MANIILAQ ASSOCIATION KOTZEBUE, ALASKA

Transcription

1 MANIILAQ ASSOCIATION KOTZEBUE, ALASKA REQUEST FOR PROPOSAL FOR Coding and Denial Management Outsource January 18, 2018 PO Box 43 Kotzebue, AK

2 Table of Contents Request for Proposal Pages 1 15 General Information Pages 3-7 Volume Data Page 7-8 General Scope of Work Page 8 Services Provided Service Level Agreements (SLA s). Page 8 Services Provided Key Performance Metrics (KPI s).. Page 9 Proposal Submission and Closure Pages Evaluation Team Page 10 Review of Proposals Page 10 Proposal Content and Requirements Page 11 Evaluation Criteria Page 13 Presentations Page 13 Selection Process Page Acceptance or Rejection of Proposals Page 14 Code of Ethics, Conflicts of Interest, and Business Agreement Page 14 Procurement Requirements Page 14 Exhibit A Maniilaq Association Recognized Holidays Page 15!

3 Background Maniilaq Association located in Kotzebue, Alaska provides health, tribal, and social services to residents of rural Northwest Alaska. The Maniilaq Association provides medical services at eleven remote village clinic sites and a critical access hospital in Kotzebue. Health services include a seventeen bed inpatient unit, emergency and outpatient services, as well as, a specialty clinic, vision care services, dental, pharmacy, radiology, laboratory and physical therapy. An 18 bed long term care/snf facility is co-located with Maniilaq Health Center. Maniilaq Health services employs approximately 268 employees who serve a regional population of 8,000. Health Services has an annual budget of approximately $50M. Maniilaq Association currently uses the RPMS information system. On June 4, 2018, Maniilaq will be converting to Cerner Millennium. Maniilaq is part of the Alaska Native Tribal Health Consortium (ANTHC) and will be working with Alaska Native Medical Center (ANMC) to incorporate the usage of their IT servers, Cerner workflows and etc. Maniilaq currently has four service areas where we are seeking to outsource coding, and denial management please see chart below for specifics on each division. Pharmacy currently uses ScriptPro and is out of scope for this RFP. Current Summary Chart of Service Areas and processes: Documentation system Billing Software Behavioral Health AKAIMS Medical Dental LTC RPMS Dentrix Matrix/Point Click Care Centricity Centricity Centricity Dentrix Billing Processor Emdeon Emdeon Emdeon Emdeon Person Bree Swanson Paul Hansen Augustas Kirkland Val Kreil Coding Outsourced Outsourced Internal Outsourced Primary Billing Outsourced Outsourced Outsourced Outsourced 2ndary Billing n/a Outsourced Outsourced n/a Cash Application Outsourced Outsourced Outsourced Outsourced Denial Management Outsourced Outsourced Outsourced Outsourced #

4 Medical Inpatient Outpatient Specialty Clinic Telemedicine/Radio Calls ER OB Notes We provide Observation beds, Administrative Wait Beds, no swing beds currently but may be adding prior to Cerner Go Live. Pre authorization processes are in place. M-F clinic in Kotzebue staffed with physician/midlevel providers. Eleven remote village clinics staffed with Community Health Aides/Practitioners (Medicaid reimbursed) and itinerant medical providers. Itinerant specialists from Anchorage provide weekly specialty clinic services such as ENT, pediatrics, urology, orthopedics, cardiology, surgery, etc. We do bill for the providers. Village to Village, village to Kotzebue, and village or Kotzebue to Anchorage Level IV, stabilization and air medevac to Anchorage Prenatal/ low risk OB delivery services Physical Therapy PhD provider M-F for long term care, inpatients and outpatients Medical Billing Explanation All Inclusive Rates IP and OP encounter rates are utilized for Medicare, Medicaid and the VA. Self-Pay/ Co pays/deductibles We currently do not collect copays and deductibles at time of registration. Bad Debt E Billing Supplies Collections services are currently outsourced. If you provide bad debt, please include in your bid. Currently performed at outsource vendor We do not currently bill for supplies items but would like to in the future. 7

