/or transport. Essential EMS Chart information includes: patient demographics origin and destination of transport, run times, responsible party, chief medical complaint, insurance information, technician information, type of medical assistance given, basic life support (BLS), advanced life support (ALS) and procedures performed by technicians. The Northampton County Department of EMS recognizes the importance of accurate and complete EMS Chart information. However, sometimes due to the serious nature of some patient s medical condition at the time of service, NCEMS personnel may not be able to obtain complete and accurate EMS Chart 7

8 documentation of information required by the contractor. To ensure generation and completeness of the EMS Chart, the contractor will provide appropriate training to ensure NCEMS members who are involved in the medical billing process, including pre-hospital providers, will have the necessary skills, knowledge and abilities to accurately prepare the EMS Chart. NCEMS will provide facilities, equipment and supplies for contractor conducted training. The contractor will be responsible for providing all training instructors and materials. All training will be conducted at the NCEMS training center, Machipongo, VA. The contractor will be responsible for providing NCEMS with the latest changes and modifications of the EMS Chart as required by the applicable insurance providers or as mandated by state and federal agencies. C. Proper Patient Care/Medical Necessity Documentation The contractor will provide training as listed above and continually provide updates and feedback to NCEMS management for proper demographic documentation as well as proper medical documentation for both transport and non-transport patients. The contractor will ensure proper documentation of medical care rendered and medical necessity (chief complaint) of all EMS Charts. The contractor will be responsible for providing quarterly written reports to NCEMS management on areas of deficiency and identify areas where NCEMS pre-hospital personnel can improve documentation. To ensure completeness and proper patient care/medical necessity documentation on the EMS Chart, the contractor will provide appropriate training to all NCEMS members concerning documentation, charges and requirements. D. Patient Authorization and Insurance Information The contractor will ensure completeness of the EMS Chart and patient insurance information. For quality control and checklist for documentation for NCEMS review, appropriate ongoing training by the contractor will be provided. E. Verification and Missing Information Follow-Up The contractor will provide all labor, materials, and equipment for verification of EMS Chart patient information. The contractor will gather missing patient information by but not limited to: searching the Medicare, Medicaid and other applicable carriers, including commercial insurance provider s data bases for previous patient information; searching the vendor s billing data base; contacting the medical facility; or by direct patient, family member or responsible party contact. When the contact is made with the responsible party, the contractor will verify and correct all patient information. Data Entry and Claim Submission: NCEMS utilizes EMS Charts, a web-based program for electronic charting. The contractor will be responsible for ensuring compatibility of information transfer from EMS Charts for downloading of patient information into the vendor s software. 8

9 The contractor data entry personnel at their location will perform these functions. The following functions will be performed at the data entry level: Automatic/demand claims processing with second request filing Validation and edition of all data fields that are applicable to, but not limited to the following insurance forms: i. Medicare ii. Medicaid iii. Anthem iv. Optima v. CHAMPUS vi. HCFA-1500 for all commercial insurance carriers vii. Electronic filing to all applicable carriers F. Customer Service The contractor will appoint a Customer Service Representative who will provide patient account information Monday through Friday, 9:00 am through 5:00 pm EST, excluding all major holidays. G. Accounts Receivable and Transaction Posting The contractor will be responsible for providing a written report on a monthly basis on the status of all uncollected patient accounts. All patient account payments (checks, cash, and money orders) will be sent to Northampton County EMS, PO Box 235, Eastville, VA Northampton County will be responsible for receiving and depositing ALL payments associated with pre-hospital medical billings. All data entry and posting shall be accomplished by the contractor. NCEMS will be responsible for the deposit and accounting records required by the Northampton County Treasurer. NCEMS will provide to the contractor an explanation of benefits (EOB) received from insurance providers and any accompanying correspondence for posting purposes weekly. The contractor, at a minimum, will develop the following information in an electronic and paper media format for inquiry to patient account. The contract shall be able to upload and download billing information in the EMS Charts for viewing by NCEMS. The contractor will provide, upon request paper media with all raw data and the following information: 1. The patient s account receivable report to include: Account s over thirty (30 days) Beginning and ending accounts balance by summary charges Payments by responsible parties Adjustments Net total 2. Prepare a revenue analysis report which will provide current month and YTD collection information from each responsible party. 9

