8-RFP-02-Scope of Services.pdf

CITY OF FORT WORTH - PURCHASING DIVISION

SCOPE OF SERVICES

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 1 of 34 RFP Title: EMS Billing Services

1.0 INTRODUCTION AND PURPOSE

1.1 The purpose of this solicitation is to establish an annual contract for EMS billing services for the Financial Services Department. The selected Contractor shall support the City in delivering high-integrity, community aligned revenue cycle management services. This includes claims processing, collections coordination, and strategic exploration of alternative revenue sources to sustain and enhance EMS operations.

2.0 DEFINITIONS

2.1 ALS: Advanced Life Support

2.2 BLS: Basic Life Support

2.3 SCT: Specialty Care Transport

2.4 ET3: Emergency Triage, Treat and Transport

2.5 Account: Electronic record maintained for each service that specifies the amount owed, payor identified, and transactions.

2.6 Collections: Total amount of payments received on accounts during a specified time period. For the purposes of this contract, this term does not refer to a Collection Agency, or a third-party entity that pursues payments on loans or debts when billing and collection efforts described herein have been unsuccessful.

2.7 Invoicing Cycle: An invoice is created immediately upon receipt of patient and transport information. Payment in full is due 30 days after the service was rendered. Contractor shall attempt to collect unpaid accounts using standard collection methods. Unpaid balances remaining after 180 days shall be referred to the City for further collection efforts.

2.8 Net Collections: Total amount of payments received on accounts during a specified time period, minus any refunds applied to the account.

2.9 Mutual Aid Services: Ambulance services provided by the City at locations outside the City’s service area under an agreement with another ambulance service provider.

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 2 of 34 RFP Title: EMS Billing Services

2.10 Self-Pay Account: An account where a third-party payor has not been identified and the individual receiving the service, or a responsible party, is billed.

3.0 BACKGROUND

3.1 The City desires to contract with a third-party contractor who specializes in the efficient billing and collection of ambulance fees and programs as outlined in the tables below. The rates charged for ambulance services are established by the Mayor and Council of the City. Third parties, including government and commercial insurers, are billed first when they can be identified. Deductibles and co-payments are collected from patients. Patients are also billed for all the unpaid balances left after less than full payment by third party payors. The patient is billed for the full amount if no third-party payors can be identified or if the patient is uninsured.

3.2 The City’s fiscal year runs from October 1 – September 30.

Information provided below is for the last five fiscal years.

Billable Services by the City:

FY 2021 FY 2022 FY 2023 FY 2024 FY 2025

Total Transports 123,241 121,289 143,377 140,401 134,434

Net Cash Posted by the City:

Ambulance Transport Annual Net Collections 50,610,679 55,227,948 62,712,970 71,490,799 62,913,205 Stand-By/Special Events Annual Net Collections 388,949 624,016 1,104,211 1,143,872 1,296,031 MIH Program Annual Net Collections 514,256 788,990 952,365 644,363 519,604

Gross Charges Generated by the City:

FY 2021 FY 2022 FY 2023 FY 2024 FY 2025

Ambulance Transport Annual Gross Charges 198,828,907 233,772,151 260,267,802 257,002,743 246,951,230 Stand-By/Special Events Annual Gross Charges 586,240 781,172 1,290,203 1,494,345 1,264,967 MIH Program Annual Gross Charges 539,239 787,846 975,305 755,392 539,486

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 3 of 34 RFP Title: EMS Billing Services

Number of Emergency and Non-Emergency transport broken down by service level:

FY 2021 FY 2022 FY 2023 FY 2024 FY 2025

Emergency Transports (ALSE 1) 55,384 50,874 59,954 59,908 65,614 Emergency Transports (ALSE 2) 2,965 2,813 3,324 3,221 3,198 Non-Emergency Transports (ALS-NE) 2,888 2,677 3,107 2,313 1,124 Emergency Transports (BLSE) 41,432 41,579 49,391 51,895 47,153 Non-Emergency Transports (BLSN) 12,000 12,415 13,304 12,349 5,958 ET3 Treatment in Place ALS 86 410 1,128 457 506 ET3 Treatment in Place BLS 109 415 639 219 247 Treatment no Transport (Care 3) 6,153 8,196 10,007 7,841 8,933 Care Given On Scene DOS (Care4) 611 529 563 500 686 Organ Transplants 1 164 189 118 Long distance Transports 452 462 530 426 215 Specialized and Critical Care Transports (SCT) 946 693 1,057 857 504 Air Crew Transports 214 226 209 226 178 Total Transports 123,241 121,289 143,377 140,401 134,434

Current Rates for each of the service levels:

ALSE 1 and 2 Emer $1,585.00 $1,785.00 $1,785.00 $1,785.00 $1,785.00 BLS Emer $1,585.00 $1,685.00 $1,685.00 $1,685.00 $1,685.00 ALS1 Non-Emer $911.00 $1,011.00 $1,011.00 $1,011.00 $1,011.00 BLS Non-Emer $911.00 $1,011.00 $1,011.00 $1,011.00 $1,011.00

SCT $2,540.00 $2,640.00 $2,640.00 $2,640.00 $2,640.00

Treatment no Transport $500 $500 $500 $500 $500 Care Given on Scene DOS $1,544.00 $1,685.00 $1,685.00 $1,685.00 $1,685.00 Air Crew Transports $225.27 $225.27 $225.27 $225.27 $225.27 ET3 Treatment in place - ALS $1,585.00 $1,785.00 $1,785.00 $1,785.00 $1,785.00 ET3 Treatment in place - BLS $1,585.00 $1,685.00 $1,685.00 $1,685.00 $1,685.00 ALS Disposable Supplies 156.00 $156.00 $156.00 $156.00 $156.00 BLS Disposable Supplies 100.00 $100.00 $100.00 $100.00 $100.00 Oxygen 75.00 $116.00 $116.00 $116.00 $116.00 Emergency/Non-Emergency Mileage $17.00 $27.00 $27.00 $27.00 $27.00

