HomeMy WebLinkAboutFD Emergency Medical Services (EMS) Billing and Collection____________________________________________________________________________________ FOR CITY CLERK ONLY Council Meeting: November 4, 2024 Disposition: Authorized the City Manager to negotiate a Professional Services Agreement (PSA) with Wittman Enterprises, LLC (Wittman) for Emergency Medical Services (EMS) billing and collection services in an amount not to exceed $825,000 for five years with an option for an additional 5-year extension Agenda Item No: 5.g Meeting Date: November 4, 2024 SAN RAFAEL CITY COUNCIL AGENDA REPORT Department: Fire Prepared by: Abraham Roman, Fire Chief Thomas Wong, Senior Management Analyst City Manager Approval: ______________ TOPIC: EMERGENCY MEDICAL SERVICES (EMS) BILLING AND COLLECTION SUBJECT: AUTHORIZE THE CITY MANAGER TO NEGOTIATE A PROFESSIONAL SERVICES AGREEMENT WITH WITTMAN ENTERPRISES, LLC (WITTMAN) FOR EMERGENCY MEDICAL SERVICES (EMS) BILLING AND COLLECTION SERVICES IN AN AMOUNT NOT TO EXCEED $825,000 FOR FIVE YEARS WITH AN OPTION FOR AN ADDITIONAL 5-YEAR EXTENSION. RECOMMENDATION: Authorize the City Manager to negotiate a Professional Services Agreement (PSA) with Wittman Enterprises, LLC (Wittman) for Emergency Medical Services (EMS) billing and collection services in an amount not to exceed $825,000 for five years with an option for an additional 5-year extension. BACKGROUND: The San Rafael Fire Department (SRFD) provides Emergency Medical Services (EMS) to San Rafael, Marinwood Community Services District, County Service Area (CSA) 13, and County Service Area 19. SRFD staffs two full-time ambulances with two paramedics each to respond to EMS incidents. SRFD responds to approximately 10,300 calls for service a year. Of these, approximately 7,100 calls were EMS incidents, and approximately 5,100 required a patient to be transported. Residential and commercial properties within the City of San Rafael pay for most of the costs of responding to EMS incidents via a paramedic service tax. This tax, which was first adopted in 1979, is currently set at a rate of $108 per year for each living unit and $0.14 per square foot of non-residential space. Marinwood, CSA-13, and CSA-19 property owners also pay the paramedic service tax. Additionally, San Rafael’s Master Fee Schedule includes an Ambulance Billing Fee, which is assessed by a patient’s medical insurance provider as reimbursement for medical and transport services provided by the Fire Department. The Emergency Ambulance Response Reimbursement is a collection of six different fees: Advanced Life Support (ALS) Bundled Base Rate, Basic Life Support (BLS) Bundled Base Rate, First Responder Charge, Oxygen, Mileage/mile, and Treat/Non-Transport. San Rafael, SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 2 Marinwood, CSA-13, and CSA-19 residents do not pay the Ambulance Billing Fee directly; however, non-residents may be assessed a portion of the fee if they do not have an insurance provider or if the provider does not pay the amount requested. Since 2017, the City has utilized Wittman Enterprises, LLC, to provide billing and collection services. On behalf of the City, Wittman collected $3,876,561 in EMS billing revenue in (FY) 2023-24. ANALYSIS: EMS billing and collections are time-consuming and complex, requiring compliance with laws and regulations regarding healthcare delivery, insurance, and privacy. It encompasses a variety of tasks, from gathering a patient’s insurance information to working with Medical and Medicare to collecting revenue. Customer service is also important, as patients often have questions about their bills. Importantly, Wittman employs a team of specialists who can provide over-the-phone customer service in languages including English, Spanish, Cantonese, and Vietnamese. If a patient speaks a language that is not offered, they utilize a language line service to ensure they can provide equal service to all. EMS billing requires strict adherence to state and federal laws, including compliance with the Health Insurance Portability and Accountability Act (HIPAA). Wittman employs certified Ambulance Coders and Documentation Specialists as well as Compliance, Financial, and Privacy officers. Since transitioning to Wittman in 2017, the City has received excellent service from Wittman. Prior to contracting with Wittman, the City billed and collected payments in-house. The transition to Wittman has resulted in significant cost savings over the past seven years from the reduced staffing needs. Wittman currently serves nearly 100 California public EMS clients and has an excellent reputation among municipalities for optimizing revenue collection. They process over 880,000 incidents a year and collect nearly $500,000,000 on behalf of their clients. Wittman has not raised its rate of $19.50 per EMS Incident since 2017. This new contract proposes a rate of $22 per incident for year one, rising $1 per year each year after, with a price of $26 per incident in year 5. This represents a 12.8% increase