MANIILAQ ASSOCIATION KOTZEBUE, ALASKA REQUEST FOR PROPOSAL FOR Billing and Collection, Cash Application, and Denial Management Outsource January 18, 2018 PO Box 43 Kotzebue, AK 99752 907-442-3321
MANIILAQASSOCIATION
KOTZEBUE,ALASKAREQUESTFORPROPOSALFOR
BillingandCollection,CashApplication,andDenialManagementOutsource
January18,2018
POBox43
Kotzebue,AK99752
907-442-3321
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
!
TableofContents
RequestforProposal........................................Pages1–15
§ GeneralInformation...........................Pages2-7§ VolumeData.................................Page7§ GeneralScopeofWork.........................Page8§ ServicesProvidedServiceLevelAgreements(SLA’s).Page9§ ServicesProvidedKeyPerformanceMetrics(KPI’s)..Page9
ProposalSubmissionandClosure................................Pages10-14
§ EvaluationTeam..............................Page10§ ReviewofProposals...........................Page10§ ProposalContentandRequirements..............Page13§ EvaluationCriteria.............................Page13§ Presentations..................................Page13§ SelectionProcess...............................Page13
AcceptanceorRejectionofProposals..............................Page14
CodeofEthics,ConflictsofInterest,andBusinessAgreement.........Page14
ProcurementRequirements.......................................Page14
ExhibitA
§ ManiilaqAssociationRecognizedHolidays.................Page15
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
#
Background
ManiilaqAssociationlocatedinKotzebue,Alaskaprovideshealth,tribal,andsocialservicestoresidentsofruralNorthwestAlaska.TheManiilaqAssociationprovidesmedicalservicesatelevenremotevillageclinicsitesandacriticalaccesshospitalinKotzebue.Healthservicesincludeaseventeenbedinpatientunit,emergencyandoutpatientservices,aswellas,aspecialtyclinic,visioncareservices,dental,pharmacy,radiology,laboratoryandphysicaltherapy.An18bedlongtermcare/SNFfacilityisco-locatedwithManiilaqHealthCenter.ManiilaqHealthservicesemploysapproximately268employeeswhoservearegionalpopulationof8,000.HealthServiceshasanannualbudgetofapproximately$50M.
ManiilaqAssociationcurrentlyusestheRPMSinformationsystem.OnJune4,2018,ManiilaqwillbeconvertingtoCernerMillennium.ManiilaqispartoftheAlaskaNativeTribalHealthConsortium(ANTHC)andwillbeworkingwithAlaskaNativeMedicalCenter(ANMC)toincorporatetheusageoftheirITservers,Cernerworkflowsandetc.
ManiilaqAssociationcurrentlyhasfourserviceareaswhereweareseekingtooutsourcecoding,billing,cashapplication(managementofaccountsreceivable-AR),anddenialmanagementtoasinglevendor–pleaseseechartbelowforspecificsoneachdivision.
CurrentSummaryChartofServiceAreasandprocesses:
BehavioralHealth Medical Dental LTC
Documentationsystem
BillingSoftware
AKAIMS
Centricity
RPMS
Centricity
Dentrix
Dentrix
PointClickCare
CentricityBillingProcessor Emdeon Emdeon Emdeon Emdeon
Person BreeSwanson PaulHansen AugustasKirkland ValKreilCoding Outsourced Outsourced Internal Outsourced
PrimaryBilling Outsourced Outsourced Outsourced Outsourced2ndaryBilling n/a Outsourced Outsourced n/a
CashApplication Outsourced Outsourced Outsourced OutsourcedDenial
Management Outsourced Outsourced Outsourced Outsourced
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
:
Medical Notes
Inpatient
WeprovideMedicalbeds,Observationbeds,AdministrativeWaitBeds,noswingbedscurrentlybutmaybeadded.Preauthorizationprocessesarein
place.
Outpatient
M-FclinicinKotzebuestaffedwithphysician/midlevelproviders.ElevenremotevillageclinicsstaffedwithCommunityHealthAides/Practitioners(Medicaidreimbursed)anditinerantmedicalproviders.
