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EMERGENCY MEDICAL SERVICES
BILLING AND COLLECTION
REQUEST FOR PROPOSAL BID NO. EMS001-2014
Cleveland County Emergency Medical Services System
Submitted By:
PO Box 18210
275 Curry Hollow Road Pittsburgh, PA 15236
(800) 901-1155 Edward R. Marasco
County of Cleveland Finance Department/Purchasing Dept.
311 E. Marion Street
PO Box 1210
Shelby, NC 28151-1210
Bus: 704-484-4840
Fax: 704-480-5496
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TABLE OF CONTENTS
Table of Contents 2 Transmittal Letter 3 ORGANIZATIONAL EXPERIENCE AND QUALIFICATIONS 5 BUSINESS PLAN 10 BILLING PROCESS 19 REPORTING 23 CLIENT REFERENCES 24 FINANCIAL STATEMENTS 26 COMPLIANCE PROGRAM 26 INSURANCE 30 Price Proposal 32 Attachment A: Organizational Charts 33 Attachment B: Sample Correspondence 36 Attachment C: Sample Reports 47 Attachment D: Scope of Services 70 Attachment E: Value Added Services 75
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TRANSMITTAL
SUBMISSION INFORMATION
TIMELINE
RFP Issued April 7th, 2014
Pre-Proposal Conference April 29nd, 2014 @ 2pm
Deadline for submittal of questions May 5th, 2014
Amendment(s) Issued with answers to Contractors’ questions May 9th, 2014
Proposals Due May 16th, 2014 by 12:00 pm
Evaluation of Criteria Begins May16th, 2014 (afternoon)
Selection of Short-List Vendors May 30th, 2014 (Noon)
Complete Contract Negotiations/Execute Contract Estimated June 16th, 2014
Contract to start July 1st, 2014 12:00am
CLEVELAND COUNTY PURCHASING CONTACT
Kim Ogle Cleveland County Purchasing Department 311 E. Marion Street PO Box 1210 Shelby, NC 28151-1210 Ph: 704-484-4840 QUICK MED CLAIMS CONTACT
Edward R. Marasco
Vice President of Business Development Quick Med Claims 275 Curry Hollow Road Suite G 100 Pittsburgh, PA 15236 (412) 655-6343 [email protected]
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May 12th, 2014
Kim Ogle Cleveland County Purchasing Department 311 E. Marion Street PO Box 1210 Shelby, NC 28151-1210
Dear Ms. Ogle:
Quick Med Claims (QMC) is pleased to provide this response to the Request for Proposal to provide EMS Billing and Collection Services for the Cleveland County EMS System. QMC is uniquely positioned to provide EMS billing and collection services for the Cleveland County EMS System. If awarded the EMS billing and collection services contract, we pledge to provide services in accordance with The QMC Experience:
Compliant Billing Processes
Obtain Maximum Allowable Reimbursement for Cleveland County EMS
Provide Excellent Customer Service for Patients & Families
Deploy a Custom Solution for Cleveland County EMS.
QMC is a nationally recognized medical billing service provider. Our twenty (20) + years of EMS billing experience nationally and our proven track record in North Carolina makes QMC distinctly qualified to perform this work.
The proposed price includes the services outlined herein. QMC is pleased to offer additional services that may be required by Cleveland County EMS from time to time at a price mutually agreed upon by the parties.
Should you have any questions or require any additional information, please do not hesitate to contact myself or Ed Marasco.
Sincerely,
Michael J. Lewis President Quick Med Claims 275 Curry Hollow Road Suite G 100 Pittsburgh, Pa 15236 (800)901-1155 [email protected]
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ORGANIZATIONAL EXPERIENCE AND QUALIFICATIONS
HISTORY In 1991, Harry J. Sichi and Michael J. Lewis launched Quick Med Claims (QMC) with a vision to provide superior service to the emergency medical transportation community. Since then QMC has evolved into a nationally recognized leader that has set the bar for exemplary customer service. QMC now employs more than 100 staff members and offers billing and reimbursement services for a variety of helicopter, fixed wing and ground ambulance services in 25 states. Some of the more noteworthy milestones in the evolution of the organization include:
The company was founded in 1991; the two (2) original employees were Mr. Sichi
and Mr. Lewis.
After some work in physician fee and related ancillary billing, the focus of the organization shifted to on emergency medical transportation billing and reimbursement.
o QMC provided services for local ground ambulance operations in 1992.
o The Client base expanded beyond local ground ambulance operations in 1994.
QMC served its first air medical services Client in 1997.
QMC moved to new (expanded) facilities in 2002; this move provided adequate space to support the projected growth of the operation for the following ten (10) years.
In 2003 the QMC team grew to more than 25 staff members; this growth spurred the need for more support systems and increased sophistication.
After a number of years utilizing different software products, QMC leadership settled on the Zoll RescueNet Billing System in 2004. QMC has emerged as one of the flagship clients of Zoll.
The growth of the company required recruitment of a dedicated, professional Vice President of Operations in 2005. This new role provided for the daily operations, allowing ownership to focus on more strategic considerations for the organization.
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With the size and scope of the operation, the issue of data storage and back up came to the forefront. In 2007, QMC leadership invested in a transition to bicoastal backup system for all data.
As the organization continued to grow, ownership recognized and responded to the demand for professional human resources leadership. QMC recruited a dedicated Human Resources Director in 2008.
In an effort to enhance the effectiveness of the operation and achieve additional efficiencies, QMC ownership invested in a state of the art telephone system upgrade in 2009. The new system provides for ease of use, additional expansion capability and special functions to support performance improvement and training.