Miles Driven Per Year:

Miles Driven Per Year 985,459.80 881,940.10 1,014,766.80 972,364.60 855,121.80

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Payor Mix:

Payer FY 2021 FY 2022 FY 2023 FY 2024 FY 2025 Medicare 39.67% 12.84% 12.91% 12.52% 11.52% Medicare Advantage 22.17% 23.75% 24.56% 23.84% Medicaid 15.87% 2.73% 0.78% 1.27% 1.62% Medicaid MCO 14.31% 16.70% 14.00% 12.97% Commercial 15.37% 12.83% 16.49% 19.50% 17.42% Uninsured 26.96% 31.28% 25.17% 23.54% 28.59% Facility Responsible 2.14% 1.66% 1.88% 2.15% 1.76% Other Govt Payers 2.18% 2.33% 2.46% 2.28% Stand-By/Special Events MIH Programs

4.0 GOAL AND OUTCOME

4.1 Goal: Contractor shall provide billing and collection services for all ambulance services and programs listed herein this document.

4.2 Outcome Objectives

4.2.1 Contractor shall maintain a minimum monthly gross collection rate of twenty-five percent (25%) on accounts.

4.2.2 The collection rate shall be defined as the net revenue collected divided by the gross amounts billed.

4.2.3 This calculation shall begin after the sixth month of the agreement and be calculated on revenue received for the dates of service in month one of the agreement.

4.2.4 For each month thereafter, the monthly collection rate will be determined on a rolling six-month basis, using the same calculation for the six-month look-back period.

For example:

Date of Service Amount Billed

Amount Collected (as of June for Jan Dates of Service) Collection

Jan-21 $15,000,000 $4,500,000 30.00%

4.2.5 The City recognizes that from time to time, fees charged for

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 5 of 34 RFP Title: EMS Billing Services services will change, which may change the expectation for the monthly collection rate. When fee changes are instituted, the City and the Contractor shall agree in writing on updated monthly collection rate goals and incorporate these updated goals in an addendum to the service agreement.

4.3 Process Objectives

4.3.1 Contractor shall process information for 100% of billings submitted to the Contractor by the City for all services provided as described herein this document.

5.0 TARGET POPULATION AND GEOGRAPHIC AREA

5.1 Target Population:

5.1.1 The City responds to emergency calls for both residents and non-residents within the City’s service area, as defined in section 5.2 below. In addition, the City may also be asked to respond to emergency calls outside of the City’s primary services area boundaries. Each of these situations may result in a billable fee that would be referred to the contractor.

5.2 Geographical/Regional Service Area(s):

5.2.1 The City currently provides services within the boundaries of Fort

Worth the boundaries of the following member cities:

5.2.2 Blue Mound, Edgecliff Village, Forest Hill, Haltom City, Haslet, Lakeside, Lake Worth, Richland Hills, River Oaks, Saginaw, Sansom Park, Westover Hills, Westworth Village, and White Settlement.

6.0 SCOPE OF WORK- Contractor shall

6.1 Claims Management and Billing Operations:

6.1.1 Monitor claim status, resolve denials, and ensure compliance with federal, state, and municipal regulations.

6.1.2 Maintain audit-ready documentation and collaborate with City staff during financial reviews.

6.1.3 Submit accurate and timely claims to Medicare, Medicaid, commercial insurers, and other payers for the following Ambulance services and related programs:

6.1.3.1 9-1-1 Advanced Life Support Emergent (ALSE-1)

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A0427

6.1.3.2 9 -1-1 Advanced Life Support Emergent (ALSE-2)

A0433

6.1.3.3 9-1-1 Basic Life Support Emergent (BLSE) A0429

6.1.3.4 9-1-1 Advanced Life Support Emergent Triage, Treat or Transport (ALSE-1) (ET3) A0427W

6.1.3.5 9-1-1 Basic Life Support Emergent Triage, Treat or

Transport (BLSE) (ET3) A0429W

6.1.3.6 9-1-1 Ambulance Response Treatment No Transport –

A0998

6.1.3.7 Scheduled Advanced Life Support Non-Emergent

(ALSN) A0426 – currently not billing but must maintain capability to do so.

6.1.3.8 Scheduled Basic Life Support Non-Emergent (BLSN)

A0428 - currently not billing but must maintain capability to do so

6.1.3.9 Specialty Care Treatment &Transport (SCT) A0434

6.1.3.10 Advanced Life Support Disposable Supplies A0398

6.1.3.11 Basic Life Support Disposable Supplies A0382

6.1.3.12 Advanced Life Support Oxygen A0422

6.1.3.13 Basic Life Support Oxygen A0422

6.1.3.14 Mileage (per mile) A0425

6.1.3.15 Flight Crew Transport

6.1.3.16 Medically Home Group Visits/Medically Home Group

Ambulance Transport

6.1.3.17 Membership Programs

6.1.3.18 Charity Care Program

6.1.4 Comply with all federal, state, and contractual timely filing requirements applicable to EMS billing and ambulance transport claims. This includes, but is not limited to, regulations and deadlines established under Medicare, Medicaid, managed care

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 7 of 34 RFP Title: EMS Billing Services organizations (MCOs), commercial insurance carriers, and any other payer with whom the City or the Contractor submits claims.

6.1.4.1 Contractor will be responsible for reimbursing the

City for any claim that is denied due to timely filing.

The amount Contractor will reimburse the City will be the Usual and Customary Rate as defined by the Fair Health Database.

6.2 Collections and Recovery Efforts

6.2.1 The selected Contractor will:

6.2.1.1 Implement structured follow-up protocols for unpaid

claims and patient balances.

6.2.1.2 Coordinate with third-party collection agencies to

ethically pursue delinquent accounts, ensuring compliance with consumer protection laws and municipal standards.

