ADDENDUM NUMBER FIVE
THE UNIVERSITY OF NEW MEXICO HOSPITALS
Purchasing Department
933 Bradbury Dr. SE Ste 3165
Albuquerque, New Mexico 87106
Date: 12/3/14
Proposal Number: P310-14
Name of Procurement Specialist: Ed Ybarra
Due Date: 12/17/14 @ 2:00 pm MDT
Notice to all respondents:
Amend the Proposal: UNMH Outsourcing Accounts Receivable
This addendum becomes part of the Proposal Documents and modifies, as noted below, the
original Bidding Documents.
Question 1: Is it possible to obtain a Summary ATB showing the number of accounts and
dollars by insurance carrier? If so, how can this be obtained?
UNMH Response to Question 1: See ATB previously provided
Question 2: Does the ATB (accounts and dollars) quoted include True Self Pay, Self Pay after
Insurance, and Pending Medicaid?
UNMH Response to Question 2: Yes, those are included in Self Pay.
Question 3: Are you able to provide a summary of your current number of employees by
position within your business office and any ancillary support at other locations?
UNMH Response to Question 3: See below. Subject to change.
Executive Director – 1
Supervisors – 10
Accountants – 10
IT Data Quality Analysts – 3
Coders -6
Financial Analyst – 1
Billers – 26
Collections/Denial PSRs – 67
Financial Counselors – 20
Directors - 5
IT Manager – 1
Systems Analysts – 4
Staff Development Specialist – 1
Contract Mgmt Data Quality Analysts – 4
Administrative Assistant – 1
Clerks – 9
Customer Service – 8
Patient Care Coordinators - 3
Question 4: Does the awarded company also work the credit balances? Current volume?
UNMH Response to Question 4: Yes. The approximate current volume is as follows:
UNMH – $6.5 M 61,000 accounts
SRMC – $1.3 M 2,600 accounts
UNM Cancer Center – $883K 1,600 accounts
Behavioral Health - $1.2 M 6,800 accounts
Question 5: Please provide a Detailed Aged Trial Balance (ATB) with the following
information.
UNMH Response to Question 5: See ATB previously provided.
Question 6: If a detailed ATB is not available, please provide an ATB summary with dollars
and number of accounts, by aging and by financial class.
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Facility
Patient #
Admit Date
Discharge Date
Final Bill Date
Service Type
Patient Type
Original Financial Class
Current Financial Class
Primary Insurance
Secondary Insurance
Tertiary Insurance
Self-Pay / Patient Balance
Total Charges
Total Insurance Payments
Total Patient Payments
Total Adjustments
Total Current Insurance Balance
Total Current Patient Balance
UNMH Response to Question 6: See ATB previously provided.
Question 7: Please provide the Credit Balance ATB by financial class to include number of patient
accounts.
UNMH Response to Question 7: We do not have an ATB for credit balances available according to
financial class. Below are the approximate credit balance totals:
UNMH – $6.5 M 61,000 accounts
SRMC – $1.3 M 2,600 accounts
UNM Cancer Center – $883K 1,600 accounts
Behavioral Health - $1.2 M 6,800 accounts
Question 8: Regarding credit balances, can we receive the number of current credit claims
outstanding at this point in time for scoping purposes. Assuming this work can be bid on a per
diem basis along with cash posting services?
UNMH Response to Question 8: Following are the current approximate credit balances:
UNMH – $6.5 M 61,000 accounts
SRMC – $1.3 M 2,600 accounts
UNM Cancer Center – $883K 1,600 accounts
Behavioral Health - $1.2 M 6,800 accounts
Question 9: Does this bid include third-party (bad-debt) collections or just first-party?
UNMH Response to Question 9: No, it does not include bad debt collections.
Question 10: Is having a coder or coding department a requirement for the selected vendor?
UNMH Response to Question 10: Yes. It will be necessary to have a coder or coding
department in order to effectively follow-up on accounts.
Question 11: What is the anticipated completion date of this project?
UNMH Response to Question 11: A completion date has not yet been determined.