QMC ownership invested in a substantial file server upgrade in 2009.
In 2009 the QMC team grew to more than 50 staff members; this growth spurred the need for more support systems and increased sophistication.
In 2010 QMC configured additional space, including a dedicated training area to support the operation.
In 2011 QMC staff handles more than 400,000 transports in a single year. The systems and support infrastructure are evaluated and no additional adjustments are necessary. More than 50 staff members have completed the CAC Program.
2012 saw theQMC team grow to more than 100 staff members, requiring the addition of another Billing Director and several Account Managers. QMC staff is expected to handle more than 450,000 transports across operations that cover more than 30 states. The organization celebrates its 20th anniversary at the Air Medical Transport Conference (AMTC) in Seattle.
QMC leadership recognizes that the demands of its Clients change and the organization has a solid track record of adjusting to meet these ever-changing needs. It is this dedication to needs of the customers that has earned QMC the respect of its Clients and the industry for enhancing reimbursement, hiring quality personnel, and maintaining its focus on superior customer service.
EXPERIENCE Quick Med Claims (QMC) is uniquely positioned to provide emergency medical
transportation billing, reimbursement and financial management services to medical
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transportation providers. Our broad experience nationally, along with our extensive
experience with providers of various sizes and scopes allows QMC to provide quality medical
transportation billing and reimbursement services to a diverse constituency. QMC
provides services for medical transport organizations with differing organization structures,
including:
Fire Department Based Providers
Governmental Providers
Hospital Based Providers
Municipal Third Service Providers
Not for Profit Providers
Private Ambulance Services
QMC provides services to a diverse group of Clients including:
Small Providers (less than 1,000 transports per year)
Large Providers (Over 30,000 transports per year)
Multi-modal Providers (Air & Ground)
Our commitment to excellent service will ensure the leadership of Cleveland County
EMS and the patients they serve will have the best experience possible. QMC will commit the
resources necessary to meet the objectives of Cleveland County EMS with regard to billing
and reimbursement for medical transportation. It is our commitment to our Clients and
the personal touch that sets QMC apart from other suppliers. As the incumbent EMS Billing
and Collection partner for Cleveland County EMS, the QMC Team is excited to build on our
successful relationship to improve billing and collection performance further.
THE QMC EXPERIENCE Quick Med Claims (QMC) is a nationally recognized leader in emergency medical transportation billing and reimbursement. QMC is committed to providing services in a manner that ensures compliance with all applicable billing and reimbursement regulations, while maximizing the capture of allowable reimbursement for each Client. The commitment to BOTH of these principles makes QMC the partner of choice for emergency medical transportation providers.
QMC is committed to staying on the cutting edge of capability and technology while maintaining a manageable number of Clients to provide individual attention for each. QMC is
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not the largest provider of services available to your organization; however the company experience is deep enough and broad enough to ensure a high level of quality in all aspects of the service. QMC takes great pride in getting to know each Client well. The Account Manager and staff assigned to the Cleveland County will work with designated representatives at Cleveland County EMS to become familiar with the area, people and the operation. This balance has been the hallmark of the QMC approach since the foundation of the company.
QMC is focused on the success of each emergency medical transportation program that it supports and the existing Client base will attest to this commitment. QMC leadership works closely with Client leadership to meet the strategic goals of the program and the sponsoring organizations. QMC understands the unique position of an emergency medical services (EMS) organization that is a part of a municipal government. QMC understands the special consideration associated with billing for an organization that is tax supported and is extremely skilled at implementing “soft billing” processes. By recognizing and embracing the vision of the Cleveland County, QMC can provide billing and reimbursement services effectively and provide
value added services that will further the mission of the Cleveland County EMS. QMC enjoys
the best reputation in the industry for enhancing reimbursement, deploying quality
personnel, and commitment to customer service excellence.
QMC has a wealth of expertise, including knowledge and experience billing in all of the states highlighted in red.
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Commitment of senior management team time of QMC in an effort to ensure a smooth transition through direct involvement.
Regular conference calls with the designated representatives of Cleveland County to share information and identify opportunities for improvement; the frequency of the calls will be determined by the needs of the EMS System.
Periodic on-site visits to maintain the dialogue with Cleveland County leadership and key representatives of the associated agencies; the frequency will be determined by the needs of Cleveland County EMS leadership.
Initial clinical documentation training for the Cleveland County EMS staff and ongoing feedback to Cleveland County EMS leadership regarding the performance in this area.
Please see Attachment A for Organizational Charts.
BUSINESS PLAN
STRUCTURE
QMC is organized around the Client relationship. Other billing & reimbursement service organizations are organized around payers or regions. QMC leadership believes that each Client should have a specific team assigned to it. This approach provides the following advantages:
It provides a single point of contact for Cleveland County leadership. The QMC team
assigned to Cleveland County will be led by an Account Manager.
Designated Cleveland County EMS liaison staff will interact with a limited number of
QMC staff during the course of the billing & reimbursement process.
The QMC team assigned to the project has become very familiar with the Cleveland
County EMS operation as well as the unique elements of the area (e.g. geography,
hospitals, etc). Our team is uniquely positioned to continue this important work.
The QMC team is monitored, mentored and coached by a Billing Director with a limited scope of responsibility. This allows the Billing Director to be intimately familiar with the process used to support each Client and to be sure the process is being carried out successfully. The process for each Client is described in a written Billing Guide that is developed by QMC staff, in
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concert with Client liaisons, during the transition process. The Billing Guide is updated periodically and serves as the primary reference for all staff assigned to the Client.