over the seven (7) years since the 2017 contract - substantially lower than the 28% inflation rate over that same period. Table 1. Proposed rate per incident Contract Year Rate per Incident 2017 to Current $19.50 Year 1 $22.00 Year 2 $23.00 Year 3 $24.00 Year 4 $25.00 Year 5 $26.00 The contract allows the City to terminate it with 90 days’ notice, which affords the City flexibility in the event circumstances change or the service provided does not meet the City’s standards. FISCAL IMPACT: Staff projects that fees paid to Wittman would range from $145,000 for year one to $172,000 in year five, depending upon the actual volume of billable services. This would be an increase of about $16,500 over the current rate for year one and an additional $6,600 increase for each year thereafter. SAN RAFAEL CITY COUNCIL AGENDA REPORT / Page: 3 Funding for this service is already provided in the Paramedic Tax Fund (Fund 210), and funds are currently appropriated in the FY 2024-25 budget for the increased amount this FY. Appropriations beyond FY 2024-25 will be included in the regular budgeting process for each subsequent fiscal year. OPTIONS: The City Council has the following options to consider on this matter: 1.Authorize the City Manager to enter into the agreement as recommended. 2.Do not authorize the City Manager to enter into the agreement as recommended and provide further direction to staff. RECOMMENDED ACTION: Authorize the City Manager to negotiate a Professional Services Agreement (PSA) with Wittman Enterprises, LLC (Wittman) for Emergency Medical Services (EMS) billing and collection services in an amount not to exceed $825,000 for five years with an option for an additional 5-year extension. ATTACHMENTS: 1.Wittman Proposal – October 1, 2024 Se t t i n g th e S t a n dar d fo r M S B i l l i n West Metro Fire Protection District: RFP No. 2023-001 | Ambulance Billing Services October 1 2024 City of San Rafael RFI Response/Proposal Wittman Enterprises, LLC 11093 Sun Center Drive Rancho Cordova, California 95670 www.webillems.com RFP Contact: Russ Harms Executive Director Of Business Development (916) 669-4628 Direct Line rharms@webillems.com Setting the Standard for EMS Billing City of San Rafael: EMS Billing and Collection Services | 1 wittman enterprises EMS I MC TABLE OF CONTENTS About Wittman Enterprises Message from our CEO .......................................................................................... 2 Statement of Qualifications ................................................................................... 3 California Strong ..................................................................................................... 3 California EMS/Fire Partners (Proprietary and Confidential) ............................... 3 Project Approach EMS Partner Satisfaction ....................................................................................... 4 Workload Accomplishment ................................................................................... 4 Regulation and Compliance ................................................................................... 4 Multilingual Staff .................................................................................................... 5 Billing to Payment Cycle ........................................................................................ 6 Electronic Access to Records Complete Portal System ........................................................................................ 7 Cost Proposal Superior Performance ............................................................................................ 8 EMS Billing Program Renewal: Proposed Fees .................................................... 8 City of San Rafael: EMS Billing and Collection Services | 2 wittman enterprises EMS I MC About Wittman Enterprises Message from our CEO June 27, 2024 Thank you for the opportunity to provide our response to your Request for Information and Proposal for the City of San Rafael's EMS Billing program . Since 1991 Wittman Enterprises, LLC has provided our clients complete fire and ambulance billing services in compliance with current local, state, and federal laws and statutes. We serve more than 140 EMS/Fire clients (130 of those in California) and are the largest California-based billing company with the client base, patient database, and experience with California fire departments (and multiple California government and insurance payers) for the most effective EMS billing and cost recovery programs possible. As an extension of your EMS program since 2017, Wittman Enterprises has maintained a strong customer service accountability platform, providing your team real access to all management staff starting with myself. Specialized staff are already assigned to your team so that the Department and City have direct access to the person(s) on our team who can most help with whatever situation may arise. Our Client Liaison team is always available to help provide/identify key resources you may