6.2.1.3 Provide monthly reporting on collection efforts, recovery rates, and account aging, on the schedule and availability mutually approved by the City and the Offeror. The City would prefer a process that allows real-time, dashboard type of data review.

6.3 Customer Service Requirements

6.3.1 General Expectations

6.3.1.1 The Contractor shall provide a high-quality, patient

centered customer service program that supports all billing, payment, and account-related inquiries for the City’s EMS services. The Contractor must demonstrate a commitment to accuracy, transparency, compliance, cultural competency, and timely resolution of patient concerns.

6.3.1.2 Hours of Operation

6.3.1.2.1 Minimum required hours: Monday-Friday, 8:00AM-7:00 PM (local time).

6.3.1.2.2 After-hours voicemail or automated system

must be available

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6.3.1.2.3 Ability to provide extended hours during

peak periods or as requested by the City.

6.3.1.3 Contact Channels- The Contractor shall maintain at a

minimum:

6.3.1.3.1 Toll-free telephone number dedicated to

City EMS billing.

6.3.1.3.2 Secure email for patient inquiries.

6.3.1.3.3 Online patient portal for self-service

account access, payment, and documentation requests.

6.3.1.3.4 Secure live chat capability is preferred

but optional.

6.3.1.3.5 Text/SMS communication for

notification and reminders is strongly preferred, with patient opt-in required.

6.3.1.4 Call Center Performance Standards- The Contractor shall meet or exceed the following service levels:

6.3.1.4.1 Average speed of answer: ≤ 60 seconds.

6.3.1.4.2 Call abandonment rate: ≤ 5%.

6.3.1.4.3 First-call resolution rate: ≥ 85%.

6.3.1.4.4 Quality monitoring: Monthly quality review

scoring ≥ 90%.

6.3.1.4.5 Ability to track and report call metrics and

trends.

6.3.2 Staffing Requirements

6.3.2.1 Staff must be trained and experienced in EMS billing, including Medicare/Medicaid regulations and insurance eligibility processes.

6.3.2.2 Staff must receive training in:

6.3.2.2.1 HIPAA compliance & PHI handling

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6.3.2.2.2 Trauma-informed communication

6.3.2.2.3 Cultural competency and language

sensitivity

6.3.2.2.4 Dispute resolution and de-escalation

6.3.2.3 Contractor must provide multilingual support, including at minimum Spanish; additional languages must be available on request via translation services.

6.3.2.4 Contractor shall designate a Customer Service Manager as primary point of contact for City staff.

6.4 Fee-Setting Support and Financial Analysis Requirements

6.4.1 The Contractor shall provide comprehensive Fee-Setting Support Services to assist the City in establishing, evaluating, and adjusting EMS transport and related service fees. These services shall include, but are not limited to, the following:

6.4.1.1 Unit-Hour Cost (UHC) Analysis- Contractor shall

6.4.1.1.1 Conduct a detailed Unit-Hour Cost Analysis

to determine the fully burdened cost of providing EMS services, including labor, equipment, medical supplies, fleet operations, training, overhead, and administrative support. Provide a transparent methodology, formulas, and all underlying assumptions used in calculating UHC.

6.4.1.1.2 Provide a transparent methodology, formulas, and all underlying assumptions used in calculating UHC.

6.4.1.1.3 Deliver a written report with findings and

recommendations regarding how current or proposed fee levels compare to the City’s cost of service.

6.4.2 Market and Regional Benchmarking-The Contractor shall:

6.4.2.1 Perform market benchmarking of EMS transport rates, RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 10 of 34 RFP Title: EMS Billing Services including comparison with cities in Texas and comparable metropolitan systems nationwide.

6.4.2.2 Include benchmarks for:

6.4.2.2.1 Base transport rates (ALS/BLS)

6.4.2.2.2 Mileage fees

6.4.2.2.3 Treatment-No-Transport / Assessment fees

6.4.2.2.4 Subscription/membership program rates (if

applicable)

6.4.2.2.5 Provide data sources, date of the data, and

methodology for all comparative analysis.

6.4.3 Medicare, Medicaid, and CMS Allowable Rates Review- The Contractor shall:

6.4.3.1 Analyze Medicare and Medicaid allowable

reimbursement rates, including current CMS fee schedules applicable to the City’s geographic region.

6.4.3.2 Identify gaps between allowable rates and the City’s

actual billed charges.

6.4.3.3 Advise on industry-standard charge structures (e.g., 200%–400% of Medicare) and ensure proposed fees align with federal and state regulatory requirements.

6.4.4 Revenue Projection and Scenario Modeling -The Contractor shall provide financial modeling that includes:

6.4.4.1 Revenue projections based on current fee structures

and current payer mix (Medicare, Medicaid, commercial insurance, self-pay).

6.4.4.2 Scenario-based projections for proposed fee

adjustments, including:

6.4.4.2.1 Increased/decreased transport rates

6.4.4.2.2 Adjusted mileage fees

6.4.4.2.3 Implementation or modification of additional

fees (e.g., treatment-no-transport)

6.4.4.3 Modeling of expected impact on net collections, cash

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 11 of 34 RFP Title: EMS Billing Services flow, and write-off rates.

6.4.4.4 Identification of risks, assumptions, and anticipated payer-behavior responses.

6.4.5 Recommendations for Fee Schedule Adjustments-The

Contractor shall:

6.4.5.1 Provide clear, data-driven recommendations for updating the City’s EMS fee schedule.

6.4.5.2 Align recommendations with:

6.4.5.2.1 The City’s cost of service

6.4.5.2.2 Benchmarking results

6.4.5.2.3 CMS guidance

6.4.5.2.4 Industry best practices

6.4.5.3 Prepare presentation-ready materials for City leadership, including charts, executive summaries, and supporting documentation.

6.4.6 Ongoing Advisory Support-The Contractor shall:

6.4.6.1 Provide ongoing annual or as-needed updates to the

above analyses.