PROJECT MANAGEMENT CAPABILITY
QMC will deploy the resources necessary to meet the objectives of Cleveland County in accordance with standards established by the parties in advance. An organizational chart outlining the background and qualifications of the leadership team is in Attachment A. QMC leadership will apply its experience and expertise in the training, monitoring and coaching of the assigned personnel. The QMC staff assigned to Cleveland County EMS will work directly with the designated liaison staff within Cleveland County EMS and the associated agencies to carry out the billing & reimbursement process. This includes ensuring an orderly transition process that identifies opportunities for improvement along the way.
QMC has worked with new Clients to manage the transition in a variety of circumstances
including:
The start of a new billing & reimbursement processes where none existed previously
Transition from internal billing & reimbursement resources
Transition from other outsourced billing & reimbursement services.
Our goal in each circumstance is to make the transition seamless for the Client, invisible to the Patients and mitigate any cash flow interruption. In many cases, QMC has been asked to “clean up” old billing & reimbursement issues as well. The QMC team has successfully completed this process with providers with an annual transport volume below 1,000 to providers with an annual transport volume in excess of 40,000. The transition with Cleveland County several years ago was smooth and uneventful.
CUSTOMER SERVICE PROCESS QMC has a well-tested system for handling patient inquiries of any variety; however QMC
personnel worked with the Cleveland County EMS personnel to develop a Client specific set of
protocols. The general approach to patient inquiries would include, but not be limited to:
Clinical Information
QMC personnel will process all requests for Clinical Information in accordance with the
agreed upon protocol. As required for specific circumstances, requests will be
forwarded to the designated contact at the Cleveland County EMS. These referrals will
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be made electronically via the QMC billing system and will allow for real time track of
the referrals, the disposition and the timelines for each. This will allow for excellent
performance improvement tracking.
Billing Questions
All general questions are typically handled by a Billing Specialist with direct access to the
latest information about the specific patient account. The Billing Specialist staff has
been specially trained to handle patient inquiries and provide the necessary information
in a helpful and efficient manner. All interactions are recorded as notes to the individual
account making them available for real time review by any interested/authorized party.
Billing Complaints
For the occasional patient complaint that is received by QMC, the call will be screened
to determine the most efficient disposition. The referral lines available to the Billing
Specialist include:
o Referral to Cleveland County EMS Liaison
o Referral to Senior Billing Specialist
o Referral to Account Manager
o Referral to Director of Billing Services
Appeal Assistance
QMC personnel are very well versed in strategies that can be used to assist and support
the patient when the payor requires the patient to serve as the primary point of contact
for appealing claims. This may include providing the patient with useful information
about the claim, payor contact information and helpful tips to make the process more
understandable.
QMC provides excellent access for Clients and patients alike for common inquiries and updates
on their individual claims. The QMC offices are staffed with a live operator on Monday through
Friday.
Monday 6:30 am to 9:00 pm Eastern Time
Tuesday 6:30 am to 9:00 pm Eastern Time
Wednesday 6:30 am to 9:00 pm Eastern Time
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Thursday 6:30 am to 9:00 pm Eastern Time
Friday 6:30 am to 5:00 pm Eastern Time
Saturday Closed
Sunday Closed
QMC Offices are typically closed in honor of the following recognized Holidays:
New Years Day
Good Friday (half day)
Memorial Day
Independence Day
Labor Day
Thanksgiving
Day after Thanksgiving
Christmas Eve
Christmas Day
Over the weekend and after hours a robust voice mail system is available to capture messages.
All calls that reach the voice mail system are returned within one business day of the initial
message.
Sample Patient correspondence is included in Attachment B QMC staff will work with
Cleveland County EMS staff to customize the correspondence, including but limited to, using
the Cleveland County EMS logo, preferred wording and related information.
BILLING SOFTWARE QMC uses the RescueNet Billing System supplied by ZOLL at the present time. The RescueNet Billing System was selected in 2004 following an exhaustive evaluation of the available medical transportation billing software available. The RescueNet Billing System is the most commonly used billing and reimbursement software available today. This product, combined with the other applications currently available, places ZOLL in a leadership position with respect to the medical transportation industry. ZOLL also produces other EMS and medical transportation products.
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QMC remains one of the largest RescueNet Billing Clients of ZOLL. In addition to having excellent and frequent lines of communication with ZOLL leadership, QMC has been a consistent resource to ZOLL developers as enhancements are considered, developed and deployed. This position provides many advantages to QMC and to the Clients that we serve. The Cleveland County EMS claims have been processed using the RescueNet Billing suite since the current billing & reimbursement service agreement has been in place. QMC currently employs a former ZOLL RescueNet Billing System Deployment Specialist. She will be an integral part of the Transition Team and will be available to support ongoing services to Cleveland County EMS in the areas of training, software integration and report development. QMC has a number of Clients currently using emsCharts as an ePCR solution. The QMC team is very familiar with the interface capabilities and the key elements of both software products. The working relationship between emsCharts and QMC is exceptional. The Vice President of Business Development at QMC is intimately familiar with emsCharts. He served on the Board of Directors of the STAT MedEvac Program during the development of emsCharts and was one of the earliest commercial users of the software. In addition, the headquarters for emsCharts is located a few miles from the QMC offices . . . this allows a level of access to the emsCharts team that will be unmatched by any of the other bidders in this process.
PROPOSED APPROACH FOR CLEVELAND COUNTY EMS
QMC will deploy the resources necessary to meet the objectives of Cleveland County in accordance with standards established by the parties in advance. An organizational chart of the leadership team is in Attachment A. QMC leadership will apply its experience and expertise in the training, monitoring and coaching of the assigned personnel. The staff that will be assigned includes:
A Director of Billing Services with experience and expertise that are a good fit for Cleveland County EMS. Each QMC Director has more than ten (10) years of medical transport billing experience and has attained the credential of Certified Ambulance Coder (CAC).