use to get the results you need. We use every resource necessary to provide the best in customer service and collect the most for our clients. Our ultimate focus is on, and has always been based on, the best business and client services, billing results (accurate and legal billing and the highest cost recovery), and transparency (Client Portal, Reporting, Month-End- Reporting, KPls, etc.). I look forward to continuing our services for the City of San Rafael and nurturing that longstanding partnership. Thank you for the chance to re-introduce our qualifications and commitment to your department and your city. My best, Corinne Wittman-Wong, CEO Wittman Enterprises, LLC (established 1991) 11093 Sun Center Drive, Rancho Cordova, CA 95670 916.669.4608 direct I 855.611.0056 toll free I cwittmanwong @webillems.com City of San Rafael: EMS Billing and Collection Services | 3 wittman enterprises EMS I MC Statement of Qualifications Wittman Enterprises has customized service innovations for our partners in the EMS and Fire industry since 1991. Our superior staff specializes in EMS billing and continually audits our work to ensure the highest quality of billing services. We have extensive experience in the invoicing, categorizing, recording, monitoring, supervising, and managing of ambulance billing and EMS cost recovery systems and services. Wittman bills approximately 880,000 claims annually and collect more than $485,000,000 each year for our clients. California Strong We do not believe that any California-based biller will provide as much in actual reimbursement or complete customer service as Wittman Enterprises has historically demonstrated. We have a proven record of collecting 10-20% more than our competitors. Out-of-state billing companies will not be able to arrive at these reimbursements either, due to their lack of billing and collection experience in California and inexperience with the multitude of California payers . California EMS/Fire Partners (Proprietary and Confidential) Wittman Enterprises conducts all of our work and coordinates all of our services from our single location in the Sacramento, CA area. All production and patient services activities are conducted at 11093 Sun Center Drive in Rancho Cordova, California. City of San Rafael: EMS Billing and Collection Services | 4 wittman enterprises EMS I MC Project Approach EMS Partner Satisfaction The City of San Rafael will continue to count on Wittman Enterprises to conduct diligent, regular, and uninterrupted billing and collection services in a professional, businesslike manner. Our personal approach and higher levels of service greatly exceed industry standards. Yours and your patients' expectations and overall satisfaction are attained through ongoing and regular training, continuous improvement, and our comprehensive auditing program. We maintain the industry-leading lowest claims-per-staff ratio (generally 30% lower than our competitors) based on upholding the standard of practice our clients expect. Our thorough and ongoing training program allows us to continue to improve the business activities that we conduct for our clients and ensure that each of them receive the maximum legal reimbursement possible. We do not strive to be the largest EMS billing company but expect to be the best. Workload Accomplishment Our EMS billing and collection success is tied directly to the ratio of PCRs to the number of quality people assigned to your project. We believe that our people are the key to our success. Wittman innovates by fully embracing automated and technological advances while wholly recognizing that our quality service is reliant upon our talented people providing you the best level of service. As a result of our lowest claims-per-employee- ratio, we generally collect 10-20% more than our competitors for our clients . . 110 r.r. G.2.2. 10-20% -Higher Co ll ection -Rates Than Our Competitors ***** ------------LOWEST CLAIMS-PER-EMPLOYEE RATIO Regulation and Compliance Now that Wittman Enterprises is part of EMSIMC, we have an even more robust consulting division, PWW Advisory Group (PWWIAG), which assesses and drives transformational change and adopts best practices to better serve patients and their communities. Our entire team brings a deep understanding of the industry and its complexities because we've been in it for decades. With our insight and the expertise of City of San Rafael: EMS Billing and Collection Services | 5      wittman enterprises EMS I MC our advisory and compliance group, we help you navigate compliance and operational challenges. Through PWWIAG, our clients gain access to industry-leading, National Academy of Ambulance Compliance (NAAC), accredited education and training on topics affecting the EMS and mobile healthcare industry. All Wittman Enterprises EMSIMC billing and coding staff are NAAC-certified professionals and maintain their competency through annual continuing education requirements. NAAC provides and accredits a wide range of continuing education programs throughout the