MANIILAQ ASSOCIATION KOTZEBUE, ALASKA ASSOCIATION KOTZEBUE, ALASKA ... § Services Provided Key...

MANIILAQASSOCIATION

KOTZEBUE,ALASKAREQUESTFORPROPOSALFOR

CodingandDenialManagementOutsource

January18,2018

POBox43

Kotzebue,AK99752

907-442-3321

ManiilaqAssociation–CodingandDenialManagementOutsourceRFP

!

TableofContents

RequestforProposal........................................Pages1–15

§ GeneralInformation...........................Pages3-7§ VolumeData.................................Page7-8§ GeneralScopeofWork.........................Page8§ ServicesProvidedServiceLevelAgreements(SLA’s).Page8§ ServicesProvidedKeyPerformanceMetrics(KPI’s)..Page9

ProposalSubmissionandClosure................................Pages10-14

§ EvaluationTeam..............................Page10§ ReviewofProposals...........................Page10§ ProposalContentandRequirements..............Page11§ EvaluationCriteria.............................Page13§ Presentations..................................Page13§ SelectionProcess...............................Page13-14

AcceptanceorRejectionofProposals..............................Page14

CodeofEthics,ConflictsofInterest,andBusinessAgreement.........Page14

ProcurementRequirements.......................................Page14

ExhibitA

§ ManiilaqAssociationRecognizedHolidays.................Page15


#

BackgroundManiilaqAssociationlocatedinKotzebue,Alaskaprovideshealth,tribal,andsocialservicestoresidentsofruralNorthwestAlaska.TheManiilaqAssociationprovidesmedicalservicesatelevenremotevillageclinicsitesandacriticalaccesshospitalinKotzebue.Healthservicesincludeaseventeenbedinpatientunit,emergencyandoutpatientservices,aswellas,aspecialtyclinic,visioncareservices,dental,pharmacy,radiology,laboratoryandphysicaltherapy.An18bedlongtermcare/SNFfacilityisco-locatedwithManiilaqHealthCenter.ManiilaqHealthservicesemploysapproximately268employeeswhoservearegionalpopulationof8,000.HealthServiceshasanannualbudgetofapproximately$50M.

ManiilaqAssociationcurrentlyusestheRPMSinformationsystem.OnJune4,2018,ManiilaqwillbeconvertingtoCernerMillennium.ManiilaqispartoftheAlaskaNativeTribalHealthConsortium(ANTHC)andwillbeworkingwithAlaskaNativeMedicalCenter(ANMC)toincorporatetheusageoftheirITservers,Cernerworkflowsandetc.

Maniilaqcurrentlyhasfourserviceareaswhereweareseekingtooutsourcecoding,anddenialmanagement–pleaseseechartbelowforspecificsoneachdivision.PharmacycurrentlyusesScriptProandisoutofscopeforthisRFP.

CurrentSummaryChartofServiceAreasandprocesses:

BehavioralHealth Medical Dental LTC

Documentationsystem

BillingSoftware

AKAIMS

Centricity

RPMS

Centricity

Dentrix

Dentrix

Matrix/PointClickCare

CentricityBillingProcessor Emdeon Emdeon Emdeon Emdeon

Person BreeSwanson PaulHansen AugustasKirkland ValKreil

Coding Outsourced Outsourced Internal OutsourcedPrimaryBilling Outsourced Outsourced Outsourced Outsourced2ndaryBilling n/a Outsourced Outsourced n/a

CashApplication Outsourced Outsourced Outsourced OutsourcedDenial

Management Outsourced Outsourced Outsourced Outsourced


7

Medical Notes

Inpatient

WeprovideObservationbeds,AdministrativeWaitBeds,noswingbedscurrentlybutmaybeaddingpriortoCernerGoLive.Preauthorizationprocessesarein

place.

Outpatient

M-FclinicinKotzebuestaffedwithphysician/midlevelproviders.ElevenremotevillageclinicsstaffedwithCommunityHealthAides/Practitioners(Medicaidreimbursed)anditinerantmedicalproviders.

SpecialtyClinic

ItinerantspecialistsfromAnchorageprovideweeklyspecialtyclinicservicessuchasENT,pediatrics,

urology,orthopedics,cardiology,surgery,etc.Wedobillfortheproviders.

Telemedicine/RadioCalls

VillagetoVillage,villagetoKotzebue,andvillageorKotzebuetoAnchorage

ER LevelIV,stabilizationandairmedevactoAnchorage

OB Prenatal/lowriskOBdeliveryservices

PhysicalTherapy PhDproviderM-Fforlongtermcare,inpatientsandoutpatients

MedicalBilling Explanation

AllInclusiveRates IPandOPencounterratesareutilizedforMedicare,MedicaidandtheVA.