An Account Manager with experience and expertise that are a good fit for Cleveland County EMS. Each QMC Account Manager has more than five (5) years of medical transport billing experience and has attained the credential of Certified Ambulance Coder (CAC).
A Senior Billing Specialist with experience and expertise that are a good fit for Cleveland County EMS. Each QMC Senior Billing Specialist has more than three (3) years of medical transport billing experience and has attained the credential of Certified Ambulance Coder (CAC).
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A Billing Specialist with experience and expertise that is a good fit for Cleveland County EMS. Each QMC Billing Specialist endures a formal pre-employment screening process geared to identifying their individual potential for success in the role. Upon acceptance of the position, each Billing Specialist completes an extensive orientation program and a rigorous training regime lasting from four (4) to six (6) weeks.
A Payment Poster with experience and expertise that are a good fit for Cleveland County EMS. Each Payment Poster endures a formal pre-employment screening process geared to identifying their individual potential for success in the role. Upon acceptance of the position, each Payment Poster completes an extensive orientation program and a rigorous training regime lasting from four (4) to six (6) weeks.
Commitment of senior management team time of QMC in an effort to ensure a smooth transition through direct involvement.
Regular conference calls with the designated representatives of Cleveland County to share information and identify opportunities for improvement; the frequency of the calls will be determined by the needs of the EMS System.
Periodic on-site visits to maintain the dialogue with Cleveland County leadership and key representatives of the associated agencies; the frequency will be determined by the needs of Cleveland County EMS leadership.
Initial clinical documentation training for the Cleveland County EMS staff and ongoing feedback to Cleveland County EMS leadership regarding the performance in this area.
The QMC staff assigned to Cleveland County EMS will work directly with the designated liaison staff within Cleveland County EMS and the associated agencies to carry out the billing & reimbursement process.
TRAINING FOR CLEVELAND COUNTY EMS
QMC will provide a variety of training for Cleveland County EMS staff during life of the relationship. In addition, QMC will provide source materials so that Cleveland County EMS may cover the material at other appropriate times during its natural training cycle and/or reinforce information as necessary. The training will include:
Clinical Documentation Training - Initial
QMC will provide clinical documentation training within the first three (3) months of the renewal. In our experience, this is the optimal approach because it provides enough experience with Cleveland County EMS claims to generate a customized educational program. The program typically takes two (2) hours and may be offered at multiple times and locations in order to meet the needs of the operation.
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Clinical Documentation Training
QMC will provide clinical documentation training annually to reinforce the key elements
of the training and educate new staff members. In our experience, this is the optimal
approach because it provides enough experience with Cleveland County EMS claims to
generate a customized educational program. The program typically takes two (2) hours
and may be offered at multiple times and locations in order to meet the needs of the
operation.
RISK MANAGEMENT
QMC will deploy the resources necessary to provide the services outlined herein in the most effective and efficient manner possible. The most common risks associated with medical transportation billing & reimbursement are the following:
Payer Process Changes
It is not uncommon for third party payers to change the process for adjudicating claims
from time to time. Not following these changes may result in decreased and/or delayed
reimbursement. QMC has a dedicated Audit and Compliance Officer whose primary
responsibility is to monitor such changes and spearhead the QMC efforts to adapt to
these changes.
Payer Policy Changes
It is not uncommon for third party payers to change the policies that apply to medical
transportation billing & reimbursement. Not monitoring these changes may result in
missed opportunities to influence the process, ultimately leading to decreased and/or
delayed reimbursement. QMC is actively involved in professional associations that
monitor these types of changes. Several members of the QMC leadership team
actually Chair industry committees that monitor and respond to policy events. In
addition, QMC retains Page, Wolfberg & Wirth (PWW) to provide input relative to
responses to payer policy changes. QMC has a dedicated Audit and Compliance Officer
whose primary responsibility is to monitor such changes and spearhead the QMC
efforts to adapt to these changes.
Staffing Effectiveness
The ability to deploy properly trained staff to carry out the billing & reimbursement
process is an area that presents some risks. QMC has a recruitment, retention and
staffing strategy that is designed to mitigate such a risk.
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TRANSITION PLAN As the incumbent, QMC is already organized and operating effectively. There will be no
specific transition required. However, QMC will take this opportunity to complete an
operational analysis of the billing and collection process for Cleveland County EMS and
recommend adjustments
LEGAL PROTESTS
QMC has never lodged a legal protest related to a Request for Proposal (RFP) process or a contract award.
BILLING PROCESS
QMC APPROACH
Quick Med Claims (QMC) is committed to providing the services necessary to meet the
objectives for EMS billing services as stated herein. The process outlined here describes the
manner in which QMC will comply with the requirements. The fundamental principles of the
QMC approach are to:
Provide turnkey ambulance transport billing services to the Cleveland County in a
manner that is strictly compliant with all applicable federal, state and local
regulations.
Maximize the capture of allowable reimbursement for ambulance transport services
that are provided by Cleveland County.
Provide excellent customer service to the patients and families served by Cleveland
County.
Offer custom solutions for the Cleveland County, based on the individual needs of
the organization, and leveraging the considerable general experience and expertise
of our organization for the benefit of the Fire-EMS Department.
