Questions for RFP MS 2375 Revenue Cycle Current State 1 Can you specify the process and systems used currently used for  Claims by byg16112


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									                     Questions for RFP MS-2375 Revenue Cycle

                                    Current State
1. Can you specify the process and systems used currently used for:
    Claims editing, 3M product w/in Epic to Xactimed to Payor
    Claims submission, 3M & Xactimed
    Claims remittance, Xactimed
    CDM standardization, CodeCorrect
    CDM automation CodeCorrect

2. In the past 3 years have you received any consultation of guidance from external agencies
    related to your pricing strategies? Yes, limited pricing services have been used from an
    outside vendor for the last 2 years, including provision of market data, basic analysis of
    industry practices, and provision of a download file for inclusion in the chargemaster fee

3. Can you provide an Application Inventory Matrix for your organization including
   functional area, vendor and product name? Parkland IT maintains a comprehensive
   application inventory listing but this information is not generally information that we
   would disclose in mass.

4. Is EPIC fully deployed? Please define the term ―fully deployed‖. Do you have
    additional Epic deployment phases? We are close to deploying all Epic modules that
    Parkland has currently licensed. The bulk of what is remaining is the full and complete
    deployment of the Epic EMR and clinical documentation modules across the Parkland
    enterprise. Yes, there are additional deployment phases scheduled that are remaining.
  In what area is EPIC deployed and in production use? All areas both inpatient,
   ambulatory including Patient Financial Services, IP Pharmacy, and Radiology. Parkland
   Laboratory and Retail Pharmacy run Cerner applications. Also dependent upon the
   specific Parkland department’s application needs; meaning there are many Parkland
   departments that Epic does not provide a solution for that deploy best of breed software

5. Is EPIC the only patient accounting system at Parkland? If no, please provide other
    patient revenue systems in use and within the scope of the project. Yes

6. What system is used for Pharmacy CDM codes? The Epic Rx module is used for
   dispensing and as the primary billing system. Limited use of the chargemaster module
   (EAP file) is also required.

7. What is your HIM system for coding, abstracting and compliance?
   Coding system – Ingenix WebStrat
   Abstracting system – Epic
   Coding Compliance System – none at present

8. For what function are you using Xactimed, and do you have any additional MedAssets
   products in house? Xactimed Claims Editing

                                      Page 1 of 17
9. Can you describe the integration between your ordering, patient billing, HIM systems in
   both acute and ambulatory care environments? Please include any bolt-on systems.
   Parkland is fully integrated with ordering, patient billing, and HIM as all three of these
   operational areas are running Epic modules. Of specific notes, in relation to bolt-on
   systems would be the HIM coding and abstracting system (Ingenix Webstrat), and the
   PFS collection follow up system (Ontario Systems Artiva).

10. In an effort to better understand your current operations, can you provide a Monthly
     Operations Report of your revenue performance, including:
      AR days,
      Bad Debt days,
      Outstanding receivables

                                        Future State
11. What timeframe do you have in mind for the execution of the work described, and do you
    plan on approaching the work in a phased manner? A project of this scope will not be
    accomplished overnight. While quick implementation is desired, a phased approach,
    addressing large volume, large dollar opportunities first, would meet financial goals,
    while allowing the winning vendor to provide a thorough product.

12. Can you describe areas in which you feel there are opportunities to optimize your pricing
    methodology and well as your revenue capture? Very open to ideas and suggestions for
    pricing methodologies

13. How are you coordinating this initiative with your EHR and ICD-10 / HIPAA 5010
    initiatives? We are not coordinating this effort at this time.

14. How many and in what roles does Parkland already have internal resources available to
    work on these efforts, for example:
    a.Business Subject Matter Experts The current oversight and support structure contains
    many of the SMEs that are likely to be needed during the course of this engagement.
    Parkland anticipates appropriate access to supplemental resources as required.
    b.Project Management Limited project management resources are available from
    Parkland. Most project management support is expected from the winning vendor.
    c. IT Resources Parkland recognizes the need for IT resources during the course of this
    engagement. Several large projects and a myriad of medium to small projects are
    currently in process. To some extent, IT resources will be allocated based on the benefit
    of the project to Parkland, both financial and in terms of patient care.

                                       RFP Process
15. Can you provide a list of whom the proposal was sent to or who has filed Intent to
    Submit? Vendors may be revealed after the Closing of the RFP

16. Who is or what functional areas are represented on the RFP Evaluation Committee? The
    functional areas represented are Finance, Patient Financial Services, Health Information
    Management, Purchasing, Managed Care, and Chargemaster.