Question 12: What system is UNMH moving to? Will chosen vendor be kept on once
conversion is complete?
UNMH Response to Question 12: We are moving to Soarian. We expect the vendor will be
kept until the assigned inventory is resolved. We have not determined a completion date at this
time.
Question 13: The overall Scope of Work includes work in all areas of accounts receivable.
Please provide an ATB Summary by payer that will help determine amount of third-party payer
as well as potential self pay?
UNMH Response to Question 13: See ATB previously provided.
Question 14: Please provide age of account (based on DOS) that you plan to outsource for both
self pay and third-party follow up.
UNMH Response to Question 14: See ATB previously provided.
Question 15: Will you accept separate pricing proposals based on the type of work required,
e.g. self pay vs. third party vs credit balances?
UNMH Response to Question 15: Yes
Question 16: If selected vendor is to keep accounts under 90 days in aging, at what age are
accounts placed with vendor?
UNMH Response to Question 16: See ATB previously provided.
Question 17: What is your current denial and rejection rate? How many, on average, do you
receive daily?
UNMH Response to Question 17: We do not have that information available at this time.
Question 18: Do you currently have a preferred eligibility vendor?
UNMH Response to Question 18: No. We currently use a couple.
Question 19: What do audits consist of in your Invision System?
UNMH Response to Question 19: Need provide more information. UNMH is not certain what
you are asking. Invision tracks everything a user does in the system from registration to notes,
adjustments, etc.
Question 20: If all work is being completed on your Invision system as well as payments
processed directly to UNMH accounts, what payment posting is vendor expected to post and
reconcile (section 3.4.13)? Does the proposal also include all cash applications on all payers?
UNMH Response to Question 21: See the addendum to the RFP referencing cash application.
Question 22: In regards to onsite vendor staff, is it an option to hire an internal candidate to
work as a liaison within the office?
UNMH Response to Question 22: By internal candidate, do you mean a UNMH employee or
candidate internal to your office? If you mean to your office, yes, that is an option.
Question 23: In regards to monitor and reporting requirements, will vendor have access to pull
from Invision and other client systems to provide monthly KPI reviews?
UNMH Response to Question 23: We can further discuss needs with vendor selected. We can
further discuss information needed in reporting.
Question 24: The Exhibit K included references “Retail Pharmacy Management System
Software/Hardware.” Is this the correct Exhibit K as it does not fit with the scope of services
requested?
UNMH Response to Question 24: Delete “Retail Pharmacy Management System.”
Question 25: In regards to 3.2.4, what kind of remote support will be needed?
UNMH Response to Question 25: This is to be determined by the vendor based on the
RFP’s SOW. It may not be applicable.
Question 26: In regards to 3.2.21, please clarify “support AV.” Are you asking if we have AntiVirus installed and used?
UNMH Response to Question 26: Delete this question in its entirety.
Question 27: Regarding Page 3, Scope of Work: Therefore, a total volume of accounts referred
to an accounts receivable vendor is estimated to be 237,924 accounts and approximately
$332,297,696.00 Million.
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Is this Gross or Net? If Gross, what is the Gross to Net %? UNMH Response: It is a
mixture however, most is net. We adjust our accounts to net for most payers however,
some payers are gross.
Please provide the details for the accounts that comprise the 237,924 accounts and
approximately $332,297,696.00 Million. UNMH Response: See ATB previously
provided. That is all the detail we are able to provide without violating patient privacy.
Question 28: It is noted that the Vendor is expected to perform cash posting.
UNMH Response to Question 28: See addendum regarding cash posting.
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For the accounts noted as being placed at time of the switch to Sorian, would that
inventory be accounts that are aged at Day 1, or some other protocol, and at what point in
the conversion will this occur, Day 1 of switch, Day 30, etc.? UNMH Response: All
accounts being outsourced are from our current system, Invision. We are not outsourcing
account that will be in Soarian.
Are clinic accounts included? UNMH Response: Yes
Please provide details on what percentage of your inventory is DNFB. UNMH
Response: Accounts being outsourced will not be on the DNFB. They will be billed
accounts.
