EMS Billing

Invitation to Bid #26-RFP-022
Wise County Texas
RFP Title: EMS Billing
Sealed Proposals Will Be Received Until: 10:00 a.m. central time, Thursday, June 18, 2026
Return Proposals To:
Wise County Asset Control Office
400 W Walnut, Decatur, or
P.O. Box 952, Decatur, TX 76234
Allproposalsmustbesubmittedinasealedenvelopeontheenclosedproposalformandreceivedonorbeforethetimespecifiedabove.Theproposal
envelope must have a return address in the upper left- hand corner and the RFP name and number in the lower left-hand corner.
Contents
A. Introduction 2
B. About Wise County EMS Rescue 2
C. Scope of Work 4
D. Performance Standards 8
E. Technical Requirements 8
F. Reporting Requirements 9
G. Cost Proposal 10
H. Payment Processing and Merchant Services 10
I. Response Contents 11
1. Proposal Contact Form 11
2. Additional Signed Forms 11
3. Executive Summary 12
4. Company Overview 12
5. Compliance 12
6. Experience 13
7. Approach to the Scope of Work 13
8. Implementation and Training 15
9. Service Plan 15
10. Reporting and Analytics 16
11. Cost Proposal and Projections 16
12. Attachments 16
J. General Information 16
Required Submission Checklist 23
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Bid #26-RFP-022

A. Introduction
County of Wise / Wise County EMS Rescue ("Wise County EMS Rescue") is requesting proposals
from qualified vendors interested in performing EMS Billing and Collections Services. There is no
expressed or implied obligation for the County of Wise / Wise County EMS Rescue to reimburse
responding vendors for any expenses incurred in preparing proposals in response to this request.
During the evaluation process, the County of Wise / Wise County EMS Rescue also reserves the
right, where it may serve its best interest, to request additional information or clarification from
vendors or to allow corrections of errors or omissions. At the discretion of the County of Wise /
Wise County EMS Rescue, vendors submitting proposals may be requested to make oral
presentations as part of the evaluation process.
The County of Wise / Wise County EMS Rescue reserves the right to retain all proposals
submitted and to use any idea(s) in a proposal regardless of whether that proposal is selected.
Submission of a proposal indicates acceptance by the vendor of the conditions contained in this
Request for Proposal, unless clearly and specifically noted in the proposal submitted and
confirmed in the contract between the County of Wise / Wise County EMS Rescue and the
company selected.
B. About Wise County EMS Rescue
Wise County is located in North Texas, near the Dallas/Fort Worth Metroplex. It covers
approximately 900 square miles with a population estimated at 83,778 living in and around some
18 towns and communities. According to the 2025 Census Bureau estimates, 15.9% of the
population is 65 years of age or older.
Wise County EMS Rescue provides emergency prehospital care as well as critical care transports
for the entire county. We have a staff consisting of 40 full-time and numerous part-time
paramedics and EMTs. Wise County EMS Rescue currently responds to approximately 7,600 calls
for service annually and transports approximately 5,500 patients annually. Wise County EMS
Rescue staffs 6 full-time MICU-level ambulances which are staffed with a paramedic and an EMT-
B/EMT-A or dual paramedic. We carry a full range of critical care medications and equipment.
Our staff operates under advanced clinical protocols designed to provide progressive, evidence-
based prehospital care to the residents of Wise County. In addition to the MICU units, we
operate a Rescue Unit with fire suppression capability that is staffed with the on-duty paramedic
Captain and a secondary paramedic or EMT. Our Rescue 1 staff have many years of critical care
EMS experience in addition to being trained firefighters with vehicle extrication, fire suppression,
rope rescue, and swift water rescue capabilities.
1. Information about our service:
a. Wise County EMS Rescue transports mostly to our local hospital Medical City Decatur.
Depending on the scene location, a more serious injury and/or the need for
specialized treatment (trauma, stroke, etc.), Wise County EMS Rescue will transport
to Medical City Denton; John Peter Smith (JPS) Hospital, Fort Worth; Texas Health
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Harris Methodist Hospital, Fort Worth or the most appropriate facility within the
Dallas/Fort Worth Metroplex.
b. Wise County EMS Rescue performs very limited non-emergency transports, typically
involving occasional interfacility transports for local hospital patients within the
County. These transports are infrequent and generally occur as a courtesy service for
local healthcare facilities.
c. Our current fee schedule is as follows:
HCPCS Current
Charge Description Code Charge Type Price
A2 Comprehensive Transport A0433 ALS Base Rates $2,335.80
ALS Emergency Transport A0427 ALS Base Rates $2,398.60
ALS Non-Emergency Transport A0426 ALS Base Rates $2,235.80
ALS Treatment, No Transport A0998 Other Charges $192.50
BLS Emergency Transport A0429 BLS Base Rates $1,989.00
BLS Non-Emergency Transport A0428 BLS Base Rates $1,826.00
BLS Treatment, No Transport A0998 Other Charges $192.50
Mileage - Ground A0425 Mileage $24.00
Oxygen A0422 Misc. Supplies $100.00
2. Current Systems
a. Wise County EMS Rescue currently uses ESO for our ePCR software.
b. Wise County EMS Rescue receives dispatch from the Wise County Sheriff's Office and
they currently use MDIS-Southern Software. The Wise County Sheriff's office
anticipates future CAD/software platform changes during the term of the contract.
c. EMS billing services are currently outsourced through a third-party billing vendor.