SpecialtyClinic
ItinerantspecialistsfromAnchorageprovideweeklyspecialtyclinicservicessuchasENT,pediatrics,
urology,orthopedics,cardiology,surgery,etc.Wedobillforallspecialtyvisits.
Telemedicine/RadioCalls
VillagetoVillage,villagetoKotzebue,andvillageorKotzebuetoAnchorage
ER LevelIV,stabilizationandairmedevactoAnchorage
OB Prenatal/lowriskOBdeliveryservices
PhysicalTherapy PhDproviderM-Fforlongtermcare,inpatientsandoutpatients
MedicalBilling Explanation
AllInclusiveRates IPandOPencounterratesareutilizedforMedicare,MedicaidandtheVA.
Self-Pay/Copays/Deductibles
Wecurrentlydonotcollectcopaysanddeductiblesattimeofregistration.
BadDebt Collectionsservicesarecurrentlyoutsourced.Ifyouprovidebaddebt,pleaseincludeinyourbid.
EBilling Currentlyperformedatoutsourcevendor
Supplies Wecurrentlybillforlimitedsupplyitemsbutwouldliketoexpandtoincludealleligiblesupplies.
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
@
Injection/Infusions Notcurrentlybilled,documentationinplacetostart.
InsuranceVerification
InsuranceVerificationcompletedattimeofpre-registration/registrationalongwithverificationofIHSBeneficiarystatus.WeuseExperianforverificationvendor.UninsuredpatientsarereferredtotheAlternateResourceSpecialistsforsecuringotherpotentialpayersincludingtheMarketplace.Maniilaqalsoemploysaslidingfeescale.
PayerContracts Premerapreferredprovideragreementcurrentlyinplace.
Dental Notes
Outpatient OPdentalservicesprovidedinvillagesandKotzebuebydentists,hygienistsanddentalhealthaidetherapists.
ER Dentistcalledinandpatientservicesprovidedindentalclinic.
DentalBilling Explanation
PPS Dentalisfeeschedulebilling.Medicaidreimbursesonencounterrate.
Self-Pay,CopaysandDeductibles
Notcurrentlycollectedatthetimeofregistration.Howeversystemsareinplacetoimplement.
InsuranceVerification InsuranceVerificationisdoneattimeofregistration.
EBilling Dentrix.BadDebt Sameasmedical
Pharmacy Notes
Retail ProvidedatKotzebueandvillagesforrefillsandinitialoutpatientscript.
Hospital Providedbutnotcurrentlycapturedinbilling.
LongTermCare BilledasoutpatientretailforallpayersexceptMedicare
PharmacyBilling Explanation
CopaysandDeductibles
CopaysarecollectedattheKotzebuefacilityattimeofdispensing.
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
D
Self-Pay Collectedattimeofdispensing.
InsuranceVerification POSinsuranceverification
LongTermCare Notes
Medicaid100%ofresidentsonMedicaid.Billedmonthly.Reimbursedatnegotiatedcostbasedrate.Pharmacyisexcludedinthis
rate-seeaboveforPharmacyBilling.
Self-Pay Minimalcostofcarepayments
InsuranceRegistration AlaskaMedicaidenrollment/reenrollmentassistanceprovided
BehavioralHealth Notes
Outpatient OutpatientcounselingservicesprovidedattheMSWlevel.
Inpatient
NoinpatientservicesavailableattheBehavioralHealthClinic.IP"holds"arebilledundermedical.AllotherBehavioral
HealthproviderservicesforInPatientsarenotbilledbutareincludedintheMedicaidandMedicareall-inclusiverates
received.
PutyukChildren’sHome
WeservetheNorthwestArcticregionoftwelvevillages,includingtheNativeVillageofPt.Hope.Putyukiscomprisedofninebeds,withonebeddedicatedtorespiteservicesthroughManiilaqAssociation.DocumentationwillbeoutsideofCerner
DevelopmentalDisabilityServices
ServicespaidbyMedicaidWaiversandwillbedocumentedoutsideofCerner
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
E
BehavioralHealth/SocialServicesBilling
Explanation
CopaysandDeductibles Currentlynotcollected.