17. Do you already have a business services and/or IT services vendor with whom you are
    already working who can deliver the services included in this RFP? No. While some
    components of the RFP may be provided currently, the anticipated results are
    recommendations from the successful vendor on systems that would accomplish project

                                      Page 2 of 17
    goals. For example, Parkland currently uses CodeCorrect as a chargemaster maintenance
    tool. An expected outcome would be a review of how the system is utilized and
    suggestions for improvement. But, Parkland does not currently have a system that
    identifies missing charges. An expected outcome would be a review of the current
    environment and recommendations of how we could expand upon current platforms, or
    suggestions for bolt-on systems that could accomplish identification of missing charges.

18. What is the budget for the work? Because this is a project that anticipates a return on
    investment, there is not currently a formal budget for the work, either for the cost of the
    engagement or in terms of increased revenues. Upon commencement of the engagement,
    a revenue and expense budget will be formalized for the project.

19. Which departments would be considered in scope for the charge capture review? All.
    How many physical locations are represented by those departments? Around 200.

20. RFP Question – Can you please provide additional insight or clarification into
    the nature of this question? What processes would you recommend to accurately align
    chargemaster maintenance as opposed to medical record documentation/coding and
    charge capture?

21. Does Parkland have a desired start date and end date for the projects? The desired start
    date is within 3-4 weeks of contracting. A formal end date will not be determined until
    the successful vendor is identified.
22. When was the last comprehensive CDM review conducted? Mid 2005

23. When was the last comprehensive Pricing review conducted? The last pricing review
    was completed in the last quarter of 2009. While somewhat limited in nature, it is the
    most comprehensive review to date at Parkland.

24. Seeing that you invested a large investment into medical records/healthcare information
    management – what was the new system that you implemented? Ingenix WebStrat for
    coding. Abstracting is in EPIC. We are creating a system in-house for tracking Clinical
    Documentation Improvement.         (Part of EPIC?)

25. What modules do you have set-up in EPIC? (e.g. reconciliation, claim submission, etc).
    Primary Epic modules currently in Production are hospital scheduling (Cadence),
    ADT/registration (Prelude), hospital billing and claims (Resolute), Epic advance
    clinicals, EpicRX (IP Pharmacy), all Epic HIM modules, referrals (Tapestry), orders and
    results (EpicCare), Operating room management (Optime), Emergency Department
    Management (ASAP), Radiology (Radiant), Provider Order Entry (CPOE ), Stork, Epic
    RX (Willow).

26. What provider are you working with on the new retail cash collection system?

27. What is your current number of day’s payment is outstanding?

28. Do you currently use a lockbox provider for any of the receipts? If so, how many? Yes,

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   29. How many coding errors are your staff members reporting today? Stats not available for
       this. Any target number set? How many FTE do you current have in the electronic
       posting department?

   30. What system does Parkland use for insurance verification and eligibility? McKesson Is
   Parkland using this system or another system to screen for Medicaid and charity eligibility?

   31 Does Parkland currently have a sliding fee schedule for self-pay, co-pays, deductibles, and
   co-insurance amounts? Parkland does not have a sliding fee schedule for self pay services.
   The only sliding fee copays reside within the Parkland charity program.

   32. Does Parkland currently have an automated solution for identification of variances of
       payments from contract terms? Parkland uses the Epic system for identifying
       commercial payment variances.

   33. Does Parkland have a system for monitoring payer compliance against contract terms?
       See question #32

   34. What is the GL system? Lawson

   35. Does Parkland have bar coding for pharmacy? For medication scanning into the
       pharmacy system but not at bed side

   36. Does Parkland provide retail pharmacy services? Parkland provides retail pharmacy
       services for our indigent population (verify for Medicare Part D also). Dollar
       amounts/volumes for these services are immaterial. Parkland also has a Medicare Part D
       program for Medicare eligible patients.

   37. Does Parkland have bar coding for supplies? No, but it is being considered in the future

   38. Please complete the following table. Enter in the percentage of sites with either
       automated charge capture (screen entry)or manual charge slips: answers to the below to
       be provided at a later date.

