RFP P03: Medical Cycle Revenue Management Related to the University of Texas Rio Grande Valley (UTRGV)

Transcription

1 RFP P03: Medical Cycle Revenue Management Related to the University of Texas Rio Grande Valley (UTRGV) Clarification No. 1: Questions and Answers Q: Please provide volume information so we can put forward pricing that is accurate and relevant. If actual volume data is not available, please provided projected volumes data A: Volumes are unknown at this time, but the staff is growing at a nice pace. There will be approximately 20 physicians now, and we anticipate 125 within two years. Q: Section Billing Systems of RFP: Please confirm, if UT is looking for the contractor to provide a 5010 Billing System, OR is UT expecting that contractor work on the billing system that is owned by UT? A: UT is looking for the contractor to provide a 5010 Billing System. Q: Please confirm if UT is acceptable to contractor using Global/Offshore (No Subcontracting) Billing Services for part or all of the RFP Scope. A: There is no preference. Please respond accordingly. Q: Currently 20 physicians on board (What is the Annual $$ billing with the 20 physicians) and with 125 physicians in 2 years (what is the projected Annual $$ billing)? A: Right now we don t have a lot of volume and we really don t have a good estimate on what our volume might be. We want to make sure the UTGSV is robust in order to bill and collect. It is likely that at least some initial physicians will have heavy academic responsibilities as residency program faculty. For example, one general surgery residency program director will be around 25% clinical so it s going to be a small volume. Q: Billing Systems (Pg. 17) The contractor shall have a fully implemented customizable 5010 certified as compliant billing system. The system is to have a minimum level of built in edits and have the ability to expand it s repository of edits to insure clean claim submission. A minimum of 90% of claims are to be filed electronically. The contractor shall also have the ability to utilize other systems as needed. Based on the highlighted statement (In red), we request clarity on the criteria that UTHSCSA wishes to adopt. Is it for: i) pure play RCM vendor that be chosen on their ability to provide end to end Revenue Cycle services and who is platform agnostic i.e. can integrate remotely with your current EPM systems and provide the required value, or ii) A vendor who can provide both i.e. a platform that is to be implemented and integrated all UTHSCSA clinics + end to end RCM services. A: This means that the vendor is using a certified electronic billing tool to send 837 claims receive 835 remittance in the required 5010 format. The tool should be customizable so you have the capability to customize (such as claim edits) when needed. Q: Would the University and its Selection/Evaluation board consider a partial response to the RFP? A: No Page 1 of 7

2 Q: In relation to sections , , , and , it appears that the intent is for these functions to be fully managed by the selected contractor. A: Yes, that is the intent. Below is a clarification of these requirements : This is the ability to work electronic claims that were rejected by your clearinghouse or by the payer. These are claims that didn t make it through the door of the payer for processing and are returned due to an error. Example: The member ID# is in an invalid format for the payer. We would like to know that you have a workflow to identify these when they are returned as rejected so they can be corrected and resent with valid information : Similar to above, but these claims did get processed by the payer and are returned as denied (not paid). You have the capability of using the 835 denial/remark codes to assist in the workflow for appealing these claims : You have the ability to receive the electronic remittance (835) and post to the practice management system electronically : You will work with the UTRGV to develop a process to receive deposits. Q: There is a HUB (historically underutilized business) utilization requirement that has been an issue for government bids in TX. Other RFPs in my experience contain a strong recommendation for HUB use, this RFP has a requirement. Can you give me any further insight on this, is a strong recommendation acceptable in your experience? A: In response to your question regarding the HUB requirement in the above referenced RFP, all agencies of the State of Texas are required to make a good faith effort to assist HUB vendors in receiving contract awards. As indicated in the criteria, it is not a scored criteria. A vendor is either compliant or non compliant to the requirements of the Hub Subcontracting Plan in the RFP. If a proposer does not complete the HSP in accordance with the terms and conditions of the RFP, the proposal will be non responsive to the RFP and the bid will be disqualified. Whether a proposer plans to self perform or subcontract portions of the RFP is not a factor in award. Q. Other than the name change from South Texas Practice Plan to University of Texas Rio Grande Valley (UTRVG), the omission of a Pre Proposal Conference, and the inclusion of Appendix 6 and 7, please identify any material changes from the original RFP P01 and this new RFP # P03? A: There are no significant changes. Q. It is our impression that the Scope of Work is limited to Professional charges only. Please confirm that this is correct, or if we should also anticipate managing any Technical (facility) charges. A: That is correct; this is for Profession charges only. Q. Do you have a proposed or desired timeframe for completion of the four phases outlined in section 5.4.2? Q. Will the vendor be expected to code all professional services, including procedure (CPT) and diagnostic (ICD) codes, or will any of the providers (and/or electronic medical record systems) be expected to perform coding? Page 2 of 7