InsuranceVerification HavecontractwithExperian
AllInclusive Medicaidreimbursesbasedonallinclusiveencounterrates
VolumeData(monthly)
Hospital
Billing-#ofClaimsBilled 10,540CashApplication#ofchecks&creditcardpayments 4,936
Dental Billing-#ofClaimsBilled 572CashApplication#ofchecks&creditcardpayments 387
Pharmacy
Billing-#ofPrescriptionsFilled-NonIHS 10,741
#ofTotalPrescriptionsFilled 17,640
Health Information
#ofInpatientVisitsCoded 74
#ofOutpatientVisitsCoded 12,261#ofDocumentsScanned 4,797
#ofScannedPages 11,295
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
K
GeneralScopeofWork
WearerequestingproposalsforprovidingthefollowingservicestobeperformedinCerner.
a. Implementation,pre-deploymentandassistanceaswemovetoCerner’sCommunityWorksolutionwithagolivedateofJune4,2018.
b. Processingofalle-billingsandpaperbillingswhenapplicablec. Identificationandsubmittalofsecondaryandtertiarybillingsd. E-claimscrubberresolutionse. ChargeOptimizationf. DenialandAppealManagementg. ElectronicHealthRecord(EHR)Implementation
i. ManiilaqHealthCenterwillbeimplementinganewelectronichealthrecord.Successfulvendorwillparticipateinplanningandintegrationwithanewelectronichealthrecordsystem.Successfulbidderwillensurecompetentsupportstaffforboththetechnologyandworkflowprocessimprovements.
ii. Willprovideanexperiencedrevenuecyclemanagerfull-timewithtribalexperiencetoliaisonbetweenEHRteams.
iii. Provideanelectroniccommunicationsystemtofacilitatecollaborationforaccountresolution.
h. Applicationofelectronicpayments,creditcardpayments,andpapercheckpayments.i. AppropriateuseofadjustmentcodeswithinManiilaqadjustmentpolicyguidelines.j. Movingallpayerstoelectronicpaymentsandsecuringremittanceadvices
electronically.k. Resolvingallshortpays,denials,andzeropayments.Resolutionincludessecuring
paymentorattheveryleastdeterminingthepatientshouldapplyforMedicaidasnootherpayersareavailable.
ThesuccessfulbidderwillbeginservicesattheendofMarch,2018.Itisanticipatedthatthenewcontractwillallowforthreesignificantchanges:
Ø ReviewandoptimizationofCernerChargemasterØ Increasedchargecaptureofatleast10%thefirstyearofthecontractØ Improvedandcompliantfinancialreporting.
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
O
ServicesProvidedServiceLevelAgreements(SLA’s)
Allreferencesto“days”willbecountedasworkingorbusinessdayswhichexcludeSaturday,Sunday,andallrecognizedManiilaqAssociationholidays(SeeExhibitA).All“submitted”willmeanreceivedbyManiilaqAssociationdesignatedmanagement.“Successfully”willbeacceptedtomeanthatallerrorfilesorrejectionshavebeenresolvedandsatisfied.
§ E-Billingwillbesuccessfullysubmittedthroughaprocessorwithinthree(3)businessdaysofcodingcompleted.
§ Appealswillbefiledwithinfourteen(14)daysfromreceiptofdenialletterorelectronicnotice.
KeyPerformanceIndicators(KPI’s)
§ Ninety-Fivepercent(95%)CleanClaimRate–Numberofclaimsthatpasseditsrequiringnomanualintervention/totalclaimsacceptedintoclaimsscrubbertoolforeditingpriortosubmission
§ ThreeDaysinFinalBilledNotSubmitted(FBNS)toPayer–GrossDollarsinFBNS/AverageDailyGrossRevenue
§ Fifteenpercent(15%)DenialRate–Numberofzeropaidclaimsdenied/numberoftotalclaimsremitted
§ Tenpercent(10%)DenialWrite-OffsasaPercentofNetRevenue–netdollarswrittenoffasdenials/netpatientservicesrevenue
§ Forth-five(45)averageARDays-totalAR/grossrevenue§ Increasepatientcashreceiptsby10%forFY1(October1,2018throughSeptember30,2019)
and5%foreachofthesubsequenttwo(2)years:FY20,andFY121SubsequentyearsstartingwithFY22(October1,2022)increasepatientcashreceiptswillbenegotiatedthereafter.
