Request for Proposal Electronic Health Records / Billing System

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Request for Proposal

Electronic Health Records / Billing System

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I. Overview of HSAO

HSAO is an enhanced service coordination program which works with Allegheny County’s highest risk population of children, adolescents, and adults. HSAO’s child/adolescent and adult service coordination programs were created to meet the complex and specific needs of the individual enrolled in each of these programs. Our primary goal is to link individuals and families with the service they need to improve the quality of their lives. The Child and Adolescent Service System Program (CASSP), Community Support Program (CSP), Recovery-Orientated Service Planning Principles, High Fidelity Wraparound Principles (HFW), and Single Point of Accountability (SPA) Principles serve as guidelines for the delivery of best-practice services in all of the HSAO service coordination programs.

HSAO offers five types of services coordination services:

The LIFE Project provides individualized service coordination for children/adolescents,

and their families, from ages 3 -21 who require intensive behavioral health treatment in the least restrictive community environment. Utilizing a multi-systems approach, the LIFE service coordinator plans, implements and coordinates structured services focused on specialized service coordination, intensive behavioral health treatment and advocacy. The LIFE Project monitors all services to ensure that child and family needs are met; and will also be available to assist clients and their families in accessing resources within the client's home, school and community.

The RTF Group coordinates identified behavioral health treatment for Allegheny County's children and adolescents up to age twenty-one. It is the single point of contact for referrals in Allegheny County.

The RTF Group offers individualized case management by processing RTF referrals, assisting the family in identifying a treatment program for their child and continuous monitoring while the child is in an RTF. Our case managers work closely with families and providers to ensure the delivery of quality services. We participate as part of a team to plan for ongoing mental health treatment, discharge planning and re-integration back into the community

Juvenile Justice Related Services provides individualized service coordination for

adolescents and their families who are involved in the Juvenile Justice System. These clients require coordination of their behavioral health treatment. The goal is to

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Utilizing a multi-systems approach, the Juvenile Justice Related Services plans, implements and coordinates structured services focused on specialized case management, intensive behavioral health treatment and advocacy. The Juvenile Justice Related Services monitors all services to ensure that child and family needs are met.

The Joint Planning Teams are a unique partnership between the Allegheny County

Department of Human Services, Community Care Behavioral Health, HSAO, Family Resources, Allegheny Children’s Initiative (ACI), and Allegheny Family Network (AFN). The Joint Planning Teams are a pilot program in Allegheny County utilizing the High Fidelity Wraparound Model to develop a team based, “family driven” planning process for children and their families. These children are at an imminent risk for a higher levels of care, are multi-system involved and in need of complex service coordination.

The Blended Service Coordination Program assists children and adolescents who

have serious illnesses and serious emotional disturbances in identifying their individual strengths and needs, and supporting the clients and their families in accessing the resources and services that will build upon their strengths, meet their needs and provide them with the opportunity to achieve and maintain stability and success in their communities. Blended Service Coordination services are delivered in the least restrictive environment and are provided with a creative and flexible approach to ensure quality services.

All clients enrolled in the Blended Service Coordination Program will be provided with the following services: assessment, service planning, linking with services, gaining access to services, monitoring service delivery, problem resolution, informal support network building and use of community based resources. All services will be provided in adherence to the CASSP (Child and Adolescent Service System Program) principles.

Additional detail of all of HSAO programs can be found by visiting: http://www.hsao.info

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Overview of Project

HSAO is looking to replace the current case management system with a complete Electronic Health Record (EHR) and Billing system meeting the needs of Allegheny County and the state of Pennsylvania.

HSAO is searching for a single system that can meet both the EHR and billing needs of the company.

The Request for Proposal will be sent to known and responding vendors. The vendors will be required to complete the Requirements section and offer a demonstration of their system. The requirements listed in this document are meant to be high level and to demonstrate what software will meet our high level needs. The selection of a vendor will be based on pricing, experience in the geographically local market, references and requirements met.

