Revenue Cycle Group The Request for Proposal Assignment 2. Joseph Dixon Michael Morotti David Robbins Mari Pirie - St. Pierre Nicole Wayne

Transcription

1 Revenue Cycle Group The Request for Proposal Assignment 2 Joseph Dixon Michael Morotti David Robbins Mari Pirie - St. Pierre Nicole Wayne MEDINF: 408 July 22, 2009

2 . Statement of Purpose Technical Requirements Administrative Information Cost Requirements Referenced Documents Deliverables Required Format of Proposal Submission Important Due Dates Appendix 2: Business Associate Agreement APPENDIX 2: Change Control Form... 32

3 River City Memorial Hospital (RCMH), located in West Orange, New Jersey is one of the best and fastest growing hospitals in the state. It is a 400 bed community hospital with a payer mix of 55% commercial health insurance, 30% Medicare, 12% Medicaid, and remaining self paid. Financially, the hospital is stable and capable of addressing the health needs of the community and surroundings. To support this rapid growth and improve reimbursement, River City Memorial Hospital needs to replace her ailing and obsolete revenue cycle management system. This new system must fully integrate with all internal systems including the new Electronic Medical Record System (EMR) and collaborate with the Regional Health Network (RHN). 1. Statement of Purpose The purpose of this document is to request proposals for supplying an Enterprise Revenue Information Management System (ERIMS) to replace the current system at River City Memorial Hospital. This solution must be robust to handle every aspect of the current system and provide improved functionalities and technology to cope with future needs. The current revenue cycle management system has the following issues: 1. The system is stand-alone and antiquated. As such, data must be re-keyed and processes duplicated. Sharing information is tedious and fragmented. 2. Maintenance and support are costly and, integration with internal systems impossible, etc. The objectives of the new enterprise revenue management are as follow: 1. Integrate with EMR and internal systems 2. Improve customer satisfaction and all financial processes (cash flow, reimbursement, billing, etc.) 3. Employ the latest technology, interface, and infrastructure design, etc. 4. Reduce operational cost and improve efficiency across the enterprise 5. Address future challenges HIPAA claims attachment ASC X12 V.5010, severity adjusted DRG, ICD-10-CM coding 1

4 6. Web-based patient access to account history, scheduling, charges, billing reimbursements, payments, etc. After researching the market, we have selected your organization to receive this formal Request For Proposal (RFP). We are asking that you address the costs of procurement and implementation of the software from your organization. 2. Technical Requirements The current legacy revenue cycle management system which encompasses the ADT/registration, credit/collections, and patient billing subsystems was developed using early version of the COBOL programming language, runs on non-supported Compaq Proliant 2800 platform and has been in operation at River Center Hospital for about 15 years. The system is operational 24 x 7 and approximately 50 concurrent users are using the system during peak hours (9AM-5PM). Microsoft Windows XP Operating System service pack 3, Office suite, and browsers interfaces are in use enterprise-wide. The proposed new Enterprise Revenue Cycle Management Information System must be compatible and interoperable with the following infrastructure and platform environment as is our new EMR system: 1. Windows 2003 Enterprise Server Operating System 2. Microsoft SQL Server 2005 Database Engine, Business Intelligence OLAP and Reporting Tools 3. Microsoft Browser, ASP.Net, VB.Net, XML and Dot Net Web Interfaces 4. Secure LAN/WAN Ethernet Network with TCP/IP Protocol, Secure Socket level (SSL) encryption and certificates, etc. For high availability and 24 x 7 operations, the application must be clustered aware, contains friendly graphical user interfaces (GUIs) and secure web portal developed with.net 2 framework and higher. Also, the application must have a robust interface engine to facilitate HL7, ASC x12, ICD-9-CM, and ICD- 2

5 10-CM, ASC X12 V (current) to V transactions between internal systems and RHN. The system should be easy to upgrade, expandable, maintain, and support. 3. Administrative Information Supplier Requirement & Instructions This Request for Proposal (RFP) is issued by River City Memorial Hospital (RCMH) of West Orange, New Jersey, Department of Purchasing on behalf of RCMH s Information Technology department. The purpose of this RFP is to solicit proposals to provide RCMH with a comprehensive Revenue Cycle Management system, as well as an online appointment scheduler and access to patient billing and account information, including charges, billing dates, and payers. It is the hospital s intent to award this contract to one firm, which will be responsible for the following: specification development, programming and technical architecture, unit and system testing including integration to existing systems, implementation and training of RCMH technical staff, implementation and training of RCMH end-users and patients. Further, the successful contractor will provide material defect warranty for one (1) year after successful production installation. Maintenance/service of the entire system will be based on time and material. Contactor will submit hourly rates for any T&M (time and material) position proposed for a maximum 2000 hours per contract year. The contract term will be five (5) years and can be extended for an additional five - one year periods. All conditions will remain enforced unless amended by RCMH. Cost of living allowances are at the discretion of RCMH and are the less of 3% per year or ½% less than the CPI based on the month immediately preceding the end of the contract period (one year). This award will be completed on August 10, RCMH reserves the right to extend this deadline for administrative purposes without jeopardy. 3

