Carmel Fire EMS Billing Services

The vendor is required to provide for outsourced fire emergency medical service (EMS) billing and pre-litigation collection services.
- This initiative is aimed at replacing in-house EMS billing services.
- To demonstrate a successful track record in EMS billing, compliance with healthcare regulations, and the ability to maximize revenue collection for municipal services.
a. Regulatory compliance and standards
•    Compliance with health insurance portability and accountability act (HIPAA) regulations.
•    Adherence to federal and state guidelines regarding emergency medical services billing and collections.
•    CACO and CAPO certification to ensure adherence to all regulatory guidance for EMS billing.
•    National academy of ambulance compliance (NAAC) certifications for staff handling coding and denial appeals
o    Must display ability to adhere to IC 16-31-7, governing EMS fee structures.
•    Implementation of coding standards aligned with the american medical association (ama) guidelines.
•    Follow industry best practices for revenue cycle management.
b. Billing procedures
•    Automated submission of claims to applicable insurance providers and third-party payers.
•    Direct import capabilities from cad systems and electronic patient care reporting (EPCR) tools like
•    Image trend, reducing manual entry errors.
•    Capability to process both electronic and paper claims efficiently.
•    Implementation of accurate and timely billing cycles without delays.
•    Timely partnership with local hospital providers to obtain up-to-date patient contact and insurance information.
c. Pre-litigation collections services
•    Utilization of proven collection strategies to improve the collection rates on accounts receivable.
o    Revenue recovery improvements: documentation of increasing net collection rates ≥ 15% for clients through optimized denial management.
o    sliding scale indigent care policies: experience administering fee waivers aligned with municipal financial assistance programs to avoid inequitable billing practices.
•    Engagement in proactive follow-up for outstanding payments, including telephone calls and written correspondence.
•    Employing debt recovery methods that comply with the fair debt collection practices act (FDCPA).
•    Denial management and appeals expertise: machine learning models flagging documentation gaps before submission, reducing rejection rates
•    Payer-specific workflows: customized follow-up protocols for major insurers like anthem BCBS and Medicaid, informed by historical denial patterns.
•    Engagement in lawful skip tracing best practices to obtain current contact information with outstanding bills.
d. Reporting and analytics
•    Regularly scheduled reports detailing collection rates, outstanding receivables, and trends in unpaid claims.
•    Customized reports tailored to the city of specific needs, including comparisons against historical data.
•    Real-time access to billing and collection status through a secure online portal.
o    Web-based dashboards tracking metrics such as days in accounts receivable (AR), clean claim rates, and payer specific denial trends.
•    Annual third-party audits verifying compliance with CMS billing guidelines and Medicaid and medicare reimbursement rules.
•    Provide timely recommendations and updates on what accounts need to be submitted for collection through litigation.
•    Liaise with the city of legal counsel to provide any requested information to assist with any phase of litigation.
e. Customer service
•    Dedicated client support with trained personnel available for inquiries from city officials and residents.
•    Provision of conflict resolution services to address billing disputes and resident inquiries effectively.
o    Flexible payment plans: tiered options for self-pay balances (e.g., 6/12/18-month terms) with no accruing interest.
f. SLA compliance
•    Maintain a service level agreement (SLA) with clearly defined performance metrics.
•    Agreement on response times for customer support issues and resolution timelines for billing discrepancies.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: August 7, 2025