Schedule of Vendor Selection

9/3/2013

RFP sent to known software vendors and posted on HSAO website

09/03/2013 to 9/17/2013

Vendor questions submission

10/4/2013

Proposals from vendors due to HSAO

10/7/2013 – 11/15/2013

Vendor demos

12/30/2013

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Proposal Submission

All proposals should be submitted by Friday, October 4th, 2013. Confirmation of receipt of proposal will be provided. The preferred method of delivery is to email all relevant documents to dfreeman@hsao.org . Alternatively a paper copy and electronic copy on disk or flash drive can be mailed to:

Debra Freeman HSAO 2801 Custer Avenue

Suite 1 Pittsburgh, PA 15227

Questions may be submitted by email to Deb Freeman at dfreeman@hsao.org. The timeframe for submitting questions is from 09/03/2013 to 9/17/2013. Questions and answers will be returned to all current inquiring vendors.

All proposals must include:

1. Overview of Company o History

o Size o Location

o Length of time in business and in mental health/social services field o Number of implementations similar to HSAO (similar services and size) o Evidence of financial stability (a copy of the most recent annual audit report) o Any additional information that will help demonstrate the viability of the company

and the product you are proposing 2. Contact Information

3. Experience and References

Please provide at a minimum 3 references of organizations that use the software you are proposing. All of these references should be implementations from recent years. Please do not include any organizations that were part of the original development of the proposed software (from a financial or architectural perspective

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4. Proposed System Overview

o General overview of the system that you are proposing. Please be specific about separate add-ons that might be required to meet our needs if they are not part of

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5. Requirements section of the RFP (See Section IV) filled out.

6. Miscellaneous Questions section of the RFP (See Section V) filled out. 7. Pricing

o Detail the pricing model whether it be company revenue or per seat or another model. List out any additional costs for additional modules not included with the main product (for example, if there is a separate cost for e-prescribing).

o Estimate of implementation costs. Since this cost can vary based on what portions of the software would be used as well as what pieces we would implement on our own, this can be an estimate. We would expect that implementation costs at minimum would include the setup, support, and training for several key users throughout the organization. Using past experience of a similar sized organization to estimate this is acceptable.

o Estimate of data conversion from old clinical/billing system. The amount of data to be transferred is TBD but please provide an outline of how this cost would be calculated as an example estimate.

o

Cost of on-going maintenance and support

based on a time-oriented tier system

(annual at one cost, 3 year at a reduced cost per year, etc.). 8. Implementation Overview

o Breakdown of the stages of implementing the software with estimates of time as well as the responsibility expectations of the software vendor and HSAO. An example should include the implementation of most software functionality for multiple programs/service types as well as multiple funders. Also please outline the proposed training provided during implementation.

9. Other Items

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Requirements

Please fill out the requirements section tables to the best of your ability. If there is an item that is not clear please ask for clarification.

For each requirement select only ONE of the following:

In Place – This requirement is currently available in the system.

Development – This requirement is not available in the system but could be added with

development.

If development is in progress please specify the release date

Not Available – This requirement is not available in the system and there are no plans to

include it.

Comments – Please use this area to add any additional information or clarification, such as

customization aspects and configurable areas of the system. Additional documentation can be provided to expand on any area. Please reference the appendix when providing additional documentation.

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A. Billing

# Requirement In Place Development Not Available Comments

1 Capability to produce 837 files (per the updated 5010 specifications) with an interface to configure file layout per funder. 2 Printable 1500 invoices with an interface to

configure different data placement for various funder requirements as well as printer differences.

3 Ability to upload electronic remittance files (835) into the system with upload reports for what posted, and what did not and an option for manual correction of claims not posted. 4 For remittances not received in an electronic

remittance files, ability to manually enter remittances as well as a “quick” fill down option when an entire invoice has been paid in a check.

5 System can create 271 files and receive 270 files to process eligibility checks.

6 Can attach “codes” to both programs and funders to allow matching to Cost Center, Customer Numbers and Revenue Account when transferred to GL system

7 Configurable exports to send income and reversals into GL system (Epicor) or integration with Epicor Financials to automatically submit income and reversal transactions to appropriate accounts.

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8 Capability of charging the same service to two different funders (split billing) at the same time.

9 Waterfall billing lets unpaid amount(s) from the primary to be charged to a secondary, tertiary, etc.

10 Ability to charge co-pay to client at time of service and once a month recurring. This should tie into the Scheduling module as well when necessary.

11 Process of Coordination of Benefits (co-pay, co-insurance, waterfall billing) can be done on one screen to handle adjustments and secondary billing (including invoice creation) all on one screen and/or in a condensed process.