6 If it becomes necessary for the Contactor to substitute and/or add a subcontractor, the Contractor will identify the proposed new subcontractor and the work to be performed. Documentation detailing justification for this substitution must be submitted prior to start of work on Contract. RCMH retains the right to approve all subcontractors and replacement staff prior to any action taken by the Contractor. RCMH also retains the right to remove any contractor s resource for non-performance. This bid will be awarded to the Contractor who responds to this invitation, and is found to be most advantageous to RCMH, overall price, experience of the Contractor s resources, Contractor and proposed resource(s) references will all be considered. RCHMH reserves the right to either accept or reject any and all proposals. The Contractor will post a performance bond equal to 30% of the estimated overall value of the contract. Implementation of the penalty clause of the bond will be for any deliverable that is more than thirty (30) days late, contract default or at the description of the RCMH it is determined that the Contractor did not fulfill the terms of the contract. RCMH can provide in writing exceptions to the terms of this bond on an as needed basis. The Contractor shall not begin performing work or special projects without the written approval of the Director of Purchasing. All initial requirements or change requests must be maintained in a project folder and available to RCMH without notice. Change requests for functional specifications are to be in writing and approved by the RCMH project and technical manager(s). See attached document for use in Change Control Form. The bidder is to follow instructions contained in this RFP and should clearly identify any requirements of this RFP that they are unable to satisfy. 4

7 Respondent Qualifications The bidder must be qualified and experienced with HL7, CCOW, IEEE, XML, as well as ANSI x12, etc. (See selection criteria for complete listing.) The bidder must have experience in implementation of Revenue Cycle Management systems, decision support and reporting, data conversion and migration, integration and interoperability, as well as experience with training and education methodology; all of which will be further defined in this RFP. RFP Questions and Inquiries It is the policy of RCMH Department of Purchasing to accept questions and inquiries from all potential bidders who are in receipt of this RFP. Written questions may be submitted by mail, , or fax to: Department of Purchasing River City Memorial Hospital 1 Hospital Drive West Orange, New Jersey (212) (Phone) (212) (Fax) All questions must be submitted in writing to the attention of the Director of Purchasing, RCMH. Questions should be asked in consecutive order and reference the RFP section number to which it relates. Minor procedural inquiries may be accepted by telephone by the buyer, if he so chooses. It should be noted that oral explanations or instructions provided over the telephone shall not be binding upon the Hospital. Only the assigned buyer may be contacted in regard to this RFP. Scheduled meeting information with potential respondents 5

8 A non-mandatory meeting for bidders has been scheduled as follows: Date: July 23, 2009 Time: Location: 8:00 a.m. River City Memorial Hospital Office of the Chief Financial Officer Room Hospital Drive West Orange, New Jersey Delivery Responses to the RFP should be mailed to the address listed below: Department of Purchasing River City Memorial Hospital 1 Hospital Drive West Orange, New Jersey It should be noted that RFPs received via fax or will not be considered. 6

9 Presentation Each bidder must submit one (1) complete original bid proposal as well as three (3) complete copies of the exact original. Each must be contained within a separate three-ring binder. Completion of Work The bidder must include a Contract schedule which shall include key deliverables as outlined in this RFP. The schedule must incorporate all key dates as outlined in the RFP follows: Deliverable Date Due System Specifications October 2, 2009 Software Installation March 31, 2010 Software Validation Begin April 14, 2010 Software Validation End April 21, 2010 Data Migration Begin May 5, 2010 Data Migration End May 19, 2010 Validation of Data Sources Begin June 2, 2010 Validation of Data Sources End July 14, 2010 Acceptance Testing Begin July 15, 2010 Acceptance Testing End July 30, 2010 In-service Training staff August 2, 2010 Establish Power Users August 9, 2010 Go Live RCM August 25, 2010 Training for Public October 6, 2010 Go Live Patient Portal (Scheduling & November 3, 2010 Billing) Go Live Regional Health Network January 7, 2011 Integration Post Project Review January 31,

10 Terms and Conditions Information Access Health Insurance Portability and Accountability Act (HIPAA) Compliance As a covered entity, defined under HIPAA, regulations require that the Contractor complete a Business Associate Agreement (BAA). This agreement allows access to protected health information that is considered protected under federal, state, and local laws and regulations in accordance with the privacy requirement. This BAA must be completed and submitted at the signing of the contract. Amendment of Business Associate Agreements: The HITECH Act requires that the new privacy and security requirements imposed on business associates be incorporated into all Business Associate Agreements, new and existing, on or before February 17, The Contractor must have in place all physical, technical, and administrative safeguards under specification of HIPAA. It should be noted that HITECH Act requires business associates to use or disclose protected health information ( PHI ) only if such use or disclosure is consistent with the terms of the Business Associate Agreement between the covered entity and business associate. If a business associate violates a Business Associate Agreement with respect to this new privacy requirement, the business associate may be subject to the same HIPAA civil and criminal penalties previously only applicable to covered entities. General Conditions 1 Prices quoted for software, hardware, and services to be provided by Contractor, or subcontracted, are to be valid for a minimum period of six months. Any costs incurred in preparation and providing a response to this RFP are solely the responsibility of the Contractor, as well as any costs incurred during onsite demonstration(s) of software. Your response should clearly state the ability of your organization to satisfy the requirements defined in this document. 1 Request for Proposal Template: Acquisition & Implementation of a Corporate-Wide Business Information System 8

