Issuing an EMS billing RFP this year? Selecting the right partner for EMS billing is a crucial decision for every EMS organization that outsources billing services.
Determining the best fit can be daunting. Choose wrong, and it could have devastating consequences to revenue and reputation. Choose right, and you could develop a mutually beneficial relationship with a vendor that helps your agency flourish for decades to come.
Many agencies go through a request for proposal process to find a billing partner, either for convenience and assistance with the search or because they are required by their governing body. Our team here at Digitech is highly experienced in creating proposal responses to these RFPs; we’ve read more than we care to admit over the years. In doing so, we’ve identified a standard set of questions that we believe should be in your next EMS billing RFP, whether you’re considering outsourcing for the first time, you know your department needs a change, or you are seeking to determine if your current provider is still the best fit.
This list arms you with 50 questions in six major areas to include in your EMS billing RFP. Answers to these questions will give you a deep understanding of the proposing vendors so you can make an informed choice.
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- How many years has your company been in business?
- How many years has your company provided third-party EMS billing services?
- Disclose any key business partners, subsidiaries, and/or contractor relationships.
- How many EMS billing clients do you have and what type are they (e.g. municipal, hospital-based, private)?
- How many EMS claims does your company bill annually?
- How many employees to you have dedicated to EMS billing services?
- Provide an organizational chart providing the roles and responsibilities of the employees who will manage and/or be assigned to perform services.
- How many offices do you have dedicated to providing EMS billing services? Where are these offices located?
- Provide information about your customer service policies and procedures, including escalation and issue resolution processes.
- Describe how your company is notified of changes in legislation and how that information will be incorporated into your systems and processes in a timely fashion.
- List any professional EMS associations that your company belongs to.
- Provide a list of all award protests that your company has filed in the last five years, including the reason for the protest and the outcome.
- Provide contact information, start date, annual transports, and a brief narrative covering implementation and services provided for three current EMS clients of similar size, complexity, and scope.
Compliance and Regulatory
- Does your company have a compliance plan that is updated regularly?
- Is a copy of your compliance plan available for inspection upon request?
- Has your company, its parent, or a subsidiary ever been investigated for suspected fraud and abuse by any department or agency within the federal or state government such as OIG, Medicare, Medicaid, CMS, or Recovery Audit Contractor?
- Has your company, its parent, or a subsidiary ever been required by a department or agency of the federal or any state government to follow a Corporate Integrity Agreement?
- Has there been an investigation where the final determination resulted in a client paying a fine or penalty due to coding and billing actions that were related in any way to your provision of services?
- Are you able to furnish evidence upon request that all current employees are not excluded from participation in state and federal healthcare programs?
- Please provide a brief description of your company’s quality or audit process.
- Is any auditing process provided by an external vendor or source? If yes, briefly describe these audits.
Technology and Security
- Is the EMS claims processing and billing system you use proprietary to your company or is it software developed by a third party?
- Provide a general overview of the billing and records management solution. Describe the billing software used, who owns it, who supports it, how many clients use it, and describe the process by which required programming changes are made.
- List any additional licenses that are necessary to fully operate all available aspects of the proposed billing software, including reporting software.
- What level of access will be provided into the billing system? Will it include full visibility into all actions, notes, documents, etc.?
- Does your system provide logging of all activities on a patient account for all dates of service, and do you provide access to these logs?
- How is patient information stored, and for how long is this data retained? Are these records retrievable by the client?
- Please provide a brief description of your business continuity plan or disaster recovery plan.
- Provide a detailed listing of all data breaches including volume of patients affected and current status.
- Provide evidence of at least three years of annual SOC 1 Type 2 audits.
Coding and Billing Process
- What is your preferred method for receiving ePCR information?
- Explain the format that the ePCR data will be uploaded into the billing software, and what fields will be included, e.g. patient demographics, insurance, guarantor, medical procedures performed, chief complaint, dispatched as, and found to be.
- Briefly describe the training process for a new coder that starts with your company.
- How are coding personnel audited?
- How are claims assigned to coders? Are specific coders or groups of coders assigned to certain clients?
- If there is not enough information to code the claim, what is the process for obtaining the necessary information?
- Please describe the circumstances in which a claim would be returned to a client.
- What is the typical length of time required to bill a claim once the necessary information is received?
- What is your standard invoicing process and timeline?
- Describe the appeals and review processes for denied claims and the process for limiting denied claims. Show your historical record of denials.
- Describe the cash posting process.
- Describe the refund process.
- Please describe your process, including the frequency, for providing documentation feedback to providers.
Implementation and Onboarding
- Describe the initial phases of this project, including a proposed implementation plan.
- Describe how you ensure that implementation and the transition to your system does not negatively impact the billing and collections processes for our organization.
- What resources will we need to provide during onboarding and implementation?
- Describe the support and training you provide during the onboarding process, and describe the ongoing support and training for our administrative personnel that you will provide once onboarding is complete.
- Please provide sample of weekly or monthly client reports that are part of your standard client reporting process.
- How are requests for non-standard reports handled? Is there a cost for these types of reports? If so, how is pricing determined?
- Please include any additional information regarding your reports and the data analysis tools provided to your clients.
We hope this list helps you get started in your endeavor to create or revise an RFP related to your organization’s EMS billing and coding process.