10 3. Prepare an insurance follow-up written report by individual carrier for any outstanding and/or pending patient claims. 4. Prepare an aged patient account analysis report in summary (per selected parameters) or in detailed by all responsible parties. The contractor will be responsible for transaction posting to each patient account that applies to payments, adjustments, refunds/credits and resubmission of insurance provider claims. The contractor will be required to update all patient information when patient information is found to be incorrect. The contractor will sync all electronic records with EMS Charts, allowing NCEMS authorized personnel to access all information related to patients accounts. H. Rejection Follow-Up The contractor will be responsible for the follow-up on each medical claim for service rejected by any insurance provider. The contractor will be responsible for contacting insurance providers by telephone, mail, fax, electronically in order to resolve each rejected claim, on a claim-by-claim basis. The contractor will be responsible for furnishing insurance providers with all requested patient information, medical information, medical documentation and the resubmission of the rejected claim. The contractor will prepare and deliver a written report for all rejected claims detailing the reason for rejection and provide documentation of each claim resubmitted on a monthly basis. I. Patient, Commercial, Entitlement Follow-up The contractor will be responsible for regular follow-up on unpaid accounts older than thirty (30) days to ascertain the accuracy and availability of insurance information. The contractor will send an original invoice for services provided by NCEMS within ten (10) working days for the receipt of the EMS Chart. The contractor will generate and mail a statement of account to patients, responsible parties and/or insurance carriers thirty (30) calendar days after the original date of service. The contractor will again generate and mail a statement of account to patients, responsible parties and/or insurance carriers sixty (60) calendar days after the original date of service. Patient accounts reaching ninety (90) calendar days old and remaining unpaid will require the contractor to send a pre-collection notice. The final notice for collection will sent after one hundred twenty (120) days. The format of each of these notices will be in accordance with Northampton County policy. In all cases the contractor will be responsible for preparing and mailing all invoices and overdue notices. J. Billing Process The contractor will provide an automated billing system, fully compatible with EMS Charts. 10

11 K. Patient Refunds The contractor will prepare and deliver a written monthly report of all responsible party billings which reflect an overpayment. The County will process all refunds. L. Term of Contract This contract is for an initial term of one year and may be renewed by the County for four (4) successive one year periods under the terms and conditions of the original contract. Upon a determination by the County to renew this contract for an additional term, written notification will be give to the contractor no later than 60 days from expiration of the contract. M. Project/Contract Description Any resulting contract shall be effective upon endorsement and shall be in effect or a period of time to be determined as a result of the selection process. The continuation of any contract and the terms, conditions and provisions pertaining thereto beyond any fiscal year is subject to the approval and ratification by the County of Northampton. N. Sub-Contracting of Work No portion of the work will be assigned to a sub-contractor without the written consent of the County. O. County s Responsibility The county shall: Provide to the contractor all information in possession of the County which relates to the County requirements for the project or which is relevant. Assist the contractor in obtaining permission to enter upon public and private property as required for contractors to perform the services. Examine all studies, test results, sketches, drawings, specifications, proposals, and other documents presented by the Contractor. Designate a person(s) to act as the County s representative with respect to the work to be performed under this agreement. Such person shall have the authority to transmit instructions, receive information, interpret and define the County s policies and decisions. III. PROPOSAL PREPARATION AND SUBMISSION A. Format of the Proposal Proposals should be as thorough and detailed as possible so the Local Government may properly evaluate the Vendor s ability to provide the required services. Each 11

12 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. B. Contents of the Proposal The Vendor is required to submit the following items as a complete proposal: 1) Title Page Show the RFP subject, the name of the Offeror's firm, physical and mailing address, telephone number, name of contact person and date. 2) Letter of Transmittal that includes the items listed below. a) History of the firm, including number of years in business and size of firm. b) A statement by the prospective Vendor of his understanding of the work to be performed with descriptions of the billing approach and illustrations of the procedures to be employed. c) Biographies, including experience, of the individuals who will be assigned to the engagement. d) Names, addresses and telephone numbers of persons who may be contacted for reference. 3) Submission of Price Proposal (see Section below). IV. PROPOSAL EVALUATION CATEGORIES AND MAXIMUM POINTS The categories that shall be considered in the evaluation of proposals are Qualifications and Experience, Technical Approach, Presentation/Interview (if required) and Cost. The maximum points that shall be awarded for each of these categories are: CATEGORIES MAXIMUM POINTS POSSIBLE General Proposer Qualifications & Experience 35 Technical Approach 30 Presentation/Interview (if required) 10 Cost Proposal 25 12