11 Bid Scoring Evaluation 2 A value weighted scoring system will be used. Financials will be weighted at 30% or the total score and functional specification meeting the requirements outlined in this bid will account for 70% of the total score. Any score below 70 will result in automatic disqualification. Each vendor will be evaluated using the same criteria. Category Criteria Weight Score Software Product Financials 6 Customer References 4 Ease of Use (Staff) 6 Ease of Use (Public) 5 Integration with EMR 8 Integration with Regional 7 Health Network Fitness for Use 4 Section Total 40 Implementation Implementation Plan and 8 Services Methodology Data Conversion 9 Documentation 4 Training 9 Section Total 30 Pricing 30 Grand Total Request for Proposal Template: Acquisition & Implementation of a Corporate-Wide Business Information System. 9

12 Proposal Selection Criteria 3 The following table includes some of the desired requirements and functionalities that the system must support. The vendors submitting proposal must fill out the table below and provide comments where question(s) may arise. Vendor Response Item # Requirement Yes No Comment 1. Support HL7 2. Support CCOW 3. Support IEEE 4. Support XML 5. Support ANSI X12 6. Support ASTM CCR 7. Support ICD-10-CM 8. Support CPT 9. Support HIPAA 5010 Claims 10. Support SNOMED 11. Support DICOM 12. Support NDC 13. Solution support patient self scheduling and registration via the Web. 14. Web-based patient access to financial history to include hospital charges, billing reimbursement, and payment dates and amounts. 15. Web-based patient payment process where patients or representatives can pay on their accounts. 16. Patient registration functionality to include admission, discharge, and transfer. 17. Revenue Cycle Management System (RCM) Integration with EMR which will revolve around demographic data and diagnostic information. 18. RCM Linking of clinical documentation to billing requirements. 19. Billing to include generation of patient bills; bill hold; billing requirement with alerts for missing information; generation of in-house and recurring outpatient accounts depending on length of stay, account balance, and/or payer health plan; as well as UB-04, 1500 CMS billing and HIPAA 5010 claims; support electronic billing of third party payers with automatic verification, retransmission of corrected transmittals, and cancellation of prior 3 HIMSS Sample RFP for Revenue Cycle Management, Patient Portal 10

13 Vendor Response Item # Requirement Yes No Comment transmittals. 20. Charging to include enterprise charge definition and pricing master file; entry of multiple prices for individual Charge Master file entries; automatic generation room and bed charges based on room information as well as bed type, incorporate time increments, i.e., half day, full day; ability to explode bundled charges into individual components for revenue and statistical reporting; logically group charges for Medicare 72 hour rule, mother/baby billing, and serial billing with no manual intervention. 21. Reimbursement component to include contract engine embedded in the system that calculates reimbursement, adjustments, and identified underpayments in real-time without requiring an interface with another system. 22. Contracting Functions a. Provide a contract file, which includes payer information including addresses, contacts, expiration dates etc. b. Sophisticated criteria for grouping together like services for a reimbursement calculation c. Contract terms are grouped into contract packages that apply to specific encounters e.g. inpatient, maternity, outpatient surgery, emergency, transplants, etc. d. Provide comprehensive reimbursement calculations in addition to DRG/APC that include other prospective payment calculations, case rate, stop loss, percentage of charges, fee schedules, volume based reimbursement, capitation, etc. e. Provide comprehensive reimbursement calculations in addition to DRG/APC that include other prospective payment calculations, case rate, stop loss, percentage of charges, fee schedules, volume based reimbursement, capitation, etc. f. Provide payment variance reporting that compares the expected payment amount to the actual payment 23. Account Management (AM) to provide numbering system that allows the identification of admissions, visits and/or medical episodes independently of medical record numbering. 24. AM to allow receivables based on varies criteria, including patient or guarantor name or number, phonetic name search, address, phone number, driver s license, medical record number, social security number, DOB, etc., 25. AM to allow for definition of institutional accounts against which charges for multiple patients can be posted. 26. AM to provide for the automatic discharge of recurring O/P accounts and the re-establishment of a new account on demand at selected intervals. 11

14 Vendor Response Item # Requirement Yes No Comment 27. Collections with the ability to define and monitor special payment arrangements by individual accounts. 28. To produce consolidated patient statements by guarantor showing all related patient and family accounts. 29. Collections to support automatic and on-demand generation of customer-defined collection letters based on account type and aging criteria to pull in patient and account information. 30. Collections to include ability to electronically accept claims denials and perform tracking and appeal process. 31. Payment functionality which will support electronic remittance for Medicare, Medicaid, and other insurance carriers. 32. Payment functionality which will enable both online and batch posting of payment and adjustment transactions with adequate audit trail to ensure cash controls. 33. Payment functionality which will apply payments to an account or line item level. 34. Report functionality which will generate enterprise reports for health system; ability to store all reports, bills, and statements. 35. Report functionality for Accounts Receivable (A/R) which must include generation of an A/R aging report sorted by delinquency period by specific information. 36. Report functionality should provide for a user friendly report writer tool and embedded analytics. 37. Interoperability that will support transmission of data across organizations. Exchanges must be accurate, comprehensive, current, consistent, relevant, timely, granular, precise, accessible, and well-defined Regional Health Network (RHN) integration with Service Oriented Architecture to support Systemic, Structural, and Semantic interoperability which will allow for functionality in the area of patient consent; record locator services; payor authorization; data analytics; claims processing; provider directory; RHN storage; 39. Creation of duplicate record validity procedures. 40. Staff training to reinforce accuracy of information at the initial point of capture. 4 Practice Guidelines: Managing the Integrity of Patient Identity in Health Information Exchange. Journal of AHIMA. 80/7 (July 2009):