3. Transports and Revenue
a. Annual transports by Level of Service
FY Oct 2024 - Sep 2025 FY Oct 2023 - Sep 2024
Advanced Life Support A0427 3770 Advanced Life Support A0427 3647
ALS - Non-Emergent A0426 2 ALS - Non-Emergent A0426 44
ALS-2 Emergency A0433 347 ALS-2 Emergency A0433 326
Basic Life Support A0429 1130 Basic Life Support A0429 1085
BLS - Non-Emergent A0428 1 BLS - Non-Emergent A0428 74
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b. Payer Mix by Fiscal Year
FY Oct 2024 - Sep 2025 FY Oct 2023 - Sep 2024
Medicare 20% Insurance 15% Medicare 24% Insurance 15%
Medicare Advantage 27% Patient 29% Medicare Advantage 27% Patient 25%
Medicaid 5% Facility 1% Medicaid 5% Facility 1%
Other Gov't Payers 2% TPL 1% Other Gov't Payers 2% TPL 1%
c. Average Cash per Trip
October 2024 - September 2025 $ 479.52
October 2023 - September 2024 $ 428.88
d. Average loaded mileage per transport:
October 2024 - September 2025 11.87
October 2023 - September 2024 12.28
e. Wise County EMS Rescue currently participates in the Texas Health and Human
Services Ambulance Services Supplemental Payment Program (UC Ambulance).
Vendor shall cooperate with Wise County EMS Rescue in providing documentation,
reporting, or billing support necessary for participation in supplemental
reimbursement programs.
C. Scope of Work
Vendor shall provide timely and accurate billing and accounts receivable services for emergency
medical treatment and transport services utilizing information provided by Wise County EMS
Rescue and other reliable sources. Services shall include, but not be limited to, the following:
1. Billing Operations
1.1 Provide billing and accounts receivable management services to Wise County EMS Rescue as
required on a case-by-case basis.
1.2 Maintain knowledge of applicable insurance plans and reimbursement requirements and ensure
that all billable claims are appropriately pursued.
1.3 Provide follow-up on rejected, denied, and inactive claims.
1.4 Utilize current coding standards, billing requirements, and regulatory guidance to ensure
compliance with all applicable federal, state, and local regulations.
1.5 Reconcile the number of transports processed with those received.
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1.6 Maintain responsibility for obtaining missing or incomplete insurance information.
1.7 Provide accurate coding of medical claims.
1.8 Assign billing patient numbers to provide a cross-reference to Wise County EMS Rescue's
assigned transport numbers.
1.9 Maintain records in an electronic format readily accessible by Wise County EMS Rescue
personnel and compliant with all applicable federal and state requirements for maintaining patient
medical records.
1.10 Retain all accounts for a minimum of eighteen (18) months, unless otherwise specified by
mutual agreement, before turning over accounts for which no collection has been made, unless
insurance payment remains pending.
1.11 Vendor shall not subcontract core EMS billing services, coding, customer service, or collections
functions without prior written approval from Wise County EMS Rescue.
2. Financial Management and Collections
2.1 Maintain appropriate accounting procedures for reconciling all deposits, receivables, billing
activity, patient accounts, adjustments, and refunds.
2.2 Revenues shall be collected by the vendor and remitted to Wise County in accordance with
requirements established by the Wise County Auditor. Wise County EMS Rescue prefers electronic
remittance methods that maximize timely deposit and reconciliation of collected funds. Another
acceptable remittance method would be monthly payment via direct bank transfer or check
accompanied by detailed reporting identifying:
a. Payor name
b. Amount paid
c. Patient account credited
d. Commission deducted or invoice submitted
2.3 Minimize non-payment issues by utilizing database capabilities and information networks to
identify or track non-payment history.
2.4 Provide Wise County EMS Rescue all unpaid invoices and complete account processing histories
once collection efforts are exhausted.
2.5 Negotiate and arrange modified payment schedules for individuals unable to pay the full billed
amount.
2.6 Maintain daily deposit control sheets and supporting documentation.
2.7 Process refunds in a timely manner and maintain supporting documentation for all refund
requests.
