6091 - EMS Billing & PCR Services, 3.Statement of Work/ SpecificationsCity of Denton, Fire Department
RFP #6091 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. As a part of this
process, the City of Denton may consider technological components to support the patient care reporting. Examples of this technology could include laptop computers or tablet devices.
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 2010 U.S. Census Bureau, Denton’s population is estimated to be 131,044
people in 2016. 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 seven (7) ambulances for patient transport. From October 1, 2014 to September 30, 2015, the City encountered 7,025 billable EMS incidents. Out
of these incidents 6,764 resulted in the patient being transported to a hospital.
The rates charged to patients were established by City Ordinance #2010-204. (See Exhibit 4)
The revenue generated from EMS billing services totals:
FY 2010-2011
$2,374,337
FY 2011-2012
$2,324,195
FY 2012-2013
$2,462,278
FY 2013-2014
$2,480,582
FY 2014-2015
$2,638,802
The City is a Medicare and Medicaid provider and participates in the Texas Ambulance Supplemental Payment Program.
Collection Philosophy & Contract Objective
The City’s objective is to recover costs that are allowed through Federal, State and local rates. The patient care reporting tools should be efficient and quick for paramedics to learn
and use.
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). The contractor is permitted to subcontract billing,
and/or patient care reporting services at the contractor’s expense.
Essential Requirements
Section A: EMS Billing
Prepare, process and forward all bills of service to the appropriate insurance provider, governmental program or individual, for claims processing.
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.
Account follow up on denials, rejections and appeals with insurance companies and governmental programs, such as Medicare & Medicaid.
Accurate and timely review of claims to verify completeness and compliance.
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.
Revenues will be collected either by contractor or the City of Denton;
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 on-line report
must be sent to the City of Denton showing who paid, the amount paid, and the patient account that was paid.
Develop, implement and monitor extended payment plans with patients unable to pay in full.
Must provide a complete paperless document management system to:
Include scanning of all patient and insurance company correspondence. (i.e., checks and explanation of benefit forms)
Allow secure online access to view and audit these records.
Contractor must accept MasterCard and VISA credit cards as payment for EMS services rendered.
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.
Assist in the application for 855B Medicare Revalidation Certification and Medicaid Revalidation.
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.
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.
The contractor will work in concert with the City of Denton to develop monthly reports, policies, procedures and protocols for all services provided.
Real Time Financial Reporting
The contractor will provide the City of Denton ongoing access to print statements, and run receivables reports based on real time data.
Monthly batched reports for accounts that are over 210 days. Upon review, the City will submit this report to a third party collections agency, which is contracted by the City separately.
Monthly revenue adjustment report including documented write-offs and aging accounts receivable balances.
Cash receipts by payer type and carrier.
Gross revenues, assignment/adjustment, and financial class reports.
Customizable reports that can be generated by the user or automated.
Other reports as requested.
The proposer must provide sample copies of the proposed financial reports with the proposal submission.
Audits
Annual audit of internal controls, which must be provided to the City of Denton within a 21 calendar days from the request.
The City of Denton shall be able to conduct an onsite audit of their accounts within 21 calendar days of the request. Refer to the City’s Right to Audit provision located in Exhibit
2 – General Provisions and Terms and Conditions (page 17) for further details.
Contractor must include at the contractor’s expense – EMS Billing Services
Employee wage and benefits.
Billing forms.
Postage, envelopes and office supplies.
Long distance telephone, cellular and data charges.
Toll free access numbers for patients.
Any other costs associated with patient account billing.
Section B: EMS Patient Care Reporting (PCR) System
Must be capable of seamless integration with billing services. The contractor provides PCR software that is web-based for mobile access and that is integrated with the billing process.
Must meet all legal documentation requirements for patient encounters.
Must be able to retrieve patient record history from previous encounters for seven (7) years, unless the patient is under eighteen years of age. In this circumstance, retrieval will
be required until the patient is twenty-five years of age (25).
Must allow custom software modifications, as requested by the City of Denton, on a continuing as needed/requested basis.
The PCR should integrate with Tier 1 or Tier 2 Computer Automated Dispatch (CAD) system. The City currently uses the VisionCAD system, version 3.7.3.10.
Health data exchanges with hospitals is optional, but preferred to allow for two-way access to hospital records such as auto-electronic feedback, follow-up diagnosis, and/or face sheets.