Self-Pay/Copays/Deductibles

Wecurrentlydonotcollectcopaysanddeductiblesattimeofregistration.

BadDebt Collectionsservicesarecurrentlyoutsourced.Ifyouprovidebaddebt,pleaseincludeinyourbid.

EBilling Currentlyperformedatoutsourcevendor

Supplies Wedonotcurrentlybillforsuppliesitemsbutwouldliketointhefuture.


>

Injection/Infusions Notcurrentlybilled,documentationinplacetostart.

InsuranceVerification

InsuranceVerificationcompletedattimeofpre-registration/registrationalongwithverificationofIHSBeneficiarystatus.WeuseExperianforverificationvendor.UninsuredpatientsReferredtoAlternateResourceSpecialistforsecuringotherpotentialpayersincludingtheMarketplace.

PayerContracts Premerapreferredprovideragreementcurrentlyinplace.

Dental Notes

Outpatient OPdentalservicesprovidedinvillagesandKotzebuebydentists,hygienistsanddentalhealthaidetherapists.

ER Dentistcalledinandpatientservicesprovidedindentalclinic.

DentalBilling Explanation

PPS Dentalisfeeschedulebilling.Medicaidreimbursesonencounterrate.

Self-Pay,CopaysandDeductibles

Notcurrentlycollectedatthetimeofregistration.Howeversystemsareinplacetoimplement.

InsuranceVerification InsuranceVerificationisdoneattimeofregistration.

EBilling Dentrix.BadDebt Sameasmedical

Pharmacy Notes

Retail ProvidedatKotzebueandvillagesforrefillsandinitialoutpatientscript.

Inpatient Providedbutnotcurrentlycapturedinbilling.

LongTermCare BilledasoutpatientretailforallpayersexceptMedicare

PharmacyBilling Explanation

CopaysandDeductibles

CopaysarecollectedattheKotzebuefacilityattimeofdispensing.


B

Self-Pay Collectedattimeofdispensing.

InsuranceVerification POSinsuranceverification

LongTermCare Notes

Medicaid100%ofresidentsonMedicaid.Billedmonthly.Reimbursedatnegotiatedcostbasedrate.Pharmacyisexcludedinthis

rate-seeaboveforPharmacyBilling.

Self-Pay Minimalcostofcarepayments

InsuranceRegistration AlaskaMedicaidenrollment/reenrollmentassistanceprovided

BehavioralHealth/Social

ServicesNotes

Outpatient OutpatientcounselingservicesprovidedattheMSWlevel.

Inpatient

NoinpatientservicesavailableattheBehavioralHealthClinic.IP"holds"arebilledundermedical.AllotherBehavioral

HealthproviderservicesforInPatientsarenotbilledbutareincludedintheMedicaidandMedicareall-inclusiverates

received.

PutyukChildren’sHome

WeservetheNorthwestArcticregionoftwelvevillages,includingtheNativeVillageofPt.Hope.Putyukiscomprisedofninebeds,withonebeddedicatedtorespiteservicesthroughManiilaqAssociation.DocumentationwillbeoutsideofCerner


E

DevelopmentalDisabilityServices

ServicespaidbyMedicaidWaiversandwillbedocumentedoutsideofCerner

Behavioral/SocialServices

BillingExplanation

CopaysandDeductibles Currentlynotcollected.

InsuranceVerification HavecontractwithExperian

AllInclusive Medicaidreimbursesbasedonall-inclusiveencounterrates

VolumeData(monthly)

Hospital

Billing-#ofClaimsBilled 10,540CashApplication#ofchecks&creditcardpayments 4,936

Dental Billing-#ofClaimsBilled 572CashApplication#ofchecks&creditcardpayments 387

Pharmacy

Billing-#ofPrescriptionsFilled-NonIHS 10,741

#ofTotalPrescriptionsFilled 17,640


J

Health Information

#ofInpatientVisitsCoded 74

#ofOutpatientVisitsCoded 12,261#ofDocumentsScanned 4,797

#ofScannedPages 11,295

GeneralScopeofWork

Wearerequestingaproposalforprovidingthefollowingservices:

• ICD-10,CPTandHCPCScoding

ThesuccessfulbidderwillbeginservicesendofMarch,2018.Itisanticipatedthatthenewcontractwillallowfor:

Ø LanguagetoensureHIPAAandHITECHcomplianceØ LanguagetoensurecompliancewithnationalAAPCandAHIMAcodingethics.Ø LanguagetoensurecodersarecredentialedwithAAPCorAHIMAØ LanguagetoensurecodersunderstandtheneedsofRPMS,Cerner,CriticalAccess

HospitalsandIndianHealthcoding/billingneeds.Ø Languagetoensurequalitymeasuresof95%orbetterandwhatwillhappenifmeasures

notmetintwo(2)consecutivebillingperiods.Ø Languagetoensureproductivitymeasuresaremonitored–givena“graceperiod”will

begrantedfortheCernerimplementationof30daysorasotherwiseindicated.Ø LanguagetoensurecoderswillutilizeandunderstandthepropermechanismsinCerner

toqueryaproviderforcodingquestions.