15 4. Cost Requirements In this section, the vendor shall provide costing information for the initial implementation of the system, the recurring annual maintenance support contract costs, and any recommended options. Cost Summary Initial Implementation The proposal must provide a summary of costs for implementing the proposed system at River City Memorial Hospital. These costs should include: Hardware costs (show cost for each component, i.e., workstations, printers, etc.) Software costs (show cost for each module, i.e., ADT, A/R, etc.) Any hardware or software discounts provided Installation costs Initial training costs Other costs (please specify) Cost Summary Annual Maintenance The proposal must provide a summary of annual maintenance contract costs for the system(s) proposed at RCMH including the following: Hardware maintenance costs Software maintenance costs Other recurring costs (please specify) Cost Summary Vendor Recommended Options The proposal must provide a summary of costs for any optional equipment or software recommended by the vendor, but not specifically required, to more fully satisfy RCMH s needs. Please provide the cost per hour for any custom programming that we may require as well as the cost per day for additional training of staff at the administrative site beyond what is proposed under initial training. 13

16 The costs associated with a Revenue Cycle Management System fall under five categories listed below: (Proposal must factor in all five categories in III Phases listed above) Software We expect the RCM vendors to sell licenses for the initial cost of the software. We expect there will be a discount given for commensurate with comparable facilities throughout the US. Implementation and Training We expect the vendor to teach, test, and train on the system. This will be a one-time fee for the initial implementation of the RCM which we expect will be accomplished within the parameters outlined in this RFP. Professional support - Depending on chosen solution, we may need of a short-term project manager, a lawyer to review our contract, and a team of technology professionals to establish server, internet, integration, migration and other technical hurdles. Hardware We expect we will need minimal upgrades to existing hardware (computers and servers) in order to run the RCMS. We expect to purchase equipment that is compatible with the EMR. We have also factored into our business plan the cost of regular hardware upgrades including printers, scanners and personal computers. Maintenance - Typically, RCM vendors will charge a percentage of the initial software fee on an annual basis to cover the costs for standard upgrades and database upgrades. We have factored in that the total cost of ownership may be higher due to expenses we incur to project management tasks, spending time selecting a vendor, changes in human resources, travel to conduct vendor research or make site visits, reduced productivity when we first go live and downtime. The RCM system requirements go far beyond our current traditional patient management and accounting systems and this is how we will cost justify it. Our chosen system will have embedded core functionality that includes a contract engine, an enterprise-wide master person index, a claims engine and editor, 14

17 business analytics, and denial management into a comprehensive revenue-cycle software program. We justify that what we are budgeting for will take our revenue cycle solutions to a whole new level by improving workflows, optimizing business processes and maximizing existing technology. We can justify our chosen system because it will be able to: Improve Access Management- through the use of financial clearance solutions enabling us to determine insurance eligibility but also the ability and willingness to pay healthcare costs. Fundamental to process improvement is medical necessity checking during registration, scheduling and ordering. This will help reduce Medicare denials and increase reimbursement by providing medically necessary services or by issuing an ABN for non-covered services. Utilizing improved workflow processes and eliminating the paper chase, our solution will enable physician and hospital staff to accurately authorize services, determine, validate coverage for payment, assess payment risk and schedule resources prior to the patient s arrival. Accelerate Cash Collection- After services are delivered our new revenue cycle solution will maximize revenue capture and streamline the billing and collection process with electronic claim processing, direct entry of Medicare claims, automatic secondary billing, remittance posting, document image retrieval, contract and denial management, and financial analysis. Improve Payor Performance through Web-based analysis and reporting capabilities, so our hospital can better manage and monitor payor contracts. Sophisticated cost accounting tools, combined with the ability to provide detailed information about patient utilization and outcomes, will enable us to analyze contract performance and manage contract terms and revenues. Cost Analysis Software One Time Costs Software $175,000 Modifications $30,000 Implementation (loss revenue) $50,000 15

