SCOPE_OF_WORK_BILLING_2026.docx

3.0 SCOPE OF WORK

3.1 Provide Emergency Medical Services (EMS) billing services. County will award one contract for a firm to provide all services necessary to receive and process patient billing and SC Debt Setoff collection. The term of the contract resulting from this solicitation shall be for an initial one (1) year term with four (4) additional one (1) year terms, not to exceed five (5) years.

3.2 Contractor must be prepared to furnish, within the first year a complete hardware “refresh” including ruggedized mobile computing hardware and all attendant hardware peripherals, as defined in Appendix A of this RFP, at the billing company’s expense. Also required during the term of the contract are the monthly fees paid to ESO Solutions for modules Electronic Health Records, Check Lists and Logistics, Personnel Management, Scheduling, Insights, Handtevy, and Analytics software modules. The current call volume is between 20,000 and 24,000 calls per year. Should the contract with the Billing Company and Beaufort County EMS terminate any hardware and/or software purchased during the period of the contract become the property of Beaufort County EMS.

3.3 Provide all labor, including Certified Coders, materials and technology necessary to obtain missing patient information from all available sources prior to issuing insurance claims or direct patient billing.

3.4 Electronically file insurance claims and mail direct patient billing upon verification of run ticket information no later than 10 days after receipt of run ticket. File on a CMS 1500 form any claims that are not accepted by electronic methods.

3.5 Provide follow-up billing upon receipt of “new” information received concerning a patient. This includes, but is not limited to, additional insurance information, change of address, or change of responsible party.

3.6 Electronically receive data files from insurance companies (i.e., Medicare or insurance companies) to update patient accounts. Beaufort County EMS currently has the capability to receive ERN’s (Electronic Remittance Notice) from Medicare, Medicaid and SC Blue Cross Blue Shield this cannot change. Currently Medicare, Medicaid, BCBS, VA, Tricare and all other major insurance providers make direct deposit payments into the county’s bank account, this must continue.

3.7 Update patient accounts upon receipt of payment information.

3.8 First invoice should be sent no later than 10 days from dispatch date. The Second invoice is to be sent 30 days from initial billing date. A third invoice is to be sent no later than 60 days from the initial billing date. The third statement should include delinquent notice.

3.9 Bills with no payment activity at 91 days will be forwarded to the collection agency by the billing company staff. If a payment plan has been established with the patient that exceeds 91 days, and it is being met, the account will not be turned over to the collection agency.

3.10 Provide 24/7online access to information including notes and hard copy reports required by County, including but not limited to:

• Run tickets received / billed

• Payments received

• Outstanding balances

• Adjustments and refunds

• Aging of open accounts

• Accounts forwarded to Collection agency

• Status of all accounts

• Provide listing of all accounts for debt set off

• Notify BCEMS of any change in Patient Demographics to include address changes, phone number updates, Social Security number etc.

3.11 Provide monthly reports outlining all accounts and their status to include the amount collected during that month.

3.12 Provide regular updates and on-going training to Beaufort County on changes to billing requirements based on industry standards or requirements of applicable health care laws and regulations.

3.13 Provide County with Contractor’s “Red Flag” plan and all updates throughout the term of the contract.

3.14 Provide the county with a spreadsheet of all accounts to be forwarded to the SC Setoff Debt Program annually. Additionally, the billing company would incur the cost of printing and mailing the Initial Notification Letter that is statutorily required.

3.15 Comply with all HIPAA rules and regulations.

3.16 Provide 5 references. 3 happy clients and 2 unhappy clients. (Unhappy clients need not be current clients)

3.17 Access to the company’s latest audit. This audit needs to include an audit of procedures used in billing (including insurance claims) and posting of payments.

3.18 Recovery percentages for current clients based on amount recovered. Do not need the names of the clients but would like the state information.