SOLICITATION NOTICE
R -- RX ACCOUNTS RECEIVABLESVA-249-07-RP-0109
- Notice Date
- 2/5/2007
- Notice Type
- Solicitation Notice
- Contracting Office
- Department of Veterans Affairs;ASC - VISN 9;3400 Lebanon Pike;Murfreesboro TN 37129
- ZIP Code
- 37129
- Solicitation Number
- VA-249-07-RP-0109
- Response Due
- 3/12/2007
- Archive Date
- 4/21/2007
- Description
- Request for Quote SCHEDULE OF SUPPLIES/SERVICES AND PRICE/COST Contractor shall provide all labor, materials, and transportation necessary to perform work in accounts receivables for the VA Mid-South Customer Accounts Center, in accordance with the terms, conditions and specifications contained herein. Contract period will be from date of award through September 30, 2007 Please submit a detailed project plan for providing the total scope of work. The Government will place a delivery order to the responsible offeror that represents the best value and results in the lowest overall cost alternative to meet the government's needs. The following factors shall be used to evaluate offers. 1.Technical Capability Evidence of performance of accounts receivables for a minimum of 3 years in a large tertiary healthcare organization. Quality of Service Evidence of financial responsibility 2. Past Performances Provide three references of contracts performed that are comparable to the scope of the requirements identified herein. Include contact, name of company, address and telephone number. Any contracts with other VA Hospital should be identified. 3. Price a. Cost/Price- should be quoted as a percentage of total receivables. 1. Estimated quantity/outstanding $ of prescription receivables 63,865/$3,970,732 (as of 1/24/07) Statement of Work for Accounts Receivable The contractor shall provide collection, follow-up and remittance review on all open prescription accounts receivable assigned to the contractor by the VISN 9 Mid-South Customer Accounts Center. The major emphasis on this project is to review no-pay remittances and determine if there is any additional revenue to be gained to achieve optimum collection of prescription insurance claims. If no revenue is anticipated, closing each claim with an appropriate denial justification. *THE STATEMENT OF WORK WILL NOT BE CONFINED TO PRESCRIPTION THIRD PARTY RECEIVABLE REMITTANCES. THERE MAY BE INSTANCES WHERE OTHER THIRD PARTY RECEIVABLE REMITTANCES MAY BE INCLUDED AS PART OF THIS PROJECT. * Follow-up and remittance review activities shall be accomplished in such a way as to achieve optimum collection from the insurance carrier(s), or appropriate adjustments within the AR package with proper justification after review of remittances. The review of no-pay (zero) remittances is crucial in keeping aged receivables to a minimum and the established GDRO (Gross Days Revenue Outstanding) within acceptable standards. This will include a review of VISTA reports as well as appropriate processing of correspondence including insurance remittances or explanation of benefits (EOBs). The contractor shall provide the service with a thorough understanding of electronic documentation requirements, coding requirements, and appeal processes. The contractor will identify those accounts that may warrant investigation for possible appeal or other actions. For those cases, contractor shall perform the collection activities including the working of rejections and the administrative appeals processes. Once the contractor begins work on a claim, the contractor must follow the claim until it is recommended for closure. Mid-South Customer Accounts Center staff will provide initial training to the Contractor on-site. Contractor staff may provide services on-site. Additional consultation may be provided by off-site contractor staff. Approval for off-site work must be approved by Mid-South Customer Accounts Center on an individual basis. Results of followup activity shall be provided in one of three methods. 1) A monthly report indicating total activity accomplished by the contractor, including number of accounts referred for review, number of accounts reviewed, dollar amount of claims involved in review and any other pertinent information agreed upon by the MCAC and/or the contractor. 2) A worksheet or email shall be provided for cases requiring action by the Mid-South Customer Accounts Center (see Attachment A). 3) A contractual adjustment within the Accounts Receivable Vista software, based on information provided by the insurance carrier, either by remittance, website or telephone conversation. Contractor will use this option only after being sufficiently trained, and will complete adjustments with appropriate justifications as provided by Mid-South Customer Accounts Center. The Mid-South Customer Accounts Center retains the right to not allow the contractor to perform adjustments to receivables if errors occur that result in not achieving optimum collections or appropriate claim closures. The format of the log, worksheet, and/or email can be modified upon the mutual agreement of the Mid-South Customer Accounts Center and the contractor. The contractor will maintain a file at the Mid-South Customer Accounts Center with review sheets/ communications/ reports, and will enter appropriate electronic comments into VISTA. The contractor will obtain patient information and copies of medical records when needed, and will provide access to EOBs, Insurance Correspondence, Claims Tracking, and other documents as needed regarding each claim. The Mid-South Customer Accounts Center will provide space, work table/desk, chair and PC for one on-site contract employee; actual records (paper and/or electronic), and limited computer database access to VISTA options for contract employees located off-site. Access will be provided to a copy