8206 - Scope of Work
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RFP 8206 EXHIBIT 3
Emergency Medical Billing Services & Patient Care Reporting Services
Scope of Work for the Supply of Service
Introduction
The City of Denton Fire Department is requesting proposals concerning the provision of Emergency Medical
Services (EMS) billing and patient care reporting solutions. The scope as described below will outline the City’s
essential requirements and additional options for consideration.
Background
The City of Denton, Texas is located approximately forty (40) miles north of Dallas / Fort Worth. According to the
2020 U.S. Census Bureau, Denton’s population is estimated to be 147,816 people in 2023. The Fire Department is
responsible for the provision of EMS and the emergency transportation of patients in the city to local hospitals.
The Fire Department employs the use of eight (8) ambulances for patient transport and will add a 9th ambulance in
2024. From October 1, 2021 to September 30, 2022, the City encountered 11,711 billable EMS incidents. Out of
these incidents 9,878 resulted in the patient being transported to a hospital.
The rates charged to patients were established by City Ordinance #21-2110. (See Exhibit 4)
The revenue generated from EMS billing services totals:
FY 2017-2018 $2,483,396
FY 2018-2019 $2,546,251
FY 2019-2020 $2,929,000
FY 2020-2021 $2,958,290
FY 2021-2022 $3,358,172
The City is a Medicare and Medicaid provider and participates in the Texas Ambulance Supplemental Payment
Program.
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Collection Philosophy & Contract Objective
The City’s objective is to recover costs that are allowed through Federal, State and local rates. The City’s collection
philosophy does not condone the use of aggressive tactics. It is imperative that the contractor represent the City
appropriately and honestly while maximizing revenue. This includes continual compliance with the Federal Trade
Commission’s Fair Debt Collection Practices and Fair Credit Reporting Acts. Under the provisions of the Fair
Credit Reporting Act, the contractor shall also comply with the provisions as described within the Red Flag Program
Clarification Act of 2010 (S.3987).
Essential Requirements
EMS Billing
1) Prepare, process and forward all bills of service to the appropriate insurance provider, governmental
program or individual, for claims processing.
2) Verify patient’s insurance information. If no insurance information is provided by the patient, the
contractor is responsible for conducting a search/sweep in multiple insurance informational databases to
determine if a patient has health insurance.
3) Account follow up on denials, rejections and appeals with insurance companies and governmental
programs, such as Medicare & Medicaid.
4) Accurate and timely review of claims to verify completeness and compliance.
5) Electronic submission of all insurance claims, such as commercial, governmental, auto and individual types
that can be accepted and paid electronically, except in cases where paper submission may have a financial
benefit.
6) Revenues will be collected either by contractor or the City of Denton;
a. If funds will be collected by contractor, the funds shall be disbursed to the City of Denton on a
weekly basis, either by wire or check. With the check or wire, a detailed report must be sent to the
City of Denton showing who paid, the amount paid, and the patient account that was paid.
b. Develop, implement and monitor extended payment plans with patients unable to pay in full.
7) Must provide a complete paperless document management system to:
a. Include scanning of all patient and insurance company correspondence. (i.e., checks and
explanation of benefit forms)
a. Allow secure online access to view and audit these records.
8) Contractor must accept MasterCard, VISA, and Discover credit cards as payment for EMS services
rendered.
9) Must be actively involved in EMS billing and have a minimum of five (5) years’ experience, doing
business in the state of Texas for the purposes of EMS billing. The contractor is required to possess a good
understanding and knowledge of the state of Texas’ statutes, regulations, and practices for EMS billing and
patient care reporting.
10) Contractor will provide customer support for all City of Denton patients Monday through Friday, 8:00 a.m.
to 5:00 p.m. CST.
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11) Contractor will communicate with City of Denton patients for all billing matters.
12) Assist in the application for 855B Medicare Revalidation Certification and Medicaid Revalidation.
13) The contractor’s billing team consists of certified professional coders who possess a valid International
Classification of Disease (ICD-10 (CM)) certification. Additionally, the contractor is required to maintain
Health Insurance Portability and Accountability Act (HIPAA) compliance throughout the organization.
14) The City of Denton must be able to view, access, and audit all information collected or recorded, by the
contractor, as associated with the all patient accounts, claims processing, and billing services through a
secure portal 24 hours per day, 7 days per week, and 52 weeks per year. In the event scheduled
maintenance should be required, the contractor should notify the City 72 hours in advance. In the event of
unforeseen emergency maintenance is required, the contractor will need to notify the City immediately.
15) The contractor will work in concert with the City of Denton to develop monthly reports, policies,
procedures and protocols for all services provided.
16) Ability to interface with ESO EHR as an XML import. Data fields are NEMSIS 3.5.
Real Time Financial Reporting
17) The contractor will provide the City of Denton ongoing access to print statements and run receivables
reports based on real time data.
18) Monthly batched reports for accounts that are over 210 days. After review and approval from the City, the
contractor will submit this report to a third-party collections agency, which is contracted by the City
separately.
19) Monthly revenue adjustment report including documented write-offs and aging accounts receivable
balances.
20) Cash receipts by payer type and carrier.
21) Gross revenues, assignment/adjustment, and financial class reports.
22) Customizable reports that can be generated by the user or automated.
23) Other reports as requested.
24) The proposer must provide sample copies of the proposed financial reports with the proposal submission.
Audits
25) Annual audit of internal controls, which must be provided to the City of Denton within 21 calendar days
from the request.
26) The City of Denton shall be able to conduct an onsite audit of their accounts within 21 calendar days of the
request.
Contractor must include at the contractor’s expense – EMS Billing Services
27) Employee wage and benefits.
28) Billing forms.
29) Postage, envelopes and office supplies.
30) Long distance telephone, cellular and data charges.
31) Toll free access numbers for patients.
32) Any other costs associated with patient account billing.
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Regulatory Reporting to the Texas Department of State Health Services (DSHS)
33) The contractor reports trauma related incidents as required each month to DSHS and the North Central
Texas Trauma Regional Advisory Council on behalf of the Denton Fire Department. Trauma reports must
be in full compliance with the State’s requirements.
34) Other reports as required by the State of Texas.
HIPAA Compliance
35) Contractor must be HIPAA compliant with all transactions.
36) Contractor must have a Department of Health and Human Services Office of Inspector General (OIG)
compliance program or policy in place.
Implementation
37) The implementation process will include preliminary planning meetings, data migration, testing, launch and
training. The schedule for this process will be one of the determining factors. The most reasonable
timeframe for all parties will receive a higher evaluation score.
38) It is understood that the City of Denton is the owner of all patient related data and upon request or in the
event of or at such time that the agreement between the parties expires or is terminated, contractor will
provide all data, paper, electronic, or otherwise to the City of Denton or to the specified agent of the City of
Denton’s choice in a format that is accessible and usable at no additional cost to the City unless the format
is determined by both parties to be of a nature that would require undue burden or considerable expense to
the contractor. In the event of such an occurrence, the parties will agree upon a data transfer process that is
suitable for the intended purposes. If such an agreement cannot be reached, a third party will be engaged, at
the cost of the contractor, to determine a suitable data transfer format.
39) Upon the completion of the contract term, the incumbent will turn over all accounts previously placed
unless otherwise agreed upon.
Additional Options (Including, but not limited to):
40) Compensation could be tiered based upon the billing revenue generated.
41) Pricing of implementation to occur up front and separate to remainder of ongoing services.