EMS Third Party Billing

Agency: State Government of Virginia
State: Virginia
Type of Government: State & Local
NAICS Category:
  • 541219 - Other Accounting Services
  • 541611 - Administrative Management and General Management Consulting Services
Posted Date: Aug 2, 2020
Due Date: Aug 5, 2020
Solicitation No: RFP RFP 2021-08053-04-2
Bid Source: Please Login to View Page
Contact information: Please Login to View Page
Bid Documents: Please Login to View Page
RFP RFP 2021-08053-04-2
  • EMS Third Party Billing
  • Status: Open
  • Time Left:2 days, 16 hours
  • Closing: 8/5/20 3:00 PM
  • Issued: 7/9/20 3:35 PM
  • Last Amended: 7/31/20
  • Buyer:Debra Shifflett
  • dshifflett3@albemarle.org
  • 434-296-5854

  • Issued By:Albemarle County
  • Type:Request for Proposals (RFP)
  • Category:Non-Professional Services - Non-Technology
  • Work Location: Working for Albemarle County Fire Rescue in Charlottesville, VA
  • Web Address:
  • Pre-Bid Conference:
  • Open Responses:
  • Description:EMS Third Party Billing for the Albemarle County Fire Rescue
  • Amendment/Cancellation Information:Addendum No. 1 Posted 07/31/2020

Attachments
Attachment Size Description Posted On Type
RFP_2021_08053_04_EMS_Third_Party_Billing_Services.pdf (1.62 MB) Solicitation 07/09/20 Solicitation
Addendum One RFP 2021-08053-04 EMS Billing.pdf (215.59 KB) Addendum One RFP 2021-08053-04 EMS Billing.pdf 07/31/20 Solicitation

