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HomeMy WebLinkAboutStaff Report 290-09TO: HONORABLE CITY COUNCIL ATTN: FINANCE COMMITTEE FROM: CITY MANAGER DEPARTMENT: FIRE DATE: JULY 21,2009 CMR: 290:09 SUBJECT: Approval of Scope of Services for the Ambulance Billing Contract Request for Proposal (RFP) RECOMMENDATION Staff recolnmends that the Finance Conm1ittee review and approve the scope of services (Attachment A and Attachn1ent A-I) for the ambulance billing contract Request for Proposal (RFP). DISCUSSION At the Febnlary 3,2009 Finance COlnlnittee Ineeting, the results of the City Auditor's ambulance billing audit were reviewed and approved. The Finance Comn1ittee directed staff to submit the final scope of services doclunent to the Finance COlnmittee for approval prior to engaging in the RFP process for a new billing contract. The scope of services dOCUlnent is designed to ensure that the new vendor provides service in accordance with the City Auditor's recommendations and the Adlninistrative Services Department accounting procedures. Attac1nnent A has incorporated the recon11nendations cited in the ambulance billing audit as they relate to the scope of services with input and review from Administrative Services, Fire, City Attorney and City Auditor Staff. Specifically, they are Recolnmendations #1, #3, #4, #5, #8, #15. Recolnmendation #16, directing the City to attempt a negotiation for a lower cOlnmission rate is not in the scope of services. The City is con1111itted to negotiating a rate lower than that in the current contract and equal or lower to fire agencies of comparable size and activity. Recoffilnendation #1 requires the contractor provide Inonthly lists of accounts in excess of 180 days and tunl them over to the City, ensure return of uncollected accounts in a timely manner, and ensure that accounts retun1ed to the City will not continue to be billed. These itelns are addressed in Item B 11 (a) and (b) of the scope of services. Recomlnendation #3 requires the contractor to provide the City v/ith timely exception reports it regularly reviews to insure that accounts do not remain unbilled and to inlplement a follow-up process for unbilled accounts. These items are addressed in Item B 11(e) and Item B 12(a) of the scope of services. CMR290:09 Page 1 of2 Recommendation #4 requires award of contract on a one year basis and cIiteIia developed to evaluate satisfactory contractor perfonnance. These iteins are addressed in Attachment A-I and Attachment D, Section 2 "TERM". RecOlnnlendation #5 requires the contractor to . provide consistent reporting to the City with verification regarding accuracy of accounts receivable balance and prospective wIite-off cases. These issues are addressed in Itenl B 12 and B 16 of the scope of services. Reconnnendation #8 requires the contractor provide assurances that sufficient internal controls exist to prevent nnlltiple billings. This issue is addressed in Items B 1 0 and B 12( c) of the scope of services. RecOlnnlendation #15 requires prOVISIons specifying the billing time lines the contractor will follow and the tinlefranles for the various types of accounts. This issue is addressed in Itein B 11 of the scope of services. The Finance Committee also requested City staff propose measures that would result in financial consequences for non-perfonnance by the contractor which are outlined in Attachment A-I. Staff research on other cities indicated that this nlay result in higher rates, therefore in the RFP process the potential contractors will submit responses and comnlission rates for both options (with and without penalties) so that staff can evaluate whether penalties will result in effective savings for the City. RESOURCE IMPACT Approval of this recOlnmendation has no adverse fiscal impact to the City. The changes in the scope of services from the previous contract are anticipated to help the City more fully recover costs and nlaximize revenue collections for mnbulance billing. POLICY IMPLICATIONS This recOlmnendation is consistent with existing City policies and will allow staff to fully implement the audit recoInnlendations. ENVIRONMENTAL REVIEW The actions reco1l11nended in this report do not constitute a project under the California Environmental Quality Act (CEQA). ATTACHMENTS Attachment A -Scope of Services for Anlbulance Billing RFP Attachment A-I -Penalty Parameters for the Ambulance Billing RFP PREPARED BY: CTY MANAGER APPROVAL: CMR290:09 NI OLAS MARINARO Fire Chief ... 7 .. ~ /,,1 / JAMES/KEENE City~nager ! i Page 2 of2 i. PROJECT OBJECTiVE Attachment A SCOPE OF SERVICES The City of Palo Alto is soliciting proposals from qualified and experienced firms to provide Medical Billing Services and Accounts Receivable Management Services for the City's Emergency Medical Services Division. II. SCOPE OF SERVICES A. Background Contractor shall provide complete medical billing and accounts receivable management services for CITY's first responder, BLS, paramedic, and membership program fees in accordance with the responsibilities outlined below. Contractor must have a comprehensive and successful Emergency Medical Services billing and customer service record with significant experience in Prehospital billing. Prehospital billing experience shall include 911 system ambulance transports at the ALS / BLS level as well as experience in non 911 system interfacility