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Systems Design WestY T 1\I DESION WEST Trusted EMS Billing I Compliance I Maximized Revenue I Patient -Centered Service Proposal for Emergency Medical Services Transport Billing CITY ov KALISPELL City of Kalispell RFP 2025 Due. August 25, 2025, 2:00pm MDT Proposer: Systems Design West Jennifer Braus Chief Executive Officer 19265 Powder Hill PI NE Poulsbo, WA 98370 (360) 394-7082 admin@sdwems.com SYSTEMS nIESIGN Trusted EMS Billing I Compliance I Maximized Revenue I Patient -Centered Service L: S' I August 18, 2025 Subject: EMS Billing Services for the Fire Department Request for Proposals The enclosed response is submitted in response to the EMS Billing Services RFP. Through the submission of this proposal, Systems Design West (SDW) agrees to the terms and conditions of the Request for Proposal. We have carefully read and examined the Request for Proposal and related materials as were prudent and reasonable in preparing the proposal. We agree to be bound by statements and representations made in this proposal and to any agreement resulting from the proposal. Systems Design West understands its obligation in submission of this proposal. As detailed in the remainder of the proposal, we believe that our processes and pricing are the best quality and most cost-effective option for the City of Kalispell Fire Department, based on decades of experience providing the services required in the RFP in this region_ This proposal was prepared by SDW principals Jenn Braus, CEO, and Mya Perdun, Client Services. The proposal was made without collusion with any person external to Systems Design West. Sincerely, Signed: Name: Jennifer Braus Title: CEO Legal Name of Proponent. Systems Design West, LLC Date: August 18,2025 SYST I : M S DESIGN W LS.I. Trusted EMS Billing I Compliance I Maximized Revenue I Patient -Centered Service Letter of Transmittal 1 Cover Letter............................................................................................. 1 ExecutiveSummary................................................................................................................... 4 CompanyHistory.................................................................................................................... 4 Statement of Financial Stability.............................................................................................. 4 Unique Qualifications.. ...... __ ...... ____ ............... __ .... ............................ ...... 4 Firm/Individual Profile...... ....................................... ................................. .................... 5 Management Information........................................................................................................ 5 KeyPersonnel (Confidential)............................................................................ ................... 5 Scope of Project .................................. .......... .........,..,...... ................................................,........ . 6 BillingProcess. ....................................................................................................................... 6 Implementation................................................................................................................... 7 Work Product and Process..................................................................................................... 7 DataImport & Validation..................................................................................................... 8 ClaimsSubmission............................................................................................................. 9 PayorResponds................................................................................................................. 9 Payments& Deposits.......................................................................................................... 9 CreditCards .......... ......................... ....... ............ ................................. ................... ____ ... 10 AccountFollow-Up.............................................................................................................10 Private Statement Procedure.............................................................................................10 Collections.........................................................................................................................11 PatientServices__ ............................................................................................................. 11 Month -End Review and Closing.........................................................................................11 Additional Services Offered...................................................................................................12 Reporting and Documents.....................................................................................................12 General and Technical Requirements........................................................................................13 Integrationwith First Due .....................................................................................................13 Continuity of Operations Summary........................................................................................13 Compliance and Security Plan ....... .......................... ................. ...,................. .........,.,.,.,,,,.,.,.14 Quality Control (Confidential) ............................................. ................ .............. ...................... 14 EmployeeScreening............................... ....... ............. ......... ................................................. 15 Audits and Audit Results (Confidential)..................................................................................15 Related Experience with Projects Similar to the Scope of Services...........................................15 SYSTEMS DESIGN WEST References (Confidential) Trusted EMS Billing I Compliance I Maximized Revenue I Patient -Centered Service Training............................................................................ Price proposal.................................................................. Option1........................................................................ Option2....................................................................... ....................................................16 ...................................1 6 ....................................................17 ....................................................17 ....................................................17 SYST I : M 5 I]ESIGN W ET.S-[" Company History Trusted EMS Billing I Compliance i Maximized Revenue I Patient -Centered Service Founded in 1989, Systems Design West (SDW) has focused exclusively on EMS billing in the northwestern United States. Our very first client from 1989, the City of Bremerton, WA, remains a client today! The entirety of SDW s business is EMS billing and related services. Within that, 96% of our 300 clients are governmental agencies, ranging from fire districts, fire departments, EMS districts, and hospital districts. Our headquarters and only physical office is located in Poulsbo, Washington. We employ over 100 people, some that report to our physical headquarters, and others that work remotely. All employees are based in the United States, and no work for any client is performed offshore or by a subcontractor. SDW has been performing EMS billing services in Montana since 2018 and currently partners with one of the City's neighbors, the City of Whitefish, for comprehensive EMS revenue cycle management services. The details of the EMS billing services are covered in the "Scope of Project" section of the RFP; since EMS billing is our core business, SDW's approach to the City's work is also a detailed overview of our core business. Contact Information: Jenn Braus, CEO Phone: 360-394-7020 Email: Admin(cb-sdwems.com Statement of Financial Stability SDW is a well-resourced, privately -owned LLC, incorporated in Delaware and registered in Montana in good standing. SDW has decades of continuous financial stability, demonstrated during the 2020 pandemic when we remained fully operational without interruption. SDW maintains one physical office, its corporate headquarters, at 19265 Powder Hill PI NE, Poulsbo, Washington. This Seattle suburb creates a great labor market, with at least five accredited colleges locally that offer Medical Billing & Coding Certificates. Systems Design West has not experienced a labor or skills shortage in over 30 years of operation and offers benefits and continuing education opportunities that have proven to increase employee tenure_ Unique Qualifications Systems Design West is uniquely qualified to provide services to the City, as no other business provides EMS billing services to as many public agencies in this region as Systems Design West or has as much experience with EMS billing in the western United States. SDW has important relationships established with payors, industry stakeholders, and legislative groups that help make us successful and integral to our clients' operations. We consider our work to be an extension of the EMS agency; this is not a vendor -customer relationship, but a trusted partner to handle patients and revenue with the care that we know our clients expect. Since EMS billing is our primary work, we currently maintain NAAC certifications for staff in key positions, which is eleven Certified Ambulance Coders, two Certified Ambulance Compliance Officers, one Certified Ambulance Privacy Officer, as well as a management team with over 100 years combined EMS billing experience specifically in this region. SYSTII:. M S DESIGN Trusted EMS Billing I Compliance I Maximized Revenue I Patient -Centered Service WEST Management Information Specifically for the City's EMS billing, SDW's full management team will oversee all aspects of the City's billing services on an ongoing basis. Since EMS billing is our sole focus, all managers have specific EMS billing experience. Shelley Brewington, VP of Client Services, will be one of two primary points of contact for the City, bringing nearly 30 years of experience in EMS billing and over 15 years in SDW's key leadership. Kim aroppert, VP of Operations, has over 30 years in EMS at all levels, and will oversee the day-to-day operations. Two Certified Ambulance Compliance Officers during onboarding will review documentation and policies, NAAC certified Ambulance Coders from our MT billing team will oversee the billing, along with dedicated MT Accounts Receivable Specialists for follow-up, and at least one Finance Specialist for payment posting and deposit notification. All certified coders and compliance officers remain current on billing practices through ongoing education and training, ensuring full compliance with industry standards. Communication is typically coordinated through Team Leads, but can be a single contact if preferred. One Import Specialist will manage PCR imports. First Due can transmit ePCR data via FTP integration, ensuring a seamless, no -cost process for both parties. Your work will be incorporated into Montana -based functional teams specializing in MT claims, with multiple staff trained on your account for redundancy and business continuity. Our Patient Services team answers all incoming patient calls, as "Billing Services". An organizational chart is shown on page 5; resumes are available upon request. Key Personnel (Confidential) Systems Design West employs over 100 U.S.