6.4.6.2 Advise the City on changes in Medicare/Medicaid

rates, CMS policies, and market trends that may warrant fee adjustments.

6.4.6.3 Provide consultation during budget development or at

Council request.

6.5 Alternative Revenue Source Identification

6.5.1 Conduct ongoing analysis of EMS billing trends, payer mix, and service utilization to identify funding gaps and opportunities.

6.5.2 Research and recommend supplemental revenue strategies, including:

Federal, state, and philanthropic grant opportunities.

6.5.3 EMS subscription or membership models.

6.5.4 Utility fee structures or cost-sharing mechanisms.

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6.5.5 Strategic partnerships with hospitals, insurers, or community organizations.

6.6 Other Services

6.6.1 Ambulance Supplemental Payment Program (ASPP) and Other

Incentive Programs:

6.6.1.1 The Contractor shall provide comprehensive support to the City in all aspects of participation in the Ambulance Supplemental Payment Program (ASPP), or any successor program, including but not limited to documentation, reporting, cost collection, audit support, attestation, and compliance activities. This support shall extend to all federal, state, and payer-required processes necessary for the City to fully qualify for and obtain supplemental reimbursement.

6.6.1.2 In addition, the Contractor shall assist the City in

identifying, evaluating, and participating in any other ambulance-related supplemental, incentive, or reimbursement enhancement programs that may be available from time to time. These programs may include, but are not limited to:

6.6.1.2.1 Ground Emergency Medical Transportation

(GEMT) programs

6.6.1.2.2 Other Certified Public Expenditure (CPE)

programs

6.6.1.2.3 Provider Assessment or Quality Incentive

programs

6.6.1.2.4 Medicaid supplemental or directed payment

programs

6.6.1.2.5 Value-based purchasing or performance-based

incentive programs

6.6.1.2.6 Future federal, state, or commercial payer

reimbursement initiatives applicable to EMS transport services

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6.6.1.3 The contractor shall complete all required renewals and revalidations associated with applicable programs, including but not limited to Medicaid, Veterans Affairs (VA), Texas Department of Labor (TDL) and the Commission on Accreditation of Ambulance Services (CAAS).

7.0 CONTRACTOR REQUIREMENTS

7.1 Independent Billing and Collection Service: Contractor shall operate as an independent billing and collection entity, and City will designate Contractor as its agent for the purpose of providing the billing and collection services. Contractor shall conduct itself as the intermediary for Medicare, Medicaid, Commercial Insurance, Payor agreements that include Facility, MIH programs, membership programs and other sources of payment.

7.2 Contractor shall submit billing based on the current fee schedule approved by the City Council. Established Fees are listed below:

Service Level/Type

HCPCS

Code Fee

Advanced Life Support (ALS) - Emergency A0427 $1,785.00 ALS - Level 2 - Emergency A0433 $1,785.00 ALS Disposable Supplies A0398 $156.00 Basic Life Support (BLS) - Emergency & DOS A0429 $1,685.00

BLS Disposable Supplies A0382 $100.00 Oxygen A0422 $116.00 ET3 Treatment in Place - ALS A0427W $1,785.00 ET3 Treatment in Place - BLS A0429W $1,685.00 Ambulance Response, Treatment, No Transport A0998 $500.00

Specialty Care Treatment, or Transport A0434 $2,640.00 Mileage (per mile)* A0425 $27.00 Flight Crew Transport Only N/A $225.27 *For multi-patient transfers, rate is split

7.3 Strategic Account Manager: Contractor shall designate a Strategic

Account Manager to serve as the liaison with City.

7.4 Qualifications and Role - Strategic Account Manager must have a working knowledge of emergency medical services billing operations and serve as a point of contact for communications regarding billing services.

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7.5 Notification of Personnel Changes - Contractor shall notify the City of changes to the designated Strategic Account Manager within three

(3) business days.

7.6 Turnaround Times for City Requests – Strategic Account Manger shall meet the following minimum response and completion timelines:

7.6.1 Acknowledgment of City Requests:

Contractor shall acknowledge receipt of any City request (email, phone, or ticket) within one (1) business day.

7.6.2 Routine Requests:

Routine requests (e.g., status updates, basic data inquiries, minor corrections, standard reports) shall be completed within three (3) business days unless otherwise mutually agreed.

7.6.3 Time-Sensitive or Operationally Critical Requests:

Requests requiring rapid action (e.g., urgent claim issues, payer escalations affecting cash flow, compliance concerns, system issues) shall receive a response within four (4) business hours and be resolved as soon as reasonably possible, with continuous updates provided until resolution.

7.7 Required Follow-Up and Communication Standards - The Strategic Account Manager shall:

7.7.1 Provide ongoing status updates on all open requests at least once every two (2) business days, or more frequently for urgent matters.

7.7.2 Escalate unresolved issues within the Contractor’s organization after three (3) business days without resolution unless otherwise agreed to by the City.

7.7.3 Maintain a written log of all requests, including

acknowledgment time, action steps taken, and completion date, available to the City upon request.

7.7.4 Ensure that any delays or barriers to completing a City request are communicated within one (1) business day of identification, along with a revised timeline and mitigation steps.

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7.7.5 Participate in scheduled check-in meetings with the City (weekly, biweekly, or monthly, as determined by the City).

7.8 Performance Expectations

7.8.1 Failure to meet required turnaround times or follow-up

requirements on a recurring basis shall be considered a performance deficiency, and the City may require corrective action, replacement of the Strategic Account Manager, or other remedies defined in the contract.

7.9 Compliance Manager: Contractor shall have a designated compliance officer to oversee all billing practices. The compliance Manager will monitor federal, state regulatory changes affecting EMS billing and provide written alerts to the city within 5 business days of publication.

Alerts should include a summary of regulatory change, its anticipated impact on EMS billing operations, and recommended actions.