13 V. PRICE PROPOSAL AND PAYMENT TERMS This will be the first time Northampton County has billed for EMS services. The contractor shall assist NCEMS in setting fixed rates for Basic Life Support (BLS) transports, Advanced Life Support (ALS) 1 Transports, ALS 2 transports and loaded mileage rate. All contractor's, as part of their proposal, will specify a fixed percentage rate of revenues received by the county as direct result of the Contractor s service for the purpose of determining the Contractor s fees. These fees will remain in place for a minimum of one year and then reviewed annually to ensure fees are adequate. The fee will be paid on a month basis and will be based on all the net sums received from all responsible parties and insurance providers that are forwarded to the County for deposit (gross receipts, less refunds). Accounts turned over to the County for additional collection efforts, as deemed appropriate, will not be included in determining the contractor s fees. Each contractor must submit a single fee with their proposal; the contractor s fees for services to be provided will be a percentage of actual dollars collected during the previous month. VI. GENERAL TERMS AND CONDITIONS FOR PROFESSIONAL SERVICES A. SUBMISSION OF PROPOSAL Failure to submit a proposal in accordance with the requirements set forth in this solicitation is cause for rejection of the proposal. However, the Local Government reserves the right to decide, on a case by case basis, in its sole discretion, whether or not to reject such a proposal. B. CLARIFICATION OF TERMS If any prospective Offeror has questions about the terms contained in the solicitation documents, the prospective Offeror should contact Northampton County s EMS Director, Hollye Carpenter at , no later than five working days before the due date. Any revisions to the solicitation will be made only by addendum by the Local Government. C. APPLICABLE LAWS AND COURTS This solicitation and any resulting contract shall be governed in all respects by the laws of the Commonwealth of Virginia and any litigation with respect thereto shall be brought in the courts of the Commonwealth. The Vendor shall comply with applicable federal, state and local laws and regulations. D. ANTI-DISCRIMINATION By submitting their proposals the Vendor certifies that they will conform to the provisions of the Federal Civil Rights Act of 1964, as amended, the Virginians With Disabilities Act ( of the Code of Virginia, et. seq.) and the Americans with Disabilities Act. The Vendor also agrees that during the performance of this contract that: (a) The Vendor shall not discriminate against any employee or applicant for employment because of race, religion, color, sex or national origin, 13

14 except where religion, sex or national origin is a bona fide occupational qualification reasonable and necessary to the normal operations of the Vendor. The Vendor agrees to post in a conspicuous place, available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause. (b) The Vendor, in all solicitations or advertisements for employees placed by or on behalf of the Vendor, shall state that the Vendor is an equal opportunity employer. (c) Notices, advertisements and solicitations placed in accordance with federal laws, rule or regulations shall be deemed sufficient for the purpose of meeting the requirements of this section. (d) The Vendor shall include the provisions of items (a), (b) and (c) in every subcontract or purchase order over $10,000, so that the provisions will be binding upon each subcontractor or vendor. E. ETHICS IN PUBLIC CONTRACTING By submitting their proposals, the Vendor certifies that their bids or proposals are made without collusion or fraud and that they have not offered or received any kickbacks or inducements from any other Bidder/Offeror, supplier, manufacturer or subcontractor in connection with their bid or proposal, and that they have not conferred on any public employee having official responsibility for this procurement transaction any payment, loan, subscription, advance, deposit of money, services, or anything of more than nominal value, present or promised unless consideration of substantially equal or greater value was exchanged. F. IMMIGRATION REFORM AND CONTROL ACT OF 1986 By submitting their proposals, the Vendor certifies that they do not and will not during the performance of this contract employ illegal alien workers or otherwise violate the provisions of the Federal Immigration Reform and Control Act of G. QUALIFICATIONS OF PROSPECTIVE BIDDER The Local Government may make such reasonable investigations, as they deem proper and necessary to determine the ability of the firm proposing to perform the work. The Local Government reserves the right to reject any proposal if the evidence submitted by the firm, or investigations of the firm, fail to satisfy the Local Government that the firm is properly qualified to carry out the obligations of the contract and to complete the work contemplated therein. H. CHANGES TO THE CONTRACT The Local Government may order changes within the general scope of the contract at any time by written notice to the Vendor. The Vendor shall be compensated for any additional costs incurred as a result of such order. Said compensation shall be determined by mutual agreement between the parties in writing. 14