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3. Customer Service and Patient Support
3.1 Provide a designated liaison for patient and payor concerns.
3.2 Provide all customer-related inquiry services and prepare additional third-party claims or patient
payment arrangements based on information obtained during customer interactions.
3.3 Provide a toll-free telephone number for patient inquiries as designated by Wise County EMS
Rescue.
3.4 Respond to all patient requests and inquiries, whether written or verbal, in a timely and
professional manner.
3.5 Provide sufficient Customer Service Representatives to assist Wise County EMS Rescue personnel
with billing questions and related inquiries.
4. Hospital, Insurance, and Credentialing Support
4.1 Establish arrangements with hospitals to obtain and verify patient demographic, insurance, and
contact information.
4.2 Assist Wise County EMS Rescue in updating, filing, and preparing Medicare, Medicaid, and other
insurer provider enrollment forms.
4.3 Respond to required provider enrollment revalidations on behalf of Wise County EMS Rescue.
4.4 Make recommendations regarding fee schedule changes and advise Wise County EMS Rescue
regarding changes in statutes, regulations, and industry standards affecting EMS billing and
reimbursement.
5. Compliance, Security, and Audit Requirements
5.1 Ensure all required documentation and agreements with payors, including but not limited to
Medicare, Medicaid, and commercial insurance carriers, are maintained and current.
5.2 Facilitate proper security of confidential information and proper destruction of disposed
materials containing confidential information.
5.3 Implement and maintain a Compliance Plan consistent with the U.S. Office of Inspector General
(OIG) Compliance Program Guidance for Third Party Medical Billing Companies, 63 FR 70138
(December 18, 1998).
5.4 Provide Wise County with access to all requested information necessary to perform periodic
audits. Reasonable notice shall be provided for planned audits conducted during normal business
hours.
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5.5 Vendor shall disclose whether any billing, coding, customer service, or collections functions are
performed outside the United States.
5.6 Vendor shall retain all records related to services performed under this agreement for a
minimum of seven (7) years.
5.7 Vendor shall notify Wise County EMS Rescue within twenty-four (24) hours of discovery of any
suspected, attempted, or confirmed breach involving protected health information.
6. Resident and Employee Billing and Collection Policies
6.1 Vendor shall comply with Wise County EMS Rescue's resident write-off policy.
6.2 Patients residing within Wise County and employees of Wise County shall not be balance billed
for any amount remaining after insurance payment. Information regarding either designation will be
clearly documented in the ePCR.
6.3 If a Wise County resident patient is uninsured, no patient billing statement shall be issued.
6.4 Vendor shall implement internal controls and staff training to ensure compliance with these
policies.
7. Reporting, Data Access, and Transition Support
7.1 Provide timely and comprehensive reports necessary for monitoring, evaluation, auditing, and
management of the services provided.
7.2 Provide Wise County EMS Rescue with real-time, read-only electronic access to vendor billing
records and patient account information.
7.3 All billing data, patient account information, reports, recordings, and associated records shall
remain the sole property of Wise County.
7.4 Upon termination or expiration of the contract, vendor shall fully cooperate in transitioning
services to Wise County or a successor vendor, including transfer of all billing records, electronic
files, reports, and account documentation.
7.5 Vendor shall cooperate fully with Wise County EMS Rescue and any successor vendor during
transition of services and shall continue operations without interruption until transition is complete.
7.6 Vendor shall provide data export in a mutually agreeable electronic format upon termination of
services.
7.7 Vendor shall provide a proposed implementation timeline including milestones for onboarding,
testing, training, credentialing, data migration, and go-live.
8. Specialized and Ancillary Services
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8.1 Explore options to bill, collect, or subcontract billing services for Fire/Rescue-related responses
as requested by Wise County EMS Rescue.
8.2 Provide periodic onsite and/or remote training, as reasonably requested by Wise County EMS
Rescue, regarding proper completion of patient care reports, documentation standards, and
collection of required billing information. At a minimum, vendor shall provide documentation
training no less than two (2) times annually.
D. Performance Standards
Vendor shall meet the following minimum performance standards during the term of the
contract:
1. Submit clean claims electronically within three (3) business days of receipt of complete and
accurate documentation from Wise County EMS Rescue.
2. Maintain a clean claim submission compliance rate of at least ninety-five percent (95%).
3. Respond to inquiries from Wise County EMS Rescue within one (1) business day.
4. Process refund requests within five (5) business days of receipt of complete supporting
documentation.
5. Reconcile unapplied cash and unresolved payment discrepancies within five (5) business days
of identification.
6. Return patient telephone calls and customer service inquiries within one (1) business day.
7. Initiate follow-up action on claim denials within five (5) business days of receipt or
notification of denial.
