B08 Attachment 2 task order.docx

STATEMENT OF WORK

NATIONAL PARK SERVICE (NPS)

NATIONAL EMERGENCY MEDICAL SERVICES COST RECOVERY

Performance Work Statement

1.0 Scope

A financial and business solution Vendor (the Vendor) shall conduct cost recovery for the NPS EMS program. The Vendor shall be responsible for the billing, collecting, tracking and remitting of monies owed to NPS for billable services rendered by NPS EMS programs in accordance with the statement of work listed in the IDIQ.

The Vendor shall work with others (e.g., insurance companies, international travelers’ insurance companies, Medicare, Medicaid, and/or individual patients) to conduct the specified scope of work.

2.0 Objectives

· Development and maintenance of working and contractual relationships with private and public insurance providers and collection agencies, as needed, on behalf of NPS EMS.

· Administration of the complete billing and collection process, on behalf of NPS EMS, to include both domestic and international accounts.

· Provide reports detailing the status of all NPS EMS accounts on a monthly and quarterly basis.

· Delivery of collected funds to the EMS program as specified in each individual task order.

· Compliance with:

· Health Insurance Portability and Accountability Act of 1996 (HIPAA)

· Privacy Act of 1974

· Any other applicable federal laws and regulations

3.0 Tasks Emergency Medical Services Cost Recovery

The Vendor shall provide all of the labor, software, materials, and supplies for the fulfillment of all requirements for the Emergency Medical Services Cost Recovery outlined within the following tasks in line with the IDIQ.

NPS Units to be covered are hereby attached per attachment 3.

4.0 Cost Recovery – Billing

The Vendor will provide the following services on an ongoing basis for participating units of the NPS EMS program:

· Assignment of the ICD-9/10 (International Classification of Diseases) diagnostic codes per patient’s medical record by a National Association of Ambulance Coders (NAAC) certified coder.

· Submission of HIPAA (Health Insurance Portability and Accountability Act) compliant claim forms to both contracted and non-contracted primary third-party payers on a regular and agreed upon schedule.

· Submission of claims to secondary and tertiary insurance companies, as applicable.

· Review of Explanation of Benefits (EOB) forms received from third party payers.

· Submission of bills to patients, as applicable.

· Continued processing of bill until payment is received in full or until part or all of the bill is handled through the hardship process, written off, or submitted for federal collections.

· Track/post all accounting items, including the following:

· Initial charges

· Bills issued

· Insurance payments and adjustments

· Patient responsibilities and payments

· Write-offs (hardship, inability to locate patient for payment, etc.)

· Accounts forwarded to NPS for Federal Treasury Collections

· The Vendor may be required to obtain insurance information from patients or from a medical facility that treated the patient.

· Document/archive all communications with patient, insurer, individual park units, NPS EMS and other entities involved in the billing, collection and reimbursement processes.

· Follow-up, appeal and/or re-submit all claims which are pending or inappropriately denied.

· Submission of disputed charges and requests for hardship waivers or discounts to originating units for resolution, when disputes require attention beyond the standard procedures, which shall be provided by NPS EMS.

· Generation and delivery of financial reports to NPS EMS.

· Maintenance of strict confidentiality of all information supplied by NPS EMS or any of its participating units or any other public or private entity on NPS EMS’ or any of its participating units’ behalf. Release of such information is granted only as needed for reimbursement purposes and as regulated by HIPAA.

· The return to park units, upon termination of the contract, all print and electronic records.

5.0 Cost Structure

5.1.1 Payment Structure

The Vendor may process claims in four (4) billing Tiers (See Attachment 1). Cost to process each tier should be identified in the Vendor’s response.

The table below outlines the levels in which the Vendor will receive payment. The Vendor’s proposed pricing structure will include the following;

· Initial submission to third party payer or patient

· Re-submission of claim to third party payer or patient

· Processing of hardship claims

5.1.2 Payment for ongoing Services

The Vendor shall be compensated on a monthly basis as per the terms of the resulting task order(s). Invoices will include supporting documentation of bills processed, collections received, and actual emergency services provided priced per tier and claim level. The fixed price order will be a time and materials not-to-exceed amount of $20,000.