12 Ability to set up different unit increments for different funders for the same service 13 System allows Time Based and Attendance

Based Service entry

14 Override for a service can be entered at the client level to track different rates, codes and modifiers.

15 Location Code for a service can be further filtered by client’s funding source(s)

16 Services can be restricted or opened to allow multiple staff to provide the same service to a consumer at one time or one staff to provide the same service to multiple consumers at the same time.

17 Multiple rounding options are available (please describe)

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18 A service with multiple modes of service (Billable Time, Travel) can be bundled together when billed.

19 Rules for attendance based services can be configured to determine when a service is billable (IE never, for only a certain number of days, etc) and has an override option for special circumstances

20 Travel time can be recorded either in time or mileage

21 Process to determine if all aspects of the billing have been completed to allow the service to be adjudicated (authorization, Medicaid Number, Address, Etc.)

22 Ad hoc paper invoices can be created to meet different funders (specifically counties) requirements.

23 Comment section to note unique billing scenarios or billing issues related to client for reference purposes

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B. Billing Reporting

# Requirement Out of the

Box

Development Not Available Comments

1 Aged Receivable - Analysis of accounts

receivables broken down into categories by length of time outstanding.

2 Attendance Based Service Detail Report -

Displays a detail of attendance based services for a selected program/client

3 Attendance Based Service Summary Report -

Displays a summary of attendance based services for a selected program/client 4 Billing Consumer Profile - Report providing

demographic, medical and insurance information for a consumer

5 Attendance Exception - Report of all

attendance exceptions for attendance-based programs

6 Authorizations Notice - Report providing

authorizations that are close to reaching the authorized service limit (time and/or unit limitations).

7 Billing Report - Report that provides

invoicing, receivable, adjustment and reversal information for a record.

8 Census Report - Report providing client's

attendance and/or stay and absence for dates of service delivery

9 Consumer Listing - List of consumer with

basic demographic data for a program 10 Client Statement – Reflects history of

services, payments and open balances

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12 Remittance Denials - Report listing denials on

a remittance

13 Revenue Report – Can be generated by staff,

program, service or funding source

14 Service Detail Report - Displays the service

detail broken out by modes of service 15 Staff Productivity Report – Reflects units,

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C. Assessments and Questionnaires

Box

Development Not Available Comments

1 Capability to build forms to collect

Assessment, Tests and Surveys. Should be able to collect multiple data types including: Multi-select checkbox, radio button (single select), dropdown, text box, text area. Checkboxes, radio buttons and dropdowns include assignment of values to each item configured. These items should be able to be put in any order, mixing different data types. 2 Use of “If Then” clauses to eliminate need to enter unnecessary information. Example: If a question obtains a Yes response, then more questions appear, otherwise they are hidden to the end user.

3 Printable version of Assessments, Tests and Surveys will allow each program to design their printed version to meet their needs pulling from other areas of the Client Record (Example demographics, diagnosis).

4 Notifications to monitor and be notified of when subsequent assessments are due.

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D. Clinical Notes

Box

1 Capability to build forms to collect Clinical Notes. Should be able to collect multiple data types including: Multi-select checkbox, radio button (single select), dropdown, text box, text area. Checkboxes, radio buttons and dropdowns include assignment of values to each item configured. These items should be able to be put in any order, mixing different data types.

2 Use of “If Then” clauses to eliminate need to enter unnecessary information. Example: If a question obtains a Yes response, then more questions appear, otherwise they are hidden to the end user.

3 Clinical Note can be tied to billing service (example Case Notes) or independent and just tied to the Client’s Program.

4 Printable version of the Clinical Note will allow each program to design their printed version to meet their needs pulling from the Treatment Plan and other areas of the Client Record.

5 Workflow with clinical note to allow creator to complete the note, submitting the Clinical Note to one or multiple levels of approvers. Approver can sign with electronic signature. Once signed, original clinical note cannot be modified, but changes can be noted with a separate process.

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E. Incident Reporting

Box

1 Capability to build forms to Incident Reports data. Should be able to collect multiple data types including: Multi-select checkbox, radio button (single select), dropdown, text box, text area. Checkboxes, radio buttons and dropdowns include assignment of values to each item configured. These items should be able to be put in any order, mixing different data types.

2 Ability to specify for each item configured which programs this information needs to display for. Information remains hidden for programs it does not apply to.

4 Form needs to be tied to a client’s program. 5 Reports can be created from configured

Incident Report forms with an interface that allows for dragging and dropping of

components to build report and aggregation of data where selected while enforcing proper data joins.