These guiding principles are the cornerstone of the QMC philosophy and have been
throughout its history. The principles guide the approach that is used with each Client. QMC
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leadership will meet with Cleveland County leadership and designated liaisons at the Fire-EMS
Department prior to the start up to clarify how these objectives will be achieved in concert with
the Cleveland County philosophies.
BILLING In order to achieve the above stated objectives and meet the expectations of Cleveland
County, QMC will employ the following general approach to supply billing and collection
services:
INFORMATION SYSTEMS INTERFACE
QMC uses the ZOLL RescueNet Billing System to support the billing and
reimbursement process. The RescueNet Billing System is the most commonly used
billing software in emergency medical services operations today (see Attachment C).
All of the information received by QMC is retained in digital format and attached to
the record in RescueNet. This information is available for review by the designated
representative of Cleveland County via secure access.
DEMOGRAPHIC INFORMATION VERIFICATION
QMC personnel will employ time tested strategies to obtain and verify demographic
information for all patient transports in a timely manner. The QMC team recognizes
that it is not feasible in all circumstances for clinical personnel to obtain all of the
information necessary to support the billing process at the time of the transport.
Using such strategies as electronic downloads, remote access to hospital databases,
and/or interface with third party databases (e.g. Accurint, CBC Innovis), the QMC
team works diligently to verify all of the information necessary to facilitate the
billing process. The relationships that are already in place with hospital
organizations will facilitate an expedited process for local information access and the
systems in place at QMC will provide added capability in this area.
INSURANCE VERIFICATION
QMC personnel will work diligently to obtain and verify key insurance information
on a daily basis. The QMC team is well versed in the latest mechanisms and
strategies to complete this process efficiently and effectively. QMC staff use
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electronic access to health plan databases, interactions with hospital patient
business services staff, and third party insurance verification databases (e.g.
Gateway EDI, EMDEON, etc) to support the process. QMC personnel are extremely
well prepared to complete this process as efficiently as possible.
CLAIMS PROCESSING
QMC personnel will process all claims in the most effective and efficient manner
possible. Each claim is submitted with the following considerations:
Strict adherence to applicable payor specifications
Using strategies derived from the extensive experience of the QMC staff
Handled in accordance with agreed upon protocols to ensure that the
philosophy of the Cleveland County is the guiding force in the process
QMC maximizes its electronic claims filing. More than 95% of the current claims are
submitted electronically and the balance is those where it is not permissible or
practical to pursue electronic submission. The QMC philosophy calls for daily
individual claims processing as opposed to periodic batch processing that is carried
out by other agencies. In addition, QMC staff will expedite certain claims that are
time sensitive in nature. Each of these strategies will have a positive impact on the
Cleveland County cash flow.
ACCOUNTS RECEIVABLE MANAGEMENT
QMC personnel will provide active accounts receivable management services to
ensure that all opportunities for third party reimbursement are exhausted in a
timely manner. The QMC strategy for claim follow up is directed by a set of
protocols that is derived from years of experience. The protocols are payor and
transport type specific so that each claim is treated with the proper queue. The
application of the protocols is facilitated by special prompts embedded in the billing
software to QMC specifications. QMC staff receives special training that provides
them with proven strategies for handling follow up calls with patients, families and
third party payors. QMC personnel will serve as the primary interface with patients
for all interactions related to billing for the Cleveland County. QMC will provide
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real-time direct access to designated Cleveland County representatives to view the
status of each claim through a secure gateway. The information can be viewed in
summary fashion or as detailed as the individual claim level. This will provide
Cleveland County with the peace of mind to know exactly what the status is with
each claim.
CLINICAL INFORMATION REQUESTS
QMC personnel will process all requests for Clinical Information in accordance with
the agreed upon protocol. As required for specific circumstances, requests will be
forwarded to the designated contact at the Cleveland County. These referrals will
be made electronically via the QMC billing system and will allow for real time track
of the referrals, the disposition and the timelines for each. This will allow for
excellent performance improvement tracking.
BILLING QUESTIONS
All general questions are typically handled by a Billing Specialist with direct access to
the latest information about the specific patient account. The Billing Specialist staff
has been specially trained to handle patient inquiries and provide the necessary
information in a helpful and efficient manner. All interactions are recorded as notes
to the individual account making them available for real time review by any
interested/authorized party.
PERFORMANCE REPORTS
QMC personnel will provide a standard set of performance reports that are
designed to meet the needs of the Cleveland County. This standard reporting
package will be distributed on a regular basis in an agreed upon format. In
addition, QMC will provide custom reports designed to answer specific questions
for Client organization leadership on a periodic basis.
REVIEW AND APPEALS
QMC personnel will work closely with Client Organization personnel to pursue additional review and appeal of claims when appropriate. QMC has extensive experience in this area and will employ this knowledge for the benefit of each Client.
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REPORTING
QMC uses ZOLL RescueNet Billing Software as the primary tool for tracking the billing & reimbursement process. This software is one of the most widely used in the industry and this popularity is due in large part to the extensive reporting capability that is available through the system. Attachment C provides a sample of some of the custom designed and currently provided for Cleveland County EMS. In addition, QMC employs a senior staff member with extensive experience deploying and managing RescueNet Billing Software. This expertise represents an excellent value added capability for QMC and the Clients we serve.
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FINANCIAL STATEMENTS
QMC is a privately held corporation and is not required to have audited financial statements on an annual basis. However, QMC is pleased to provide confidential copies of its annual financial statements under a separate cover for your review and consideration.