machine, telephone, and FAX machine, if located on-site. Review of remittances commences when forwarded to the contactor by the MCAC. Remittances will be thoroughly reviewed for appropriate denials; and corresponding AR claims are decrease adjusted. Those denials deemed collectible will have aggressive telephone followup or written correspondence completed until payment is secured. Follow-up will be performed on all prescription receivables when they are sixty (60) days old or when insurance remittances are received and forwarded to contactor; and until they are recommended for closure by the contractor, or have been paid by the insurance carrier. Contractor will provide a grace period for payment receipt after referral of claim (generally 10 days). The contractor will not recoup payments received within this period. Payment will not be made on any receivable that has had no followup, but is paid by the insurance carrier. A minimum of four aggressive telephone followup or written correspondence to the insurance carrier will be initiated before recommendations to close a claim are initiated. Mid-South Customer Accounts Center reserves the right to restrict certain carriers, or certain accounts depending on the center's needs. This restriction request will be initiated before the account/claim becomes 60 days old. MCAC will annotate each claim with ***MCAC APPEAL to alert contractor of followup exclusion. Restriction of carriers will be kept to a minimum to allow the contractor for range of outstanding prescription accounts. The Mid-South Customer Accounts Center will provide a monthly detailed report of each payment posted to an insurance claim that the contractor has provided sufficient, quality documented electronic followup, or has closed the claim with appropriate closure justification(s), unless otherwise noted that the contractor will accomplish this process. Invoice billings will be prepared to the Mid-South Customer Accounts Center on a monthly basis. An invoice may not be billed on an insurance claim until follow-up is complete and the bill is recommended for closure or paid by the insurance carrier. Payment to the vendor will be determined by a percentage of collections received from the insurance carrier, and by the number of claims closed due to review of no-pay remittances. Contractor will be paid for work completed prior to the expiration of the contract, and for three months after the contract has expired or ended. Refund requests determined to be valid on claims previously paid in which a contractor's invoice has been submitted and paid, will have a future invoice reduced by the refunded amount. Detailed actions will appear as an addendum on the Mid-South Customer Accounts Center monthly detailed payment report. Documentation on the refund request will be provided to the contractor. Specific accounts or insurance carriers that have been restricted from the contractor's responsibility will not be paid to the contractor, even if the contractor has provided followup activity. Detailed actions will appear as an addendum on the Mid-South Customer Accounts Center monthly detailed payment report. Documentation on the restrictions will be provided to the contractor. Claims that should be appealed for medical reasons will be referred to the Mid-South Customer Accounts Center to complete the appeal process. The contractor will provide specific information to the Mid-South Customer Accounts Center on what needs to be appealed. Time schedules and deadlines are to be established based on mutual agreement of the Mid-South Customer Accounts Center and the contractor. Failure of the contractor to meet VHA deadlines may result in canceling all or part of the contract. Contractor will be responsible for maintaining aged receivables to specific end-of-month outstanding percentages by dollar amount. There will be documented evidence that the oldest aged receivables are worked for followup and final disposition, before new referred accounts are worked. Contract performance has been established with the following outstanding accounts receivable balance portfolio to be achieved as satisfactory: Between 91-120 days - no more than 6% of outstanding rx receivables Between 121-180 days - no more than 5% of outstanding rx receivables Between 180-365 days - no more than 4% of outstanding rx receivables Over 365 days - no more than 1% of outstanding rx receivables (performance measure will be reviewed starting at the end of the second month of the contract) Contractor shall provide all labor, materials, transportation, and supervision necessary to provide these services. Unclear policies will be discussed with the Mid-South Customer Accounts Center for clarification. Contractor must maintain frequent (at least weekly) communications with the Accounts Receivable Supervisor, or designee, regarding progress, workload status and/or problems. The contractor must specify a contact/liaison person, and alternate, and phone numbers for the duration of the work. Failure to comply with procedures and guidelines may result in immediate termination of this contract. Contractor will offer consultative/informational services off-site for one month after work is complete. Contractor will continue to followup on any outstanding claims which were started prior to the end of the contract. The contractor must work within the following guidelines: Contractor will operate within federal law and within VHA directives and guidelines as well as Mid-South Customer Accounts Center procedures for this contract. The contractor must contact the Mid-South Customer Accounts Center if there are conflicts or disagreements with the guidelines. Information and guidelines on billing and collections within the Veterans Health