7.10 City Coordination-Contractor shall coordinate with the City to obtain the following:

7.10.1 All ePCR information contained in Image Trend which includes but is not limited to the following: patient demographic information, level of service, priority level of incoming call to the call center, patient assessment and treatment, mileage, chief complaint, HIPAA signature, billing signature and crew information.

7.10.2 Medically Home program documentation required to complete the billing process for each program.

7.10.3 Membership Program documentation.

7.10.4 Contractor shall provide training to City staff regarding Contractor’s billing processes at least once a year and at City’s request.

7.11 City Access: Contractor shall allow the City to monitor, audit, review, examine, or study the methods, procedures, and results of the billing and collection methods used.

7.12 Adherence to State and Federal Laws and Regulations: Contractor shall

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7.13 Confidentiality:

7.13.1 Contractor shall be responsible for abiding by applicable laws and regulations regarding data collected for City with adherence with all applicable federal standards for privacy and security of identifiable health information, located at 45 C.F.R. parts 160 and 164, Subparts A and E (the “Privacy Rule”) and Part 164, Subparts A and C (the “Security Rule”); as amended by the Health Information, Technology for Economic and Clinical Health (HITECH) Act, Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (“ARRA”), and the HIPAA Omnibus Final Rule, 78 Fed. Reg.

5566 (Jan. 25, 2013) (collectively the “HIPAA Rules”)

7.13.2 Contactor shall use administrative, physical, and technical safeguards to prevent unauthorized access to patient records.

7.13.3 Contractor shall not use or disclose patient information beyond the uses specified in this contract.

7.13.4 Contractor will promptly report any unauthorized access to patient information to the City, as required by the Contract.

7.13.5 Contractor shall execute a Business Associate Agreement (“BAA”) with City and shall abide by all provision therein throughout the duration of services provided.

7.14 Financial and Banking Information:

7.14.1 City will establish and maintain a lock box at J.P. Morgan Chase Bank.

7.14.2 Contractor shall deposit all collections received into the designated bank account.

7.15 Specific Requirements for Service Delivery

7.15.1 Operational Efficiency

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7.15.1.1 Contractor must meet stipulated metrics throughout

the contract term:

7.15.1.2 Claim Submission Turnaround: ≤ 48 hours from

receipt of complete patient care report(except for Insurance and Medicare claims which are pended for 30-60 days to ensure deductible requirements are satisfied).

7.15.1.3 Denial Resolution Time: ≤ 30 days from payer

notification

7.15.1.4 Patient Inquiry Response Time: ≤ 2 business days

7.15.2 Compliance & Accuracy - Contractor must meet stipulated metrics throughout the contract term:

7.15.2.1 Coding Accuracy: ≥ 98%

7.15.2.2 HIPAA Compliance: 100% adherence, with no

reportable breaches

7.15.2.3 Audit Findings: ≤ 2% error rate in quarterly audits

7.15.3 Customer Service - Contractor must meet stipulated metrics throughout the contract term:

7.15.3.1 Patient Satisfaction: ≥ 90% positive rating in surveys

7.15.3.2 Complaint Resolution Time: ≤ 10 business days

7.15.4 Reporting Requirements

7.15.4.1 Contractor shall provide monthly KPI dashboards

with trend analysis

7.15.4.2 Contractor shall participate in Monthly performance

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7.15.4.3 Contractor shall provide annual compliance

certifications and audit summaries.

7.15.5 Retrieval of Patient Demographic Information for Billing

7.15.5.1 The City uses ImageTrend as its ePCR provider.

Contractor shall develop and maintain procedures for electronic retrieval of information from ImageTrend regarding ambulance services which include but are not limited to the following: patient demographic information, level of service, priority level of incoming call to the call center, patient assessment and treatment, mileage, chief complaint, HIPAA acknowledgement signature, billing signature, crew information and signature. Contractor shall provide this information to the City upon request.

7.15.5.2 Notification to the City of any accounts that require special attention when an ePCR is incomplete.

7.15.5.3 Contractor shall begin retrieval of Patient

Demographic Information and patient electronic medical record for ambulance services provided on or after the effective date of the Contract.

7.15.5.4 Contractor will develop and implement a process to

bill and collect for all Emergency and Non-Emergency transports performed by the City.

7.15.5.5 Contractor will develop and implement a process

to manage the City’s Membership Programs.

7.15.5.6 Contractor will develop and implement a process to

bill and collect for City’s Mobile Integrated Health Programs.

7.15.5.7 Contractor will develop and implement a process to

track all transports deemed to be Charity Care.

7.15.6 Process for Verification of Patient Demographic Information

7.15.6.1 Once the Patient Demographic Information is

received, Contractor shall review each record for completeness and accuracy.

7.15.6.2 Contractor shall develop and maintain procedures to

verify Patient Demographic Information. Contractor shall provide this information to the City upon request. Contractor shall make efforts to complete the missing information including the following:

7.15.6.1.1 Contact with the appropriate City

personnel.

7.15.6.1.2 Contact with patients who

received

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 19 of 34 RFP Title: EMS Billing Services services, when appropriate.

7.15.6.1.3 Contact with facilities that receive

transported patients, when appropriate.

7.15.6.1.4 Discuss issues regarding information

verification at City/Contractor meetings.

7.15.6.1.5 Once patient information is complete, Contractor shall create a patient account for the service provided.

7.15.7 Determination of Appropriate Payor

7.15.7.1 For all accounts, Contractor shall screen for all

available payors, including but not limited to individuals, insurance carriers, Medicare FFS, Medicare Risk, Medicaid, Medicaid MCO, third parties, governmental and quasi-governmental payors or payment programs, and any other source of payment.

7.15.7.2 Prepare and submit claim(s) and any other

required forms to all appropriate payors, electronically when possible.

7.15.7.3 Track all claims submitted and implement a

follow-up system for denied or disallowed claims and claims that have not received a response or were returned as undeliverable. Contractor shall provide this information to the City upon request.