COMPLIANCE PROGRAM
PHILOSOPHY
In order to maintain compliance with the standards outlined in HIPAA within our organization, QMC is committed to a multi-faceted approach to raising and maintaining awareness regarding the need for confidentiality. The core of the effort is an active education program that includes initial and ongoing training. In addition, QMC leadership embraces an active audit program that monitors the employees. In 2012, QMC hosted eight (8) Compliance Webinars for employees throughout the year. In addition, Page, Wolfberg and Wirth (PWW) conducted annual compliance training. QMC also adopted the National Academy of Ambulance Coding Course (NAAC). This is a course that is specific to Ambulance Billing and the critical knowledge necessary to have accurate, thorough and compliant billing. QMC is proud to have 31 NAAC graduates. To date in 2013, QMC has hosted 8 Compliance Webinars, along with attending CMS Open Door Forums, and other MAC ask-the-contractor Forums. We are also proud to announce the hiring of a Corporate Trainer, Edie Valencia. Edie has an extensive background in many areas in the EMS Field. We offer weekly training to our employees, along with daily internal audits of pre-bill and post-bill activities.
Each QMC employee has been trained in HIPAA Compliance of the Privacy Rules/Security Rules and transaction code set rules, the Red Flag Rules and Breach Notification Rules. QMC will continue to train its employees as changes occur. QMC has taken safeguards for any and all Protected Health Information.
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QMC leadership employs a daily rounding strategy to monitor compliance. Each day the Audit and Compliance Officer and each Billing Director make rounds to assess performance in the following areas:
Keeping PHI from exposed areas.
Proper disposal and shredding of PHI.
Proper handling of printed and faxed materials.
Proper adherence to log on/log off procedures for computers.
Proper adherence to the visitor policy.
QMC does have a Breach Notification Policy that is followed in the event PHI is exposed.
PLAN
QMC maintains an active Corporate Compliance Program that is designed to promote compliant processes and behavior throughout the organization. The Program was developed in accordance with the “Seven Fundamental Elements of an effective Compliance Program” as published by The Office of Inspector General. The QMC Corporate Compliance Program includes the following key elements:
Implementing written policies procedures and standards of conduct
QMC, in conjunction with the law firm Page, Wolfberg and Wirth, LLC (PWW) has developed a written Corporate Compliance Plan (CCP) that spells out specific policies and procedures along with acceptable standards of conduct. PWW is a firm that specializes in EMS law and is on retainer with QMC to provide advice, guidance and opinions in matters such as these. The Plan is monitored on an on-going basis by our Corporate Compliance Officer and revised annually as necessary to remain practical and current. Some recent additions have included a revised HIPAA standards section to accommodate the new Red Flag Policy.
Designating a Compliance Officer and Compliance Committee
QMC has a designated Corporate Compliance Officer with the authority and
responsibility for the implementation and monitoring of the CCP. This individual reports
directly to the President of QMC. The Corporate Compliance Officer is an employee who
has worked with the organization for over 12 years and is responsible for ensuring that
all QMC employees are aware of and understand the importance of an effective and
strong corporate compliance program. QMC has always solicited comments and
feedback on the CCP from the management and key personnel. The Corporate
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Compliance Committee is comprised of the Corporate Compliance Officer and the
Officers of the Corporation.
Conductive effective training and education
The Corporate Compliance Officer is responsible for the coordination of all compliance
education and training to include documentation of all attendees as well as the
retention of those records. This extensive training covers many compliance and billing
seminars as well as our annual compliance training provided by PWW. The annual
training includes initial corporate compliance training for new employees as well as
advanced training for more experienced employees. Other educational and training
seminars are hosted by our law firm, Medicare and Medicaid providers as well as the
Centers for Medicare and Medicaid Services. QMC has a mandatory attendance policy
for designated training sessions that applies to all appropriate personnel. In the event
an individual is unable to attend, the employee is responsible for viewing and reviewing
the meeting information and completing the required documentation.
Developing effective lines of communication
QMC includes an orientation to the CCP for all new employees during the first training
sessions. Part of the strength of that CCP is the people that can help us identify any
issues small or large that may affect corporate compliance. Employees are encouraged
to bring those issues to management or the Corporate Compliance Officer when
necessary. QMC also has an email address that employees can email issues or questions
to as well as a hotline for anonymous calls. QMC has locked drop box that allows
anonymous reporting for employees.
Enforcing standards through well-publicized disciplinary guidelines
QMC leadership provides ongoing reinforcement of expectations through the employee
handbook as well as monthly staff meetings. In certain circumstances, QMC has
employees sign off on policies to ensure their understanding of the policy as well as the
discipline associated with not following those policies.
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Conducting internal monitoring and auditing
QMC has an active audit program to support internal monitoring of compliance. On
average, QMC attempts to audit 3% of all claims on an annual basis. The client specific
audits may vary based upon the client being new, having employees new to the
account, etc. The audits are performed by the Corporate Compliance Officer and some
of the areas that are audited regularly include appropriate patient signatures or
equivalent allowable signatures, documentation supporting level of service billed,
appropriate units billed and other items. Feedback from the audits comes in a monthly
Q&A meeting with the Account Supervisor responsible for the account audited. All the
results are reviewed and if needed action plans are developed. If the audit findings
unveil any issues that require further monitoring.
Responding promptly to detected offenses and developing corrective action
QMC has a three step process for managing billing issues on claims. The first is a “Root
Cause Analysis” that will identify what the issue is, whether it is isolated and who or
what systems are causing the issue. Our second step is a “Corrective Action” which sets
in motion the processes to isolate and fix or mitigate the issue. These processes may
include additional training, software issues that need to be addressed, clarification from
a Payor, etc. The individuals responsible for implementing and following through on the
“Corrective Action” are identified at that time. The last step is a “Post Case Analysis”
and this is a specific audit that is done at a designated time that relooks at the original
issue. It is determined at this time whether the “Corrective Action” was successful or if
some further steps need to be taken.