Administration (VHA) may be found at http://www.va.gov/mccr. VA bills health insurance carriers for treatment of non-service connected conditions provided to veterans. Any questions regarding a veteran's service connected status should be referred to the Mid-South Customer Accounts Center. The VA is not authorized to bill Medicare or Medicaid. Medicare supplemental policies are required to pay without Medicare Explanation of Benefits. Unpaid insurance claims are not converted to self-pay status. The veteran must not be told he/she will become liable if the insurer fails to pay. Eligibility for VA care is not affected by insurance coverage. Prior to September 1, 1999, inpatient bills consisted of an all inclusive per diem rate that included facility and professional charges. Such bills are not itemized. Outpatient bills consisted of an all inclusive rate that included facility and professional charges. All services provided in a day were included in one charge. For care provided on and after September 1, 1999, VHA implemented a new rate structure commonly called reasonable charges. Any updated patient demographic information obtained during collection/followup activities, including updated insurance information, must be furnished to the Mid-South Customer Accounts Center on a daily basis. Contractor will use standardized methods to record pertinent information prior to submission (either by mail or fax) to the Mid-South Customer Accounts Center. All scripts to be used for contacting insurance carriers and/or veterans must be approved in advance by the Mid-South Customer Accounts Center. The contractor must instruct all debtors to remit payment to the Mid-South Customer Accounts Center, under the appropriate medical center's business name, as it appears on the UB-92 or HCFA-1500 form. Any proposed legal action to be taken must be coordinated with VA Regional Counsel through the Mid-South Customer Accounts Center. Contractor agrees that all deliverables, associated working papers, and other material deemed relevant by the contractor in the performance of these tasks are the property of the United States Government. The contractor must treat all individually identifiable health records with the strictest confidentiality. Access to records must be limited to essential personnel only. Records must be secured when not in use. At the conclusion of the contract all copies of individually identifiable health records must be destroyed or returned to the Mid-South Customer Accounts Center. Contractor staff shall sign and follow confidentiality statements as required. Contractor shall ensure that no fraud will be committed on work performed by the contractor. The contractor's claims expediting and collection activities must be legal, ethical and in compliance with applicable legislation regulating debt collection practices. The contractor shall comply with the Privacy Act, 38 USC 5701 and 38 USC 7332. The contract period will be from date of award to September 30, 2007. The contract may have 4 option years. The estimated number of potential receivables for the time period of this contract is as follows: Hospital: Outstanding Claims Estimated Value Huntington, WV 14,000 $1,007,623.69 Lexington, KY 9,884 $809,985.06 Louisville, KY 8,605 $506,181.66 Memphis, TN 11,499 $869,173.59 Mtn Home, TN 7,298 $521,297.38 Nashville, TN 12,579 $985,461.47 (as of January 24, 2007) SECURITY REQUIREMENTS FOR CONTRACTOR EMPLOYEES Contractor(s) shall insure the confidentiality of all patient and employee information and shall be held liable in the event of breach of confidentiality. Any person, who knowingly or willingly discloses confidential information from the VA Medical Center may be subject to fines of up to $20,000.00. Background Investigations: Contractor personnel performing work under this contract shall satisfy all requirements for appropriate security eligibility in dealing with access to sensitive information systems belonging to or being used on behalf of the Department of Veterans Affairs. To satisfy the requirements of the Department of Veterans Affairs a Minimum Background Investigation shall be conducted prior to performing work under this contract. The level of access and the individual's capability to perform work under this contract will be the determining factor in deciding if a higher investigative requirement is needed. The contractor shall ensure that those requirements are fully satisfied within 30 days of initiation of such investigations. The investigative history for contractor personnel working under this contract must be maintained in the databases of either with the Office of Personnel Management (OPM) or the Defense Industrial Security Clearance Organization (DISCO). Should the contractor use another vendor other than OPM or Defense Security Service (DSS) to conduct investigation, the investigative company must be certified by OPM/DSS to conduct contractor investigations. All costs associated with obtaining clearances for contractor provided personnel will be the responsibility of the contractor. Further, the contractor will be responsible for the actions of those individuals they provide to perform work for the VA under this contract. In the event that damages arise from work performed by contractor provided personnel, under the auspices of this contract, the contractor will be responsible for all resources necessary to remedy the incident. Records: Contractor personnel who obtain access to hardware or media which may manipulate or store drug or alcohol abuse data, sickle cell anemia treatment records, records or tests or treatment for or infection with HIV, medical quality assurance records, or any other sensitive information protected under 38 U.S.C. §4132 or §3305, as defined by