                                                                              Targeted date for
Department                      Screen entry          Manual charge slips     implementation
Inpatient services

                                         Page 4 of 17
Central Services/supplies
Surgery supplies
Surgery centers (mini
School based clinics
Dialysis centers
Infusion centers
HOMES mobile services

  39. Does Parkland currently have a clinical documentation program for both inpatient and
      outpatient/clinic services? (staff assigned to review documentation concurrently and
      retrospectively for completeness) 9 CDI staff plus a manager review inpatient only at
      this time. Reviews are concurrent, however there are occasional retrospective reviews.

  40. Does Parkland provide transplant services? Yes, kidney transplants are provided.

  41. Does Parkland participate in any CMS demonstration projects or have a waiver of any
      type? No

  42. Does Parkland provide Homecare services? No

  43. Does Parkland provide Hospice services? No

  44. Does Parkland provide retail DME? DME is provided for patients that meet the criteria
      for charity care.

  45. Did Parkland use an outside consultant for implement Phase I of the long-term revenue
      cycle strategy? If so, can you provide the name of the consulting firm? KPMG

  46. Who is assisting Parkland with the EPIC roll-out? IBM


                                       Page 5 of 17
47. May we get the names and titles of the individuals on the evaluation committee?
    Functional areas provided above.
48. The RFP outlines an approach with some questions that are best answered during the
    course of the project, e.g. ―In what ways does the current chargemaster maintenance tool,
    CodeCorrect, meet these requirements? Fail to meet these requirements?‖ Is it
    Parkland’s intent that Vendor’s address each of the questions in the outlined Approach, or
    is this a guide for engagement delivery? Value of a vendor according to the approach.
Charge Master Scrubbing
49. The RFP refers to 24,000 line items in the charge master. Do all of these items have
    volume in the past 12 months? A small number of procedures do not have volume in the
    past year. If not, how many have volume? At least 95% of the procedures do have
    volume in the last 12-18 months. Is it the intent that the vendor will review all items
    regardless of volume? In creating the RFP, the intent was for the successful vendor to
    review all items in the CDM. However, proposals that include only limited review of the
    CDM will be equally considered, as long as the rationale and benefits to Parkland are
    clearly stated.
50. How many revenue producing departments exist within the Parkland CDM? Are all of
    these departments considered to be within the scope of this project? In creating the RFP,
    the intent was for the successful vendor to review all departments. However, proposals
    that include only limited review of departments will be equally considered, as long as the
    rationale and benefits to Parkland are clearly stated.
51. Are there any off-site clinical areas not-represented on the CDM that are considered a
    part of the scope of this project? No
52. The RFP contemplates the ―cost report interface.‖ Is it the intent that the Vendor should
    review past cost reports and analyze cost allocations? No. Alternatively, is the vendor
    being asked to provide recommendations on appropriate cost allocation models to
    facilitate cost report preparation? No.
Price Setting and Optimization
53. Has an outside vendor worked with you in the past on Medicare Disproportionate Share
    issues? Yes. If so, can you please describe the nature of the engagement/s? Parkland
    has received external assistance with identification of Medicaid eligible patient days
    through reopenings and appeals.
HIM/CDM Coding
54. Who codes outpatient services today, i.e. department, medical records, CDM? Outpatient
    coding is done by both CDM and HIM. HIM is responsible for coding diagnoses and
    procedure codes for outpatient areas for surgical procedures (10000-60000 code series),
    fluoroscopy, hydration, therapeutic infusions and chemotherapy. Currently these surgical
    and infusion codes are hardcoded on the CDM, but HIM has the final responsibility for
    coding these services. We are working towards removing procedure codes from the
    CDM for services that HIM codes. HIM does not have override capability when coding
    services that are hardcoded from the CDM.
55. How many coding FTEs are on staff? 68 (Inpatient = 18 FTEs) How many are outpatient
    only? 50