-based staff trained in various functions of EMS billing, with no work performed offshore. SDW does not subcontract any part of the revenue cycle management process, as detailed in the Scope of Project section. Key leadership staff who will work on the project include (name, title, tenure with SSW), but are not limited to: •Jerin Braus, CEO,10 years •Shelley Brewington, VP Ctient Services, 28 years *Mya Perdun, Client Services, 5 years -Nicole Jones, Enrollments Manager, 8 years *Atissa Christenbury, Education Director, 8 years -71 *Hope Logue, Billing Manager, 12 years *Megan Owen, Payor Team Lead, 15years -Kim Droppert, VP Operations, 5 years -Carmen Rusnak, Finance Manager, 6 years *Shyan Hoefer, Compliance Officer, 11 years 5YSTL NI S DESIGN Trusted EMS Billing I Compliance I Maximized Rr venue I Patient -Centered Service W1(.:SS,F While other team members will assist with day-to-day operations, the named individuals will lead the work, provide management oversight, ensure compliance with customized processes, handle onboarding, and perform all other functions outlined in the Scope of Project section_ Mya Perdun, Client Services, will be the Primary Point of Contact, if the City prefers a single contact. Largely influenced by the global pandemic, SDW has invested in technology to support virtual meetings. All SDW staff are equipped with webcams and virtual meeting software. allowing any team member to meet "face-to-face" with clients on short notice. We also offer a process for clients to conduct annual financial audits virtually with our audit teams_ Management can easily visit the City over the normal course of business should a need or desire arise. �uem srrv� Irim1KYE -Finor'" SwIaN.15 Tom o m19�r d T"M I.r & loam TE man & o' c SIIIC1k11Y w TgmLwtl � ?umL�rtl 9F7E r� MRnper 15 FTE, 2 ME la yau. 6 y"to 114yrn, S yre, Byre) PTE S 7 yMn Punllt AR PrM.y AR E'nrplimgnl& t SR4cfoli4Se — swrallhk _ In Lyon�. iuman Imporl. Spucw Ju:c Ill SP..W1 to 13FTTi PTE BFfB 2FTE IFTF_1 PTE Pelient 9trhlcnYa Tleni,Rar 4Lr 105. R 5 .0p ;, $PpeMl.ki L vorlhl. t sp.einyel 6PY IPTi' 1KIk Systems Design West provides customized EMS billing services, with many aspects of the process able to be tailored to the City of Kalispell's needs. We supply all labor, materials, and equipment necessary to perform the work. Billing Process As a leader in the EMS billing industry for 35} years, we have proven procedures and policies proven successful for our clients. We have developed a comprehensive database of valuable information and established connections with professional resources throughout the industry. Our focus on customer service begins with caring and compassion for the patient, and the belief that we are a direct representative of the City to its citizens. This mission is consistent throughout our entire process to ensure that we are conscientious stewards tasked to recover the public funds without bias. SYSTEMS DESIGN Trusted EMS Billing j Compliance I Maximized Revenue I Patient -Centered Service WLST, Our process is specifically optimized to serve public EMS agencies in the western US as our core business. For Montana clients, we assign department experts in MT claims processing. Our staff is uniquely familiar with the City's primary payors, including Noridian, MT Medicaid, 1HS, and other local payors, submitting all claims per applicable laws. We also build relationships with the receiving hospitals, such as Logan Health Medical Center, to ensure a seamless flow of patient information for efficient claims processing. SDW provides billing services to the City of Whitefish, MT, that transports to Kalispell hospitals, and thus have processes established to obtain insurance information. The primary role of a first responder is to administer aid, and as such, we recognize that they may be unable to gather billing details from seriously ill or injured patients, Understanding this, we incorporate procedures to obtain missing or correct information. These include direct hospital access for current insurance information, skip -tracing, insurance portal access, and insurance discovery and verification through Payorl-ogic. Implementation Systems Design West has dedicated management and Enrollments staff for onboarding new clients, a process typically completed in 3-5 weeks and included in our services. Mya Perdun will be the City's primary contact throughout onboarding and beyond. Our Onboarding Team manages updating all payor enrollments and setting up electronic access across payor portals. The Onboarding Team builds custom webpages, invoices, and statements for clients. Additionally, client onboarding includes a detailed PCR documentation compliance review with actionable feedback, as well as a review of fees and policies against industry best practices. Training will be