Treatment or Transport Billing Services

The vendor is required to provide that treatment or transport billing services recipients, individual and/or third-party clients, filing and collecting medicare/medicaid claims, filing and collecting private insurance claims and processing all payments.
- To collect delinquent accounts, resolve fee-related inquiries and complaints from emergency medical transport service recipients, provide copies of bills, support and process hardship requests, and provide performance reports.
- The vendor shall be available to meet monthly with agency boston emergency medical services (EMS) to review collections for the month prior, performance reports and other pertinent issues.
- Billing:
• Agency interface: An operational and reliable billing interface in place with metropcr EPCR software.
o Agency boston EMS shall generate an electronic file for each patient care report to be billed.
o Agency boston EMS shall make every attempt to generate these files daily, on a t-4 schedule.
• Receiving facility demographic validation: all receiving facilities to ensure patient demographic information, as entered by receiving facility personnel, are effectively matched against boston EMS transport records.
o The data exchange shall include data points as defined by boston EMS and occur on an agreed schedule, allowing for updates to demographic information.
o The vendor shall have access to medical records at the facility to further validate patient demographic information.
o While boston EMS will facilitate the introductions, it is the responsibility of the vendor to establish the data exchanges.
o The data fed from the receiving facility must include patient name, plan codes, insurance names, insurance address, ACO and MCO identifiers, medical record number, boston EMS incident number with the option to add more fields, as defined by boston EMS.
o The vendor will actively manage and monitor the data exchange with receiving facilities to optimize demographic accuracy and mitigate potential interruptions associated with system changes.
• Modifications: It is the responsibility of the vendor to modify its billing system at its own expense to capture the necessary data generated from the agency /boston EMS EPCR software and support data exchange with receiving facilities.
o agency /boston EMS shall not under any circumstances be required to modify its current system nor shall it authorize the vendor to make any modifications to AGENCY/boston EMS’ current system or receiving facility systems in order to satisfy the vendor’s requirements in response to this solicitation.
o The vendor will develop new interfaces, at no additional cost, should agency /boston EMS or hospitals make changes to their systems.
• Insurance verificaiton - The vendor shall conduct any and all follow-up required to verify they have the appropriate insurance information for patients.
o The vendor shall utilize resources available, including but not limited to healthcare clearinghouses and the new england healthcare exchange network (NEHEN), to support verification of patient insurance information.
o All costs for such services shall be covered by the vendor.
• Diagnosis codes - The vendor will verify medical necessity and diagnosis codes for accuracy before submission.
o The vendor will contact agency /boston EMS with problem codes.
o The vendor will be required to assist agency / boston EMS in maintaining and updating its master diagnosis code table.
o To streamline the coding process by restricting codes available for selection are discouraged
• Invoice processing - Agency /boston EMS expects that initial invoices will be processed within ten (10) business days of the date of service.
o All efforts shall be made to streamline the billing process, including data collection and validation, to support not only timely but also comprehensive and accurate billing.
• Rates - The vendor shall prepare invoices in accordance with the rates established by agency/boston EMS, the guidelines and procedures established by agency /boston EMS in conjunction with the vendor, and all applicable laws, rules and regulations.
• Charity care – The vendor shall strive to identify patients who qualify for charity care, including enrollment in the health safety net or qualification for a hardship waiver in the last year, to allow the account to be written off as charity care prior to billing the patient.
• Invoices - Invoices for services rendered shall be in accordance with agency vendor invoice requirement and submission letter and contain the following information: account number, invoice number, date issued, name of patient, name of responsible party complete patient address, date of transport, cost of transport amount patient owes incident number, tollfree billing inquiry telephone number, URL for secure online payment, and appropriate messaging as approved by boston EMS/agency.
• Invoice filing - The vendor shall file invoices, electronically or by mail, to the appropriate parties including insurance companies, medicare, medicaid, and individuals, using a process approved by agency /boston EMS.
o Agency /boston EMS shall approve all forms and correspondence.
o Agency /boston EMS will work with the vendor to establish procedures for monitoring the timeliness of filing.
• Record access –the vendor shall provide boston EMS with access to view the status of patient claims.
o All third-party invoice record requests shall be handled in accordance with boston EMS’ record sharing practice, which currently involves using the chart swap online application
- Contract Period/Term: 3 years
- Questions/Inquires Deadline: January 24, 2025