                                      Page 6 of 17
   56. Does any concurrent coding happen today in any of the outpatient departments? HIM
       coding is done prior to charging in the surgical specialty clinics that have not gone live on
       the EMR. As each clinic goes live, this is discontinued.
   57. Has Parkland identified the number of claims it would like reviewed? No The areas of
       focus? No.
   Charge Capture
   58. Has Parkland completed an assessment of the Mid Revenue Cycle in the past two years?
       If so, will you provide a copy of the report or high-level findings to assist with scoping?
   59. Has Parkland identified specific ―high volume‖ clinical areas on which they would like
       the Vendor’s focused, e.g. Surgery, Cardiac Catheterization, Emergency, etc? The
       successful vendor should review payment methodology and volume to create a workplan
       that identifies areas of focus of areas to review first.
   60. The RFP asks for a ―high level review of the current Epic install and plans over the next
       12-18 months.‖ Is it Parkland’s intent that the vendor will be engaged during this entire
       period? It is possible the vendor could be engaged during this time period. If not, does
       Parkland have an implementation timeline for the next 18 months? Parkland will provide
       the successful vendor with an implementation timeline for the next 18 months.
   Discounting Policy
   61. With how many managed care companies does Parkland currently contract? Less than 15
       companies. There are also 15 contracts, although several plans for an individual MCO
       are encompassed within a single contract. Most contracts contain a single rate and
       methodology for all plans.
   62. Is there a written policy regarding the periodic evaluation of managed care contracts?
       Yes. If so, how often does the policy require periodic evaluation of managed care
       contracts? Formally, they’re reviewed once per year. Operationally they’re reviewed
       monthly. The monthly review is a review of payment performance and sample account
       audits. Is the monthly review for over/under payments? Yes, there are other operational
       elements monitored that could be rolled-up into over/under payments.


   63. Are there any hospital departments that are not included in the review? No.

   64. Are any clinics provider based? ALL

   65. How long have you been using EPIC? Parkland converted to Epic HB in September
       2005. What version(s) are you using? Were the clinical aspects of Epic implemented
       before or in conjunction with the patient billing aspects? Spring 07 version, PFS was the
       first the rest followed

3.1 Charge Master Scrubbing – Page 24/25

                                          Page 7 of 17
   66. Is CDM maintenance currently centralized? Yes. Where does this function reside within
   the organization? Within the Finance division, in the Government Reimbursement
   department. How is the CDM maintenance function structured (e.g., number of FTEs, focus
   areas for each FTE, etc.)? The department housing the CDM function has several areas of
   accountability. The chargemaster function is supported by 4 FTEs, a manager, a senior
   analyst, and midlevel staff. Basic research as well as maintenance is performed by the
   midlevel staff. There is no specific areas of focus for these two FTEs. The senior analyst and
   manager provide support for compliance and more complex research.

   67. What tools are currently used to maintain and monitor the CDM? Parkland uses
       MedAssets CodeCorrect as the electronic maintenance tool and for documentation of
       appropriate approvals. Reports from the system are used to monitor the CDM.
       Additionally the department has an FTE dedicated to compliance activities, including
       several activities that include manual monitoring of chargemaster functions.

3.2 Price Setting and Optimization – Page 26

   68 . Is it your intent to have a pricing strategy implemented for only the hospital or will the
   clinics also be included? Professional and technical fees for both hospital and clinics should
   be included.

   69. Does your hospital/clinics share a common charge description master? Yes.
       Additionally, the primary care clinics share global procedure codes within the
       chargemaster. If no, then how many different charge descriptions masters do you have?

   70. Do you have multiple prices (e.g. I/P, O/P, ER, etc.) within your charge master or one
       price? Parkland has one price, regardless of environment of care. This includes
       procedures that cross departments. There is a strong desire to retain this approach, unless
       significant benefits could be realized from a change in methodology.

   71. Does your charge description master contain zero priced items? Yes. If so, how are
       prices assigned for those items? In some situations, these procedures are used for
       tracking and do not appear on a patient bill. These procedures are assigned a revenue
       code of 220 and can easily be segregated. Pharmacy procedures are assigned a price
       through the clinical IS system, Epic Rx. Parkland plans to roll out this approach to
       supplies within the next 12-18 months, using the Lawson system to provide pricing for
       supply items.

   72. Do you have any restrictions (e.g. managed care contracting, physicians, etc.) that will
       limit our ability to come up with a system wide pricing strategy? Yes, there are some
       traditional barriers in place, but there are also some traditional barriers that aren’t in

                                          Page 8 of 17
   73. Do any of your payor contracts require prior notification of a rate increase? If so, what
       time period is required (30, 45, 60 days)? Yes, most restrict-60 days prior notification.
       The most lenient-30 days prior notification. Some don’t require any notice.

   74. Are any of your major payor contracts under negotiation or will they be during the
       timeframe of this project? Yes, all of them.

   75. Do any of your clinic split-bill with the hospital for any procedures performed? All
       clinics are hospital-based, with a technical fee charged and billed on a UB and a
       professional fee charged and billed with a 22 site of service indicator on a 1500. In many
       cases, UTSW bills for the professional fee, although Parkland bills for physicians in the
       primary care clinics as well as midlevel providers employed by Parkland.

