EMS Billing, Collection, and Posting Services

The vendor is required to provide billing, collection, and posting services for the county emergency medical services (EMS).
- Requirement:
•    Successfully receive an electronic file of treatment and billing information from the current software vendor (ESO). 
•    Preference will be given for integration of charting information to the billing system to reduce duplication of entry.
•    Responsible for reviewing each PCR for content to accomplish the following:
o    Require reconciliation between PCR export counts and billing system intake counts (daily and weekly) with exception reporting. 
o    Review electronic health record (EHRs) for information necessary for either a clean claim submission or a determination of lacking medical necessity; and, in a timely manner consistent with permitting timely filing, request of client clarifications or corrections to cure deficient documentation. 
o    Assign the appropriate billing procedure code and diagnosis code based on the documentation, treatment, and chief complaint of the patient; all in accordance with health care regulations set for the industry. 
o    Obtain current patient insurance information per claim and exercise due diligence in obtaining such information in a timely manner consistent with timely filing requirements: including but not limited to documented mailings, emails, third party services and phone calls to the holder of information.
•    File all insurance claims to the appropriate payer for services, including identifying and billing third party liability claims apart from health insurance claims, and submitting claims appropriately based on proper order of responsible parties and within timely filing requirements.
•    Mail an invoice to each transported individual at the approved rate for transportation services. 
•    Unless another method to obtain information is available, or for no other available options remaining, a phone call to the individual to obtain said required information shall be warranted and shall be documented to obtain insurance information.
•    Have either a local telephone number, or a toll-free telephone number in which customers can contact the billing company for questions and concerns.
•    Provide required documentation to Medicare, Medicaid, insurance companies or third-party payers by electronic file transfer when applicable.
•    Mail copies of invoices to patients, Medicare, Medicaid, insurance companies or other third-party payers, when requested or required.
•    Record customer payments from various electronic uploads (mail/lockbox file, credit card file, etc.) and manual listings (wire receipts).
•    Provide the county with an independent auditor’s report regarding the firms’ adequacy of and compliance with their internal controls on an annual basis.
•    Provide evidence of red flag identity theft compliance as well as payment card industry compliance.
•    Explain how data integration and migration will include the old (county’s system b), new (awarded contractor), and current (518) debt setoff program.
•    Provide a summary of how your firm will transition EMS from their current provider including timeline and benchmarks for implementation.