year, both in classroom and online offerings. Wittman and the entire EMSIMC group comply with all applicable federal , state, and local laws/regulations as they apply to the services being provided: including maintaining confidentiality for all medical and patient information in accordance with HIPAA rules. Certified Ambulance Coder (CAC) Certified Ambulance Documentation Specialist (CADS) Certified Ambulance Compliance Officer (CACO) Certified Ambulance Financial Officer (CAFO) Certified Ambulance Privacy Officer (CAPO) Multilingual Staff Wittman Enterprises employs several Spanish, Chinese, and Vietnamese-speaking customer service representatives in management and non-management positions. Such valuable resources provide your patients with the highest quality of service possible. On rare occasions, if a patient speaks a language we are not staffed to service, we utilize Language Line Services to assist those customers effectively. City of San Rafael: EMS Billing and Collection Services | 6 wittman enterprises EMS I MC Billing to Payment Cycle ' Cash Receip ts ,,,,, , _. -• ~/~ ~ Payments Posted I I I (WITHI N 24 HOURS) I I I ~ Electron ics Claims Department Import and Cla im Entry (DAILY) I I Insurance and Private Pay Follow-Up IIHlllJIRV CMPUAIICE ~ Claim Review, Coding and QA /QC (1-3 DAYS) I \ \ ·• ----.- Cu stomer ', Service , Departm ent ', ' ' ~--.. .... Electronic Claim Submission To All Payors (DA ILY) -- 0 Transmission Department ... ..... --- Billing De partm ent City of San Rafael: EMS Billing and Collection Services | 7 wittman enterprises EMS I MC Electronic Access to Records Complete Portal Solutions Wittman offers secured internet access to our billing system v i a our Complete Portal System, 24 hours a day. The system includes: Client Portal/Electronic Dashboard ■ No additional softwa re is required for the City and Fi r e Department to access Portal/Dashboard i nformation through our secured server . ■ A password protected, secure login is req uired to access. ■ Information i s in real t i me, allowing autho ri zed City and Fi re per so nnel to v iew each cla i m wherever it is in the billing and collecti o n process. Patient Portal ■ Provides pati ents with Pat ient Portal Access. Each invoi ce, statement, and l etter to patients provide a webs ite link for them to access, login, provide i nsurance information, leave a n email and /or simply inq uire about thei r b ill. Credit Card Payment Portal ■ We provide credit card payment options fo r your patients w ho w ish to process their b ills th is way. ■ Patients are informed through our correspondences and our c u stomer service staff how to make credit card payments {if accepted by client). ■ We can prov i de seamless links to v irtual merc h ant term inals that can be followed from our Portal and from client websites, a llowing patients to pay thei r invoices in o n e location, using approved credit cards. ■ Like all of our service s, thi s i s customizabl e to fit the needs of your City and your program. Collections Portal ■ Thi s Portal provides the most common ly requested items from third -party collectio n agencies, based on cl ient approval. ■ It prov ides : reviewi ng accounts electron ica lly, printing invo ic es , pr int ing patient ca r e reports, and p ri nting 1500 billi ng forms . City of San Rafael: EMS Billing and Collection Services | 8 wittman enterprises EMS I MC Cost Proposal Superior Performance We are committed to competitive fees for our clients; however, we are not typically the "cheapest". We have chosen as part of our business model to charge a fair market rate that will still allow us to maintain a superior level of service with a staffing level that provides both exceptional collection results and unmatched customer service. Reducing fees to "beat" the competition would mean that we cannot provide the level of customer service and performance on which our company is built. EMS Billing Program Renewal: Proposed Fees Wittman Enterprises, LLC is pleased to offer the City of San Rafael all billing, collections, financial reporting, and accounts receivable management described in our previous contract and in this RFI Response/Proposal based on the following schedule. A minimal increase to our charged fees may be applied if any insurance reimbursement rate is reduced at any time during our contract term. Both pricing options assume one (1) 5-year contract term plus (1) optional 5-year contract extension. Price per processed incident Contract Year 1 $22 Contract Year 2 $23 Contract Year 3 $24 Contract Year 4 $25 Contract Year 5 $26 Note: Wittman Enterprises, LLC provides complementar y annual revenue enhancement training fo r EMS and financial staff as requested. This includes (4) hours of teleconference, webinar, or ZOOM-facilitated trai ning for San Rafael general staff, and (6) h o urs for EMS/EMS Management. Additional and/o r onsite training as requested by the City of San Rafael will be at the contracted rate of $125 per hour (personnel rate) plus associated travel expenses.