These are the Seven Minimum Standards set-forth by the Office of Inspector General for
a successful CCP. QMC understands that compliance is an ongoing and serious issue and
continues to strive on behalf of its Clients to continuously offer ideas and processes that
support Corporate Compliance. We view Corporate Compliance not so much as a set of
rules that need to be followed but as a culture that resonates from the entire
management team as well as its owners.
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INSURANCE
QMC currently carries the insurance requirements as specified in section 31.0. A copy of QMC’S Insurance Certificate was sent to Cleveland County EMS by Erie Insurance as of January 2014, and should be on file.
Insurance Requirements Contractor shall not commence work under this Agreement until it has obtained all insurances and endorsements required under this paragraph and such insurances have been approved by the County. Contractor shall require that all subcontractors possess and maintain the insurance required herein. Contractor shall provide the County a Certificate of Insurance and/or policies attested by a duly authorized representative of the insurance carrier evidencing that the insurance required hereunder is in effect. All insurance companies must be acceptable to the County. QMC Agrees Each certificate or policy and endorsement shall require and state in writing that “thirty days (30) prior to cancellation or material change in the policy, notice thereof shall be given to the County by registered mail, return receipt requested” for all the following stated insurance policies. If any of the insurance requirements are not complied with at their renewal dates, payment to Contractor may be withheld until those requirements have been met, or at the option of the County, the County may pay the renewal premiums and withhold such payments from any monies due Contractor. QMC Agrees The following clause must appear on the Certificate of Insurance: “The County of Cleveland is named as the additional Insured on all liability policies." The additional insured endorsements shall be attached to the Certificate of Insurance. It is further agreed that coverage under the above listed policies shall be primary to, and not contribute with, any insurance or self-insurance maintained by the County. Contractor shall maintain at its expense, at minimum, the following insurance coverage during the life of the Agreement:
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PRICING PROPOSAL
QMC is pleased to present this Pricing Proposal for Cleveland County EMS billing & collection services.
Option A:
QMC will provide the Billing and Collection Services outlined in this RFP, the Scope of Services
described in Attachment D, and all of the Value Added Services outlined in Attachment E.
Fee: 8.25% of Collected Revenue
Estimated Annual Value = $46,200
Option B:
QMC will provide the Billing and Collection Services outlined in this RFP, the Scope of Services
described in Attachment D, and only of the following Value Added Services outlined in
Attachment E:
Software Support
Other Services
Fee: 6.95% of Collected Revenue
Estimated Annual Value = $27,700
Collected Revenue is all revenue that is accurately posted in the RescueNet Billing System and
reported to Cleveland County EMS on a monthly basis.
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ATTACHMENT A:
ORGANIZATIONAL CHARTS
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ATTACHMENT B:
SAMPLE CORRISPONDENCE
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ATTACHMENT C:
SAMPLE REPORTS
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ATTACHMENT D:
SCOPE OF SERVICES
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SCOPE OF SERVICES
1. Provide Emergency Medical Services (EMS) billing services. County will award one
contract for a firm to provide all services necessary to receive and process patient billing
and NC Debt Setoff collection. The term of the contract resulting from this solicitation
shall be for a period not to exceed more than three (3) years.
QMC Agrees
2. The term of the contract resulting from this solicitation shall be for an initial period of
one (1) year with 2 optional 1 year extensions.
QMC Agrees
3. Create and maintain interface capability to receive electronic run tickets from the existing
emsCharts system, check for discrepancies to ensure all run tickets have been received,
and verify that required trip and patient information is included.
QMC Agrees QMC will provide weekly or monthly reports that consist of
trips with discrepancies.
4. Contractor must be prepared to furnish, at some point during the term of the contract,
either an electronic patient care reporting software system (ePCR) should the County
decide to replace its existing system, and/or a complete hardware “refresh” including
ruggedized mobile computing hardware and all attendant hardware peripherals.
QMC Agrees
5. Provide all labor, materials and technology necessary to obtain missing patient
information from all available sources prior to issuing insurance claims or direct patient
billing.
QMC Agrees
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6. Electronically file insurance claims and mail direct patient billing upon verification of run
ticket information no later than 25 days after receipt of run ticket.
QMC Agrees
7. Electronically file insurance claims and mail direct patient billing upon verification of run
ticket information no later than 25 days after receipt of run ticket.
QMC Agrees
8. Provide follow-up billing upon receipt of “new” information received concerning a
patient. This includes, but is not limited to, additional insurance information, change of
address, or change of responsible party.
QMC Agrees
9. Electronically receive data files from County’s lockbox and/or other sources (i.e.,
Medicare or insurance companies) to update patient accounts. Use the County’s lockbox
system (when available) for viewing lockbox receipts including check copies and
enclosed correspondence .Hard copies of these items will not be provided, but may be
printed from the online system.
QMC Agrees
10. Update patient accounts upon receipt of payment information.
QMC Agrees
11. First invoice should be sent no later than 30 days from dispatch date. Second invoice to
be sent at 60 days from dispatch date. A third invoice to be sent no later than 90 days
from the dispatch date. This third statement should include delinquent notice along with
debt setoff and garnishment notice.
QMC Agrees
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12. Bills with no payment activity at 120 days will be forwarded to County agency in XML
format (xml file layout in appendix). If a payment plan has been established with the
patient that exceeds 120days for non-insurance bills, and it is being met, the account will
not be turned over to the collection agency.
