ESBD_544005_1786636647971_Addendum 2 - Vendor Questions - RFP 739-SL3813963 Healthcare Compliance Auditing and Revenue Integrity Platform.pdf

REQUEST FOR PROPOSALS

Healthcare Compliance, Auditing, and Revenue Integrity Platform

Addendum No. 2

RFP 739-SL3813963

Addendum No. 2

Healthcare Compliance, Auditing, and Revenue Integrity Platform

RESPONSE TO QUESTIONS

The following responses to participant questions are fully incorporated into the Request for Proposals 739-SL3813963.

Question TTUHSC Response

1. Could TTUHSC confirm the current billing/practice-management/EHR system(s) in use across its campuses?

• Epic for EMR and Revenue Cycle (Lubbock)

• Cerner for EMR (Permian Basin)

• Cerner Practice Management for Revenue Cycle (Permian Basin)

• Athena for Revenue Cycle (Amarillo)

• Touch Works for EMR (Amarillo)

• Permian Basin and Amarillo will transition to Epic by July 2027.

2. Today, each campus submits its own claims data file separately. Will per-campus setup continue under any resulting agreement?

• Each TTUHSC campus will continue to submit claims separately until all campuses are utilizing Epic. An 837p Claim Information will need to be sent via sFTP (Secure File Transfer Protocall).

3. Are additional campuses or plans expected to be added during the term of the agreement?

• No

4. What file format/type would each new campus be expected to submit?

• CSV (Permian Basin)

• CSV (Amarillo)

• CSV or XML (Lubbock)

5. Will any new campus files conform to the same format and business requirements as the current campuses' files (i.e., the same flat-file layout, or the same 837 format and business rules), or will new or different formats require separate implementation work?

• There would be separate implementation work across three TTUHSC campuses until all three TTUHSC campuses are on the same EHR (Epic) by July 2027.

• Currently, an 837p Claim Information is sent via sFTP (Secure File Transfer Protocall) for Permian Basin.

6. This RFP is titled "Healthcare Compliance, Auditing, and Revenue Integrity Platform," and Section 5.4 lists Risk Assessments, Policy Management, Incident Management, and Training & LMS as required capabilities in addition to auditing and revenue integrity monitoring. Does TTUHSC expect proposals to address the broader compliance-software scope (Risk Assessments, Policy Management, Incident Management, and Training & LMS)?

• Yes, we would like to review any broader compliance software services you may be able to provide.

7. What is the scope of TTUHSC's compliance program?

• The Billing Compliance goal is to maintain an active program of monitoring and reporting improper health care billing claims. Our program does this by using problem-solving skills to provide options and alternatives to support proper billing and providing accurate, concise, and current information and advice to TTUHSC clinical departments.

8. Is the program's focus primarily on billing related activities, or does it also include non-billing items within its workplans?

• The primary focus will be on billing, audit related activities, and identification of coding and billing risks.

9. What compliance, operational, and departmental risks does TTUHSC's compliance program monitor and assess?

• The compliance program monitors and assesses a broad range of compliance, operational, financial, regulatory, and departmental risks that could affect the institution’s ability to fulfill its healthcare, educational, research, and patient care missions. Routine monitoring and auditing shall be conducted on risk areas identified in the annual work plan, routine reviews, requested reviews, reported concerns, and/or ad hoc issues based on federal documentation guidelines, and other applicable regulations in accordance with approved billing compliance policies.

10. What specifically prompted TTUHSC to issue this RFP?

• TTUHSC has approached the end of our existing agreement and wanted to explore available options.

11. Who is sponsoring and ultimately owning this initiative:

Compliance, Internal Audit, HIM/Coding, Revenue Integrity, or Revenue Cycle/MIPPS?

• Institutional Compliance

12. What solutions are you using today for compliance management, auditing, revenue integrity, policy management, and training?

• TTUHSC currently uses a healthcare technology and services company that provides compliance, medical auditing, and revenue-cycle solutions for hospitals, physician groups, and payers.

13. Which of those solutions are you evaluating to replace through this RFP?

• It would be a full replacement of the solutions TTUHSC currently utilizes.

14. Are you looking to replace a single platform, or consolidate multiple systems into one?

• TTUHSC is seeking to replace a single platform.

