The Contractor shall be responsible for providing and hosting a comprehensive billing and collection system in compliance with all requirements of Medicare, Medicaid, CHAMPUS, other governmental insurance programs and commercial insurance companies (collectively referred to as insurance providers). Note: If the Contractor wishes to use alternative procedures or methods of service delivery and pricing which would result in more cost effective or otherwise advantageous provision of services, than those set out in this Scope, the Contractor should describe and identify those alternates in the proposal in addition to what has been requested. The County may consider alternate methods in the process of review of proposals and Contract negotiation. Any alternate methods of service delivery agreed upon by the County shall be detailed in the resulting Contract. Otherwise, all mandatory provisions of this RFP, including this scope, shall govern service delivery and performance by the Contractor. A. Medical Billing and Services 1.1 Preparation for Billing. The Contractor shall obtain all approvals and reviews by insurance providers, including government entities, Medicare, Medicaid, Black Lung, and any other insurance companies that require a partnership along with obtaining the National Provider Identifier (NPI) designation, which are necessary for the purpose of establishing fee amounts. The Contractor shall advise the County of any measures, including those relating to arrangements with volunteer service providers, which are necessary prior to initiation of billing, and shall perform all necessary pre-billing functions, including the training described below. In addition to gaining approval the Contractor agrees to mutually sponsor numerous educational sessions, set by the County, for community education of the revenue recovery process. 1.2 Pre-hospital Patient Care Report (PPCR) Processing The Contractor shall provide all labor, material and equipment, to gather all essential information for generating and processing all PPCR’s relating to transport services. The Contractor shall provide appropriate training, by qualified instructors, including training materials, to ensure that all personnel designated by the County who are involved in the billing process, have the necessary skills, knowledge and abilities to prepare the PPCR accurately and in compliance with all requirements. The training shall be provided at mutually agreeable times, and on multiple dates, in order to accommodate all staff and volunteers. The County will provide facilities and office supplies for the training. All training shall be conducted at a location designated by County. The Contractor shall coordinate training dates and times with the EMS Ambulance Committee. The Contractor shall be responsible for providing the County with the latest changes and modifications of the PPCR format and requirements, as required by the applicable insurance providers or as mandated by state and federal regulations and for providing training throughout the term of the resulting Contract, for new personnel, for personnel needing retraining, and in the event of changes in requirements, forms or procedures. The Contractor shall have software that is compatible with any software program currently in use by the County.