ServicesProvidedServiceLevelAgreements(SLA’s)

Allreferencesto“days”willbecountedasworkingorbusinessdayswhichexcludeSaturday,Sunday,andallrecognizedManiilaqAssociationholidays(SeeExhibitA).All“submitted”willmeanreceivedbyManiilaqAssociationdesignatedmanagement.“Successfully”willbeacceptedtomeanthatallerrorfilesorrejectionshavebeenresolvedandsatisfied.

§ Codingwillbecompletedwithinthree(3)daysofeithervisitordateofdischarge(providedtherecordiscompletedandavailable).


Q

KeyPerformanceIndicators(KPI’s)

§ Ninety-Fivepercent(95%)Accuracyofcodingaccounts–Accuracyratewilltakeintoaccountifalldocumentationwasavailable.CodingVendorwillproviderates.

§ ThreeDaysinFinalBilledNotSubmitted(FBNS)toPayer–GrossDollarsinFBNS/AverageDailyGrossRevenue

§ Coderswillmeetestablishedproductionratesof3chartsperhourforinpatient/observationaccounts.

§ Meetorexceedproductionlevelsforoutpatientchartscodedperhour.Averageisbasedonamonth.Note:the6/4/18projecteddateoftheCernergolivewilltakeintoaccountproductivitydelaysforapproximatelythefirst30days.

§ ED=14/hour§ DaySurgery=10/hour§ OtherOutpatient=25/hour


TU

BidderSelectionProcessPlan

Contractawardisestimatedtobeapprovedbythe23rdofFebruary,2018allowingfor120daysimplementationwithagolivedateofJune4,2018

January18,2017throughJune4th,2018

DateRange Department Task

January18th PFS RFPDistributedtoVendors

WeekofJanuary29th

ManiilaqandBiddingVendorsdevelopmentofproposals

ThisperiodmayincludeALLvendorsparticipatinginconferencecallstodiscussRFPresponsequestions

February16th BiddingVendors DeadlineforbidstobesubmittedtoManiilaq

ByFebruary23rd Maniilaq VendorSelectionandnotificationtowinningbid

March26ththruApril2nd

ImplementationTeams Testingofcoding,billing,cashapplication,anddenialmanagementforalldivisionsusinglivedata.

June4th ImplementationTeams NewVendorstartswithRevenueCycleoutsourcing

AdditionalInformationorClarificationofRFP

Ifpotentialbiddersortheevaluationteambelievesadditionalinformationorclarificationisnecessary,biddersmaysubmitquestionsto:[email protected]

Allknownbidderswillbenotifiedseven(7)daysinadvanceofasharedconferencecallinwhichallvendorswillbeinvitedtoparticipatetoheartherequestsforadditionalinformationortoreceivetheadditionalclarifications.Noevaluationmemberorbiddingvendorwillbeallowedduringselectionreviewtoparticipateinanywrittenorverbalcommunicationunlessallvendorsarepresentandincludedandhavereceivedatleastaminimumofaseven(7)daynotice.

EvaluationTeam

EvaluationTeamwillbecomprisedofthefollowingmembersfromManiilaqAssociation:HospitalAdministrator,AssociationVP/CFO,HIMDirector,PFSDirector,SocialServicesAdministrator,andChiefInformationOfficer.HospitalAdministratorwillheadthecommitteeandcanbecontactedat907-442-7150oremail:[email protected]

ReviewofProposals

Reviewofproposalswilltakeplacewithinthegenerallyacceptedbidcontrolguidelines.AllbidswillbeopenedatthesametimewithaquorumofEvaluationTeammemberspresent.Foranyproposalthatisdeterminednottomeetminimumrequirements,thevendorwillreceivearejectionnotice.Evaluationteamreservestherighttonotifyindividualbiddersforclarificationofproposalsubmissions.