provided to City staff to ensure a smooth transition. Our management team has completed hundreds of successful onboardings and regularly advises clients on billing and collection policies, financial projections, communications, reporting requirements, and much more. With hundreds of years of combined EMS billing experience, SDW's expertise is unmatched. We do not foresee significant time commitments from the City, beyond providing written policies, fees, and coordination on appropriate access. The majority of the work is conducted via email and brief check -in meetings as needed or requested. Worst Product and Process The work SDW performs is outlined in the process map below and includes customizations such as billing review and error correction, payment and deposit notifications, refund processing, collection write-off approval, and comprehensive operational and financial reports. The claim processing overview is shown in the graphic below, followed by a detailed explanation. SYSTT- M S DESIGN Trusted EMS Billing I Compliance 1 Maximized Revenue i Patient -Centered Service VI! L'S_f. Data Tran¢fer tG $Illing Ageney ra Aptplrrpun u,So 13411-0 soRwme Process * Cpael _ Imports Billing •eeaueu R.aeawanta Anenee Patlont Services Aptnl610*110n a MansOHRsnt Payer Follow-up Data Import & Validation Patient Follow-up [+a ffimpmN 9mC atMawarki. ,Rom Pauft • tali fthml a � Oph PMl "i, flsswett Supporting P1'Deesses RpfMQ�i 4 Oak" Audkim In the initial phase, First Due ePCR data is securely transmitted from the ePCR servers to SDW's servers, with seamless export and data field trapping between the ePCR and SDW's billing software. Many SIDW clients use First Due ePCR, so this is a familiar process for the team. Data is automatically imported into SDW's billing database, initiating the billing process. Once an account is established, it is processed through a series of data validity checks. Research specialists use tools such as LexisNexis (Aocurint) and hospital access to confirm patient identity and insurance coverage, along with PayorLogic and other verification resources. Shortly after receipt, a Billing Specialist reviews the incident and prepares the claim. Insurance eligibility is checked electronically via clearinghouses such as Waystar, Noridian, and MT Medicaid. SDW will establish a process with the receiving facility to quickly obtain insurance information. If provided, hospital facesheets are reviewed alongside the PCR for accuracy. Once validated, each ePCR and its attachments are examined for completeness and accuracy. Missing or incorrect information is reported to the City for correction, and recurring documentation issues (e.g., missing patient signatures) are addressed immediately with the client. SDW develops customized training for crews or QA teams when problem areas are identified. If a patient signature is missing, a letter is mailed to the patient requesting a signature. SDW utilizes electronic forms to collect patient authorization signatures as well as updated insurance information from the patients. For motor vehicle accidents (MVA), a separate letter requesting MVA insurance is sent. All patient mailings include clear, customized messages explaining why the letter or invoice was sent (e.g. denial description messages, co -pay owed messages, etc.), SYST Ly M S 0ES ICi N W Es' F Trusted EMS Billing i Compliance i Maximized Revenue 1 Patient -Centered Service along with a request for insurance information and signature. The City may further customize the patient mailings, if desired. Billing can also provide weekly claims reconciliation reports tailored to the City's needs. Claims Submission After patient demographics and insurance information are validated and the claim is coded per the trip report and narrative, the claim is submitted. If insurance information cannot be located through payor research, an invoice is sent to the patient requesting completion of an Insurance Information form. if the PCR is missing an Assignment of Benefits signature required by the patient's insurance, the patient is invoiced with a message requesting the signature. Once the payor is identified, claims are sent electronically whenever possible — over 90% are submitted this way — or by mail if the payor does not accept electronic claims. Our software immediately returns claims status response to our Accounts Receivable Department for follow- up. If a claim is rejected from the clearinghouse, we are notified before the claim reaches the payor and is re -billed — typically within 24 hours. If additional mediation or appeal is needed, our Appeals Department are experts at navigating the various insurance company's processes. Recognizing that private payors often have lower collection rates and longer payment timelines, we work to convert as many claims as possible to insurance payors, which are typically paid In - full and faster. We avoid unnecessary full -balance write-offs by performing a second -level review of every case — one reason our net collection rate exceeds 90% for clients. Payolr Responds When a payor issues payment via electronic funds transfer (EFT), credit card, or check, our Finance Specialists verify it against the charges and EOB for accuracy. If the payor's response requires additional information or is incorrect, our Claims Specialists research the account and track it to resolution. Denials, including the reason, are posted and sent to the Accounts Receivable Department for follow-up. Payments & Deposits Systems Design West primarily bills for municipal and county fire organizations, so our procedures are built around close client coordination. Whenever possible, EFT payments are established, with a Finance Specialist posting and notifying the City daily, typically within 24 hours of receipt. Physical payments from insurers and patients, along with other mail, are sent to our P.O. Box in Silverdale, WA. For security, checks are scanned upon arrival to create an electronic copy and remain under dual -control procedures until deposited. If the City intends to use a lockbox or its own address, alternative processes will be put in place to accommodate. SDW uses iStream, a universal check scanning service, to deposit checks directly into the City's bank account at no cost — often reducing current deposit expenses. Clients are notified by their preferred method once payments are posted; currently, we email Transaction Journal details for each deposit, EFT, and credit card/ACH transaction on the day of deposit. In addition, we provide a Deposit Reconciliation Report that ties each deposit to the individual payments and accounts posted, ensuring a complete audit trail and supporting the City's reconciliation and audit processes. SYs,4Nws E ~:S KG N Trusted EMS Billing i Compliance i Maximized Revenue I Patient -Centered Service W ES,Y If overpayment is identified, the account is scheduled for refund within the week. For insurance payors, a recoupment (takeback/offset) is submitted to apply against a future payments. if owed to a patient or when recoupment unavailable, refund paperwork is sent to the City with instructions for issuing a check; once the City confirms payment, the account closed. Credit Cards Systems Design West partners with RevSpring, a PCI-compliant e-payment portal that accepts credit, debit, HSA cards, and e-checks. Patients can log in to view balances, download statements, set up City -approved payment plans with automated withdrawals, and more. A customized customer service representative (CSR) portal is available to both SDW and the City for full transparency. Used by many hospitals nationwide, RevSpring enhances patient satisfaction with its secure platform, professional design, and Improved information access. If the City adopts RevSpring, it may either absorb the standard 2.95% processing fee or pass it to the patients. There is no implementation fee for the City. If preferred, SDW can work with the City's existing credit card processor instead. A demo of RevSpring is available at any time. Account Fallow -Up Our billing system offers reports and tools for managers and specialists to track each pending claim, ensuring timely follow-up and preventing accounts from being left in limbo. We prioritize identifying and billing secondary insurance quickly, along with reviewing payment accuracy, EOBs, refunds, and denials. Account follow-up focuses on managing aged receivables and re - billing outstanding claims as needed to secure prompt payment. Private Statement Procedure Our standard process, refined over three decades, can be customized to the City's private billing schedule. Patient mailings and messages are fully customizable, and a sample of the patient mailings are available upon request. Invoice: Sent for a single incident and clearly stating any balance or co -pay due, missing insurance information, required signature, and/or insurance inquiry form W always with a message explaining why it was issued. Invoices are mailed only after insurance responds, or after 45 days with no response and at least one follow-up attempt. First patient statement (30 Days). Sent for all open incidents, incorporating invoice messages and explaining the balance due. Second statement (60 days): Requires a documented phone call to the patient and/or hospital inquiry, plus another insurance discovery search. All actions are documented in the patient account history. Final statement (90 days): Requires one additional phone contact and hospital follow-up if needed. The Final Notice is included in this statement. After completion and documentation, the account is ready for collections at 120 days. SYSTEMS E )E : iC N Trusted EMS Billing I Compliance i Maximized Revenue I Patient -Centered Service W ES`F If any statement is returned as undeliverable or there is no patient phone number, we use skip - tracing, PayorLogic, and hospital records to update contact information. A phone call during the second statement stage also confirms the address for future invoices and statements. Collections To effectively collect ambulance service fees, SIDW has dedicated teams for timely follow-up on pending insurance claims and patient balances. Recognizing these patients are part of your community, we follow the City's established collections policies and procedures for unpaid accounts. In coordination with the City, we apply appropriate notices and dunning messages on statements and phone calls until an account is deemed uncollectible and sent to the City's chosen collection agency. In rare cases of extreme financial hardship, SDW will contact the responsible party to collect financial information and present the case to the Fire Chief for consideration of adjustment or relief of charges, in accordance with City policy. We provide a complete history of all billing activities prior to transfer and can assist in selecting a collection agency, though we will work with whichever the City designates. Per the RFP request, SDW can provide