Published on February 17, 2014
SAMPLE RFP QUESTIONNAIRE CRITERIA AND SPECIFICATIONS 1. COMPANY BACKGROUND: Corporate Philosophy and Vision Statement Ownership, national, regional or local in scope? Approach to providing Collection and Early Out services? Additional Service Options Available:? Pricing Structure Organization Associations Tiburonllc.com 11510 Blondo Street Omaha, Nebraska 68130 1
SAMPLE RFP QUESTIONNAIRE 2. EVOLUTION OF SERVICE LINE AND SCOPE OF SERVICES. a. Include a description of the company’s programs that encourage minority and women employment. b. Financial Profile: Give a brief description of your company’s financial structure and general financial condition. Include copies of two most recent year’s audited financial statements and/or annual report. c. Organizational structure: Provide a brief description of your company’s organization. Include organizational charts that relate to pertinent processes and functions. Indicate the number of personnel assigned under each of these departments. Organizational Chart d. Proposed employee structure and manager for the Healthcare Organization account. Describe manager’s experience in managing a primary eligibility service in a facility of comparable volume and scope . Tiburonllc.com 11510 Blondo Street Omaha, Nebraska 68130 2
SAMPLE RFP QUESTIONNAIRE 3. SERVICE DESCRIPTION- COMPLETE OVERVIEW a. Describe the Early Out process and how it differs from Bad Debt. b. Does your firm specialize in Early Out and Bad Debt collections in the medical industry? If so, please explain and include any experience with other institutions of comparable size and function to the Healthcare Organization in relation to Early Out and Bad debt services delivered. Include any comparable institutions in your response. c. Describe any processes in place that facilitate performance standards that meet or exceed others in the field of collections in each of the various sections as described above. d. Describe your experience with third party eligibility such as Medicaid, SSI, and other funding sources. Please describe in detail the tools and mechanisms in place to identify these third party eligibility sources. e. Describe procedures/processes associated with payment agreements made with guarantors. Provide example of documents and/or scripts to accomplish this process. f. Describe how discounted, “prompt pay settlement” account pay-offs are processed. Provide examples of documents and/or scripts used to accomplish this. g. Describe the scenarios and related processes that results in credit reporting. Tiburonllc.com 11510 Blondo Street Omaha, Nebraska 68130 3
SAMPLE RFP QUESTIONNAIRE h. Describe other methods to identify and locate the correct guarantor. Is “skip tracing” utilized? i. Describe the method(s) in which all account transaction activity (normal transactions, reversals, and other adjustments) will be transmitted and received. j. Describe the method(s) guarantors can submit payments to you. Include how other payment transactions are received by your company and subsequently forwarded to the client. Include the privacy and security features associated to the method or mechanisms to be used. k. Provide samples of the following documents or similar type in use: 1. Fax Cover Sheets 2. Notices, Letters and Statements/Bills to patients 3. Other documents/ letters used during collection and credit reporting procedures. l. Describe staff training. Please indicate training inclusive to the following areas: 1. 2. 3. 4. Collection of patient amounts due Third-party insurance follow-up Handling of PHI (Protected-Health Information) and HIPPA. Customer service with consideration to the handling of medical related type accounts during follow-ups. 5. FTC (Federal Trade Commission) guidelines and regulations Tiburonllc.com 11510 Blondo Street Omaha, Nebraska 68130 4
SAMPLE RFP QUESTIONNAIRE m. Describe your standard policy regarding closed and returns of accounts to client. n. Describe or explain scenarios when your agency would deem it appropriate to recommend possible litigation on accounts. o. Describe the current claims processing software/application and features in use. Include as description how your software and services will ensure HIPPA compliance. p. Describe the manner in how your company will provide ongoing continuous quality improvement suggestions. q. Is your agency a member of American Collector Association? r. Describe the specific report used to calculate your collection performance. s. Provide copies or sample reports under or related to the following titles: 1. 2. 3. 4. 5. 6. Tiburonllc.com Monthly Invoice Monthly Invoice detail of accounts End of Month Collection Activity (for Bad Debt) and related fees Placement of Accounts to Bad Debt Payment Transactions (type, source amount, discounts, adjustments.) Returned Accounts (recalls) Report. 11510 Blondo Street Omaha, Nebraska 68130 5
SAMPLE RFP QUESTIONNAIRE 4. CLIENT SUPPORT a. Assigned Personnel Provide a detailed list of the staff the personnel who will be assigned as members of the implementation team and indicate their specific function. Please include management as well as service/account/collector representatives. Provide a Project Plan outlining the names of personnel involved and their responsibilities. b. Hours of Operation: Please provide current and projected hours of operation indicating the staffing structure and number of staff that will be on duty. c. Additional Support: Specify if a service manager will be assigned to client for the purpose of continued support response to issues and prompt resolution thereof. Can service manager be on site at least once a month? d. Customer Service Operations: Explain the method in which patients/guarantors can contact you to resolve account balances placed in your bad debt inventory for resolution. Tiburonllc.com 11510 Blondo Street Omaha, Nebraska 68130 6
SAMPLE RFP QUESTIONNAIRE 5. IMPLEMENTATION APPROACH a. Describe your Project/ Implementation plan and include timelines to complete each element, the number of personnel dedicated to each task, and specific individuals who will be responsible for ensuring implementation is successful. b. Indicate the standard number of man-days required by your agency for service implementation related to the specific tasks which are involved. c. Describe how you will implement your service and at minimum maintain the current cash flow from bad debt services. What guarantees can you provide to ensure that no decrease in cash will occur if you are selected to provide these services? 6. EXPERIENCE AND REFERENCES Please provide the following lists to facilitate our review. For each list requested, follow the “LIST FORMAT” indicated and provide your response in the form of a table. A. List of all clients you currently have contracts with for Early Out & Bad Debt services. LIST FORMAT A.Type of facility (Hospital or Clinic) B.Reference Contact Names, Title, current Email address and telephone numbers. C.Contracted date periods. D.Indicate if you are providing early out and/or bad debt collections. E.Indicate if you are the Sole or Shared vendor. F.Provide average # accounts and dollars placed monthly Tiburonllc.com 11510 Blondo Street Omaha, Nebraska 68130 7
SAMPLE RFP QUESTIONNAIRE 7. STANDARD CONTRACT TERMS Provide sample copies of your standard contracts. 8. FEES • Define the fees to provide the services as described in your response to this proposal. The Healthcare Organization requires that the fees submitted for this service be based on a percentage of cash collected. • Define fees for each service separately (Early Out, Bad Debt and 3rd Third Party payor activities) as sole or shared vendor for each. 9. BUSINESS ASSOCIATE AGREEMENT All vendors must complete Attachment (BAA). 10. Insurance Certificate/ Workers Compensation Coverage Please Provide a copy of your Business Insurance Certificates Tiburonllc.com 11510 Blondo Street Omaha, Nebraska 68130 8
SAMPLE RFP QUESTIONNAIRE STATEMENT OF WORK MINIMUM SERVICE REQUIREMENTS: Provide a Summary of the Statement of Work so the Vendor can make sure upfront decision whether they should participate in the RFP and does their Skill-set align with the Specific Requirements of your Organization. Include Volume of Accounts, Placement Average Balance Size and Past Liquidation/Recovery Rate. Vendor initials confirming understanding of and ability to perform Criteria and Specifications: Tiburonllc.com 11510 Blondo Street Omaha, Nebraska 68130 9
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