7.15.8 Denied or Disallowed Claims: Contractor shall implement a procedure for handling denied or disallowed claims that includes:

7.15.8.1 Reviewing claims previously submitted for

accuracy.

7.15.8.2 Resubmitting claims per the payor’s appeal

process where applicable.

7.15.8.3 Contacting patients who received services.

7.15.9 Claims with No Response or Returned as Undeliverable

7.15.9.1 For submitted claims that do not receive a response

within 30 calendar days (or longer per payor guidelines) or are returned as undeliverable, contractor shall follow up with payor on claim and resubmit claim where appropriate.

7.15.9.2 If it is determined that claim was not submitted to

the appropriate payor, contractor shall re-screen to determine appropriate payor.

7.15.9.3 If no appropriate third-party payor can be

identified, contractor shall handle the account as a self-pay account.

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 20 of 35 RFP Title: EMS Billing Services

7.15.10 Self-Pay Accounts

7.15.10.1 When a third-party payor cannot be identified, Contractor shall send an invoice for services to the individual who received services or to a responsible party for that individual.

circumstances. The invoice shall contain:

7.15.10.1.1 Date of services.

7.15.10.1.2 Name of patient.

7.15.10.1.3 Services provided.

7.15.10.1.4 Name of hospital for ambulance

transports.

7.15.10.2.5 Account information including

account number, amount due, and a due date.

7.15.10.1.6 A toll-free number and email address

on all billing statements for direct patient contact with Contractor.

7.15.10.1.7 Payment instructions.

7.15.11 Contractor shall implement procedures to offer interest free, structured payment plans on self-pay accounts, when requested, on terms approved by City, and to refer accounts to City for qualifications under City’s Charity Care policy.

7.15.11.1 Contractor shall send a monthly invoice to patients who opt for a structured payment plan.

7.15.11.2 Monthly invoices must meet the criteria specified

herein.

7.15.11.3 Contractor shall submit payment plan procedures

to the City for approval within 60 days of Contract execution and annually thereafter, if requested.

7.15.11.4 Contractor shall identify patients who meet the

criteria for charity care under City’s Charity Care Policy and return those accounts to City and take no further action for collection until requested by City in writing.

7.15.11.5 If no payments or response is received from initial invoice and invoice was not returned as undeliverable, contractor shall send another invoice on identified accounts meeting the same criteria outlined above and clearly labeled as the second attempt to collect.

7.15.11.6 Contractor shall submit a report to the City of all accounts where no response is received after the second invoice.

7.15.11.7 If the patient receives the invoice and contacts the

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 21 of 35 RFP Title: EMS Billing Services contractor with new third-party billing information, contractor shall follow the requirements for third party billing.

7.15.12 Receipt of Payments

7.15.12.1 Contractor must develop and maintain a process to

ensure that every payment received is tracked, credited to the appropriate account, deposited into the designated bank account, and included in the required reporting to the City. Contractor shall provide this information to the City upon request.

7.15.12.2 All payments received by the Contractor must be

deposited into the designated bank account within three (3) business days.

7.15.13 Unpaid Accounts

7.15.13.1 Contractor shall transition all remaining unpaid

accounts from the City’s current third-party billing company system into its billing system within 90 days after execution of this contract.

7.15.13.2 90 days after the completion of the contract term, including any option years, Contractor shall transition all remaining unpaid accounts into the billing system of the new selected provider of billing and collection services for the City and shall be paid in accordance with Exhibit A Percent of Net Collections document.

7.15.13.3 Contractor shall track accounts more than 180

days old for which no payments have been received and previous attempts to bill and collect have been unsuccessful and provide the list of accounts monthly to the City.

7.15.13.4 Contractor shall implement and maintain a

process for tracking payments collected by the City’s collection company for accounts older than 180 days.

7.15.13.5 City will determine which unpaid accounts are

uncollectible and may be written off.

7.15.14 Refunds

7.15.14.1 Contractor shall submit refund requests monthly

and required documentation to City for processing and payment.

7.15.14.2 Refund documentation shall include at a

minimum: official refund request letter, account refund report or account summary, copy of original payment, payor financial summaries, and the date the payment was deposited into City bank account.

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 22 of 35

8.0 DATA COLLECTIONS AND REPORTING REQUIREMENTS

8.1 Contractor shall provide City reports with charts after each month end closeout with monthly and cumulative data by the 5th business day of the following month in a format to be agreed upon between Contractor and City.

Contractor will provide City with access to an Online Dashboard with real-time drillable data with the ability to download in excel and pdf formats. The reports and charts should be tied to the monthly invoice and should include, at least, the following:

8.1.1 Monthly and year-to-date Activity Summary report by payor run by

Period or Trip Date that includes Gross Charges, Contractual allowances, net charges, revenue adjustments, payments, write-offs, refunds and net balance.

8.1.2 Monthly and year to date reporting by run number, trip date, posted date, charge type, HCPCS code, modifier, ICD9 code, ICD10 code, to include gross charge, contractual allowances, net charges, revenue adjustments, payments, write-offs, refunds and net balance.

8.1.3 Monthly reporting on Net Collections by service, Net Collections by month, Payor Mix, Run Mix, Loaded Patient Miles and AR Days.

8.1.4 Monthly Activity Summary Report by member city.

8.1.5 Summary and Detail Monthly Credit as a Type Report detailing the credits posted for the month to include manual and automatic contractuals, revenue adjustments, refunds, payments and write-offs.

8.1.6 Monthly and Year to date gross charges by Emergent level of service and Non-Emergent level of service.

8.1.7 Monthly and Year to date gross charges by Facility responsible party, Stand-by/Special Event responsible party and MIH responsible party.

8.1.8 Membership Reporting: Monthly Roster Report. Membership Revenue Report to include trip data by member with gross charges, contractual allowances, net charges, revenue adjustments, payments, write-offs, refunds and net balance. Also provide year-over-year comparison reports on the number of renewals vs number of non-renewals.