In addition the exchange could allow for the PCR records to be sent to the hospital electronically, including the patients’ histories. In the proposal, a description of capability to
electronically exchange health information and hospital status data is required to accompany this option. The proposer shall describe how the proposed system aligns with relevant national
standards from Health Level Seven International (HL7) and Organization for the Advancement of Structured Information Standards (OASIS) and the recently published HL7 Version 2.7.1 Implementation
Guide: Message Transformations with OASIS Tracking of Emergency Patients (TEP), Release 1. http://docs.oasis-open.org/emergency/TEP-HL7v2-transforms/v1.0/TEP-HL7v2-transforms-v1.0.html
The proposer must provide a sample copy of the Patient Care Report with the proposal submission.
Immediate Access Reporting
Quality assurance / quality improvement recommendation reports.
Call volume and call location reports.
Medic statistic reports, including individual medic encounters, refusal counts, and medic performance statistics (i.e., intubations and IV attempt statistics).
Customizable reports.
Patient age reports.
Call type reports.
“Response time” and “On Scene” reports.
The system must submit a report on a daily basis to the City of Denton containing a summary of the EMS calls and the call locations for the previous day.
Regulatory Reporting to the Texas Department of State Health Services (DSHS)
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.
Other reports as required by the State of Texas.
Technological Components
The contractor provides mobile devices containing the most up-to-date hardware and software components available for PCR purposes. Devices for PCR purposes proposed could be tablet or
laptop technology. The Denton Fire Department will test the mobile devices to make a preference determination during EMS response for a trial period during the evaluation phase, if
more than one option is proposed. In addition, a patient driver’s license imaging capture or scanning device is also preferred. Please provide information on supported interfaces for
this component.
If devices become faulty or broken, the contractor provides equipment on loan until repairs are complete.
The devices must be replaced by the contractor once they reach three years in age, or prior if they become inoperable. The replacement devices shall contain the most up-to-date hardware
and software components available.
The contractor must provide mobile access in the field to the web based software by way of cellular data devices and service.
The contractor also provides technical support associated with the device operation and user support during and after hours. Technical support shall include, but not limited to, continuous
software maintenance, software patches, fixes, and upgrades as soon as they become available.
Compensation for the technological components listed in this section must be proposed as a fixed cost.
EMS Patient Care Reporting System Specifications Spreadsheet (Exhibit 5)
The Functional Specifications Spreadsheet, displayed as Exhibit 5, is a Microsoft Excel document listing the detailed specifications for the proposed system.
The City expects that Respondents will respond to each specification, in a manner described below, and return the completed spreadsheet as an item of the response package in electronic
format as a Microsoft Excel document, unlocked and not password protected. The elements of the Functional Specifications Spreadsheet are described below:
Spec ID - The unique identifier associated with each requirement.
Response - Entry of responses to an individual specification is accomplished through the selection of an item from a drop down list. The responses can only be:
Comply- The Respondent’s proposed system includes the specification or service as part of their currently developed version and is available for shipment and installation. Comply also
indicates that the specification is included as part of the baseline cost of the system (i.e. not an added cost module)
Partially Comply or Alternative - The Respondent’s proposed system either does not fully meet the described specification and addresses it through methodology other than that implied
in the statement, or includes the specification at an additional cost. (Additional comments or supporting documentation are recommended.)
Does Not Comply - The Respondent’s proposed system does not include the specification. Explain in detail the reason(s) if the proposed system cannot comply with the specification.
Not Answered – Response to specification not provided. DFD recommends Respondents respond to each specification. An omitted response will be scored the same as a response code of Does
Not Comply.
Comments - Supportive information and explanations can be provided. Please be concise.
Contractor must include at the contractor’s expense – ePCR System
Quality assurance / quality improvement recommendation reports in a manner to provide the City of Denton with the ability to monitor EMS provision standards.
Training for City of Denton employees to utilize the proposer’s process and systems on an as needed continuing basis, including and not limited to post-implementation training for PCR
and billing functions.
All software related costs required for the services requested herein, including upgrades, technical support, maintenance and web hosting services.
HIPAA Compliance
Contractor must be HIPAA compliant with all transactions.
Contractor must have a Department of Health and Human Services Office of Inspector General (OIG) compliance program or policy in place.
Implementation
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.
Insurance – Special Conditions
Please refer to Appendix A of Exhibit 2 – Solicitation General Provisions-Terms and Conditions for specific insurance requirements.
It is required that the contractor obtain and maintain the following special policies: Corporate Identity Protection Policy, also known as Cyber and Privacy Insurance, and Commercial
Crime Protection Insurance Policy, in the amount of $1 million for each policy.
Transitional Assistance – EMS Billing and ePCR System
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.
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):
Compensation could be tiered based upon the billing revenue generated.
Pricing of implementation to occur up front and separate to remainder of ongoing services.