transports. This level of experience would typically require 5 plus years of EMS / Ambulance billing business at a volume equal to or greater than the City of Palo Alto Fire Department. Contractor must offer leading technology in electronic billing and insurance follow-up. The contractor shall have highly qualified staff with a background in a Prehospital billing. Contractor shall provide data on company history of collections including payer mix with percentage of collections for each category. The contractor shall provide the City with customer references. Currently the City of Palo Alto is utilizing an electronic patient care report (ePCR). The City may still have occasional paper PCR's for processing. Contractor shall provide a fee schedule based on an ePCR and/or paper PCR if there is a differentiation. The total transports for the City of Palo Alto is approximately 3000 transports per year. Contractor shall be responsible to interface with ESO Solutions, the current ePCR vendor without cost to the City. B. Specific Scope Requirements: The CONTRACTOR will provide the following specific services: 1. Provide general billing and accounts receivable management services to CITY for Emergency and Non-Emergency transport services consistent with the provisions in City's Municipal Fee Schedule, ensuring that every billable claim is pursued. 2. Maintain up-to-date knowledge of different industry insurance plans and providers, and utilize most up-to-date knowledge and information with regard to coding requirements and standards, to ensure compliance with applicable Federal, State and local regulations. 3. When a new account is received, assign billing account numbers that provide a cross-reference to the CITY's assigned incident numbers. 4. On a monthly basis, reconcile the number of transports processed with those received. 5. Maintain responsibility for obtaining missing or incomplete insurance information and billing information. 6. Provide accurate coding of medical Claims as set by State and Federal requirements: and facilitate proper security of confidential information and proper shredding of all disposed material containing such information in accordance with HIPAA and Red Flag Rules and regulations. 7. Make recornlllendations as requested for fee schedule changes. Regularly advise CITY of changes in statues and industry regulations. Provide Bay Area average billing/fee schedules, as needed. Provide strategies to maximize programs, including cOlllpany charts that estimate the impact of billing system changes. 8. For any accounts previously returned to the City for follow up or further action or which any payment is received by contractor, report such payment to ASD within 3 business days of receipt. 9. Pursue payment from international and local patients in the same manner with the same diligence. 10. Patient Account Log. CONTRACTOR shall file and maintain a log (the "patient account log") for each patient account documenting the complete history of all notices, phone calls, other correspondence, and actions taken to collect insurance payment, including but not limited to: • all invoice and billing records, • dates of all written and oral correspondence, a details of such correspondence, • notations of billing contacts and updates, • patient contacts, e returned mail, phone disconnects, etc., ct all records of re-submittals and corrections. G all information regarding the patient including CITY's incident number, name, gender, date of birth, date of service, call type, address @ in the case of account write-ofts, the reason why the account is uncollectible. o all required documentation and agreements with payors (including Medicare, Medicaid, Champus, etc) Contractor shall provide a copy of the Patient Account Log to City when referring the account back to the City. 11. Invoices and Billing. Billing cycles will be reset upon billing a different payer and therefore may be extended beyond the 180 period for collections described in sections a through c below. Contractor shall take all reasonable measures to ensure that patients are billed for services, including establishing contacts with local hospitals to obtain and/or verify patient insurance and demographic information, as necessary. In general, if sufficient billing information is provided by the city, the account shall be invoiced within 3 days. If insufficient billing information is provided by the city, the contractor shall pursue information within 10 days. This includes; skip search, send patient a signature card, request a facesheet from the receiving facility, etc. Once sufficient information is obtained by the contractor the account shall be invoiced within 3 days and follow the timelines as detailed below. Contractor shall invoice patients according to the following billing cycle. Receipt of account shall be defined as the date the paper PCR or ePCRs received by the vendor. a. Self Pay Cycle -C mplete PCR/ePCR: Correspondence: Initial Invoice First Letter Contact Second Notice Secondary Letter Contact Continued Follow Ups Final Demand Notice Refer to City for action or repo rt status b. Insurance Accounts: Correspondence: Initial Invoice First Follow Up Continued Follow Ups Refer/report to City for action or report status c. Incomplete PCR/ePCR 1V1ail no later than: 3 days for ePC Rand 5 days for paper peR from receipt of account 15 days from receipt of account 