Attachment Preview

REQUEST FOR PROPOSAL
(RFP)
Issue Date: July 9, 2020
RFP# 2021-08053-04
Title: EMS Third Party Billing
Issuing Agency: County of Albemarle
Purchasing Office
401 McIntire Road
Room 248
Charlottesville, VA 22902
Period of Contract: One year with four (4) additional one (1) year renewal options remaining.
Sealed Proposals will be received until 3:00 p.m. on August 5, 2020 for furnishing the goods/services described herein.
Proposals received after the announced time and date for receipt will remain unopened. No telephoned, faxed, or emailed
proposals will be considered.
The face of the envelope or shipping container shall be clearly marked in the lower left-hand corner as follows:
RFP#:
2021-08053-04
TITLE:
EMS(Emergency Medical Services) Third Party Billing Services
PROPOSAL DUE: August 5, 2020
All Inquiries for Information Should Submitted in Writing and Be Directed To: Debra Shifflett, Buyer II, at
dshifflett3@albemarle.org or by Fax: (434) 972-4006.
PROPOSALS MUST BE SHIPPED/MAILED, OR HAND DELIVERED TO THE ADDRESS SHOWN ABOVE.
PREPROPOSAL CONFERENCE: No preproposal conference will be held.
In compliance with this request for proposal and to all the conditions imposed therein, the undersigned offers and agrees to
furnish the goods/services herein.
By my signature on this solicitation, I certify that this firm/individual and subcontractor is properly licensed for providing the
goods/services specified.
Name And Address Of Firm:
_____________________________________________
_____________________________________________
__________________________Zip Code:___________
Telephone Number: (___)________________________
Fax Number: (___) ____________________________
E-mail Address: ________________________________
Virginia Contractor License No. _____________________
Date: ________________________________________
By: _________________________________________
(Signature In Ink)
Name: ________________________________________
(Please Print)
Title: _________________________________________
I have the authority to bind the corporation.
Class: __________ Specialty Codes: ________________
SMALL, WOMAN, MINORITY AND SERVICE DISABLED VETERAN-OWNED BUSINESS:
NO
IF YES ⇒⇒ SMALL; WOMAN; MINORITY; SERVICE DISABLED VETERAN-OWNED
YES;
This public body does not discriminate against faith-based organizations in accordance with the Virginia Code § 2.2-4343.1
or against a bidder or offeror because of race, religion, color, sex, national origin, age, disability, or any other basis
prohibited by state law relating to discrimination in employment.
RFP# 2021-08053-04
Page 1 of 28
TABLE OF CONTENTS FOR RFP#2021-08053-04
I.
PURPOSE
II.
BACKGROUND
III. TERM OF CONTRACT
IV. COMPETITION INTENDED
V. STATEMENT OF NEEDS
VI. PROPOSAL PREPARATION AND SUBMISSION INSTRUCTIONS
VII. EVALUATION AND AWARD CRITERIA
VIII. PREPROPOSAL CONFERNCE
IX. GENERAL TERMS AND CONDITIONS
X.
SPECIFIC TERMS AND CONDITIONS
XI. METHOD OF PAYMENT
XII. PRICING SCHEDULE
XIII. ATTACHMENTS
PAGE
3
3
4
4
5
16
19
20
20
27
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28
RFP# 2021-08053-04
Page 2 of 28
I. PURPOSE:
The County of Albemarle (“the County”) is soliciting sealed proposals from qualified vendors to establish a contract
through competitive negotiation to provide revenue recovery services for Albemarle County Fire Rescue (ACFR) and its
volunteer agencies that bill for ambulance transports.
The services shall include routine billings for EMS transports; follow-up with resident and non-resident patients; as well
as claim submissions to Medicaid, Medicare, insurance companies and other designated third parties. The billing and
collection services include fees for Level 1 and Level 2 Advanced Life Support (ALS), Basic Life Support (BLS), and
loaded mileage of the transport services provided by ACFR and its volunteer agencies.
The County is looking for a reputable, qualified billing company with experience and knowledge of the emergency
medical services field and an ability to conduct all activities on the County’s behalf with the greatest attention paid to
compliance and business ethics. Offerors are advised that the County will look to and rely in part upon the professional
judgment, knowledge, experience, and expertise of the firm with respect to the rules, laws, regulations and policies that
govern billing and reimbursement of health care services.
Vendor firms and their personnel must have knowledge of ambulance operations; data processing experience in the
ambulance transport and fee collection industry; systems management integration and security experience in the
ambulance transport and fee collection industry; a demonstrable record of high achievement in accounts receivable
collections; staff experienced in health care collections and collections activities servicing municipal EMS agencies;
thorough knowledge of state and federal regulations and laws pertaining to ambulance billing and collections, including
but not limited to HIPAA, the Fair Debt Collections Act, Affordable Care Act (ACA) and the Americans with
Disabilities Act (ADA); and thorough knowledge of Federal Medicaid and Medicare policies and procedures pertaining
to ambulance transport reimbursement.
The primary performance outcome for this procurement is to ensure that the County recoups the maximum possible
reimbursement for providing ambulance services, while performing the highest level of customer service and adhering
to state and federal regulations.
II. BACKGROUND:
Albemarle County, Virginia is home to roughly 108,000 citizens and covers 726 square miles. It includes both urban and
rural areas.
The County’s fire rescue system includes a total of 15 stations, staffed by career staff and volunteers.
The stations that provide EMS transports in the County of Albemarle are as follows:
Station 4
Rescue 5
Station 11
Station 12
Station 15
Station 16
Station 17
Station 18
Earlysville (Earlysville Volunteer Fire Company & ACFR Career Day Light Staff)
Western Albemarle Rescue Squad (Volunteer Only)
ACFR Station 11 (ACFR Career Staff & Station Volunteers)
ACFR Station 12 (ACFR Career Staff & Station Volunteers)
ACFR Station 15 (ACFR Career Staff & Station Volunteers)
ACFR Station 16 (ACFR Career Day Light Staff & Station Volunteers)
ACFR Station 17 (ACFR Career Staff)
ACFR Station 18 (ACFR Career Staff)
Overall, the County has 112 career and 138 volunteer EMS certified providers. Of these, 71 career staff are ALS
providers and 42 volunteers are ALS providers. All ACFR units are staffed with at least one ALS provider.
Albemarle County Fire Rescue and its volunteer agencies comprise an emergency 911 system. It does not provide non-
emergency ambulance transports. Citizens access the emergency response system via 9-1-1. The County’s dispatch and
emergency communications are handled by the regional Emergency Communications Center (ECC) which provides
emergency communications for the City of Charlottesville and the University of Virginia in addition to the County. ECC
receives all 9-1-1 calls in the area and serves as a central dispatch for the three local police departments, all fire and
rescue calls.
RFP# 2021-08053-04