6 Data exports can be formatted to be sent to external sources. Setup of export is

customizable (different delimitations, field positions, field order) to meet the needs of external sources

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7 Paper form of the Incident Report can be scanned into the system and tied to fields to pre-populate the form, eliminating the need to manually enter information. This

functionality is used in programs where access to the system is limited and paper forms are more efficient and timely. 8 Report to allow for debriefing with clients.

Report must be customizable to select what information should be displayed with client. Integration with electronic signatures for client to sign off on debriefing report 9 Workflow with incident to allow creator to

complete the incident, submitting the incident to one or multiple levels of

approvers. Approver can sign with electronic signature. Once signed, original incident cannot be modified, but changes can be noted with a separate process.

10 Alerts can be setup to send notifications and/or appear on a dashboard for identified staff around selected items when they are indicated on the Incident Report.

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F. Medical Information and ePrescribing

Box

1 Medication tracking with a complete history of medication and dosage

2 Track a complete history of immunizations and the status of each including multiple entries for each immunization type (When necessary)

3 Current and history of diagnoses

4 Multiple screenings with dates and history when necessary including, but not limited to: TB, Scoliosis, MISA Drug/Alcohol/Tobacco screen, STD’s and suicide screening 5 History of exams with dates, type of exam,

exam notes as well as next exam due date (tie to alerts below). Exams including, but not limited to: physical (EPSDT), hearing, vision, dental

6 Current and history of height, weight and BMI (auto calculated from height and weight) 7 Tracking of Lab/diagnostic tests with results 8 Current and history of Vital Signs

9 Storage of scanned consents /authorizations 10 Checklist of child development health

concerns

11 Checklist of known allergies with notes for treatment of allergic reactions

12 Health history of previous illnesses, surgeries, etc.

13 Client’s mother’s prenatal history 14 Alerts based on due dates or missing

information for information such as routine physicals, immunizations

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G. Outcomes Data

Box

1 Capability to build forms to collect outcomes data. Should be able to collect multiple data types including: Multi-select checkbox, radio button (single select), dropdown, text box, text area. Checkboxes, radio buttons and dropdowns include assignment of values to each item configured. These items should be able to be put in any order, mixing different data types.

2 Ability to group multiple like items (all checkboxes or all radio buttons) together and auto-sum the values with an output available on the form to users.

4 Form can be tied to a client’s: Program Admit date, Program Discharge date, Program or just to the client

5 Reports can be created from configured outcomes forms with an interface that allows for dragging and dropping of components to build report and aggregation of data where selected while enforcing proper data joins. These reports can be built by limited staff, but published for others to pick parameters and run.

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H. Referral and Intake

Box

1 General demographic information can be collected for prospective client including contacts and funding.

2 Program(s) interest can be indicated for prospective client.

3 Referral information for prospective client can be tracked including referral agency, and the individual general demographic

information.

4 A checklist of pre-test requirements (based on program interest) and ability to enter results as well as diagnosis.

5 Presenting problems can be tracked

6 Prior to an admissions decision being made, a status can be associated to the prospective client to indicate the stage of the process where they stand. Additionally a flag is available to mark urgent needs.

7 Non admissions reasons can be tracked and reported by program and by referral source. 8 Dashboard functionality to display available

census in programs and the number of prospective clients in the referral process. 9 Once admission is determined, configurable

(by program) to indicate what requirements must be met prior to start date.

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I. Scheduling

Box

1 View schedules by client or by staff 2 Appointments need to collect:

program/location, staff, start time, end time, service, notes

3 Appointments need to display: funding source(s), remaining authorizations and co- payment when service is selected

4 Availability can be set for staff to indicate when they are/are not available to take appointments.

5 Group Appointments can be scheduled allowing multiple clients to receive the same service at the same time.

6 Search feature to retrieve available appointments and allow filtering on any of the following: Date, Time, Staff, Location, Service.

7 Staff can print a readable version of their schedule.

8 Integration of staff schedule with Outlook. Appointment must be marked private to not reveal any patient information.

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J. Treatment Planning

Box

1 Capability to build forms to collect Treatment Plans. Should be able to collect multiple data types including: Multi-select checkbox, radio button (single select), dropdown, text box, text area. Checkboxes, radio buttons and dropdowns include assignment of values to each item configured. These items should be able to be put in any order, mixing different data types.