5 Injection/Infusions Insurance Verification Payer Contracts Not currently billed, documentation in place to start. Insurance Verification completed at time of preregistration/registration along with verification of I HS Beneficiary status. We use Experian for verification vendor. Uninsured patients Referred to Alternate Resource Specialist for securing other potential payers including the Marketplace. Premera preferred provider agreement currently in place. Dental Outpatient ER Notes OP dental services provided in villages and Kotzebue by dentists, hygienists and dental health aide therapists. Dentist called in and patient services provided in dental clinic. Dental Billing PPS Self-Pay, Copays and Deductibles Insurance Verification E Billing Bad Debt Pharmacy Retail Inpatient Long Term Care Explanation Dental is fee schedule billing. Medicaid reimburses on encounter rate. Not currently collected at the time of registration. However systems are in place to implement. Insurance Verification is done at time of registration. Dentrix. Same as medical Notes Provided at Kotzebue and villages for refills and initial outpatient script. Provided but not currently captured in billing. Billed as outpatient retail for all payers except Medicare Pharmacy Billing Copays and Deductibles Explanation Copays are collected at the Kotzebue facility at time of dispensing. >

6 Self-Pay Collected at time of dispensing. Insurance Verification POS insurance verification Long Term Care Medicaid Notes 100% of residents on Medicaid. Billed monthly. Reimbursed at negotiated cost based rate. Pharmacy is excluded in this rate - see above for Pharmacy Billing. Self-Pay Insurance Registration Minimal cost of care payments Alaska Medicaid enrollment/reenrollment assistance provided Behavioral Health/Social Services Outpatient Notes Outpatient counseling services provided at the MSW level. Inpatient No inpatient services available at the Behavioral Health Clinic. IP "holds" are billed under medical. All other Behavioral Health provider services for In Patients are not billed but are included in the Medicaid and Medicare all-inclusive rates received. Putyuk Children s Home We serve the Northwest Arctic region of twelve villages, including the Native Village of Pt. Hope. Putyuk is comprised of nine beds, with one bed dedicated to respite services through Maniilaq Association. Documentation will be outside of Cerner B

7 Developmental Disability Services Services paid by Medicaid Waivers and will be documented outside of Cerner Behavioral /Social Services Billing Copays and Deductibles Explanation Currently not collected. Insurance Verification All Inclusive Have contract with Experian Medicaid reimburses based on all-inclusive encounter rates Volume Data (monthly) Hospital Billing - # of Claims Billed 10,540 Cash Application # of checks & credit card payments 4,936 Dental Billing - # of Claims Billed 572 Cash Application # of checks & credit card payments 387 Pharmacy Billing - # of Prescriptions Filled - Non I HS 10,741 # of Total Prescriptions Filled 17,640 E

8 Health Information # of Inpatient Visits Coded 74 # of Outpatient Visits Coded 12,261 # of Documents Scanned # of Scanned Pages 4,797 11,295 General Scope of Work We are requesting a proposal for providing the following services: J ICD-10, CPT and HCPCS coding The successful bidder will begin services end of March, It is anticipated that the new contract will allow for: Ø Language to ensure HIPAA and HITECH compliance Ø Language to ensure compliance with national AAPC and AHIMA coding ethics. Ø Language to ensure coders are credentialed with AAPC or AHIMA Ø Language to ensure coders understand the needs of RPMS, Cerner, Critical Access Hospitals and Indian Health coding/billing needs. Ø Language to ensure quality measures of 95% or better and what will happen if measures not met in two (2) consecutive billing periods. Ø Language to ensure productivity measures are monitored given a grace period will be granted for the Cerner implementation of 30 days or as otherwise indicated. Ø Language to ensure coders will utilize and understand the proper mechanisms in Cerner to query a provider for coding questions. Services Provided Service Level Agreements (SLA s) All references to days will be counted as working or business days which exclude Saturday, Sunday, and all recognized Maniilaq Association holidays (See Exhibit A). All submitted will mean received by Maniilaq Association designated management. Successfully will be accepted to mean that all error files or rejections have been resolved and satisfied. Coding will be completed within three (3) days of either visit or date of discharge (provided the record is completed and available).