Question 29: Insurance Data Request - Current month-end Insurance Aged Trial Balance
(ATB) run with the following parameters (please provide Query Parameters in cover sheet):
UNMH Response to Question 29 – Please ATB previously provided.
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By date of service
By current financial class (e.g., Medicare, Medicaid, Commercial, Blue Cross Blue
Shield, etc.)
Dollars and associated counts (e.g., unique invoices, claims, account, charge – please
specify the parameter used)
The following date of service aging categories are preferred (if not date of service, please
specify the report aging parameters):
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0-30
31-60
61-90
91-180
181-365
365 +
Question 30: Gross collection rates by financial class for the last 12 months of activity. If
available by date of service aging category, please include.
UNMH Response to Question 30: This information will be made available upon request to the
selected vendor.
Question 31: Payments by payment code description by month for the last 12 months
Self Pay Data Request. Current month-end Self Pay Aged Trial Balance (ATB) run with the
following parameters (please provide Query Parameters in cover sheet):
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By date of service
By current financial class (e.g., Self Pay, Self Pay After Insurance, etc.)
Dollars and associated counts (e.g., unique invoices, unique patients – please specify the
parameter used)
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The following date of service aging categories are preferred (if not date of service, please
specify the report aging parameters)
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0-30
31-60
61-90
91-180
181-365
365 +
UNMH Response to Question 31: See attached ATB.
Question 32: Gross collection rates by financial class for the last 12 months of activity. If
available by date of service aging category, please include.
UNMH Response to Question 32: This information will be made available upon request to the
selected vendor.
Question 33: Payments by payment code description (e.g., POS Payments, Co-Payments, etc.)
by month for the last 12 months
UNMH Response to Question 33: This information will be made available upon request to the
selected vendor.
Question 34: Number of statements generated for the last 12 months broken down by month
UNMH Response to Question 34: Monthly breakdown for the last 12 months is not available
however, we generate an average of 24,500 accounts monthly
Question 35: Intended placement criteria (i.e. Day One (1), Day Forty-five (45))
UNMH Response to Question 35: This criteria is still being determine. Aging of accounts will
vary. We expect to stagger placement.
Question 36: Can accounts be worked offshore?
UNMH Response to question 36: No
Question 37: What portion of the total volume indicated in the RFP is self-pay?
1.1 Scope of Work)
RFP (Section
UNMH Response to Question 37: Please refer to self pay in the ATB previously provided.
Question 38: Can you confirm if total volume of accounts reflected in RFP is gross or net? RFP
(Section 1.1 Scope of Work)
UNMH Response to Question 38: Total volume is a combination of gross and net. We net
down our contracted accounts. Other non-contracted payers, i.e. “generic insurances” remain at
gross charges.
Question 39: Please provide an aged trial balance that breaks out the proposed placements.
Please include in the ATB the following:
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Payer classes
# of accounts
Dollars
Aging
Please designate which payers are at gross and which are at net – UNMH Response:
Again, there is a combination of net and gross for payers.
UNMH Response to Question 39: Please see ATB previously provided.
Question 40: Please provide an estimate of the gross to net ratio for gross accounts.
UNMH Response to Question 41: Rough estimate is 70 - 80% net
Question 42: In section 1.1 Scope of Work, you indicate there may be multiple Awardee(s),
please provide your expectation of how many Awardees there may be.
UNMH Response to Question 42: That is yet to be determined. UNMH may award to multiple
Awardees.
Question 43: What is the anticipated conversion date from Siemens Invision to Siemens Sorian?
What is the anticipated date accounts will be placed with the receivables vendor?
UNMH Response to Question 43: Anticipated conversion date to Soarian is first quarter of
2015. Placement date is dependent upon the completion of the RFP and vendor selection.
Question 44: Does UNMH currently outsource it’s self-pay receivable? If so, at what day are
accounts outsourced and when do accounts return? What has the collection recovery of
outsourced accounts been for the last 12 months and in 2013?