8. Maintain sufficient staffing levels and operational capacity to ensure timely claims
processing, follow-up, and customer service functions.
9. Provide monthly reports demonstrating compliance with all contractual performance
standards, including claim submission timeliness, denial activity, accounts receivable aging,
unapplied cash, call response metrics, and refund processing.
Failure to consistently meet performance standards may constitute grounds for corrective action,
financial penalties, or contract termination at the discretion of Wise County EMS Rescue.
E. Technical Requirements
1. Vendor must demonstrate the ability to integrate and interface with the County's current and
future electronic patient care reporting (ePCR) software systems.
2. Vendor shall include all costs associated with software integration, interface development,
maintenance, support, clearinghouse connectivity, and data exchange services within the
proposed billing fee structure. Current estimated annual interface-related costs are
approximately $40,000; however, Vendor shall clearly disclose all associated fees and pricing
assumptions within the proposal.
3. Electronic field data collection devices must be capable of receiving and transmitting ECG data
from cardiac monitors utilizing Bluetooth or equivalent wireless technology.
4. Vendor shall maintain commercially reasonable cybersecurity protections, including but not
limited to:
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Multi-factor authentication (MFA)
Encryption of data in transit and at rest
Secure backup and disaster recovery procedures
Replicated or redundant data storage protections
Incident response and breach notification procedures
Compliance with all applicable HIPAA and healthcare data security requirements
5. Upon contract termination or expiration, Vendor shall provide all County-owned billing,
patient, claims, remittance, and account data in a mutually agreeable electronic format at no
additional cost to Wise County EMS Rescue.
6. Vendor shall provide and maintain the following hardware, or current equivalent models
approved by Wise County EMS Rescue:
Six (6) Panasonic Toughbook CF-33 12" devices
Twenty-five (25) Apple iPad 11" devices
Equivalent devices shall meet or exceed the performance specifications of the identified equipment.
Vendor shall include:
Full hardware support and warranty coverage
Repair and replacement procedures
Expected replacement timelines
A replacement/upgrade cycle not to exceed three (3) years
All equipment shall remain the property of the Vendor and shall be returned upon contract
termination or replacement.
Wise County EMS Rescue shall be responsible for cellular/data service costs.
Vendor shall not be responsible for replacement costs associated with accidental damage,
misuse, theft, or loss unless otherwise agreed in writing.
Vendor shall maintain written business continuity and disaster recovery plans and provide copies
upon request.
F. Reporting Requirements
Provide timely, comprehensive reports facilitating all required aspects of monitoring, evaluation,
auditing and management of the services provided.
1. Monthly aging reports
2. Payer mix reports
3. Refund reports
4. Deposit reconciliation reports
5. Denial reports
6. Performance standard reporting
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7. Custom and ad hoc reporting availability
G. Cost Proposal
1. Compensation must be based solely on a percentage of net collections actually received. Flat-
fee, per-claim, hybrid, or tiered pricing structures will not be considered unless specifically
approved by Wise County EMS Rescue.
2. All fees, expenses, interfaces, clearinghouse fees, statement fees, merchant processing fees,
lockbox fees, and ancillary billing costs must be fully disclosed within the proposal.
3. Provide the expected net revenue per transport.
H. Payment Processing and Merchant Services
Vendor may process patient credit card, debit card, ACH, online payment, and virtual credit card
transactions on behalf of Wise County EMS Rescue.
Vendor shall clearly disclose all merchant processing arrangements, transaction fees, virtual
credit card fees, gateway fees, lockbox fees, ACH fees, and any other payment-related costs
within the proposal.
Vendor shall provide detailed monthly reconciliation reports identifying:
Gross payments collected
Merchant processing fees
Virtual credit card fees
Refunds issued
Net deposits/remittances
Outstanding unapplied balances
Date and method of payment transmission
Deposit batch details
Transaction-level payment reporting
Vendor shall remit all collected funds to Wise County EMS Rescue in accordance with procedures
established by the County and within timelines specified in the final contract.
Vendor may retain credit card, debit card, ACH, online payment, and virtual credit card proceeds
for purposes of deducting approved contractual billing fees and authorized payment processing
expenses. If collected payment amounts exceed amounts owed to Vendor for services rendered
during the applicable billing period, Vendor shall remit the remaining balance to Wise County
EMS Rescue with supporting reconciliation documentation. If amounts owed to Vendor exceed
collected payment amounts, Vendor may invoice Wise County EMS Rescue for the remaining
balance due.
Electronic payments and remittances collected on behalf of Wise County EMS Rescue shall be
deposited or remitted no later than one (1) business day following receipt when reasonably
possible through standard banking processes. Vendor shall provide settlement reports and
merchant batch documentation upon request.
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