Billing Services

The vendor is required to provide for patient billing services related to the town’s emergency medical service (EMS).
- Provide a proposal for fully-outsourced EMS billing services that also includes high-touch expert support for patients, EMS and finance leadership.
- The following services are required:
• Implementation and transition support:
1. Review current procedures and documentation and collaborate with current billing vendor to ensure
a Smooth transition
2. Provide and execute an implementation and transition plan (e.g., initiating data and insurance carrier
state, establishing fund transfer process)
3. Review current state of accounts receivable and provide recommendations for transition
• Automated integration with our electronic patient care report system (EMS charts).
• Automatically receive required demographic, condition and billing information for patients that are transported to the hospital.
• Pre-billing quality and documentation review. prior to submission of claims for billing, review
documentation and patient insurance information to attempt correction of any deficiencies.
• For example, this may involve utilizing vendor connections with the hospital to obtain insurance information.
• Note that town EMS intends to implement the ESO health data exchange module that will provide access to insurance information for patients transported to certain hospitals.
• Revenue cycle management. proactive management of the entire revenue cycle – from initial notification of patient transport to insurance verification, billing (including all patient communications and statements), coding, payment posting and follow-up on unpaid claims.
• Insurance carrier, medicare and Medicaid claim submission
• Self-payment support (e.g., credit card, check and debit)
• Proactively monitor claims adjudication outcomes (e.g., insurance denials) and attempt to resolve or move to self-pay approach.
• Conduct phone outreach to patients to assist with resolution of issues.
• Provide phone support (regular business hours) for patients who have questions related to their bills.
• Utilize case management to track outstanding issues and resolution.
• Manage town-approved policy for write-offs and payment plans related to patient bills.
• This will involve coordination with the town’s finance department.
• Proven processes for quality management and continuous improvement.
• This includes monitoring trends for claims denials, timeliness of collections, issues with patient demographic information, and data integration and technical issues
• We expect the vendor to identify root cause and provide recommended solutions to address.
• Provide access to self-service analytics that can be used for inquiries and insights into trends.
• This includes:
1. Vendor performance and service levels
2. Collections, outstanding amounts and related aging.
3. Payer breakout (e.g., by insurance carrier, medicare, Medicaid, self-pay)
4. Year-over-year and year-to-date comparisons – for the time period supported by vendor.
5. Write-offs
• Compliance. vendor shall maintain compliance with applicable billing regulations data privacy (e.g., act), and accounting standards.
• A full audit trail of all transactions, collections and financials will be maintained.
• Vendor will be required to enter into an act business associate agreement with the town.
• Audit vendor shall provide results of annual audit conducted by impartial third-party and the town shall have the right to audit processes and town -specific data and transactions on an annual basis.
• Account support for EMS and finance leadership
1. Provide dedicated account executive who serves as single point of contact
2. Ability to join in-person meetings as required
• All services provided on-shore services and data cannot be moved off-shore without the approval of the town.
• Technology utilizes secure cloud-based solutions and data storage and ongoing data security threat detection and mitigation.
• Ensure that automated data and system back-up as well as business continuity procedures are in place.
• Vendor fees should be based on a percentage of revenue collected.