15 I. DEFAULT In case of failure to deliver services in accordance with the contract terms and conditions, the Local Government, after due oral or written notice, may procure them from other sources and hold the Vendor responsible for any resulting additional purchase and administrative costs. This remedy shall be in addition to any other remedies that the Local Government may have. J. CANCELING OR AMENDING A SOLICITATION The Local Government may cancel or withdraw a solicitation in whole or in part and reject any and all proposals at any time prior to an award. The Local Government also may amend the solicitation by the issuance of an addendum prior to the time set for receipt of response. K. PROTEST OF AWARD OR DECISION TO AWARD Any Vendor submitting a proposal in response to a solicitation may protest the award or decision to award a contract by submitting such protest in writing no later than ten days after the award is made or the notice of intent to award is posted. The written protest must be received by the County Administrator. The protest shall include the specific basis for the protest and the relief sought. The County Administrator shall issue a decision in writing within ten days stating the reason for the action taken. This decision shall be final unless the Offeror appeals within ten days of the written decision by invoking the Local Government's appeal procedures, or institutes legal action as provided in of the Code of Virginia. If the protest of any Offeror depends in whole or in part upon information contained in public records pertaining to the procurement which are subject to inspection, then the time within which the protest must be submitted shall expire ten days after those records are available for public inspection by such Offeror, or at such later time as provided in this section. No protest shall lie for a claim that the selected Offeror is not a responsible Offeror. L. CLAIMS Contractual claims for money or other relief shall be submitted in writing no later than sixty days after final payment; however, written notice of the Vendor's intention to file such claim must be given at the time of the occurrence or beginning of the work upon which the claim is based. Nothing herein shall preclude a contract from requiring submission of an invoice for final payment within a certain time after completion and acceptance of the work. Precedence of claims shall not delay payment of amounts agreed due in the final payment. VII. SPECIAL TERMS AND CONDITIONS A. AVAILABILITY OF FUNDS It is understood and agreed between the parties herein that the Local Government shall be bound hereunder only to the extent of the funds available or which may hereafter become available for the purpose of this agreement. 15

16 B. CANCELLATION OF CONTRACT The Local Government reserves the right to cancel and terminate any resulting contract, in part or in whole, without penalty, upon 60 days written notice to the Vendor. C. EXTENSION OF CONTRACT This contract may be extended by the Local Government upon written agreement of both parties for four (4) successive one year periods, under the terms of the current contract, and at a reasonable time (sixty days) prior to the expiration. D. RETENTION OF WORKING PAPERS The Vendor hereby agrees to retain all books, records and other working papers relative to this contract for five (5) years after final payment. The Local Government, its authorized agents, and/or state and federal Vendors shall have full access to and the right to examine any of said materials during said period. E. SUBCONTRACTS No portion of this work shall be subcontracted without prior written consent of the Local Government. The Vendor shall, however, remain fully liable and responsible for the work to be done by the subcontractor(s) and shall assure compliance with all requirements of the contract. 16

17 County of Northampton Automated Ambulance Billing, Insurance Services & Collection System, with Four One year Renewals Mailing List Cornerstone Adminisystems, Inc. Jim Jones, CAC Manager, Advanced Billing Solutions P.O. Box 726 New Cumberland, PA (866) (717) EMS Consultants Kelli Cassarino Marketing Coordinator P.O Box 2584 LaGrange, GA (800) ext 237 Fax (706) Med3000 Gary Matthews PO Box 6401 Virginia Beach, VA (757) Fax (412) Fidelis 397 Little Neck Road, Bldg 3300 South, Suite 300 Virginia Beach, VA (800) (757) Fax (757)