guidance and recommendations on selecting a collection service at no charge to COK. Patient Services Fire departments and EMS providers are a vital park of their communities, and SI]W recognizes we represent you in every patient interaction, Our approach is professional, helpful, and caring, reflecting the attitude of the first responders. Billing statements and invoices include a toll -free number, website, and email for patient contact. We provide live Patient Services support from 9:00 a.m. to 7:00 p.m. MT Monday — Thursday and until 6:00 p.m. MT on Friday, accommodating evening call-backs. All voicemails are returned within one business day. Statements and invoices are customized with the agency logo for a familiar, official appearance. We maintain a customized web page, linked to the City's website (see sample at ems patient.comisampie), which can include downloadable Assignment of Benefits and Insurance Information Request forms, Notice of Privacy Practices, online payment links, billing information, and contact details. Patients can call the toll -free number and will always talk to a live person. All Patient Services staff are trained in your billing procedure and have immediate access to the City's written policies to ensure accurate, courteous assistance. If a patient has billing concern, we first determine if additional coverage can be applied; if not, we offer payment plans per City policy, We work with attorneys to fulfill billing and medical record requests in compliance with HIPAA. If a bill results from an insurance denial, we explain the reason to the patient and, when appropriate, assist in submitting an appeal. We strive to resolve all billing disputes, but if a patient requests to speak with someone about policy, we take their contact information, notify the City, and relay the details so the appropriate person can respond. Under no circumstances do we direct patients to contact the City directly regarding transport billing matters. Month -End Review and Closing Once all transports for the month are processed, SDW begins month end closing with a run count reconciliation with the City to confirm all transports have been billed. We then conduct an SYSTLiMS DESIGN W E S' F Trusted EMS Billing I Compliance I Maximized Revenue I Patient -Centered Service internal audit to verify transactions, identify errors, and review the City's pending balances and payments to ensure trends are as expected. Any issues — such as a large pending balance with a specific payor — are noted, researched, and discussed with the City along with next steps. The City can choose its preferred level of involvement and communication during this process. Additional Services Offered Other Expertise and Services Offered Documentation & Compliance Training We believe compliant billing begins with complete, well -documented patient care reports. Our Compliance & Training team offers presentations, recorded webinars, and live or onsite training — using the City's own documentation as examples when needed. Customized Reporting Web Access Portal Our secure web portal provides on -demand access to financial, operational, and patient billing data. The customizable reporting module can generate reports from any data in our billing system, delivering not just numbers, but actionable insights. With a large regional database, deep industry experience, and in-house report design, we can quickly create tailored reports in a usable format. A new client dashboard with real-time analytics will be available in 04 2025. Regional Education Events and Access to Education director Our Education Director hosts no -cost, region -specific events offering actionable updates on topics Mobile Integrated Health, HIPAA, insurance changes, and Medicare/Medicaid audit trends. These events also provide networking opportunities for providers to share EMS and billing challenges and successes, The Education Director — an accredited CAC, CACO, CAPO senior staff member — is available to the City for questions or meeting anytime_ Patient Information Web Page We create a customized webpage for each client during onboarding, designed to supplement the City's existing website and recommend linking it. The web address appears on every patient invoice and statement. The page can include downloadable forms, Notice of Privacy Practices, FAQs, online payment links, billing details, and contact information. Please visit ems patient. comisampie for a sample. Enrollments & Revalidation Our Enrollments and Onboarding teams specialize in Medicare, Medicaid, and other payor enrollment and revalidation. While providers typically handle this themselves, errors can significantly disrupt revenue. We manage the process, monitor and update information as needed, and prepare documents so the City usually only needs to sign. Cost Recovery Billing Services As a separate service, Systems Design West provides cost recovery services for clients that wish to bill to recover costs for motor vehicle collision cleanup, hazmat response, fire inspections, illegal burn violations, and much more. Reporting and Documents SSW uses highly customized software for billing and reporting, capable of producing both standard and specialized reports, including by cost center. While our standard reports generally SYS'll" MIS DESTON W LS'I' Trusted EMS Billing I Compliance I Maximized Revenue i Patient -Centered Service meet clients' internal auditing needs, we can tailor reporting to the City's requirements