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BHHF 2
| EXHIBIT A PRICING PAGE |
| BUREAU FOR BEHAVIORAL HEALTH AND HEALTH FACILITIES (BBHHF) |
ARFQ BHH19*3
Professional Accounting & Financial Mgmt. Services for all Seven (7) State Owned Facilities
Description
4.1.1 Professional Accounting & Financial Management Services
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.1 | Vendor shall prepare Centers for Medicare & Medicaid Services Cost Reports (CMS2552), Provider Cost Report Reimbursement Questionnaires (CMS339) and supporting documentation for the seven state facilities. These reports are to be submitted prior to the deadline established by The Centers for Medicare & Medicaid Services, which can be found at the following link: http://cms.hhs.gov/ . support subsidiary. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.2 | Vendor shall prepare all required Health Care Authority (HCA) reports for all seven state facilities. All reports are to be submitted prior to the deadline established by HCA, which can be found at the following link: http://www.hca.wv.gov/Pages/default.aspx . | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.3 | Vendor shall annually prepare all disproportionate share hospital calculations as requested by Welch, William R.Sharpe and Mildred Mitchell-Bateman Hospitals and assist with the filing of DSH audit information. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.4 | Vendor shall provide financial records review and analysis to all seven state facilities on a quarterly basis. Financial analysis must highlight any variances from original budget that exceed 10% cumulatively for the period reported or extrapolated for more than 10% variance when projected for the year using trend data. the period reported or extrapolated for more than 10% variance when projected for the year using trend data. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.5 | Vendor shall ensure the facility chargemasters are accurate and updated annually for Welch, William R.Sharpe and Mildred Mitchell-Bateman Hospitals. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.6 | Vendor shall prepare annual comparison of cost per patient day, current charge schedule, and current collections schedule based on contractual allowances and/or percentage of cost to charge rates for all payor sources. Vendor shall make recommendations for charges to maximize revenues. All seven state facilities. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.7 | Vendor shall provide ongoing consulting services to the Facilities as requested through utilization of a statement of work process. Once requested by the facilities, the vendor will have five (5) working days to respond to the requestor with a detailed staff classifications and projected hours for the work to be done within five (5) working days of the Bureau’s request. All costs shall be incurred on an hourly rate for the staffing classifications as listed in the cost sheet by the vendor. | | | | | | | |
| | $ | x | | = | $ | | $ |
4.1.1.8 Vendor shall be able to provide the following services as requested by the facilities:
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.1 | Vendor shall provide assistance to the facilities related to their accounting functions including monthly, quarterly, and yearly analysis of financial statements, general ledger, and support subsidiary. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | Estimated Quantity | Total Cost | Lump Sum | Total |
| 4.1.1.8.2 | Vendor shall provide assistance to the hospital business office and accounting personnel to develop the data necessary for the vendor to complete Federal and State regulatory requirements. | | | | | |
$ x = $ $
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.3 | Vendor shall provide assistance and training with all prior authorization and pre-certification requirements. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | Estimated Quantity | Total Cost | Lump Sum | Total |
| 4.1.1.8.4 | Vendor shall provide technical assistance in setting each facility’s Medicaid rates. | | | | | |
$ x = $ $
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.5 | Vendor shall provide for research and monitoring of reimbursement regulations and issue guidance to the facilities as to how changes will affect revenues. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.6 | Vendor shall provide in-service and technical assistance training as requested by the Bureau and at locations designated by the Bureau. Topics may include general accounting techniques for healthcare facilities; Medicare and Medicaid cost accounting; and, statistical methods for cost reporting purposes. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.7 | Vendor shall review and recommend methods for recovering Medicare deductibles and coinsurance amounts. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.8 | Vendor shall provide ongoing review of revenue opportunities with a focus on the revenue cycle process. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.9 | Vendor shall prepare and recommend improvements and options to consider related to the efficiency, effectiveness and opportunities in areas of cost reimbursement and revenue management. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.10 | Vendor shall provide technical assistance for maximizing reimbursement from third party payers, including modification and/or updating of each of the facility’s fee schedules and billing and collection procedures in accordance with Medicare and Medicaid principles. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.11 | Vendor shall prepare an observation and recommendation letter to both the Bureau and the management of each facility for the purpose of improving reimbursement, collections and agency funding. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.12 | Vendor shall assist and participate in the development of specifications for solicitation of third party vendors for provision of financial systems and services. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.13 | Vendor shall ensure that there is a process in place to collect Insurance deductibles and Coinsurance Amounts prior to any Surgeries/Outpatient Procedures including Labs and X-Rays. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.14 | Vendor shall provide Case Mix/MDS reviews for Coding Compliance and capture patient/resident acuity and provide training for staff. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.15 | Vendor shall perform Medical Necessity Audits and Reviews. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.16 | Vendor shall provide technical assistance to Welch Community Hospital with the Rural Health Clinic. | | | | | | | |
| | $ | x | | = | $ | | $ |
| | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| 4.1.1.8.17 | Vendor shall provide technical assistance to Welch Community Hospital with the 340B Drug Program. | | | | | | | |
| | $ | x | | = | $ | | $ |
| Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| Year 1 | $ | x | | = | $ | | $ |
| Partner/Member | $ | x | | = | $ | | $ |
| Manager | $ | x | | = | $ | | $ |
| Supervisor | $ | x | | = | $ | | $ |
| Staff | $ | x | | = | $ | | $ |
| Clerical | $ | x | | = | $ | | $ |
| Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| Year 2 | $ | x | | = | $ | | $ |
| Partner/Member | $ | x | | = | $ | | $ |
| Manager | $ | x | | = | $ | | $ |
| Supervisor | $ | x | | = | $ | | $ |
| Staff | $ | x | | = | $ | | $ |
| Clerical | $ | x | | = | $ | | $ |
| Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| Year 3 | $ | x | | = | $ | | $ |
| Partner/Member | $ | x | | = | $ | | $ |
| Manager | $ | x | | = | $ | | $ |
| Supervisor | $ | x | | = | $ | | $ |
| Staff | $ | x | | = | $ | | $ |
| Clerical | $ | x | | = | $ | | $ |
| Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost | Lump Sum | Total |
| Year 4 | $ | x | | = | $ | | $ |
| Partner/Member | $ | x | | = | $ | | $ |
| Manager | $ | x | | = | $ | | $ |
| Supervisor | $ | x | | = | $ | | $ |
| Staff | $ | x | | = | $ | | $ |
| Clerical | $ | x | | = | $ | | $ |
Grand Total $
Please Print Information Below.