3.3 HIM/CDM Interface – Page 27

   76. What does HIM code (CPT/HCPCS)? HIM is responsible for coding diagnoses and
   procedure codes for outpatient areas for surgical procedures (10000-60000 code series),
   fluoroscopy, hydration, therapeutic infusions and chemotherapy. Currently these surgical and
   medical codes are hardcoded on the CDM, but HIM has the final responsibility for coding
   these services. We are working towards removing procedure codes from the CDM for
   services that HIM codes. HIM does not have override capability when coding services that
   are hardcoded from the CDM.

   77. What is hard coded (CPT/HCPCS) in the CDM? Right now, almost everything, except
       the surgical procedures provided in the day surgery units and the ER. The ER recently
       removed the CPT codes for surgical procedures from the CDM. They now charge
       procedure levels. HIM codes the surgical procedure that links to the level charge.

   78. For hard coded charges, how are charges captured and who is responsible for selecting
       the charge? The departments are responsible for charging. In the EMR, physician orders
       trigger charges. Prior to EMR, clerks in the clinics entered charges.

3.4 Charge Capture – Page 28

   79. Is EPIC used to automate charge capture for certain services? If so, what services, in
   which departments, are included? Does clinical documentation directly trigger charges in any
   areas? We are working on a process for surgical clinics to link a clinic surgical level charge
   to the procedure preference list for each clinic. The physician would select the name of the
   procedure. The procedure level linked to that procedure would be charged when the
   physician selects/documents the procedure on a template. HIM would code the procedure.
   The CPT code would link up with the surgical level charge line item.

   80. Are EPIC procedure navigators utilized to capture charges? Yes.

                                         Page 9 of 17
   81. Are EPIC charge navigators utilized? Yes.

3.5 Discounting Policy – Page 25

   82. Do current financial counseling resources report through the financial counseling /
   finance organization structure? Financial counseling currently reports through Patient
   Financial Services.

   83. Does Parkland use a patient propensity to pay / scoring software? Yes. If yes, is Parkland
   open to exploring new vendors? Yes. If no, is Parkland open to exploring this option? Need
   the name of the current vendor. Search America is the current vendor, but software is
   currently not in operation.

3.1. Charge Master Scrubbing Item:      Page # 24

   3.1.3 Evaluate services by HCPCS that might be unnecessarily aggregated or separately

    84. Question: Please clarify as to what specifically is meant by ―aggregated and separately
    reported‖. Is this in reference to bundling and unbundling? The industry often uses the
    words bundling and unbundling to describe specific types of activity that are typically
    considered outside of compliant billing practices. Parkland is not referring to that type of
    activity. We do wish to separately report any charge that may be compliantly reported in
    that manner, and which makes sense from the perspective of revenues vs. resources
    consumed to report.

Item: Pages 24 & 25

     3.1.4 Review charge master to existing interfaces:
   Charge interfaces (validate hospital charge formulas and algorithms, pricing
            consistency across common items, charges relative to fee schedule payments, cost to
            charge ratios relative to consistent pricing, geographic charge information, proper
            device and expensive supply charges, proper markup of pharmaceutical items, patient
            complaints about improper charges);

  Charge capture interface (process flow among service areas, training and
           competency of personnel entering charges, services being provided or items
           dispensed with no charging, validation of service area activities versus charge master

    85. Question #1: Exactly how many separate charge capture interfaces exist that will be
    mapped to the CDM? This may impact the effort involved and impact the fee. EPIC
    Orders, Radiology, Cerner.

    86. Question #2: How many ancillary systems are responsible for driving prices to the
    claim outside of the CDM? Currently, only the pharmacy Epic Rx system drives prices

                                        Page 10 of 17
    outside of the CDM. However, Parkland plans to use Lawson to drive supply prices to the
    claim within the next 12-18 months.

3.3 HIM/CDM Interface Page 27

    3.3.6 Assist with grouping assignment of surgical procedures identified in number four
    above to clinic/ancillary procedure group levels; and

    87. Question: Please confirm that this refers specifically to item # 3.3.4 ―Review back-end
    edits within the Epic and Xactimed system for accuracy and appropriateness;‖ If not, to
    which item ―number four‖ above does it refer? And if so, can you elaborate on the purpose
    or outcome Parkland desires from this exercise so that we can plan our work efforts
    Please see question and response 3.4.1 above. Grouping assignment of clinic surgical
    procedures refers to the clinic surgical levels identified in that response. We have grouped
    our clinic surgical procedures into 15 levels for charging based on APC payment rate.
    Review these levels and charges for appropriateness of level and charge assignment.