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
TU
BidderSelectionProcessPlan
Contractawardisestimatedtobeapprovedbythe23rdofFebruary,2018withservicescommencingwithintegratedtestingstartingattheendofMarch,2018.
January18,2017throughJune4th,2018
DateRange Department Task
January18th PFS RFPDistributedtoVendors
WeekofJanuary29th
ManiilaqandBiddingVendorsdevelopmentofproposals
ThisperiodmayincludeALLvendorsparticipatinginconferencecallstodiscussRFPresponsequestions
February16th BiddingVendors DeadlineforbidstobesubmittedtoManiilaq
ByFebruary23rd Maniilaq VendorSelectionandnotificationtowinningbid
March26ththruApril2nd
ImplementationTeams Testingofcoding,billing,cashapplication,anddenialmanagementforalldivisionsusinglivedata.
June4th ImplementationTeams NewVendorstartswithRevenueCycleoutsourcing
AdditionalInformationorClarificationofRFP
Ifpotentialbiddersortheevaluationteambelievesadditionalinformationorclarificationisnecessary,biddersmaysubmitquestionsto:[email protected]
Allknownbidderswillbenotifiedseven(7)daysinadvanceofasharedconferencecallinwhichallvendorswillbeinvitedtoparticipatetoheartherequestsforadditionalinformationortoreceivetheadditionalclarifications.Noevaluationmemberorbiddingvendorwillbeallowedduringselectionreviewtoparticipateinanywrittenorverbalcommunicationunlessallvendorsarepresentandincludedandhavereceivedatleastaminimumofaseven(7)daynotice.
EvaluationTeam
EvaluationTeamwillbecomprisedofthefollowingmembersfromManiilaqAssociation:HospitalAdministrator,AssociationVP/CFO,HIMDirector,PFSDirector,SocialServicesAdministrator,andChiefInformationOfficer.HospitalAdministratorwillheadthecommitteeandcanbecontactedat907-442-7150oremail:[email protected]
ReviewofProposals
Reviewofproposalswilltakeplacewithinthegenerallyacceptedbidcontrolguidelines.AllbidswillbeopenedatthesametimewithaquorumofEvaluationTeammemberspresent.Foranyproposalthatisdeterminednottomeetminimumrequirements,thevendorwillreceivearejectionnotice.Evaluationteamreservestherighttonotifyindividualbiddersforclarificationofproposalsubmissions.
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
TT
Pleasenoteallvendorswillbeassumedattimeofsubmissionofbidtoagreetoand/orbeabletoprovidethefollowingifthevendorisselected:
§ Proofof$1,000,000liabilitypolicycurrentandactive.§ AgreetoenterintoabusinessagreementforfulladherencetoHIPAArulesandregulations
effectivefortheperiodofthecontractawardincludingHIPAAclausesthatpertaintosecurityandprotectionofdataafterthecloseofthecontract.