QMC Agrees
13. Provide 24/7online access to information including notes and hard copy reports required
by County, including but not limited to:
Run tickets received / billed
Payments received
Outstanding balances
Adjustments and refunds
Aging of open accounts
Accounts forwarded to County agency
Status of all accounts
QMC Agrees. QMC will provide access through a secure remote desktop. This
connection provides live access to the data, makes a set of standard reports
available, and provides access to custom reporting capability
14. Provide regular updates and on-going training to County on changes to billing
requirements based on industry standards or requirements of applicable health care laws
and regulations.
QMC Agrees.
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15. Provide County with Contractor’s “Red Flag” plan and all updates throughout the term of
the contract.
QMC Agrees. QMC, in conjunction with the law firm Page, Wolfberg and Wirth,
LLC (PWW) has developed a written Corporate Compliance Plan (CCP) that spells
out specific policies and procedures along with acceptable standards of conduct.
PWW is a firm that specializes in EMS law and is on retainer with QMC to provide
advice, guidance and opinions in matters such as these. The Plan is monitored on an
on-going basis by our Corporate Compliance Officer and revised annually as
necessary to remain practical and current. Some recent additions have included a
revised HIPAA standards section to accommodate the new Red Flag Policy.
16. Comply with all HIPAA rules and regulations.
QMC Agrees QMC Agrees. QMC is intimately familiar with HIPAA rules and
regulations and the Audit and Compliance Officer leads an active effort to maintain
compliance with HIPAA standards as they are updated from time to time.
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ATTACHMENT E:
VALUE ADDED SERVICES
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HARDWARE SUPPORT
SEQUEL SERVER REPLACEMENT COST
QMC will participate in annual funding for a Server replacement for Cleveland County EMS
at an annual cost not to exceed $3,000.
SEQUEL SERVER CROSSOVER COST
QMC will participate in annual funding for Sequel Server Crossover costs for Cleveland
County EMS at an annual cost not to exceed $5,000.
ANNUAL OSSI MAINTENANCE FEE
QMC will participate in annual funding for OSSI maintenance fees for Cleveland County EMS
at an annual cost not to exceed $1,500.
ANNUAL PANASONIC TOUGHBOOK REPLACEMENT
QMC will participate in an annual replacement program for Cleveland County EMS mobile
hardware that includes the purchase of three (3) CF-19 (or equivalent) devices during each
year of the contract up to a total of fifteen (15). The program will be carried out at an
annual cost not to exceed $9,000.
SOFTWARE SUPPORT
ANNUAL EMSCHARTS USER FEES
QMC will provide emsCharts to Cleveland County EMS in the current configuration without
cost. This support will be provided at an annual cost not to exceed $10,200.
ANNUAL WIRELESS CARD FEES
QMC will absorb the cost of the wireless cards for Cleveland County EMS in the current
configuration. This support will be provided at an annual cost not to exceed $6,000.
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OTHER SERVICES
ANNUAL CHARGE STRUCTURE REVIEW
QMC will provide an annual review of the Cleveland County EMS charge structure and make
recommendations to Cleveland County EMS leadership. This support will be provided at an
annual cost not to exceed $1,000.
CLINICAL DOCUMENTATION TRAINING – ANNUAL
QMC will provide initial Clinical Documentation Training for the field personnel annually.
The program will be offered at times, locations and a frequency that is mutually agreed
upon by the parties. This support will be provided at an annual cost not to exceed $2,000.
CUSTOM REPORT DEVELOPMENT
QMC will provide custom report development services for RescueNet Billing Software. The
services will include development of reports beyond the standard reporting capability of the
software. This support will be provided at an annual cost not to exceed $1,000.
BANK LOCK BOX FEES
QMC will fund annual the cost of a Bank Lock Box in excess of $2,500 up to a maximum cost
of $10,000 per year. Cleveland County EMS will be responsible for the first $2,500. This
support will be provided at an annual cost not to exceed $7,500.
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SUMMARY OF ANNUAL VALUE $46,200
HARDWARE Total Value Added: $18,500
Sequel Server Replacement Cost
The estimated value to Cleveland County EMS (cost to QMC) per year is $3,000.
Sequel Server Crossover Cost
The estimated value to Cleveland County EMS (cost to QMC) per year is $5,000.
Annual OSSI Maintenance Fee
The estimated value to Cleveland County EMS (cost to QMC) per year is $1,500.
Replacement of three (3) Panasonic Toughbooks Per Year
The estimated value to Cleveland County EMS (cost to QMC) per year is $9,000.
SOFTWARE Total Value Added: $16,200
emsCharts
The estimated value to Cleveland County EMS (cost to QMC) per year is $10,200.
Wireless Card Support
The estimated value to Cleveland County EMS (cost to QMC) per year is $6,000.
OTHER SERVICES Total Value Added: $11,500
Annual Charge Structure Review
The estimated value to Cleveland County EMS (cost to QMC) per year is $1,000. This
includes the staff time to complete the analysis and prepare a report for Cleveland
County EMS leadership.
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Clinical Documentations Training – Annual
The estimated value to Cleveland County EMS (cost to QMC) per year is $2,000. This
includes the staff time to prepare the program and complete the training for Pittsburgh
EMS personnel.
Custom Report Development
The estimated value to Cleveland County EMS (cost to QMC) per years is $1,000. This
includes the staff time to complete and prepare reports for Cleveland County EMS
leadership.
Bank Lock Box Fees
The estimated value to Cleveland County EMS (cost to QMC) per year is $7,500. This
includes the cost of Bank Lock Box minus the $2,500 Cleveland County EMS
participation.