3.4 Charge Capture Page 28

    3.4.7 Evaluation of clinical IS systems and identification of opportunities to more effectively
    use of automation in the charge capture process.

    88. Question: What is the number and type of clinical IS systems outside of the EPIC
    system to be evaluated, so that we can better estimate the resources required. Cerner, Pyxis,
    McKesson Pacs, EKG Muse, Xcelera, Rals, Allscripts, Milliman (Care Manager).

Item 3.2.4 Questions

   89. Has Parkland completed any previous assessments of DHS/UPL opportunities within the
       current price setting methodologies and will we have access to them? No

   90. Does Parkland separately identify uncompensated care related to inpatient and outpatient
       services provided to individuals with no source of third party coverage from other
       uncompensated costs? Yes

   91. Does Parkland have a process to ensure that there is no duplication of eligible charges in
       order to properly calculate uncompensated care costs incurred in furnishing inpatient and
       outpatient hospital services for individuals without health insurance coverage or other
       third party coverage? Yes

   92. How does Parkland currently verify Medicaid eligibility status for the purpose of
       identifying the appropriate patients in the DSH calculation? This process is completed
       internally, using the cost accounting system to obtain data. Reviews completed after
       submission of the Medicare cost report have identified an error rate of less than 2%,
       largely attributable to the large number of patients who receive Medicaid eligibility
       months after services are provided.

   Questions pertaining to 3.3 and 4.4 Hospital based clinic coding/billing questions:

                                         Page 11 of 17
93. Will any hospital based clinics be evaluated? If so, how many and will the physician
    billing portion also be included?
94. Is coding performed at each clinic site or is there a centralized coding dept? HIM is
    responsible for the coding. However, coding is currently done in our HIM locations,
    point of service in the clinics and remotely by contract coders. We expect to implement
    remote coding for our staff before the end of the year. Point of service coding as we
    provide today would be phased out, however we plan rotate coders through clinics as

95. Is billing for outpatient clinics centralized or is it performed at the clinic site? All billing
    is centralized within the Patient Financial Services division of the hospital.

96. Are the clinic records electronic or paper? If paper, are they scanned? Some are
    electronic some have not converted yet. ED (except dialysis), WISH, COPC and various
    medicine clinics are EMR. Surgical specialty clinics have not converted yet. We are
    working with hybrid records for inpatient, observation, day surgery, dialysis performed
    for ED patients. Nothing is being scanned at this time. Scanning should begin mid to late
    summer 2010.

97. Are credentialed coders used for this coding/billing? We do still have some outpatient
    coders who are not credentialed. All of our contract coders and new hires are
    credentialed. All inpatient coders are credentialed.

Questions regarding managed care contracts/discounts

98. When do PHHS’ top commercial / managed care contracts come up for renewal? Beyond
    the initial term. Please provide the top 5 contracts and associated renewal date? All up
    for renegotiation.

99. In how many Medicare Advantage Plans do you participate? 4, working on the 5th.
    When were the most recent rates negotiated? In 2009.

100. In how many Managed Medicaid plans does PHHS participate? 1. Were rates
    negotiated or set by the payer? Negotiated.

101. When was the last price increase and what methodology was used for the increase?
     The last price increase was implemented during the 4th quarter of 2009. A market-
     based approach was used.
102. Are there any current policies/procedures for prompt pay discounts? Need clarification
     (patient portion or manage-care company)?

103. What are the key components of the self pay discount policy? Dallas County residents
     only, if they pay in full, it’s up to 15% discount.

General Questions

104. What is PHHS’s payer mix percentage (IP payer mix vs OP payer mix)? Total mix:
    Medicaid 33%, Charity 31%, Medicare 15%, Self Pay 11%, Insurance 10%.

                                        Page 12 of 17
    105. What is the inpatient volume and the outpatient volume (ER volume separate from

    106. What is the outpatient service mix (e.g., percent Radiology vs. ER vs. Surgical, etc)?

    107. What is the bill hold for outpatients (e.g., 3-day hold, 4-day hold)? 8 days.

    108. Please provide insight into PHHS’ DNFB average performance level.

    109. Please provide insight into Denial Processes or Technology that help assist/address
         coding (including CDM) denials for the organization. ARTIVA.