§ Agreetoabidebyallfederalrulesandregulationsandinparticularthosethatarecontainedwithinthefollowing:
o StarkLawo DepartmentofLaborWageandHouro DavisBaconActo CentersforMedicareandMedicaido StateofAlaskaStatutesandAdministrativeCodeo IndianHealthServices
§ CompliancewithanyapplicableJointCommissionand/orCARFrequirements
PROPOSALCONTENTANDREQUIREMENTSProposalFormat:PleasesubmitelectronicallyyourproposalonorbeforeFebruary16thbetween0800-
1000AlaskaTime.Proposalsshallnotexceedtwelve(12)pages,exclusiveofresumesandexhibits.Proposalsshouldbeorganizedaccordingtothefollowingoutline:
1. Table of Contents: The proposal will have a table of contents with page numbers and pages
numberedthroughouttheproposal.2. Introduction:Briefintroductionwhichincludes:2.1 Theproposer’snameandaddress;2.2 Statement that indicates the proposal is valid for at least ninety (90) days from the proposal
submissiondeadline;2.3 Statementthatindicatestheproposer’swillingnesstoperformtheservicesdescribedinthisRFP;2.4 Provide a detailed, including examples and/or documentation, ofmeeting each element of the
scopeofwork.2.5 Proofofanyotherlicensesand/orregistrationsasrequiredbythisRFP.2.6 Astatementthatallstaffandotherresourceswhicharerequiredtoperformtheservicesdescribed
inthisRFPwillbemadeavailablebyyourorganizationoverthelifeoftheanticipatedcontract;2.7 Statementthatthesignatoryhasauthoritytobindtheproposer;and2.8 Signatureofauthorizedindividual.3. Strategic Planning&Development: Consistentwith theManiilaqAssociation’s commitment to
continuous improvement, proposal must show evidence of its understanding of qualityimprovementandhowyouwillsupportourmissionandvision.
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
T!
4. FirmProfile:Proposalmustprovideatableorchartthatshowsorganizationalstructure,chainofsupervision,decisionauthority,andcommunications. Includeboththerespondentfirmandanysubconsultantfirms/subcontractors.
5. ProfessionalQualifications: Professional qualifications of the firms proposed Project
Manager,otherkeypersonnel,and/orteammembersnecessary forsatisfactoryperformanceofrequiredservices.Includeallpersonnelthatwillactivelybeinvolvedwithperformingthework,toincludea listingofall subcontractors, ifany,withanexplanationofpurpose. Inspecific,pleasecompletethefollowingtable:
Category#of
ProductionStaff
#withOthercodingandbillingsoftware-please
specifyCertifiedBillers(HFMA,AHIMA,CRCorAAPC)
RevenueCycleCertifications(HFMA,AHIMA,orCRC)
Billersnotcertified CashApplicationStaff DenialManagementStaff
*Pleasenoteapersoncanonlybecountedonce.Forexample,ifapersonhasaRevenueCycleCertificationandaProjectManagementCertificationyouwillONLYenterthatpersononceeitherunderProjectManagementorRevenueCycleCertification.Secondexample,ifyouhaveapersonwhoisCertifiedasanICD-10coderandasatraineryoucanONLYcountthemonceeitherasacoderorasatrainer.Namesandcertificationscaneitherbesubmittedwiththebidorwillberequiredtobesubmittedpriortoawardingofcontract.
6. ProjectUnderstanding/ProjectApproach:Narrativesubmittalmustaddressscopeofworktobecompleted.
7. PastPerformance:Pastperformanceinlastfive(5)yearsoncontractswithGovernmentagencies
andprivate industry intermsofcostcontrol,qualityofwork,andcompliancewithperformanceschedules.IncludealistofallcontactsofsimilarservicesperformedforworkinAlaskaduringthelasttwo(2)years,withnameofContractingOfficerand/orProjectOfficerforeachcontract.Providephonenumbersandemailsforthenamedindividuals.
8. CapacitytoRespondandAccomplishtheWork: Includea listofprojectsthefirmcurrentlyhas
undercontract.9. PriceProposal:Providepricingdesignatedbythemeasurementsuchasbutnotlimitedtobypiece,
bythehour,orasapercentageofpaymentsreceived.Includediscountforperformancepenalty.
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
T#
10. AlaskaNative/AmericanIndianPreference:ManiilaqAssociationisaPL93-638organizationandshall give preference to Indian/Alaska Native organizations provided that goods or services areequalorequivalent.BiddersseekingIndian/AlaskaNativePreferencemustprovidedocumentation.
EvaluationCriteria
Thefollowingwillbethemajorcriteriaforvendorselectionbutisnotintendedtobeacompletelistingallowingfortheevaluationteamtofactorinotherconsiderationsthatmaypresentthemselvestoberelevanttotheselection.