15. What are the biggest gaps or frustrations with your current solution(s) and processes?

• The consistency of the data transfer.

16. When you reference coding and billing audits, are you looking for a tool that manages audits, or one that also identifies coding and billing risks?

• Both. TTUHSC requires a tool that manages audits and identifies coding and billing risks.

17. Can you elaborate on whether coding accuracy and billing compliance are strategic goals of this project?

• Yes. Coding accuracy and billing compliance are key strategic objectives of this project. Ensuring that clinical services are accurately documented, coded, and billed in accordance with federal and state regulations helps reduce compliance risk, prevent billing errors, mitigate potential fraud, waste, and abuse concerns, and support appropriate reimbursement. The project should evaluate the effectiveness of existing coding and billing controls, identify areas of risk, strengthen compliance with Medicare, Medicaid, and other payer requirements, and promote accurate clinical documentation practices. In addition to supporting regulatory compliance, improvements in coding accuracy and billing integrity contribute to operational efficiency, financial stewardship, and reduced institutional risk. TTUHSC's compliance framework recognizes clinical billing compliance as a significant oversight area and utilizes monitoring and auditing activities to assess compliance with coding and billing standards.

18. How do you currently identify providers, departments, or claims that should be audited?

• Through the implementation of risk assessment and development of the annual workplan.

19. Do you want the platform to help identify reimbursement opportunities, revenue leakage, denials, and coding risk?

• Yes

20. How important is it to connect coding audits and audit findings directly to revenue integrity performance?

• This is very important for TTUHSC. Coding audits should be viewed as both a compliance and revenue integrity function. Directly connecting audit findings to financial and operational performance enables TTUHSC to identify compliance risks, improve reimbursement accuracy, reduce revenue leakage, strengthen internal controls, and demonstrate the value of compliance oversight. The strongest compliance programs leverage audit results not only to meet regulatory expectations but also to drive measurable improvements in revenue cycle performance and organizational effectiveness.

21. Are you evaluating coding accuracy analysis and physician documentation improvement capabilities, or are you primarily looking for compliance, policy management, and training functionality?

• The primary focus will be on coding accuracy analysis and physician documentation improvement capabilities while also exploring additional compliance software services that support our mission.

22. Has a budget been established for the project, and if so, what range has been allocated for software, implementation, and ongoing support?

• Will be discussed after award

23. Can you share the annual professional encounters at TTUHSC annually?

• 185,000 (Amarillo)

• 122,000 (Permian Basin)

24. How many physicians does TTUHSC employ?

• 668

25. What is the total count of providers (including APP’s (Advanced Practice Providers) if they are in scope).

Please specify whether APP's are in scope?

• 668; yes, APPs are included in this scope.

26. Is the scope of this RFP just limited to professional billing or also hospital billing?

• It is professional fee only, not facility fee.

27. Are auditing coders in scope for the RFP? If yes, how many total coders

• No

28. Does the scope include both prospective (pre-bill) and retrospective auditing(post-bill)?

• Yes

29. Does the scope include both internal and external payer audits or just internal audits?

• Internal audits only.

30. How many users will be using the platform in terms of auditors and coders combined

• Five team members

31. What are the key billing systems / EHR involved and how many instances of billing systems are in scope

• Epic for EMR and Revenue Cycle (Lubbock)

• Cerner for EMR (Permian Basin)

• Cerner Practice Management for Revenue Cycle (Permian Basin)

• Athena for Revenue Cycle (Amarillo)

• Touch Works for EMR (Amarillo)

• Permian Basin and Amarillo will transition to Epic by July 2027.

• There are three billing systems utilized currently. We will combine to one in

July 2027

32. What are some strategic goals of the compliance program.

• The Billing Compliance goal is to maintain an active program of monitoring and reporting improper health care billing claims. Our program does this by using problem-solving skills to provide options and alternatives to support proper billing and providing accurate, concise, and current information and advice to TTUHSC clinical departments. Coding accuracy and billing compliance are key strategic objectives of our program. Ensuring that clinical services are accurately documented, coded, and billed in accordance with federal and state regulations helps reduce compliance risk, prevent billing errors, mitigate potential fraud, waste, and abuse concerns, and support appropriate reimbursement.

33. How many types of physician specialties are at TTUHSC. For example, family medicine, oncology, pediatrics, etc.

• 16