18 Hardware $20,000 Site Preparation $5,000 Training $80,000 Documentation $5000 Other Products $5000 Total One-Time Cost $360,000 Budget $360,000 Variance from Budget $0 Annual Operating Expenses Maintenance - Annual $8,000 Maintenance Data Migration $12,000 Maintenance - Hardware $20,000 Total $40,000 Budget $40,000 Variance $0 Projected Professional Support Cost Consulting Programming Telephone Support $160/hr $200/hr $100/hr 5. Referenced Documents Our expectation at RCMH is that we will only have to deal with a few vendor relationships, not as many as we have now. We think it is inevitable--simplicity is what we're after. Use of existing standards are a key part of our acquisition strategy. Please list software development standards used for development and integration solutions. The following is a sample but it not all-inclusive: Organization Brief Name Name AENOR UNE-CR Safety and Security Related Software Quality Standards for Healthcare (SSQS) ANSI HL7v2.XML HL7 Version 2.5 ASTM E ª Standard Practice for Healthcare Certificate Policy ASTM E Standard Specification for Healthcare Document Formats 16

19 ASTM E Standard Specification for Transferring Digital Waveform Data Between Independent Computer Systems ASTM E (2003) Standard Guide for Properties of Electronic Health Records and Record Systems ASTM E Standard guide for description of reservation/registration-admission, discharge, transfer systems for Electronic Health Record (EHR) systems ASTM E ª Standard guide for content and structure of the Electronic Health Record (EHR) ASTM E Standard guide for view of emergency medical care in the computerized-based patient record 6. Deliverables The following tables specify the deliverables to be created by the vendor and delivered to RCMH. Attached to each deliverable is a due date. Each deliverable must meet the acceptability criteria of RCMH. Project Management Deliverables Item # Description Due 41. Project Plan 4 weeks after project award 42. Staffing Plan w/contact information 2 weeks after project award 43. Organizational Chart 2 weeks after project award 44. Quality Assurance Plan 4 weeks after project award 45. Weekly Status Reports Weekly through full contract 46. Monthly Steering Reports Monthly through full contract 47. Issue Log Maintained daily, provided weekly and at request 48. Risk Log Maintained daily, provided weekly and at request 49. Dependency Matrix Maintained daily, provided weekly and at request 50. Change Log Maintained daily, provided weekly and at request 51. Communication Plan 2 weeks after project award 52. Change Management Plan 4 weeks after project award 53. Project meeting documentation (agendas 1 day before and 1 day after each meeting & minutes) Training documentation Item # Description Due 54. Help files Prior to implementation 55. Employee Procedures Manual Prior to implementation 17

20 Requirements Documentation Item # Description Due 56. Business rules 10 weeks after project award 57. Use Cases 14 weeks after project award 58. Process Flow Diagrams 16 weeks after project award 59. Disaster Procedures 8 weeks after project award 60. Documentation of existing processes 6 weeks after project award 61. Gap analysis of existing processes 8 weeks after project award 62. Revised existing processes 14 weeks after project award System documentation Item # Description Due 63. Data Flow Diagrams At conclusion of development phase 64. State Diagrams At conclusion of development phase 65. Technical Specifications At conclusion of development phase 66. Database Schemas At conclusion of development phase 18

21 Implementation Item # Description Due 67. Implementation Plan Prior to product go-live 68. Security Processes Prior to product go-live 69. Release Management Plan Prior to product go-live Testing Item # Description Due 70. Test Plan Prior to beginning of test phase 71. Test Cases Prior to beginning of test phase 72. Requirements Traceability Matrix Prior to beginning of test phase Technical Deliverables Item # Description Due 73 Performance tuning During test phase and go-live 74 Load balancing During test phase and go-live 75 User Interface customization During requirements phase and through test phase and go-live 76 Migration of legacy data Prior to go-live 77 Interfaces with internal/external entities Prior to go-live 78 Reporting mechanism and sample reports Prior to go-live 79 Hardware Prior to test phase 19

22 7. Required Format of Proposal Submission General Instructions The Vendor must follow the format listed in this RFP, issued by River City Memorial Hospital (RCMH) of West Orange, New Jersey, Department of Purchasing, on behalf of RCMH s Information Technology department Length and Font Size: Length of proposal, including title page, cover letter, any qualifications and proposal should not be greater than 35 pages. This does not include the supplemental requirements (resumes, financial statements). Please use font size no less than Cover Letter: The cover letter must be signed by the person or persons authorized to sign and negotiate the contract on behalf of the company Title Page: Must include: River City Memorial Hospital, of West Orange, New Jersey, Revenue Cycle Development Proposal, your company name, address, web site address, telephone number, fax number, address and primary contact person Submission: 5 Request for Proposal, P09-122, University of Medicine and Dental of New Jersey. May 27, Retrieved on July 20, From: 20

23 Each bidder must submit one (1) complete original bid proposal as well as three (3) complete copies of the exact original. Each must be contained within a separate three-ring binder. The proposal must be submitted to address listed below, by August 3, Department of Purchasing River City Memorial Hospital 1 Hospital Drive West Orange, New Jersey It should be noted that RFPs received via fax or will not be considered. 7.2 Technical proposal The vendor needs to outline their approach to completing the work, as outlined in the Deliverables Section 6. This includes citing the requirements of this RFP and their ability in completing the contract. This discussion needs to include the benefits of your solution. Discuss how you will complete the project. List the details of all procedures and methodologies used for the project. Please include a description of any recommended changes and include rationale for each proposed change. Included in this requirement is the submission of a completed table see Proposal Selection Criteria, the table includes some of the desired requirements and functionalities that the system must support. The vendors submitting proposal must fill out the table below and provide comments where question(s) may arise. In addition the proposal must contain the following information: Management Proposal The vendor will describe the technical plans to meet all requirements of the RFP. This needs to convey that the vendor has a full understanding of the objectives, and will be expected to convince RCMH that the vendor s plans to address all objectives realistically. Additionally, the detailed outline needs to show how the vendor will complete each task to complete the contract. 21