the Department of Veterans Affairs, shall not have access to the records unless absolutely necessary to perform their contractual duties. Any individual who has access to these data will disclose them to no one, including other employees of the contractor not involved in the performance of the particular contractual duty for which access was obtained. Violation of these statutory provisions, as stated in department regulations by the contractor's employees may involve imposition of criminal penalties. System of Records: The Veterans Administration system(s) of records to which the contractor personnel will have access in order to maintain is "Patient Medical Records - VA (24VA136). System Security: The Contractor shall provide VHA with the full assurance that security measures have been implemented which are consistent with OMB Circular A-130 and VA Departmental Standards. Procedures for User Access: Access requirements to VA information systems by contractors and contractor personnel shall meet or exceed those requirements established for VHA employees as described in VHA Directives (and others) and in any subsequent VHA policy statements. A written and signed request for user access by VHA Management, or designee(s), constitutes management approval (sponsorship) to initiate a request for access to any sensitive automated information system. Access shall be granted to non-VA users only if the purpose for access meets criteria of the Privacy Act and VA Confidentiality regulations and transfer. Contractor will be required to sign and abide by the VA Computer Access Security Agreement and Confidentiality Agreement. 52.224-1 Privacy Act Notification. (Apr 1984) The Contractor will be required to design, develop, or operate a system of records on individuals, to accomplish an agency function subject to the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable agency regulations. Violation of the Act may involve the imposition of criminal penalties. 52.224-2 Privacy Act. (Apr 1984) (a) The Contractor agrees to-- (1) Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies-- (i) The systems of records; and (ii) The design, development, or operation work that the contractor is to perform; (2) Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcontract awarded without a solicitation, when the work statement in the proposed subcontract requires the redesign, development, or operation of a system of records on individuals that is subject to the Act; and (3) Include this clause, including this subparagraph (3), in all subcontracts awarded under this contract, which requires the design, development, or operation of such a system of records. (b) In the event of violations of the Act, a civil action may be brought against the agency involved when the violation concerns the design, development, or operation of a system of records on individuals to accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of the agency when the violation concerns the operation of a system of records on individuals to accomplish an agency function. For purposes of the Act, when the contract is for the operation of a system of records on individuals to accomplish an agency function, the Contractor is considered to be an employee of the agency. (c)(1) "Operation of a system of records," as used in this clause, means performance of any of the activities associated with maintaining the system of records, including the collection, use, and dissemination of records. (2) "Record," as used in this clause, means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, education, financial transactions, medical history, and criminal or employment history and that contains the person's name, or the identifying number, symbol, or other identifying particular assigned to the individual, such as a fingerprint or voiceprint or a photograph. (3) "System of records on individuals," as used in this clause, means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual. Veterans Benefits, Health Care, and Information Technology Act of 2006 ,Public Law 109-461 Sec. 5725. Contracts for data processing or maintenance (a) Contract Requirements- If the Secretary enters into a contract for the performance of any Department function that requires access to sensitive personal information, the Secretary shall require as a condition of the contract that-- (1) the contractor shall not, directly or through an affiliate of the contractor, disclose such information to any other person unless the disclosure is lawful and is expressly permitted under the contract; (2) the contractor, or any subcontractor for a subcontract of the contract, shall promptly notify the Secretary of any data breach that occurs with respect to such information. (b) Liquidated Damages- Each contract subject to the requirements of subsection (a) shall provide for liquidated damages to be paid by the contractor to the Secretary in the event of a data breach with respect to any sensitive personal information processed or maintained by the contractor or any subcontractor under that contract. (c) Provision of Credit Protection Services- Any amount collected by the Secretary under subsection (b) shall be deposited in or credited to the Department account from which the contractor was paid and shall remain available for obligation without fiscal year limitation exclusively for the purpose of providing credit protection services pursuant to section 5724(b) of this title.
- Place of Performance
- Address: Department of Veterans Affairs;Tennessee Valley Health care system;3400 Lebanon Pike;Murfreesboro, Tennessee
- Zip Code: 37129
- Country: USA
- Zip Code: 37129
- Record
- SN01225821-W 20070207/070205220357 (fbodaily.com)
- Source
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