    110. Based on the systems listed in the RFP (CodeCorrect, EPIC and Ingenix), could you
         please provide the latest implemented version of each system?
         We are on the latest version of Ingenix WebStrat.

Legal Review Comments/Questions

111. Exhibit A, 2.1—there is no mention of internet availability in what they Parkland will
provide while vendor is performing the project; Please comment. If internet availability is
required to complete the project, indicate this need in the response. Parkland is not averse to
providing any tool reasonably needed to complete this project.

Page 4 section General Information Revenue Cycle Activity

RFP indicates ―significant improvements in charge capture, much of this through EPIC

112. What are these significant improvements, examples, and how were these completed through
EPIC? When was your most recent CDM assessment performed and was this performed prior to
Epic implementation? The most recent assessment was performed in mid 2005, immediately
preceding the conversion to Epic.

Page 4 section General Information Revenue Cycle Activity

RFP indicates ―Ongoing integration of the newly installed Lawson ERP system, in particular the
item master with the ―CDM‖.

113. Can you describe the process to link supply line items in the CDM to the Item Master?
Under design and to be determined.

Page 4 section General Information Revenue Cycle Activity

RFP indicates ―Charge simplification‖

                                          Page 13 of 17
114. Can you explain how charging was simplified? Our chargemaster has same CPT, same
price. The pricing function is centralized in the chargemaster area. Parkland went from different
methodologies to 1 methodology.

Page 5 General Information Revenue Cycle Activity

115. Is the scope of work required by the RFP limited to Parkland Memorial Hospital? Yes,
including all hospital-based entities, such as the outpatient and primary care clinics. If not, please
indicate which entities are included in the scope. Does the scope include both professional and
technical fee charge capture? Yes

116. If Community Oriented Primary Care (COPC) is part of the scope, are COPCs on a standard
fee schedule? The chargemaster for the COPCs are contained within the hospital chargemaster.
All COPCs use the same group of charges, which we call global charges. Based on the charge
clerk’s location, the revenue is routed to the appropriate cost center. So, only a single set of
charges exists for all COPC locations. Are any of the COPC classified as a Provider Based
Clinics? All locations that provide hospitals services within the Parkland system are considered

Page 5 General Information Revenue Cycle Activity

117. Based on question 4, could you provide a listing and/or number of high volume hospital
departments and/other entities included in the scope of work.

Page 6 General Information Revenue Cycle Activity

118. Can you provide additional detail regarding you current payer mix? Answered on page 12
(# 104).

Page 24 Section 3 Specifications 3.1 – Chargemaster Scrubbing 3.1.4 Review charge master
to existing interfaces

Parkland would like to have their CDM reviewed against existing interfaces

119. Can you provide a list of Epic applications are currently installed and interfaced with CDM
processes/data? Answered on page 3 (number 25). Additionally, if there are any additional Epic
applications planned for implementation in the next 12-18 months can you provide this list as
well? Additional applications targeted for the next 12 to 18 months are Beacon (oncology),
Phoenix (transplant), My Chart, Care Everywhere and Break the Glass.

120. Can Parkland provide a list of all ancillary and Epic applications that are currently being
used and planned to be interfaced with the CDM? Beacon and Phoenix are future Epic
implementations that will be interfaced to the CDM.
Page 24, Section 3 Specifications 3.1 – Chargemaster Scrubbing 3.1.5 Recommendations
for annual charge master maintenance

121. RFP indicates that Parkland uses MedAssets Code Correct. What are all of the MedAssets
products that Parkland currently uses?

                                           Page 14 of 17
122. In addition to the MedAssets Code Correct tool does Parkland use a CDM maintenance and
/or charge capture tool? What CDM maintenance/Charge capture application is used? Code
Correct is the CDM maintenance tool used at Parkland. Other than limited Epic charge capture
resources, Parkland does not utilize a charge capture application.

Page 25 Section 3 Specifications

123. When was your last strategic pricing analysis completed? 3rd quarter of 2009 What is the
annual process for updating the prices within the CDM?. Market facilities are identified. By
CPT code, procedures are priced at a percentage of market. Surgical procedures are reviewed to
assure base vs more complex procedures are priced rationally. Surgical time, room rates, and
other procedures that are not practically priced at a procedure level are aggregated and aggregate
market determined. A multiplier is applied to each procedure item, to result in aggregate pricing
at market. Amounts are provided to IS through an upload file. Certain departments use different
methodology, such as pharmacy, priced at a markup from AWP and supplies, priced at a markup
from acquisition cost. These areas are identified by a specific category code and are easily
separated from other CDM procedures.