24 7.2.2 Contract Management The vendor should cite the how the contract will be managed to enable completion of the contract within the required timeframe. This needs to include the communications approach with RCMH, to include status meetings and reports etc Contract Schedule The vendor must include a contract schedule. The key dates of this RFP, see Section 8 part c, should be incorporated into the contract schedule, including completion dates for each task. This schedule is required to include the related deliverable item that will be submitted, as proof of completion for each task. Noting any restrictions on start date or upon completion System Requirements The bidder must address the following system requirements: Cite the name and version of the proposed system for RCMH Cite evidence that proves the new system to be fully functional and appropriate for a hospital the size of RCMH Demonstrate how the system works with each of the listed Technical Requirements General Requirements The vendor must meet the following requirements: The vendor must explain and demonstrate the ability to meet the objectives listed in this RFP, Section The vendor must explain and demonstrate how the deliverables, defined separately, will be met. 22

25 The vendor must explain how the company supports HIPPAA and other requirements. (such as, but not exclusively, JCAHO, Medicaid and Medicare, etc) Describe how the information will be integrated with the EMR and internal systems Describe how the information will be integrated with the Regional Health Network Describe how the System will Address future challenges HIPAA claims attachment ASC X12 V.5010, severity adjusted DRG, ICD-10-CM coding Describe the security or restrictions regarding the records of patients. Include security during web-based patient access, while reviewing account history, charges, billing reimbursements, payments, etc Describe the training classes, and any other applicable training information, for the technical training of the system proposed. Offer as much detail as possible Explain the system s back up system. Include the ability to restore key system data files and if assistance of the vendor would be required Provide examples of management reports and explain how detailed reporting can be customized The vendor must explain the plan for data conversion, this should include the proposed timeframe Explain the possibilities of expansion, with specific attention to the interface engine, in order to facilitate the use of ICD-10-CM and ASC X12 V

26 The vendor should describe in summary any anticipated problems that may occur during the contract term. Please offer a proposed solution for every identified problem. 7.3 Pricing proposal The vendor must submit pricing information. This is to include all requested pricing information as listed in Section Initial Implementation Costs: Hardware costs (show cost for each component, i.e., workstations, printers, etc.) Software costs (show cost for each module, i.e., ADT, A/R, etc.) Any hardware or software discounts provided Installation costs Initial training costs Other costs (please specify) Annual Maintenance Costs: Hardware maintenance costs Software maintenance costs Other recurring costs (please specify) Vendor Recommended Options Costs: Provide the cost per hour for any custom programming that we may require as well as the cost per day for additional training of staff at the administrative site beyond what is proposed under initial training Ongoing/Additional Costs: 24

27 Professional support - The vendor may list options of ongoing support offered and associated costs of such Hardware - The vendor may offer pricing for any additional hardware that may be needed Maintenance - The vendor must provide fees for the ongoing support and maintenance for all components of the system, as stated in Section The vendor must include a schedule for payment of such, based on the deliverables, Section 8 part c, of the RFP. The vendor must hold the price(s) for the minimum of six months. After submission there may NOT be any changes to the pricing of the original proposal. 7.4 Financial Report of Respondent s Organization The vendor must submit financial statements, certified, this must include a statement of cash flow, income statement, balance sheet, and any pertinent notes, this should be for the most recent fiscal year. If the vendor does not have access to such statements, they need to provide a statement from an independent accountant with the same information required as above. This statement must also be certified by the CEO and CFO to accurately represent the company. The vendor should also list a bank reference. 7.5 Organization The vendor must include any information regarding the organization, personnel, and experience. Including references with contact information (names and telephone numbers), giving sufficient evidence of the qualifications required of the RFP. The vendor must include the location of the vendor s office responsible for the management of the contract. Telephone and name must be included also Organization Chart (contract oriented) 25

28 The vendor must include a chart outlining the roles and responsibilities of management, supervisory and all key employees for the project. This must also include any subcontracted personnel. List the category and title of every individual. List the time alloted to the project for each member. Discuss the organization s commitment to completing the project on a timely basis Respondent s Technical Credentials. List the company s technical credentials and qualifications, include all key personnel Resumes of Key Personnel Submit resumes of each key personnel. The resumes should show relevant experience and qualifications, as well as technical credentials. The resumes should list any contract experience of similar scope and magnitude. This should include a description of the contracts worked on as the experiences relate to this RFP. Name, and reference phone number should be included for each resume Organization Chart (for the vendor s company) The vendor must provide an organizational chart that shows the company s structure Vendor Experience Three references: Please submit three completed projects of revenue cycle management implementation projects for our review. These references need to be of comparable size and scope to the proposed project in this RFP. Please include the technical aspects, management, timeline of work (start and end dates), and ongoing technical support that is provided for each reference. Include names and phone numbers of the contact person for each reference. 7.6 Subcontractor(s) If the vendor plans to use a subcontractor(s) to complete the contract, in any part, the vendor will be responsible for the performance of the subcontractor(s), regarding compliance with all parts of the contract, and all applicable laws. 26