§ KnowledgeandexperienceofAlaskaspecifichealthcareandinparticularAlaskaMedicaidandIndianHealth.
§ SuccessfulservicesprovidedtoanAlaskaCriticalAccessHospital.§ KnowledgeandexperiencewithCernerCommunityWorks§ KnowledgeandexperiencewithTribalBilling(MedicareandMedicaid)§ KnowledgeandexperiencewithPointClickCare§ KnowledgeandexperiencewithDentrix§ ProgramManagementexpertiseforsoftwareimplementations.§ Knowledgeandexperienceacrossabreadthofthevendor’semployeesofCriticalAccess
Hospitals.§ PriceProposalincludingperformancepenaltyforperformancefallingbelowSLA’sand/orKPI’s§ NativePreference
Presentations
Theevaluationteammayinvitetwotothreevendorstomakeon-linepresentationsandanswerquestionsduringthefinalselectionphase.PresentationswillbeuptothevendortocreatebutageneralguidelinewouldbetopresenthowthevendorwillensuresuccesswiththeManiilaqpartnership.
SelectionProcess
EvaluationTeamwillcompletetheselectionprocessandnotifyallvendorsbyemailatthesametimebyFebruary23,2018.FinalnegotiationsforthecontractandapprovalforthebusinessagreementwillbecompletedbetweenFebruary26thandMarch2nd,2018.
ProposalTimetable
§ ProposalssentoutJanuary18,2018§ BidssubmittedFebruary16th
AcceptanceorRejectionofProposals
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
T:
ItistherightofManiilaqAssociationtoacceptorrejectanyproposalsubmitted.SubmittingaproposalisnottobeconsideredanagreementwithManiilaqAssociationuntilacontractandabusinesspartnershipagreementarebothsignedandapprovedbybothManiilaqandthevendor’sofficialrepresentatives.TheEvaluationTeamwillhavesolediscretiontoacceptorrejectaproposalsolongasthereisaquorumagreement.NoonememberornooneemployeeofManiilaqAssociationmayacceptorrejectaproposal.OrganizationalEthicsStatement,ConflictsofInterest,andBusinessAssociateAgreementDuringthecontractapprovalprocess,ManiilaqAssociationwillputforthaCodeofEthics,aConflictofInterest,andaBusinessAgreement.TheOrganizationalEthicsStatementandConflictofInterestwillneedtobereviewedandsignedbykeystakeholders.TheManiilaqBusinessAssociateAgreementwillneedtobesignedbythevendor’sauthorizedrepresentative.ProcurementRequirements(mustbeincludedinfinalcontract)
Termination forCauseand forConvenience:All contracts inexcessof $10,000must includelanguageapprovedbytheGeneralCounseladdressingterminationforcauseandforconveniencebyManiilaq,includingthemannerbywhichitwillbeeffectedandthebasisforsettlement.
Remedies Clauses for Contracts Over $150,000: All contracts over $150,000 must containlanguageapprovedbytheGeneralCounselthataddressesadministrative,contractual,orlegalremediesininstanceswherecontractorsviolateorbreachcontractterms,andprovideforsuchsanctionsandpenaltiesasappropriate.
ManiilaqAssociation–Billing&Collection,CashApplicationandDenialManagementOutsourceRFP
T@
EXHIBITA
ManiilaqAssociationAnnualHolidaysThe first day January................................... New Year's Day The third Monday in January...................... Martin Luther King/Della Keats
Day The third Monday in February.................... President's day Last Monday in May................................... Memorial Day The Fourth of July....................................... Independence Day First Monday in September......................... Labor Day Second Monday in October......................... Columbus Day/Maniilaq Day Eleventh Day of November...................….. Veteran's Day The Last Thursday in November..............….. Thanksgiving Day The Day After Thanksgiving……………..Employee Appreciation Day The 25th of December................................. Christmas Day Holidays that fall on Saturday will be observed on the preceding Friday. Holidays that fall on Sunday will be observed on the following Monday.