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ACFR and all its volunteer agencies that bill currently utilize the State version of ImageTrend software to create
electronic patient care reports (PCRs). The ePCRs are pulled from the State version of ImageTrend into the current
billing company’s system via a secure connection.
Patients transported by ACFR or one of its volunteer agencies are taken primarily to UVA Health System, Martha
Jefferson Hospital or the Martha Jefferson’s standalone Emergency Department at Proffit Road. On occasion, Western
Albemarle Rescue Squad transports patients to Augusta Health Emergency Department.
The County began its EMS Cost Recovery program in February 2010. Since the EMS Cost Recovery program began, it
has used a third-party billing company. The County follows a “compassionate billing” approach. The program’s
philosophy is that all persons will be treated with the highest level of care without respect to the ability to pay.
On July 1, 2014 the County began a Resident Program. The County uses a service defined question in ImageTrend to
identify County residents. The Resident Program collects all possible reimbursements from Medicaid, Medicare, and
private insurers then waives the remaining balance for County residents. If a patient who is a County resident has no
insurance, all fees are waived. Non-residents who are unable to pay their balance after all applicable insurance is
collected are treated with compassion and provided with options to ensure that financial hardship is avoided, with the
bottom line being that people who cannot pay will not have to pay.
The County utilizes a lock box for central payment collection. Each banking day, check copies and correspondence are
transferred by FTP site to billing company.
Historical Data:
Total EMS Calls for Service
Total EMS Transports
Total Billable EMS Transports
FY18 Actual
8070
6785
6541
FY19 Actual
10417
7153
6809
Revenue Collected
$2,242,041.36 $ 2,370,278.75
*FY20s data is from July 1, 2019 to Jan. 31, 2020
FY20 Actual *
5497
4388
4049
$ 1,123,073.12
Current Fees:
Description of Service
Fee
Additional Charge
Basic Life Support (BLS)
$500
$15 per loaded mile
Advanced Life Support 1 (ALS-1) $600
$15 per loaded mile
Advance Life Support 2 (ALS-2)
$850
$15 per loaded mile
(Billing rates are subject to change by resolution of the Board of Supervisors.)
III. PROCUREMENT SCHEDULE AND TERM OF ANTICIPATED CONTRACT:
This is the proposed schedule and is subjected to change.
Proposed Schedule
Proposal Issued
June 2020
Proposal Due
July 2020
Distribute Proposals to Selection Committee
Late July 2020/Early August 2020
Selection Committee Interviews with Selected Firms
August 2020
Award Contract
September 2020
Contract Effective
December 17, 2020
IV. COMPETITION INTENDED:
It is the County’s intent that this Request for Proposal (RFP) permits competition. It shall be the Offeror’s
responsibility to advise the Purchasing Agent in writing if any language requirement, specification, etc. or any
combination thereof, inadvertently restricts or limits the requirements stated in this RFP to a single source, or otherwise
RFP# 2021-08053-04
Page 4 of 28
restrict competition. All comments, questions, or requests for clarification, including any notification regarding
restrictions to competition, must be received by the Purchasing Agent not later than seven (7) days prior to the date set
for receipt of offers. Offerors may not rely on any oral explanations, clarifications, or changes to the solicitation. All
explanations, clarifications, or changes will be issued in written form as detailed below. The County will not be bound
by any oral statements.
All inquiries and any changes to the requirements of this solicitation shall be answered by issue of written addenda to
the solicitation. It shall be the responsibility of the Offeror to acknowledge all addenda by signing and returning a copy
of all addenda with the offer submission or by separate acknowledgement of each addendum by number and date, in
writing. Offerors are advised to contact this office to confirm the number of addenda five (5) days before the date
established for offer due date. All addenda will be issued by not later than five (5) days prior to offer due date.
V.
STATEMENT OF NEEDS:
A. Scope of Work:
The Contractor shall provide a comprehensive medical billing and collection system which provides solutions that
meet all the requirements of Medicare, Medicaid, CHAMPUS, other governmental insurance programs such as the
Affordable Care Act (ACA) and commercial insurance companies (collectively referred to as Insurance
Providers).
The Contractor will provide assistance with credentialing services, such as completing and submitting revalidation
form for Medicare
B. Services Required:
1. Patient Care Report (PCR) Processing
The Contractor should be prepared to retrieve/receive necessary patient care reports to be billed from the
County’s current system-wide records management system based on the State version of ImageTrend within
thirty (30) to sixty (60) days following the execution of the resulting contract.
The Contractor shall provide all labor, material, and equipment to gather all essential information for
generating and processing all PCRs and coordinate invoicing and collections to insurance companies including
but not limited to Medicare, Medicaid, managed care organizations, commercial insurance companies and
other designated third parties and payers for billing rates established by the County.
The Contractor shall provide routine billings for EMS transport, including follow-up with resident and non-
resident patients, and filing claim submissions to Medicaid, Medicare, insurance companies and other
designated third parties. The billing and collection services include fees for Level 1 and Level 2 Advanced Life
Support (ALS), Basic Life Support (BLS), and loaded mileage of the transport services provided by ACFR.
Additional fees could be added during the term of the contract.
The Contractor shall prepare and submit claims, bills, invoices etc. based on the PCRs or data made available
to the Contractor by ACFR and its volunteer agencies via its Image Trend records management system.
Knowledge, experience and judgment shall be applied to avoid or prevent the submission or claims, bills, or
invoices to any third-party payer in error.
The Contractor is to provide quarterly feedback and recommendations for documentation improvements to the
County’s EMS Cost Recovery Program Specialist to improve the overall billing process and so that medical
care rendered, and medical necessity are properly documented by ACFR.
The Contractor must be currently filing Medicare and Medicaid Claims electronically. The Contractor is
solely responsible for all data entry functions.
2. Required Verification and Missing Information Follow-up
ACFR recognizes the importance of accurate and complete PCR information and endeavors to obtain patient
demographic information and insurance information as well as patient signatures for each patient to the best of
RFP# 2021-08053-04
Page 5 of 28

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