9 Key Performance Indicators (KPI s) Ninety-Five percent (95%) Accuracy of coding accounts Accuracy rate will take into account if all documentation was available. Coding Vendor will provide rates. Three Days in Final Billed Not Submitted (FBNS) to Payer Gross Dollars in FBNS / Average Daily Gross Revenue Coders will meet established production rates of 3 charts per hour for inpatient/observation accounts. Meet or exceed production levels for outpatient charts coded per hour. Average is based on a month. Note: the 6/4/18 projected date of the Cerner go live will take into account productivity delays for approximately the first 30 days. ED = 14/hour Day Surgery = 10/hour Other Outpatient = 25/hour Q

10 Bidder Selection Process Plan Contract award is estimated to be approved by the 23 rd of February, 2018 allowing for 120 days implementation with a go live date of June 4, 2018 January 18, 2017 through June 4 th, 2018 Date Range Department Task January 18th PFS RFP Distributed to Vendors Week of January 29th Maniilaq and Bidding Vendors development of proposals This period may include ALL vendors participating in conference calls to discuss RFP response questions February 16th Bidding Vendors Deadline for bids to be submitted to Maniilaq By February 23rd Maniilaq Vendor Selection and notification to winning bid March 26 th thru April 2nd Implementation Teams Testing of coding, billing, cash application, and denial management for all divisions using live data. June 4th Implementation Teams New Vendor starts with Revenue Cycle outsourcing Additional Information or Clarification of RFP If potential bidders or the evaluation team believes additional information or clarification is necessary, bidders may submit questions to: Vicki Dickson at vicki.dickson@maniilaq.org All known bidders will be notified seven (7) days in advance of a shared conference call in which all vendors will be invited to participate to hear the requests for additional information or to receive the additional clarifications. No evaluation member or bidding vendor will be allowed during selection review to participate in any written or verbal communication unless all vendors are present and included and have received at least a minimum of a seven (7) day notice. Evaluation Team Evaluation Team will be comprised of the following members from Maniilaq Association: Hospital Administrator, Association VP/CFO, HIM Director, PFS Director, Social Services Administrator, and Chief Information Officer. Hospital Administrator will head the committee and can be contacted at or phansen@manillaq.org Review of Proposals Review of proposals will take place within the generally accepted bid control guidelines. All bids will be opened at the same time with a quorum of Evaluation Team members present. For any proposal that is determined not to meet minimum requirements, the vendor will receive a rejection notice. Evaluation team reserves the right to notify individual bidders for clarification of proposal submissions. TU

11 Please note all vendors will be assumed at time of submission of bid to agree to and/or be able to provide the following if the vendor is selected: Proof of $1,000,000 liability policy current and active. Agree to enter into a business agreement for full adherence to HIPAA rules and regulations effective for the period of the contract award including HIPAA clauses that pertain to security and protection of data after the close of the contract. Agree to abide by all federal rules and regulations and in particular those that are contained within the following: o Stark Law o Department of Labor Wage and Hour o Davis Bacon Act o Centers for Medicare and Medicaid Meet minimum requirements for software firewalls and redundant systems o State of Alaska Statutes and Administrative Code o Indian Health Services Compliance with any applicable Joint Commission and/or CARF requirements PROPOSAL CONTENT AND REQUIREMENTS Proposal Format: Please submit electronically your proposal on or before January 15 th between Alaska Time. Proposals shall not exceed twelve (12) pages, exclusive of resumes and exhibits. Proposals should be organized according to the following outline: 1. Table of Contents: The proposal will have a table of contents with page numbers and pages numbered throughout the proposal. 2. Introduction: Brief introduction which includes: 2.1 The proposer s name and address; 2.2 Statement that indicates the proposal is valid for at least ninety (90) days from the proposal submission deadline; 2.3 Statement that indicates the proposer s willingness to perform the services described in this RFP; 2.4 Provide a detailed, including examples and/or documentation, of meeting each element of the scope of work. 2.5 Proof of any other licenses and/or registrations as required by this RFP. 2.6 A statement that all staff and other resources which are required to perform the services described in this RFP will be made available by your organization over the life of the anticipated contract; 2.7 Statement that the signatory has authority to bind the proposer; and 2.8 Signature of authorized individual. 3. Strategic Planning & Development: Consistent with the Maniilaq Association s commitment to continuous improvement, proposal must show evidence of its understanding of quality improvement and how you will support our mission and vision. TT