3 A: There is no proposed timeframe; we are interested in how quickly this could be accomplished by the vendors. Q. Can you tell us what EMR system(s) UTRVG will use to document clinical services that the vendor will be expected to interface with? A: The vendor will be expected to code a DX and cpt for all professional services. Q. Our company is an authorized reseller of NextGen, eclinicalworks and Allscripts. Is there any chance that UTRVG could use one of these EHR/PM systems at any of their places of service? A: DHR uses Cerner. I believe Valley Baptist is using WebMD. It is unlikely DHR would allow a different EMR. The other location is undetermined at this time. Q. Can you provide any projections or estimates for any of the following metrics, for Year 1 3: 1). # of active providers; 2). Average # of patient visits per month (non surgical); 3). Average number of patient visits per month, charity care; 4). Average # of surgical procedures per month; 5). Average gross dollars billed per month (professional fees only); 6). Average net dollars collected per month (professional fees only); 7). Projected payer mix A: Volumes are unknown at this time, but the staff is growing at a nice pace. There will be approximately 20 physicians now, and we anticipate 125 within two years. Q: When will we know the size, specialty, and volumes of the practices that are being considered under this services model? A: There are approximately 20 physicians now and we anticipate 125 within two years. Q: Who provides billing today? A: DHR is providing the service for pro fee billing in the interim. Some services provided outside DHR may not be billed. Q: Does UTRGV have a current clearinghouse and will that relationship persist after the work is awarded? If so, are we expected to take over the relationship (and to pay for it), or will that responsibility rest with UTRGV? A: There is no current clearinghouse. It is assumed the billing service has the capability to submit claims electronically. Q: Do the services in scope result in any UB 04 claims? There is a difference between Inpatient services claimed by an Ambulatory provider (essentially the Professional Component of the traditional PC/TC split) and the Technical component claims. A: There will not be any UB 04 claims. This is pro fee only. Q: Section 5.4.2: What is client current expectation for timeframe for 4 Phases of Implementation? A: We are interested in understanding how quickly the vendors can accomplish these phases. Q: Does UTRGV have a current lock box service designed to support payment administration for the single Tax ID Physician organization? If not, when will it be available? Page 3 of 7

4 A: Yes, a lock box has been set up for the single Tax ID. Q: What EMR systems are deployed in the range of practices under consideration for these services? A: DHR is using Cerner. Valley Baptist may be using WebMD. Q: Section 5.4.3: What is meant by The contractor will have current agreements with participating hospitals that interface regularly with UTRGV? A: The contractor awarded this RFP will create and maintain agreements with the hospital to obtain any electronic data. It is not expected these would already be in place. Q: Section 5.4.4: Who provides credentialing today? A: UTRGV is responsible for credentialing staff. Q: Section 5.4.5: How many managed care contracts are in place that will need to be monitored for this group of physicians? A: There are contracts in place for all major payers. Q: Section : How will UTRGV monitor and drive adoption of front end revenue cycle policies and procedures? Will this local support structure manage ongoing education and growth? A: UTRGV will have Revenue Cycle management in place to support the vendor to make sure they get what they need in a timely manner in order to be successful and reduce risk of uncollectible activity. Q: What is the current technology in place for capturing Credit Card payments for the practices in the scope of this solution? A: This will need to be assessed during the implementation. Q: What is the UTRGV expected Implementation timeframe from the start of the agreement? A: We are interested in hearing from the vendors as to how quickly the implementation phase can happen. Q: What is the UTRGV expected start date? A: Phase I will start upon a signed agreement. Q: What are the systems used for Billing, Claims management, scheduling, etc.? A: These are new physicians and no billing system has been set up yet. DHR activity is currently billed out of Cerner as a temporary solution. Each location has their own scheduling process. Page 4 of 7