TT

Pleasenoteallvendorswillbeassumedattimeofsubmissionofbidtoagreetoand/orbeabletoprovidethefollowingifthevendorisselected:

§ Proofof$1,000,000liabilitypolicycurrentandactive.§ AgreetoenterintoabusinessagreementforfulladherencetoHIPAArulesandregulations

effectivefortheperiodofthecontractawardincludingHIPAAclausesthatpertaintosecurityandprotectionofdataafterthecloseofthecontract.

§ Agreetoabidebyallfederalrulesandregulationsandinparticularthosethatarecontainedwithinthefollowing:

o StarkLawo DepartmentofLaborWageandHouro DavisBaconActo CentersforMedicareandMedicaid

§ Meetminimumrequirementsforsoftwarefirewallsandredundantsystemso StateofAlaskaStatutesandAdministrativeCodeo IndianHealthServices

§ CompliancewithanyapplicableJointCommissionand/orCARFrequirements

PROPOSALCONTENTANDREQUIREMENTSProposalFormat: PleasesubmitelectronicallyyourproposalonorbeforeJanuary15thbetween0800-

1000AlaskaTime.Proposalsshallnotexceedtwelve(12)pages,exclusiveofresumesandexhibits.Proposalsshouldbeorganizedaccordingtothefollowingoutline:

1. Table of Contents: The proposal will have a table of contents with page numbers and pages

numberedthroughouttheproposal.2. Introduction:Briefintroductionwhichincludes:2.1 Theproposer’snameandaddress;2.2 Statement that indicates the proposal is valid for at least ninety (90) days from the proposal

submissiondeadline;2.3 Statementthatindicatestheproposer’swillingnesstoperformtheservicesdescribedinthisRFP;2.4 Provide a detailed, including examples and/or documentation, ofmeeting each element of the

scopeofwork.2.5 Proofofanyotherlicensesand/orregistrationsasrequiredbythisRFP.2.6 Astatementthatallstaffandotherresourceswhicharerequiredtoperformtheservicesdescribed

inthisRFPwillbemadeavailablebyyourorganizationoverthelifeoftheanticipatedcontract;2.7 Statementthatthesignatoryhasauthoritytobindtheproposer;and2.8 Signatureofauthorizedindividual.3. Strategic Planning&Development: Consistentwith theManiilaqAssociation’s commitment to

continuous improvement, proposal must show evidence of its understanding of qualityimprovementandhowyouwillsupportourmissionandvision.


T!

4. FirmProfile:Proposalmustprovideatableorchartthatshowsorganizationalstructure,chainofsupervision,decisionauthority,andcommunications. Includeboththerespondentfirmandanysubconsultantfirms/subcontractors.

5. ProfessionalQualifications: Professional qualifications of the firms proposed Project

Manager,otherkeypersonnel,and/orteammembersnecessary forsatisfactoryperformanceofrequiredservices.Includeallpersonnelthatwillactivelybeinvolvedwithperformingthework,toincludea listingofall subcontractors, ifany,withanexplanationofpurpose. Inspecific,pleasecompletethefollowingtable:

Category#of

ProductionStaff

#withOthercodingandbillingsoftware-please

specifyCertifiedICD-10codersmedical CertifiedICD-10codersbehavioralhealth CertifiedICD-10codersdental CertifiedICD-10codingtrainers ICD-10codersnotcertified DenialManagementStaff

*Pleasenoteapersoncanonlybecountedonce.Forexample,ifapersonhasaRevenueCycleCertificationandaProjectManagementCertificationyouwillONLYenterthatpersononceeitherunderProjectManagementorRevenueCycleCertification.Secondexample,ifyouhaveapersonwhoisCertifiedasanICD-10coderandasatraineryoucanONLYcountthemonceeitherasacoderorasatrainer.Namesandcertificationscaneitherbesubmittedwiththebidorwillberequiredtobesubmittedpriortoawardingofcontract.

6. ProjectUnderstanding/ProjectApproach:Narrativesubmittalmustaddressscopeofworktobecompleted.

7. PastPerformance:Pastperformanceinlastfive(5)yearsoncontractswithGovernmentagencies

andprivate industry intermsofcostcontrol,qualityofwork,andcompliancewithperformanceschedules.IncludealistofallcontactsofsimilarservicesperformedforworkinAlaskaduringthelasttwo(2)years,withnameofContractingOfficerand/orProjectOfficerforeachcontract.Providephonenumbersandemailsforthenamedindividuals.

8. CapacitytoRespondandAccomplishtheWork: Includea listofprojectsthefirmcurrentlyhas

undercontract.9. PriceProposal:Providepricingdesignatedbythemeasurementsuchasbutnotlimitedtobypiece,

bythehour,orasapercentageofpaymentsreceived.