12 4. Firm Profile: Proposal must provide a table or chart that shows organizational structure, chain of supervision, decision authority, and communications. Include both the respondent firm and any sub consultant firms / subcontractors. 5. Professional Qualifications: Professional qualifications of the firms proposed Project Manager, other key personnel, and/or team members necessary for satisfactory performance of required services. Include all personnel that will actively be involved with performing the work, to include a listing of all subcontractors, if any, with an explanation of purpose. In specific, please complete the following table: Category Certified ICD-10 coders medical Certified ICD-10 coders behavioral health Certified ICD-10 coders dental Certified ICD-10 coding trainers ICD-10 coders not certified Denial Management Staff # of Production Staff # with Other coding and billing software - please specify *Please note a person can only be counted once. For example, if a person has a Revenue Cycle Certification and a Project Management Certification you will ONLY enter that person once either under Project Management or Revenue Cycle Certification. Second example, if you have a person who is Certified as an ICD-10 coder and as a trainer you can ONLY count them once either as a coder or as a trainer. Names and certifications can either be submitted with the bid or will be required to be submitted prior to awarding of contract. 6. Project Understanding/Project Approach: Narrative submittal must address scope of work to be completed. 7. Past Performance: Past performance in last five (5) years on contracts with Government agencies and private industry in terms of cost control, quality of work, and compliance with performance schedules. Include a list of all contacts of similar services performed for work in Alaska during the last two (2) years, with name of Contracting Officer and/or Project Officer for each contract. Provide phone numbers and s for the named individuals. 8. Capacity to Respond and Accomplish the Work: Include a list of projects the firm currently has under contract. 9. Price Proposal: Provide pricing designated by the measurement such as but not limited to by piece, by the hour, or as a percentage of payments received. T!

13 10. Alaska Native / American Indian Preference: Maniilaq Association is a PL organization and shall give preference to Indian/Alaska Native organizations provided that goods or services are equal or equivalent. Bidders seeking Indian/Alaska Native Preference must provide documentation. Evaluation Criteria The following will be the major criteria for vendor selection but is not intended to be a complete listing allowing for the evaluation team to factor in other considerations that may present themselves to be relevant to the selection. Knowledge and experience of Alaska specific healthcare and in particular Alaska Medicaid and Indian Health. Successful services provided to an Alaska Critical Access Hospital. Knowledge and experience with Cerner Community Works Knowledge and experience with Tribal Billing (Medicare and Medicaid) Knowledge and experience with Point Click Care Knowledge and experience with Dentrix Program Management expertise for software implementations. Knowledge and experience across a breadth of the vendor s employees of Critical Access Hospitals. Price Proposal including performance penalty for performance falling below SLA s and/or KPI s Native Preference Presentations The evaluation team may invite two to three vendors to make on-line presentations and answer questions during the final selection phase. Presentations will be up to the vendor to create but a general guideline would be to present how the vendor will ensure success with the Maniilaq partnership. Selection Process Evaluation Team will complete the selection process and notify all vendors by at the same time by February 23, Final negotiations for the contract and approval for the business agreement will be completed between February 26 th and March 2nd, Proposal Timetable Proposals sent out January 18, 2018 Bids submitted February 16th Acceptance or Rejection of Proposals T#

14 It is the right of Maniilaq Association to accept or reject any proposal submitted. Submitting a proposal is not to be considered an agreement with Maniilaq Association until a contract and a business partnership agreement are both signed and approved by both Maniilaq and the vendor s official representatives. The Evaluation Team will have sole discretion to accept or reject a proposal so long as there is a quorum agreement. No one member or no one employee of Maniilaq Association may accept or reject a proposal. Organizational Ethics Statement, Conflicts of Interest, and Business Associate Agreement During the contract approval process, Maniilaq Association will put forth a Code of Ethics, a Conflict of Interest, and a Business Agreement. The Organizational Ethics Statement and Conflict of Interest will need to be reviewed and signed by key stakeholders. The Maniilaq Business Associate Agreement will need to be signed by the vendor s authorized representative. Procurement Requirements (must be included in final contract) Termination for Cause and for Convenience: All contracts in excess of $10,000 must include language approved by the General Counsel addressing termination for cause and for convenience by Maniilaq, including the manner by which it will be effected and the basis for settlement. Remedies Clauses for Contracts Over $150,000: All contracts over $150,000 must contain language approved by the General Counsel that addresses administrative, contractual, or legal remedies in instances where contractors violate or breach contract terms, and provide for such sanctions and penalties as appropriate. T7

15 EXHIBIT A Maniilaq Association Annual Holidays The 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. T>