45 days from receipt of account 45 days from receipt of account 80 days from receipt of account 115 days from receipt of account 145 days from receipt of account 180 days from receipt of account Mail no later than: 3 days for ePCR and 5 days for paper PCR from receipt of accou nt 35 days from receipt of account 80 days from receipt of account 115 days from receipt of account 145 days from receipt of account 180 days from receipt of account Contractor shall pursue information within 10 days. Once information is complete, the timelines shall be the same as in Section (a) above. d. Special Accounts/Modified Payment: Contractor shall negotiate and arrange modified payment schedules for individuals unable to pay full amount when billed and shall work with customers to establish special payment cycles to accommodate these individual payment needs to accommodate installment payments, liens, bankruptcy, or other special payment arrangements. Such payment plans shall be established in writing, with the record of the plan, installment invoices, and all payments retained in the Patient Account Log. Installments and other special accounts shall be mailed no later than every thirty (30) days until paid in full. If, after a modified payment plan is arranged and no payments are made for a continuous 180 day period, Contractor shall refer the account to the City for action. e. Return Mail and Accounts Requiring Additional Information: In addition to adhering to the billing cycle deadlines listed above, Contractor shall conduct skip search requests and/or request additional assistance from: Skip Search Request Hospital Assistance: No Later than 3 days from receipt of return mail/date f. Communication with patients and customers: All correspondence or phone calls shall identify the Contractor's name and clearly state they are working on behalf of the City of Palo Alto. g. Deli nquenc~/ orice: All initial and subsequent invoices shall state the date on which the patient's account will become (or did become) delinquent, h. Secondary insurance: Secondary insurance provider claims shall be submitted after the primary insurance provider has paid. i. Return of delinquent and uncollectible accounts to City: Delinquent accounts shall be referred back to the CITY at the 180 day deadline as listed above in sections 11 (a) -(c) with a copy of the Patient Account log . (1) Legally uncollectible amounts (such as Medicare and Medical approved payments lower than City rates) shall be reported separately and submitted Illonthly for City review. (2) In returning delinquent accounts back to City, CONTRACTOR shall provide with the Patient Account Log proof and dates of attempts to collect on the account. (3) Contractor shall hold all accounts transferred back to City in inactive status and shall perform no collection activity unless and until directed in writing by City. j. Payment progress reports: For accounts in which insurance payment is pending or a modified schedule has been arranged, CONTRACTOR shall provide a report to the City at 180 days from receipt of account and every thirty days thereafter that shows status and payment progress. 12. Reports: CONTRACTOR shall provide reports to as requested by the City of Palo Alto. All reports submitted to the City shall be in order of the City's incident numbers, and shall be submitted no later than 10th day of the following month. Required reports include but are not limited to: a. Monthly reports for the Month and Year-to-Date Activity, to City's Revenue Collections and Accounting: > Billing Report ? Payment Report );> Detail Open Items Report including account status by date of service ? Legally Uncollectible Report (Medicare and Medical) ? Delinquent Accounts (referred to City) >-Overpayment Report > Detailed Report of Collections for Each Service (1FT, Downgrades, ALS) >-Comprehensive Fiscal Year End Report > Payer Mix Report ? Exception Report on Unbilled Invoices :> Report on payments received on items in collection status b. Monthly reports to Fire Department EMS Coordinator: :> Itemized Patient Account Report Monthly (Listed: in order of City incident number) should include: date of service, dispatch time, unit number, patient name, age, 008, status of account, i.e. invoiced olj2ending information r-'-n-ci-de-n-t-#--r--d-at-e-o-f ----,-d-is-p-a-tch unit Pi r'~-a-m-e------'Ir-J-\g-e--I DOB I status service time number )-Detailed Summary Report of Collections for Each Service Monthly (1FT, Downgrades, ALS) c. Other reports to be provided as requested by City include but are not limited to: >-Miscellaneous Reports as requested >-Comprehensive Fiscal Year End Report Annually (listing: sum of accounts, sum of charges, sum of adjustments, sum of PaYlllents, sum of write-Offs, sum of reimbursement balances by month) ~ Payer Mix Report as requested ~ Miscellaneous Reports as requested 13. Electronic records: CONTRACTOR shall be able to receive and send data compatible with the CITY's field data system software (ePCR). CONTRACTOR shall interface or have a link that is capable of downloading or uploading information from the CITY's data collection system. (ESO Solutions is the current ePCR vendor) The Contractor shall provide a billing interface with the CITY's current ePCR program and have it operational within 60 days of the award of the Contract. Contractor shall also l11aintain records in an electronic format that is accessible by designated CITY personnel, who will be given direct long on access to the vendor's database, and meets all Federal and State requirements for maintaining patient medical records and privacy. 