8.1.9 Aging reports by payor, aging date and trip date.

8.1.10 Denial Reason Report of all denials by Payor, denial reason and patient name.

8.1.11 Compliance reporting: ePCR Documentation by Paramedic Analysis

Summary Report, ePCR Documentation by City Analysis Summary Report and ePCR Documentation Analysis Summary with industry benchmarking. Collection rates/amount by crew member.

8.1.12 Monthly records of daily bank deposits by type.

8.1.13 Other data:

8.1.13.1 Provide an annual report in a format that is easily followed for the purpose of sharing with City Executives and Board

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 23 of 35 of Directors. The annual report shall include a summary of the year’s work by the contractor and their success in handling revenues and collections and include graphs and charts as visual aid.

8.1.13.2 Self-Pay Accounts more than 90 days old with no payments or responses

8.1.13.3 Other information and reports requested by the City.

8.1.14 Contractor shall provide reporting to the City for Medicaid and

Medicare cost reporting purposes. Contractor shall also provide year-end ad-hoc reports to City’s outside audit company.

8.1.15 Contractor shall retain all source documentation for seven (7) years from incident date, or until the patients’ 21st birthday if a minor at the time of service, after which time Contractor shall destroy such documentation using records disposal procedures that prevent physical and/or digital retrieval or reconstruction of said documentation using NIST 800-88 guidelines.

8.1.16 Contractor shall maintain the confidentiality of all source documentation by securing it in locked, secure, and/or password protected storage when not in use and until such time as it is destroyed.

8.1.17 Contractor shall maintain and make available to the City upon request, a destruction record which shall include a description of the documentation destroyed, the format of the documentation, and the date and method of destruction using NIST 800-88 guidelines.

9.0 AUTOMATION

9.1 Contractor shall provide and maintain an electronic system or a system integrated with ImageTrend for retrieving patient ambulance data including demographic information, insurance, and miles of transport from ambulance service providers.

9.2 Computerized Billing System: Contractor shall provide and maintain a computerized billing system with the following capabilities:

9.2.1 Create accounts for all ambulance records received from City.

9.2.2 Generate electronic claims to be filed with major payors.

9.2.3 Track status of all accounts, including a method for follow up notifications at timed intervals after an action has been taken on an account.

9.3 Contractor shall provide all required reports electronically to include monthly reports accompanying the invoices and maintain records of each reports.

10.0 METHOD OF AWARD - Proposals will be evaluated based on “best value”

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 24 of 35 RFP Title: EMS Billing Services to the City. Any Proposals that receive less than 50% of the total available points, excluding price points, will be considered non-responsive.

11.0 PROPOSER REQUIREMENTS IN ORDER TO BE EVALUATED

11.1 Proposer shall have a minimum of five (5) years of experience working with in EMS/ambulance billing, including Medicare, Medicaid, managed care, and commercial insurance billing for municipal similar to the size of the City of Fort Worth or large-scale EMS systems.

11.2 Proposer shall demonstrate compliance with HIPPA/HITECH

requirements.

11.3 Proposer shall demonstrate knowledge of EMS ambulance billing regulations.

11.4 Proposer shall have the ability to support CAAS, Medicaid, VA, and other required program compliance and revalidations.

11.5 Proposer shall have sufficient trained staff to meet service level requirements, including a designated Strategic Account Manager, Compliance Manager, and customer service representatives.

12.0 EVALUATION FACTORS

12.1 To be considered, the Proposer must submit a complete Proposal by the stated deadline and in accordance with all Proposal requirements.

All required documentation must be included for evaluation. Proposals that meet these requirements will be evaluated based on the criteria listed below.

12.1.1 Proposer’s Qualifications and Experience in EMS Billing - up to

30 points available

12.1.2 Proposer’s Demonstrated Compliance and Performance Metrics – up to 20 points available

12.1.3 Proposer’s Reporting Capabilities and Customer Service

Approach – up to 20 points available

11.1.4 Fee Setting and Financial Analysis Capabilities – up to 10 points available

11.1.5 Percentage of Net Collection – up to 10 points available

10 points- 6.0% or less

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8 points- between 6.01% and 7.0% 6 points- between 7.01% and 8.0% 3 points- between 8.01% and 9.0% 0 points- greater than 9%

11.1.6 Small Business Goal – up to 10 points available

11.1.6.1 The criteria will be evaluated using a tiered point

structure based on the percentage of Small Business participation proposed by the bidder.

Points will be awarded according to the following tiers:

10 points - SB participation greater than

30% 8 points - SB participation between 30% and 20% 6 points - SB participation between 19% and 10% 4 points - SB participation between 9% and

1%

12.0 PRICING STRUCTURE

12.1 Bidders shall submit pricing in accordance with the format provided in the Bid Table. All pricing shall be clearly identified and shall represent the full cost to furnish, deliver, and, if applicable, remove the specified equipment and services. Prices shall include all labor, materials, supplies, fuel, delivery, overhead, and profit. No additional charges will be allowed unless specifically authorized in writing by the City.

13.0 SMALL BUSINESS PROGRAM

13.1 The City of Fort Worth has established a 30% Small Business (SB) participation goal for this solicitation. This goal reflects the City’s determination that certified Small Business Firms are available to provide the goods and/or services required under this bid.

Accordingly, at least 30% of the total awarded contract value must be subcontracted or spent with a certified Small Business Firm. All

RFP Ref. #: 26-0066 Doc. Ref#: RFP-02 Page 26 of 35 RFP Title: EMS Billing Services provisions and requirements outlined in City Ordinance No. 27832- 08-2025 apply to this solicitation. Bidders are required to submit the following documentation with their proposal:

13.1.1 Small Business Utilization form V1 (RFP-05), detailing how the Small Business goal will be achieved.

13.1.2 Current Small Business Certification issued by the North Central Texas Regional Certification Agency (NCTRCA), Women’s Business Council-Southwest (WBCS), Dallas-Fort Worth Business Council (formerly DFW/MSDC), Texas Historically Underutilized Business (HUB) Program, Texas Unified Certification Program (TUCP) DBE/ACDBE and TxDOT SBE Directory.