29 7.6.2 The vendor must list detailed explanation of any services to be rendered by every subcontractor The vendor must provide resumes for each subcontractor, as well as documented experience that demonstrates the ability of each contractor to complete work on contracts of a similar nature. 8. Statement of Work: See section 6, Hospital Commitments, completed for Statement of Work. RCMH has made commitments to ensure the overall success of this project. This list may change as requirements change. Cite any requirements of RCMH personnel, list the rationale for each of the added requirements. Site Visits: Please plan a visit for an on-site review. If you cannot attend the non-mandatory meeting for bidders you may call for appointment (212) , or us The non-mandatory meeting for bidders has been scheduled as follows: Date: July 23, 2009 Time: 8:00 a.m. Location: River City Memorial Hospital Office of the Chief Financial Officer Room Hospital Drive West Orange, New Jersey Important Due Dates Date Due July 23, 2009 August 3, 2009 August 12, 2009 August 17, 2009 Due with Sign Off Item Vendor Questions and Clarification Requests RFP Response due at RCMH RCMH Vendor Award Sign Off Completed Business Associate Agreement 27

30 9. APPENDIX 1: Business Associate Agreement 6 River City Memorial Hospital 1 Hospital Drive West Orange, New Jersey (Vendor Information Inserted here) This Business Associate Agreement (this Agreement ) is entered into effective as of [insert date], by and among [River City Memorial Hospital] (herein Covered Entity ) and [Vendor Name Here] (herein Business Associate ) in order to comply with 45 C.F.R (e) and (e), governing protected health information ( PHI ) and business associates under the Health Insurance Portability and Accountability Act of 1996 (P.L ), 42 U.S.C. Section 1320d, et. seq., and regulations promulgated there under, as amended from time to time (statute and regulations hereafter collectively referred to as HIPAA ) [Covered Entity and Business Associate may be referred to herein individually as a Party or collectively as the Parties ].... STATEMENT OF AGREEMENT 1. HIPAA Compliance and Agents. Business Associate hereby agrees to fully comply with the Business Associate requirements under HIPAA, throughout the term of this Agreement. Further, Business Associate agrees that to the extent it has access to PHI, Business Associate will fully comply with the requirements of HIPAA and this Agreement with respect to such PHI; and, further, that every agent, employee, subsidiary, and affiliate of Business Associate to whom it provides PHI received from, or created or received by Business Associate on behalf of, Covered Entity will be required to fully comply with HIPAA, and will be bound by written agreement to the same restrictions and terms and conditions as set forth in this Agreement. 2. Use and Disclosure; Rights. Business Associate agrees that it shall not to use or disclose PHI except as permitted under this Agreement or as required by law. Business Associate acknowledges that this Agreement does not in any manner grant Business Associate any greater rights than Covered Entity enjoys, nor shall it be deemed to permit or authorize Business Associate to use or further disclose PHI in a manner that would otherwise violate the requirements of HIPAA if done by Covered Entity. 3. Required or Permitted Uses. [Vendor Name Here] Business Associate agrees that it is permitted to use or disclose PHI only: (a) upon obtaining the authorization of the patient to whom such information pertains in accordance with 45 C.F.R (a)(1)(iv) and , (b) upon obtaining the consent of a patient to whom such information pertains, if the use or disclosure is for purposes of treatment, payment, or health care operations, in accordance with 45 C.F.R (a)(1)(ii) and , or (c) without an authorization or consent, if in accordance with 45 6 BAA from d=3&hl=en&ct=clnk&gl=us. Accessed: 7/15/09. 28