3 Treatment plan will tie to a specific program for the client

4 Option to tie the Treatment Plan to Billable and Non-Billable notes, carrying key information into these notes (example: Goals)

5 Printable version of the Treatment Plan will allow each program to design their printed version to meet their needs pulling from the Treatment Plan and other areas of the Client Record.

6 Once an initial Treatment Plan is created, subsequent Treatment Plans will pull flagged data into the new Treatment Plan to avoid duplicate data entry.

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7 Electronic Signatures can be integrated for clients, parents and/or staff to sign off on Treatment Plan

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K. Misc. Items

Box

1 Configurable dashboards allows home page content to be designed based on user’s role to show information pertinent to their job. 2 Ad Hoc Reporting that allows non-technical

staff to create reports while enforcing data integrity. Reports can be published for others to run with defined parameters. All reports should be able to be provided in PDF and Excel.

3 Security is built around what clients a user can see (at the program or client level) as well as what functionality in the system the user has access to (roles): view, edit and or delete.

4 Mobile version is available with some functionality that allows data viewing, data entry and electronic signatures through a Smart Phone such as an iPhone and/or an iPad.

5 Document Management System is tied to software to allow for the scanning of related client documents. Documents can be categorized and are searchable

6 Voice Dictation software, such as Dragon is embedded in the software to allow for dictation of some areas, such as clinical notes.

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7 A community of software users is available to interact with other users of the software as well as sharing best practices, reports and other customizable portions of the software. 8 Contacts associated to a client can be tracked

with general demographic information as well as linking other clients that are family members (when multiple family members are being served)

9 Clients can be tracked in a facility (multiple facilities per program)

10 Are audit trail logs available including the date, time user and action?

11 Login credentials pulled from Active Directory.

12 Active Directory groups can be used to dictate rights in the system (who and what can be seen in the system)

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Miscellaneous Questions

Please answer the questions below, providing a clear and detailed response. Any additional materials you have to answer these questions can be provided with the proposal.

A) Please describe your current certifications or plans to achieve required certification to meet meaningful use criteria.

B) Detail how the proposed product provides reports to the end user including out of the box reports as well as customizable reporting. Describe what technologies (Crystal Reports) are used to create the customizable reports as well as what level of technical expertise is required to create these reports. Please provide a listing and short description of reports already built in the system.

C) Is the system available as a ‘Software as a Service’ cloud model (SaaS) or a local server-based software?

D) In the case that the software is available in a local server-based model, please describe the technical requirements including hardware and database.

E) Describe, in the past, how you have set up integration with other systems or software (state, local, QuickBooks or other accounting software) to share pertinent data. Do you have the staff to help with these integrations?

F) Describe your support model. What are the hours of support and methods of contacting support? What is the expectation on the amount of time to address a support call? Please describe what qualifies as a support call and what would be considered a cost beyond support.

G) How often are releases available for the product? Please describe the frequency and types of releases (IE patches, major updates). H) How are updates and patches done for a local server-based model?

I) Are user guides available for the software? If so please provide an example.

J) What initial and ongoing trainings do you provide? How are these trainings delivered? If new product features are released what training (materials and training sessions) are available to help understand and implement these modules?

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K) For the SaaS model, describe security protocols for data protection. For example, is all data encrypted? Is one customer’s database kept separate from another?

L) For the SaaS model, do you contractually agree to compensate customers for security breaches that result in a permanent loss or compromise of data?

M) For the SaaS model, do you contractually agree to notify customers of all security incidents?

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Confidentiality Agreement

Declaration of Confidentiality

This request for proposal includes proprietary information on HSAO. Additional information may be disclosed to you as a result of your obtaining and working on the contract to which this quote relates, and the terms of this Confidentiality Declaration shall apply to all subsequently disclosed HSAO information.

This information includes, but is not limited to, equipment specifications, design specifications, software, software specifications, software source code, drawings, component lists, operational and service procedures. The information is the sole property of HSAO, may not be disclosed in any manner, including written, oral, or visually, and shall remain proprietary and confidential to HSAO no matter how it is disclosed to you.

All documentation and information, including financial information obtained by the HSAO from the Vendor, will be used for evaluation purposes only and will be held in the strictest confidence.

Request for Proposal Electronic Health Records / Billing System