14.0 CONTRACT AWARD PROCESS

14.1 The Purchasing Division will facilitate and manage the evaluation process.

14.2 An Evaluation Panel consisting of representatives from various City departments and City consultants may be appointed to review and evaluate RFP responses in accordance with this RFP. City reserves the right at its sole discretion to include additional representatives at any point during the evaluation.

14.3 The Evaluation Committee will evaluate responses and may select Proposer for onsite interviews, presentations or demonstrations.

14.4 At its sole discretion, the City may request Best and Final Offers (BAFO) from proposers whose proposals are deemed most advantageous. Contract negotiations will be based on the BAFO submissions.

14.5 The City reserves the right to negotiate all elements that comprise the successful Proposer’s response to ensure that the best possible consideration be afforded to all concerned.

14.6 The City reserves the right to shortlist firms based upon scores/ratings received during the evaluation process.

14.7 The City will notify all proposers in writing of the outcome once an award determination has been made.

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15.0 PROPOSAL FORMAT AND ATTACHMENTS

To facilitate and expedite the evaluation process, Proposals should adequately address all evaluation factors and include the following list below of required items that will be used as part of the evaluation. A Proposal may be deemed to be non-responsive and may be disqualified, at the City’s discretion, if the Proposal fails to comply with the following instructions.

15.1 Proposal Format Requirements

15.1.1 Proposal format shall be in font no smaller than 12 point, 8.5-inch by

11-inch paper size, with one inch margins and single-spaced for the entire submitted proposal.

15.2 Required Response Forms

15.2.1 Completed and signed RFP-03.

15.2.2 Completed and signed RFP-05.

15.2.3 Completed and signed RFP-06.

15.2.4 Completed RFP-07, if applicable.

15.2.5 Signed Addendum(s), if applicable.

15.3 Technical Response

15.3.1 Qualifications and Experience in EMS Billing:

15.3.1.1 Company Profile

15.3.1.1.1 Provide a brief overview including:

15.3.1.1.1.1 Years in business;

15.3.1.1.1.2 Ownership structure;

15.3.1.1.1.3 Primary business lines;

15.3.1.1.1.4 Office locations providing

EMS billing services.

15.3.1.2 EMS Billing Experience

15.3.1.2.1 Describe experience billing for:

15.3.1.2.1.1 ALS and BLS transports;

15.3.1.2.1.2 Emergency and non-emergency

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15.3.1.2.1.3 ET3, MIH, treatment-no-

transport, and specialty programs;

15.3.1.2.1.4 Membership or subscription

programs (if applicable).

15.3.1.2.1.5 Include the number of EMS

clients currently served.

15.3.1.3 Comparable Contracts

15.3.1.3.1 Provide information for a minimum of

three (3) EMS billing contracts comparable to the size of the City of Fort Worth within the past five

(5) years, including:

15.3.1.3.1.1 Client name;

15.3.1.3.1.2 Size and complexity of EMS

system;

15.3.1.3.1.3 Scope of services provided;

15.3.1.3.1.4 Contract term and duration.

15.3.1.4 Key Personnel

15.3.1.4.1 Provide resumes for key personnel

assigned to the City, including at a minimum:

15.3.1.4.1.1 Strategic Account Manager;

15.3.1.4.1.2 Compliance Officer;

15.3.1.4.1.3 Financial or analytics lead (if

applicable).

15.3.2 Compliance Program Documentation

15.3.2.1 Proposers shall provide a complete copy of their

current Compliance Program or Compliance Policy.

At a minimum, the documentation must include:

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15.3.2.1.1 Description of the

organization’s compliance structure and reporting lines;

15.3.2.1.2 Description of the

organization’s compliance structure and reporting lines;

15.3.2.1.3 Roles and responsibilities of

the Compliance Officer;

15.3.2.1.4 Written policies related to

billing, coding, documentation, auditing, and regulatory oversight;

15.3.2.1.5 Procedures for monitoring

regulatory changes;

15.3.2.1.6 Internal audit processes and

corrective action protocols;

15.3.2.1.7 Policies on employee training, disciplinary standards, and reporting mechanisms for suspected non-compliance;

15.3.2.1.8 HIPAA and HITECH

compliance policies.

15.3.3 Reporting Capabilities and Customer Service

Approach

15.3.3.1 Proposers shall demonstrate their ability to

provide transparent reporting and high-quality, patient-centered customer service

15.3.3.2 Describe the Proposer’s reporting systems, including:

15.3.3.2.1 Real-time or near real-time

dashboard access;

15.3.3.2.2 Drill-down and export

capabilities;

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15.3.3.2.3 Standard monthly and annual

reports.

15.3.3.2.4 Submit sample report

screenshots or dashboards (redacted).

15.3.3.2.5 Customer Service Model

15.3.3.3 Describe the customer service approach, including:

15.3.3.3.1 Call center staffing and

management;

15.3.3.3.2 Hours of operation;

15.3.3.3.3 Multilingual support;

15.3.3.3.4 Escalation and complaint

resolution processes.

15.3.3.3.5 Call Center Performance

Metrics

15.3.3.4 Provide historical performance metrics, including:

15.3.3.4.1 Average speed of answer;

15.3.3.4.2 Call abandonment rate;

15.3.3.4.3 First-call resolution rate;

15.3.3.4.4 Patient satisfaction scores.

15.3.3.5 Patient Engagement Tools

15.3.3.5.1 Describe available patient

engagement tools, including:

15.3.3.5.2 Online patient portal;

15.3.3.5.3 Electronic payment options;

15.3.3.5.4 Payment plans;

15.3.3.