Company Name:
Sales Representative:
Vendor Address:
Vendor Phone:
Email Address:
Remit to Address:
SIGNATURE DATE
http://www.hca.wv.gov/Pages/default.aspxhttp://cms.hhs.gov/ Sheet1
| EXHIBIT A PRICING PAGE |
| Department of Health Facilities (DHF) |
ARFQ OHF27*2
Professional Accounting & Financial Mgmt. Services for all Three (3) State Owned Facilities
| Commodity Line, OASIS | Spec | Description | | Hourly Rate(Unit Price) | | Estimated Quantity | | Total Cost/Lump Sum |
| 4.1.1.1 | Prepare Cost Reports, 3 State Hospitals | | | | | | |
| 1 | | Year 1 | | | | | | $ |
| 2 | | Year 2 | | | | | | $ |
| 3 | | Year 3 | | | | | | $ |
| 4 | | Year 4 | | | | | | $ |
| 4.1.1.2 | Prepare Health Care Authority (HCA) Reports, Welch, William R.Sharpe and Mildred Mitchell-Bateman Hospitals | | | | | | |
| 5 | | Year 1 | | | | | | $ |
| 6 | | Year 2 | | | | | | $ |
| 7 | | Year 3 | | | | | | $ |
| 8 | | Year 4 | | | | | | $ |
| 4.1.1.3 | | Prepare Calculations - Welch, William R.Sharpe and Mildred Mitchell-Bateman Hospitals | | | | | |
| 9 | | Year 1 | | | | | | $ |
| 10 | | Year 2 | | | | | | $ |
| 11 | | Year 3 | | | | | | $ |
| 12 | | Year 4 | | | | | | $ |
| 4.1.1.4 | | Provide financial records review and analysis, 3 State Hospitals | | | | | |
| 13 | | Year 1 | | | | | | $ |
| 14 | | Year 2 | | | | | | $ |
| 15 | | Year 3 | | | | | | $ |
| 16 | | Year 4 | | | | | | $ |
| 4.1.1.5 | | Ensure accurate chargemasters - Welch, William R.Sharpe and Mildred Mitchell-Bateman Hospitals. | | | | | |
| 17 | | Year 1 | | | | | | $ |
| 18 | | Year 2 | | | | | | $ |
| 19 | | Year 3 | | | | | | $ |
| 20 | | Year 4 | | | | | | $ |
| 4.1.1.6 | | Prepare annual comparison of cost per patient. 3 State Hospitals | | | | | |
| 21 | | Year 1 | | | | | | $ |
| 22 | | Year 2 | | | | | | $ |
| 23 | | Year 3 | | | | | | $ |
| 24 | | Year 4 | | | | | | $ |
| 4.1.1.7 | | Hourly Rate - Consulting Services, shall include 4.1.1.7.1 through 4.1.1.7.17. | | | | | |
| 25 | | Year 1 | Partner/Member | $ | x | 100 | = | $ |
| 26 | | | Manager | $ | x | 250 | = | $ |
| 27 | | | Supervisor | $ | x | 250 | = | $ |
| 28 | | | Staff | $ | x | 150 | = | $ |
| 29 | | | Clerical | $ | x | 100 | = | $ |
| 30 | | Year 2 | Partner/Member | $ | x | 100 | = | $ |
| 31 | | | Manager | $ | x | 250 | = | $ |
| 32 | | | Supervisor | $ | x | 250 | = | $ |
| 33 | | | Staff | $ | x | 150 | = | $ |
| 34 | | | Clerical | $ | x | 100 | = | $ |
| 35 | | Year 3 | Partner/Member | $ | x | 100 | = | $ |
| 36 | | | Manager | $ | x | 250 | = | $ |
| 37 | | | Supervisor | $ | x | 250 | = | $ |
| 38 | | | Staff | $ | x | 150 | = | $ |
| 39 | | | Clerical | $ | x | 100 | = | $ |
| 40 | | Year 4 | Partner/Member | $ | x | 100 | = | $ |
| 41 | | | Manager | $ | x | 250 | = | $ |
| 42 | | | Supervisor | $ | x | 250 | = | $ |
| 43 | | | Staff | $ | x | 150 | = | $ |
| 44 | | | Clerical | $ | x | 100 | = | $ |
Grand Total Cost $
Please Print Information Below.
| Company Name: |
| Sales Representative: |
| Vendor Address: |
| Vendor Phone: |
| Email Address: |
SIGNATURE DATE
*Any quantities listed are estimates only and are not guaranteed. Actual quantities may vary.*