T#

10. AlaskaNative/AmericanIndianPreference:ManiilaqAssociationisaPL93-638organizationandshall give preference to Indian/Alaska Native organizations provided that goods or services areequalorequivalent.BiddersseekingIndian/AlaskaNativePreferencemustprovidedocumentation.

EvaluationCriteria

Thefollowingwillbethemajorcriteriaforvendorselectionbutisnotintendedtobeacompletelistingallowingfortheevaluationteamtofactorinotherconsiderationsthatmaypresentthemselvestoberelevanttotheselection.

§ KnowledgeandexperienceofAlaskaspecifichealthcareandinparticularAlaskaMedicaidandIndianHealth.

§ SuccessfulservicesprovidedtoanAlaskaCriticalAccessHospital.§ KnowledgeandexperiencewithCernerCommunityWorks§ KnowledgeandexperiencewithTribalBilling(MedicareandMedicaid)§ KnowledgeandexperiencewithPointClickCare§ KnowledgeandexperiencewithDentrix§ ProgramManagementexpertiseforsoftwareimplementations.§ Knowledgeandexperienceacrossabreadthofthevendor’semployeesofCriticalAccess

Hospitals.§ PriceProposalincludingperformancepenaltyforperformancefallingbelowSLA’sand/orKPI’s§ NativePreference

Presentations

Theevaluationteammayinvitetwotothreevendorstomakeon-linepresentationsandanswerquestionsduringthefinalselectionphase.PresentationswillbeuptothevendortocreatebutageneralguidelinewouldbetopresenthowthevendorwillensuresuccesswiththeManiilaqpartnership.

SelectionProcess

EvaluationTeamwillcompletetheselectionprocessandnotifyallvendorsbyemailatthesametimebyFebruary23,2018.FinalnegotiationsforthecontractandapprovalforthebusinessagreementwillbecompletedbetweenFebruary26thandMarch2nd,2018.

ProposalTimetable

§ ProposalssentoutJanuary18,2018§ BidssubmittedFebruary16th

AcceptanceorRejectionofProposals


T7

ItistherightofManiilaqAssociationtoacceptorrejectanyproposalsubmitted.SubmittingaproposalisnottobeconsideredanagreementwithManiilaqAssociationuntilacontractandabusinesspartnershipagreementarebothsignedandapprovedbybothManiilaqandthevendor’sofficialrepresentatives.TheEvaluationTeamwillhavesolediscretiontoacceptorrejectaproposalsolongasthereisaquorumagreement.NoonememberornooneemployeeofManiilaqAssociationmayacceptorrejectaproposal.OrganizationalEthicsStatement,ConflictsofInterest,andBusinessAssociateAgreementDuringthecontractapprovalprocess,ManiilaqAssociationwillputforthaCodeofEthics,aConflictofInterest,andaBusinessAgreement.TheOrganizationalEthicsStatementandConflictofInterestwillneedtobereviewedandsignedbykeystakeholders.TheManiilaqBusinessAssociateAgreementwillneedtobesignedbythevendor’sauthorizedrepresentative.ProcurementRequirements(mustbeincludedinfinalcontract)

Termination forCauseand forConvenience:All contracts inexcessof $10,000must includelanguageapprovedbytheGeneralCounseladdressingterminationforcauseandforconveniencebyManiilaq,includingthemannerbywhichitwillbeeffectedandthebasisforsettlement.

Remedies Clauses for Contracts Over $150,000: All contracts over $150,000 must containlanguageapprovedbytheGeneralCounselthataddressesadministrative,contractual,orlegalremediesininstanceswherecontractorsviolateorbreachcontractterms,andprovideforsuchsanctionsandpenaltiesasappropriate.


T>

EXHIBITA

ManiilaqAssociationAnnualHolidaysThe first day January................................... New Year's Day The third Monday in January...................... Martin Luther King/Della Keats

Day The third Monday in February.................... President's day Last Monday in May................................... Memorial Day The Fourth of July....................................... Independence Day First Monday in September......................... Labor Day Second Monday in October......................... Columbus Day/Maniilaq Day Eleventh Day of November...................….. Veteran's Day The Last Thursday in November..............….. Thanksgiving Day The Day After Thanksgiving……………..Employee Appreciation Day The 25th of December................................. Christmas Day Holidays that fall on Saturday will be observed on the preceding Friday. Holidays that fall on Sunday will be observed on the following Monday.

MANIILAQ ASSOCIATION KOTZEBUE, ALASKA ASSOCIATION KOTZEBUE, ALASKA ... § Services Provided Key...

Documents

Transcript of MANIILAQ ASSOCIATION KOTZEBUE, ALASKA ASSOCIATION KOTZEBUE, ALASKA ... § Services Provided Key...