5 Q: What is the expected timeframe to provide system access to the successful vendor? A: Access will be granted to systems where services are provided in order to perform the tasks outlined in the SOW. Q: What is the flexibility of the data files availability in the event of Work flow tool implementation at our Company? A: This will have to be explored during phase 1 of the implementation. Data should be available for you, but the flexibility of data files is unknown. Q: We understand the phased approach for implementing RCM solution as described in RFP, however is there any preference to prioritize the scope from a project implementation standpoint? A: The selected vendor will be working with UTRGV staff to make this project as successful as possible. Together you will determine how best to approach the project. Q: Are the existing processes and procedures documented already by UTRGV across all the scope areas? A: Policy and procedures from other UT institutions have been shared with UTRGV. These will need to be edited to fit into the RGV sites. This will be new to the front end staff that are responsible for this new activity. Does this include detailed process maps as well? No Q: Do UTRGV have Training documents for the contractor to review during System trainings? A: Unknown at this time. Q: Will UTRGV provide contractor an up to date copy of Aged Trial Balance? A: These charges are being billed by the facility where the services are rendered at this time. The selected vendor will not be responsible for old receivables. Q: In order for us to propose contingency fee based pricing we will need the following details: b. Denial Rate not available c. Current Bad Debt not available d. Payer mix not available e. Liquidation reports N/A f. Current number of FTE s there are approximately 20 physicians now. g. Current growth projection of the health system. We anticipate 125 physicians within 2 years. Q: Will contractor be working ALL accounts cradle to grave? A: Insurance yes. Self-pay may be forwarded to outside collections after a period of time. Page 5 of 7

6 Q: How and what timeframe will UTRGV be providing system training to the awarded Contractor? A: This will be determined at during Phase I. Q: Will UTRGV be awarding this contract to one vendor or multiple vendors? (Ex. By services requested or core competencies) A: One vendor. Q: Does UTRGV have any productivity and liquidation reports/rates that they can share? A: There is no data available for this report request. Q: Please outline UTRGV s reporting structure. A: The vendor will be reporting to Senior Management at UTRGV. This is in the process of being established. Q: Does the covered population for this RFP include Physician AR? Hospital AR? Both? A: Physician AR only. Q: During the assessment our company will utilize multiple techniques to evaluate specialties and locations. Will UTRGV be selecting providers from each of these locations, specialties and provider levels as a sampling group that will be available during our assessment process? A: The selected vendor will meet with providers from each location during phase 1. Q: How many specialties are there universally and how many locations (clinics) does UTRGV currently run within your network? A: OB Gyn, Internal Medicine, Family Medicine, Psychiatry and Pediatrics. Others will be added. There are facilities in Edinburg, Harlingen and McAllen. Q: Will the providers within these arrangements only be MD, PAs, NAs, Residence, Interns or will it also include dental and other such specialties providers? A: This engagement will not include dental, orthotics, nursing school nor allied medical. Q: Section Physician Credentialing and Enrollment: Just a clarification, does UTRGV want the selected vendor qualifying the credentials of their practicing Physicians? A: The vendor will not be responsible for credentialing the physicians. UTRGV will be performing this task. Q: Section Managed Care Contract Management: Clarification as to the Central Repository, is this the Vendor s Repository or UTRGV s? A: This is a vendor repository. UTRGV will supply the contract for your reference. During phase I, you can work out how best to make these available to you and the staff that may have questions about the contract. Q: Would you need a company or vendor to analyze and negotiate third party payer agreements directly with payers? A: No, UTRGV will be responsible for negotiating the payer contracts. Page 6 of 7

7 Q: Section Coding: Do you want our coders to be on site at UTRGV? A: On site is not required. Q: How many EHR systems will be involved? A: Two that we re aware of at this time. DHR has Cerner, Valley Baptist has WebMD (to our best knowledge) Q: What types of Physician Specialties will be involved? A: At this time: Internal Medicine Family Medicine Surgery OB Gyn Pediatrics Psychiatry Q: Section Customer Service/Self Pay/Patient Financial Services: Will the vendor be required to provide a Call Center for collections? A: Yes Q: Section Deposits: Would you consider allowing the Vendor to provide these LockBox Services as part of the RFP? A: A lockbox has been set up already. Posting these payments will be a part of the RFP. Q: Section Payment: What do you expect your collections to be in the first Quarter, as well as first fiscal year? A: Right now we don t have a lot of volume and we really don t have a good estimate on what our volume might be. We want to make sure the UTGSV is robust in order to bill and collect. It is likely that at least some initial physicians will have heavy academic responsibilities as residency program faculty. For example, one general surgery residency program director will be around 25% clinical so it s going to be a small volume. Q: Will you allow a minimum fee until revenues exceed an agreed collected amount? A: You are welcome to make a proposal. Page 7 of 7