31 C.F.R , , , (e), (f), (g), or as otherwise permitted or required by agreement or law. 4. Safeguards; Location. Business Associate agrees to develop and use appropriate procedural, physical, and electronic safeguards to prevent misuse of PHI other than as provided by this Agreement. Business Associate agrees to notify Covered Entity of the location of any PHI disclosed by Covered Entity or created by Business Associate on behalf of Covered Entity and held by or under the control of Business Associate or those to whom Business Associate has disclosed such PHI. 5. Minimum Necessary. Business Associate must limit any use, disclosure, or request for use or disclosure to the minimum amount necessary to accomplish the intended purpose of the use, disclosure, or request in accordance with the requirements of HIPAA. Business Associate represents that all uses, disclosures, and requests it will make shall be the minimum necessary in accordance with HIPAA requirements. Covered Entity may, pursuant to HIPAA, reasonably rely on any requested disclosure as the minimum necessary for the stated purpose when the information is requested by Business Associate. Business Associate acknowledges that if Business Associate is also a covered entity, as defined by HIPAA, Business Associate is required, independent of Business Associate s obligations under this Agreement, to comply with the HIPAA minimum necessary requirements when making any request for PHI from Covered Entity. 6. Records; Covered Entity Access. Business Associate shall maintain such records of PHI received from, or created or received on behalf of, Covered Entity and shall document subsequent uses and disclosures of such information by Business Associate as may be deemed necessary and appropriate in the sole discretion of Covered Entity. Business Associate shall provide the Covered Entity with reasonable access to examine and copy such records and documents of Business Associate during normal business hours. Business Associate agrees to fully cooperate in good faith with and to assist Covered Entity in complying with the requirements of HIPAA and any investigation of Covered Entity regarding compliance with HIPAA conducted by the U.S. Department of Health and Human Services ( DHHS ), Office of Civil Rights, or any other administrative or judicial body with jurisdiction. 7. DHHS Access to Books, Records, and Other Information. Business Associate shall make available to DHHS its internal practices, books, and records relating to the use and disclosure of PHI received from, or created or received by Business Associate on behalf of, Covered Entity for purposes of determining the Covered Entity s or Business Associate s compliance with HIPAA. 8. Designated Record Set; Individual Access. Business Associate shall maintain a designated record set, as defined by HIPAA, for each individual patient for which it has PHI. In accordance with an individual s right to access to their own PHI under HIPAA, Business Associate shall make available all PHI in that designated record set to the individual to whom that information pertains, or such individual s representative, all PHI in that designated record set, upon a request by such individual or such individual s representative. 9. Accounting. Business Associate shall make available PHI or any other information required to provide, or assist in preparing, an accounting of disclosures in accordance with HIPAA. 10. Report of Improper Use or Disclosure. Business Associate shall report to Covered Entity any information of which it becomes aware concerning any use or disclosure of PHI that is not provided for by this Agreement. 11. Amendment of and Access to PHI; Notification. Business Associate shall make available PHI for amendment and shall incorporate any amendments to PHI accordingly. Business Associate shall make reasonable efforts to notify persons, organizations, or other entities, including other business associates, known by Business Associate to have received the erroneous or incomplete information and 29

32 who may have relied, or could foreseeably rely, on such information to the detriment of the individual patient. Business Associate must update this information when notified by Covered Entity. 12. Termination Rights. [Vendor Name Here] Business Associate acknowledges and agrees that Covered Entity shall have the right to immediately terminate this Agreement in the event Business Associate fails to comply with HIPAA requirements concerning PHI and the above requirements. This Agreement authorizes Covered Entity to terminate the Agreement, if Covered Entity determines, in its sole discretion, that Business Associate has violated a material term of the Agreement required by HIPAA. 13. Breach or Violation; Knowledge. If Covered Entity knows of a pattern of activity or practice of Business Associate that constitutes a material breach or violation of Business Associate s obligations under this Agreement, Covered Entity shall take any steps reasonably necessary to cure such breach or end such violation, and, if such steps are unsuccessful, shall either (a) terminate this Agreement, if feasible, pursuant to 12, or (b) if termination is not feasible, report the breach or violation to DHHS. If Business Associate as a covered entity, defined by HIPAA, violates the terms and conditions of this Agreement in its capacity as a business associate of another covered entity, Business Associate will be in noncompliance with the standards, implementation specifications, and requirements of HIPAA. 14. Return of PHI. Business Associate agrees that upon termination of this Agreement, and if feasible, Business Associate shall (a) return or destroy all PHI received from, or created or received by Business Associate on behalf of, Covered Entity that Business Associate still maintains in any form and retain no copies of such information or, (b) if such return or destruction is not feasible, extend the protection of this Agreement to such PHI and limit further uses and disclosures to those purposes that make the return or destruction of the PHI infeasible. 15. Notices. All notices and other communications under this Agreement to any Party shall be in writing and shall be deemed given when delivered personally, telecopied (which is confirmed) to that Party at the telecopy number for that Party set forth at the end of this Agreement, mailed by certified mail (return receipt requested) to that Party at the address for that Party set forth at the end of this Agreement (or at such other address for such Party as such Party shall have specified in a notice to the other Parties), or delivered to Federal Express, UPS, or any similar express delivery service for delivery to that Party at that address. 16. Non-Waiver. No failure by any Party to insist upon strict compliance with any term or provision of this Agreement, to exercise any option, to enforce any right, or to seek any remedy upon any default of any other Party shall affect, or constitute a waiver of, any Party s right to insist upon such strict compliance, exercise that option, enforce that right, or seek that remedy with respect to that default or any prior, contemporaneous, or subsequent default. No custom or practice of the Parties at variance with any provision of this Agreement shall affect or constitute a waiver of, any Party s right to demand strict compliance with all provisions of this Agreement. 17. Gender and Numbers; Headings. Where permitted by the context, each pronoun used in this Agreement includes the same pronoun in other genders and numbers, and each noun used in this Agreement includes the same noun in other numbers. The headings of the various sections of this Agreement are not part of the context of this Agreement, are merely labels to assist in locating such sections, and shall be ignored in construing this Agreement. 18. Counterparts. This Agreement may be executed in multiple counterparts, each of which shall be deemed to be an original, but all of which taken together shall constitute one and the same Agreement. 19. Entire Agreement. This Agreement constitutes the entire agreement and supersedes all prior agreements and understandings, bot written and oral, among the Parties with respect to the subject matter of this Agreement. 30