14. Customer inquiries: CONSULTANT shall provide a designated liaison to respond to patient/payor concerns, establish a toll free telephone number for customers to call for inquiries, and respond to customer questions or concerns as soon as possible but no later than 24 hours of the initial inquiry (excluding holidays and weekends). Contractor shall also provide assistance in responding to inquiries concerning third-party claims. 15. Training: Keep City apprised of changes to industry regulations and periodically provide training as requested by CITY to CITY's EMS and/or CITY fire personnel regarding the gathering of the necessary information and proper completion of run tickets 16. Payments and accounting: Contractor shall maintain appropriate accounting procedures for reconciling all deposits, receivables, billings, patient accounts, adjustments and refunds. Contractor shall maintain daily deposit control sheets and original documentation of payments. Contractor shall accept cash, checks and credit card payments as acceptable forms of payment for invoiced services. All funds received by Contractor shall be deposited di rectly in to the Citis designated bank account immediately upon recei pt. 17. Audits: Cooperate with City as required to complete periodic audits. 18. Contractor shall transition to full implementation of services once according to the following schedule: dates and deadlines TBD as provided by contractor and to be incorporated into this scope 19. Monthly meetings: To ensure that Contractor returns uncollected accounts in a timely manner and provide a check to ensure that Contractor does not continue to bill accounts that have already been returned to City, CONTRACTOR's Account Manager shall meet at least once per month with the City of Palo Alto Staff from the Fire Department and from the Administrative Services Department. To review open accounts, accounts referred back to City, problems and opportunities related to ambulance billing, and other related issues. At each meeting, Contractor shall report on all accounts over 180 days and the status of accounts that have not been invoiced, as well as provide any other updates requested by City. The monthly meetings will be pre-scheduled and the City of Palo Alto may request additional meetings if deemed necessary. III. City's Responsibilities: 1. CITY shall provide CONTRACTOR with patient information on a timely basis and in sufficient detail to support diagnosis and procedure coding. CITY will also provide patient demographic information necessary for accurate patient identification including nanle, address, social security number, date of birth, and telephone number, whenever possible. Where possible, CITY will obtain and provide CONTRACTOR with patient health insurance, auto insurance or other insurance information. 2. CITY shall provide CONTRACTOR with necessary documents required by third parties to allow for the electronic filing of claims by CONTRACTOR on City's behalf. 3. CITY shall provide CONTRACTOR with its approved billing policies and procedures including municipal fee schedules and collection protocols. CITY will be responsible for engaging any third party collection service for uncollectible accounts after CONTRACTOR has exhausted its collection efforts. 4. CITY will process refunds identified by COI\lTRACTOR in a timely manner for account overpayments. 5. CITY will cooperate with CONTRACTOR in all matters to ensure proper compliance with laws and regulations. Penalty RFP Detailed below are CONSEQUENCES for NON PERFOR-MANCE vvhich the CITY reserves the option to implement in conjunction with the award of this contract. The CITY is requesting a Cost Proposal from potential Firms without the Non Performance Consequences and a Cost Proposal which would apply with Non Performance Consequences included (see Attachment E and Attachlnent E-l) included in this RFP document. Consequences for Non Perfornlance 1) Billing correspondence shall be submitted according to the timelines set forth in Attachment A, Sections 11(a), (b) and (c). Failure to meet the standard with a minimum 95% compliance in that month will result in a 2.50/0 reduction to the collection amount for the month in which the standard was not met. For exmnple, if the contractor collection amount for that month is $15,000, the penalty for that month for non compliance would be $375. 2) The contractor shall meet the 180 day referral back to the City for non-collection of billing. Failure to meet the standard with a minimum 950/0 compliance will result in a 2.50/0 reduction to that month's collection amount. 3) Submit all reports as required in Attachment A, Section 12 by the 10th of each nlon1h to verify satisfactory perfornlance in nlonthly nleetings with Fire and ASD Staff. Failure to l11eet this standard will result in a 2.5% reduction to that Inonth's collection anlount. 4) The contractor shall initiate follow-up action within 10 days to gather all necessary data when insufficient information exists on initial submission to generate an invoice. Failure to nleet this standard with a mininlum 95% compliance vvill result in a 2.5% reduction to that month's collection amount.