124. Does the strategic pricing scope include professional and technical services or technical
only? Both technical and professional

125. Does the scope include the completion of a strategic pricing analysis or only providing
recommendations related to pricing process, strategy, and methodology? Completion of an
analysis, including assistance in implementation.

If the scope does include a strategic pricing analysis we have the following additional

126. Are line items in the CDM without HCPCS codes (i.e., soft-coded) included in the scope of
the price setting and optimization initiative (e.g., OR Time Charges, Room and Board charges)?

127. Do you have multiple prices (e.g. I/P, O/P, ER, etc.) within your charge master currently, or
a single price? Single price If only a single price, is the CDM capable of handling multiple
prices? Yes

128. Are you looking have a gross and net revenue increase or is this only based on coming up
with a pricing strategy with revenue neutrality? A consistent, rational approach that mitigates
risk associated with large swings in price from year to year is the ultimate goal, however,
Parkland anticipates any approach that meets this criteria is likely to result in increased revenues.

129. Is it expected that every department will be neutral or gross/net revenue positive? Parkland
will review impact at both a department and a net revenue level. Or can the impact be measured
hospital-wide with variances by department (i.e., some departments may be gross/net revenue
negative while others may be positive)? This approach would be considered during the
evaluation process, if benefit to Parkland could be demonstrated.

130. Do any of your payor contracts require prior notification of a rate increase? If so, what time
period is required (30, 45, 60 days)? See question #73

                                           Page 15 of 17
131. Do you currently have a specified day/date that price changes occur (e.g., Jan 1 annually)
While we currently have a specific date that prices change, Parkland is open to other models, such
as more frequent but smaller increases or changing the current annual date.

Page 26 Section 3 Specifications 3.3 HIM/CDM Interfaces

132. Does HIM enter codes directly into EPIC or into an abstracting system? What abstracting
system is currently used? No. We enter codes into Ingenix Encoders System and abstract into

Page 27 Section 3 Specifications
3.3 HIM/CDM Interfaces
3.3.6 Assist with grouping assignment of surgical procedures identified in number four
above to clinic/ancillary procedure group levels; and

133. Please clarify this section above.

Page 27 Section 3 Specifications
3.3 HIM/CDM Interfaces
3.3.7 Review the spreadsheet of procedure names and levels to be utilized in updating the
EPIC charge entry process

134. Please clarify this section above.

Page 28- Section 3 Specifications
3.5 Discounting Policy

135. What type of eligibility assistance process does Parkland utilize to qualify self-pay patients
for coverage? Network Sciences (Austin, TX). Does Parkland utilize outside eligibility vendors?
Yes. If so please provide a list of the vendors. Chamberlin & Edwards, Cardon MASH, DSHS
and HHSC workers on site.

Page 3 General Information

Approximately 40% of the volume is for Professional Services, and billed on the HCFA-1500
claim form. The chargemaster supporting data on these claims is less than 25,000 lines, due in
part to the ability of the patient accounting system to have master (or global) procedures used by

136. Can you clarify if there are 2 CDMs (1 for for professional and 1 for technical services) or
does a centralized CDM exist for both professional and technical services. How many total lines
exist for all of these services? A single CDM, comprised of approximately 25,000 lines exists at
Parkland. This chargemaster contains procedures for both professional and technical services.

                                          Page 16 of 17
Page 26 Section 3 Specifications
3.3.1 Review of a sample of outpatient medical records and billing documents
representative of all outpatient services to ensure that codes submitted on hospital claims
accurately reflect medical record documentation;

137. In the claim review against medical record can you clarify if the scope will include assessing
all codes on the claim (hard coded from CDM and soft coded from HIM)? Review all procedure

Section 3.5 Discounting Policies

138. Can you clarify what is intended by completing a closed audit on managed care contracts
related to the discounting policy? The closed audit does not relate to the discounting policy. It is
a limited audit of claims to determine if commercial payers are paying according to contract

Pages 28 & 34 Section 3.4,Charge Capture and Section 4.5 Approach – Charge Capture

139. Can you clarify if the charge capture portion of the RFP is seeking an assessment and
recommendations only or implementation also? The charge capture portion of the RFP seeks
both assessment and assistance in implementation.

                                          Page 17 of 17

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