RFP ID : MB-0003
We are California; USA organization looking for qualified and experienced service provider for our requirement of Emergency Medical Service (EMS) Billing Services. Contract will be for the period of 3 years.
[A] Notice Type: Request for Proposal (RFP)
[B] Budget: Looking for Proposals
[C] Scope of Service:
(1) We response areas that provides emergency medical services. The Ambulance Billing & Collection Transport was billed directly until 2007.
(2) Vendor shall maintain all records and books pertaining to the delivery of services under this Contract and demonstrate accountability for Contract performance. County shall have the right upon reasonable notice and at reasonable hours of business to examine and inspect such records and books.
(3) Fiscal records shall be kept in accordance with Generally Accepted Accounting Principles and must account for all funds, tangible assets, revenue and expenditures. Fiscal records must also comply with the appropriate Office of Management and Budget (OMB) Circulars that state the administrative requirements, cost principles and other standards for accountancy.
(4) All records shall be complete and current and comply with all Contract requirements. Failure to maintain acceptable records per the preceding requirements will be considered grounds for withholding of payments for billings submitted and for termination of the Contract.
(5) Vendor shall notify designated County staff, via fax or telephone, ten (10) days preceding any change in address. Vendor shall follow-up with written notification within three (3) days of change.
(6) Vendor shall designate its own full-time employee as a Contact Representative. Such designation shall be in writing and provided to County. Vendor Contract Representative and an approved alternate shall be available locally Monday through Friday and available by pager for telephone contact twenty-four (24) hours a day, Monday through Sunday, including all holidays. This Contract Representative shall provide overall management and coordination of the Contract on the Vendor’s behalf, shall act as the central point of contact with County, and have access to technical assistance at all times.
(7) Have the ability to set up financial categories (e.g. Medicare, Medi-Cal, HMO’s, Private Pay,Insurance, etc) as required by the County for a minimum of six (6) individual entities (ambulance response areas).
(8) Have the ability to receive ambulance transport documentation on paper and electronically.
(9) Verify the receipt of these documents and return confirmation of receipt to the County.
(10) Screen each document for completeness of data and level of service, medications administered, appropriate ICD9 diagnosis codes and procedure codes for billing purposes.
(11) Obtain patients’ or guardian’s signature and authorizations as required.
(12) Have the ability to interpret ambulance transport documentation for accurate billing to the responsible party or insurance company. Generate appropriate charges from approved fee schedules provided by the County.
(13) Transmit billing data electronically to all payers accepting electronic claim submission.
(14) Produce and mail accurate insurance claims for payers that only accept hard copy claims submissions. Claims must be submitted to the correct address for claim submission.
(15) Produce and mail initial invoices to self-pay accounts with no third party information, requesting third party information, or payment in full.
(16) Verify eligibility for third party payers prior to claim submission (e.g. Attorneys, Workers’ Compensation, etc).
(17) Appeal all inaccurately, denied or down-coded claims from Medicare, Medi-Cal, Workers’ Compensation and insurance carriers.
(18) Request Appeal Hearing or Lien Conference when necessary.
(19) Coordinate all disputed claims with the designated County representative.
(20) Produce and mail second notices or other letters and make telephone calls on all open accounts, according to a pre-defined timetable, to collect amounts due to the County.
(21) Send “cross-over” and balance billings to responsible parties as necessary.
(22) Process payments, adjustments, receipts and correspondence.
(23) Forward accumulated revenue to the County on a weekly basis, with a report detailing the amount of revenue received by ambulance area.
(24) Forward refund requests and associated back-up documentation, in a timely manner, to the County for processing.
(25) Review all accounts deemed delinquent (according to pre-defined timetable) before transferring to the County for further action.
(26) Provide nationwide toll-free telephone line(s) to accommodate billing inquires from patients and other responsible parties.
(27) Handle all telephone calls and correspondence in a timely, professional and courteous manner.
(28) Routinely meet with the County to discuss problems, special needs and future changes.
(29) Provide a multi-lingual staff for communication with patients and other responsible parties.
(30) Monitor all billing and regulatory changes impacting ambulance/EMS reimbursement and adjust system to ensure regulatory compliance; update the County of any such changes with an explanation of how it will affect the County and/or patients.
(31) Provide continuous training for Vendor’s billing staff, updating them immediately on all changes in the industry or government regulations that may have an impact on reimbursement and/or patients of the County.
(32) Maintain updated and current technology that will continuously provide the highest level of reimbursement and patient service possible.
[D] Questions regarding RFP must be submitted on or before April 8, 2010.
We are looking for best proposals and payment terms will be in accordance with Government Law. Interested service providers are requested to submit proposals on or before April 30, 2010 via post, courier or hand delivery only.
Status: RFP Expired