UNMH Response to Question 44: Yes, self-pay are outsourced at approximately 30 days from
the date the patient becomes self-pay. Accounts are moved to the collection agency once
completion with our vendor occurs. Collection recovery of these accounts is irrelevant to this
RFP.
Question 45: If UNMH does not currently outsource, what is the current self-pay process from
date of service to referral to bad debt?
UNMH Response to Question 45: Self pay accounts are outsourced at approximately 30 days
after they become self-pay.
Question 46: What collection attempts are required before bad debt placement? What
percentage of your receivable do you currently collect?
UNMH Response to question 46: Self pay accounts are outsourced at approximately 30 days
after they become self-pay. Through collection efforts are made on insurance, Medicare,
Medicaid accounts prior to being sent to our early out vendor. Our vendor works accounts for a
specified time period prior to placing with bad debt. Collection percentages for this vendor are
irrelevant to this RFP.
Question 47: How many bad debt agencies are currently used?
UNMH Response to Question 47: One collection agency, one early out, extended Business
Office.
Question 48: What is their rate of recovery in the last 12 months and in 2013?
UNMH Response to question 48: Their recovery rates are irrelevant for the RFP. The RFP is
not for EBO or Collection agencies.
Question 49: When does UNMH plan to convert to Soarian? Will all facilities convert at the
same time? If not, what is the implementation timeline?
UNMH Response to Question 49: Yes, all facilities will convert to Soarian. It is a staggered
implementation. All facilities are scheduled to implement in the first quarter of 2015.
Question 50: How many resources does UNMH currently have on staff in Customer Service,
Billing and Collections? What is the reporting structure of these departments? Is there a CBO?
UNMH Response to Question 50: See response in question 22. Yes, we operate as a CBO.
Question 51: Are Patient Advocates or Financial Counselors currently utilized and are they
comprised of UNMH staff?
UNMH Response to question 51: Yes, we have financial counselors that work with patients
regarding financial assistance, enrollment in Healthcare Exchange programs and payment plans.
They are UNMH staff.
Question 52: Are there unique discount programs or financial assistance programs available to
patients?
UNMH Response to Question 52: Yes, we have discount programs and financial assistance
available.
Question 53: Are pay plans administered in house? What are agreeable payment terms?
UNMH Response to Question 54: Pay plans are administered by our Extended Business
Office.
Question 55: What is the biggest customer complaint you hear from patients?
UNMH Response to Question 55: Confusion regarding UNM Medical Group bills and UNMH
bills.
Question 56: What manual processes currently exist that you would like to automate?
UNMH Response to Question 56: Our focus is on ensuring those processes are automated in
Soarian.
Question 57: Does UNMH currently have staff to financially clear a patient prior to service?
UNMH Response to question 57: PFS does have staff that work with patients at any time, prior
to or after services is provided, to apply for financial assistance. Patients are pre-registered prior
to service and insurance information is obtained and verified.
Question 58: Does UNMH currently have a scoring vendor and if so what company is used?
UNMH Response to Question 58: No, we will be internally scoring per the RFP.
Question 59: Are statements consolidating physician and hospital accounts across the
healthcare system? Is a patient portal available to patients to manage their healthcare expense
and to pay online?
UNMH Response to Question 59: No, statements are not consolidated with physicians. No, we
do not have a patient portal available to patients.
Question 60: Can patients make payments over the phone with IVR technology?
UNMH Response to question 60: No, unfortunately we do not have IVR technology available.
Patients can call our customer service department to make payments.
Question 61: Does UNMH currently survey patients to measure patient satisfaction?
UNMH Response to Question 61: Yes
Question 62: Can we get a two week extension?
UNMH Response to Question 62: Yes, the RFP new due date and time 12/17/14 at 2:00 pm.
Acknowledge receipt of this Addendum in the space provided in Exhibit B. Failure to do so may
subject Offeror to disqualification.
All other provisions of the Proposal Documents shall remain unchanged. This addendum is
hereby made a part of the Proposal Documents to the same extent as those provisions contained
in the original documents and all itemized listing thereof.