and preferred format. As part of onboarding, we will conduct a reporting needs assessment to customize both operational and financial reports, which are accessible via our secure web portal. Reports can also be emailed on a set schedule or upon request. A new client dashboard will launch in Q4 2025 to provide real-time performance insights, complementing the current web portal. Samples are available upon request. In addition to the monthly reports outlined in this RFP, SDW can generate customized reports designed to strengthen the City's billing process and analytics, and provide additional reporting on uncollectabie accounts and payment plan status in the format required by the Fire Chief. At a minimum, SDW can provide the following reports via email to the KFD Fire Chief on a monthly basis, or upon request (due date to be established jointly after award): A. Monthly Invoice Listing B. Monthly Call Summary C. Change Detail D. Change Summary E. Credit Detail F, Credit Summary Q, Aging Detail H. Aging Summary I. Accounts Receivable Balance We also provide audit support for annual financial audits and any other audits or reviews conducted by the City or external agencies. This includes timely access to historical billing, payment, and adjustment records, reconciliation reports, and any supporting documentation requested_ As revenue experts, SDW also provides revenue projections and analyses at no additional cost. Using robust analytical tools, we can model the impact of rate increases, policy changes, and other operational decisions, delivering data -driven insights to support informed choices. Integration with First Due SDW integrates directly with First Due via secure data transmission, with seamless export, field mapping, and automatic import into our billing database to initiate the billing process. Continuity of Operations Summary Systems Design West employs an active Risk Assessment tool that it uses to identify and mitigate risks. The tool is regularly updated with best practices, and as new risks are found, mitigations are put in place. Part of the Risk Assessment is the active Disaster Recovery Plan, routinely updated to support our IT and physical infrastructure. This is a confidential document and is available upon request. SDW partners with third -party IT services that include a 24/7 5YS"1 1 ; M S IDES I G N Trusted EMS 8ifling i Compliance I Maximized Revenue I Patient -Centered Service W ES-1 Network Operations Center (NOC) and 2417 Security Operations Center (SOC). All network and security issues, no matter how small, are addressed immediately. For example, every phishing email received at SDW is sent to the SOC for a threat review. Since SDW is within Poulsbo city limits, SDW utilities are all maintained through well -established channels and are not susceptible to outages. Compliance and Security Plan All documents and electronic data containing protected 0 health information (PHI) are handled in compliance with --joj HIPAA privacy and security rules, including the HIPAA Security I Rule_ SDW confirms patients have signed an "assignment of Compliant benefits" form authorizing information sharing with insurers and payment acceptance. New employees receive extensive PHI disclosure training, with all staff completing at least annual HIPAA and quarterly cybersecurity training. Periodic audits ensure compliance, and annual refresher training with a required knowledge check is logged for every employee. We are the sole occupant of a 12,200 square foot Class A office building that is secured at all times, It is equipped with 24/7/365 monitored security system. Access to the in-house data center is cypher lock controlled for access by select individuals only_ Computer system and network access are controlled via a two-tier authentication process and the passwords are changed routinely. The redundant network firewalls are configured to only allow predictable safe traffic and thwarts attempts to port sense into its environment. Within the firewall, servers and individual systems are virus protected to prevent such intrusions that disguise themselves through e-mails, attachments, executable files and macros. The virus protection is enabled to update automatically on a prescribed scheduled basis. Both the firewall and the servers are continuously monitored by an external IT security company. All PHI is encrypted enroute and at rest. We undergo routine cybersecurity evaluation and updates quarterly to keep up with industry best practices. Quality Control (Confidential) Systems Design West understands that correct, compliant claims are paramount to the billing process. More than any set of processes, SDW maintains a culture of compliance, spanning billing rules, HIPAA, and data security. Strictly speaking for billing compliance, SDW focuses on a three -pronged approach. First, all people responsible for billing and coding are thoroughly trained, with documented processes and checklists. All new billets have their work reviewed for the first six months of training. Second, SDW uses its billing software and clearinghouse, Waystar, to ensure claims are complete and correct to go to the specified payor. Finally, SDW Compliance performs monthly audits of each biller's work to ensure that processes and billing guides are followed completely. These audits include spot checks of every biller, an audit of all modifiers associated with emergency levels of service, audit of claims with GY modifiers, payment posting audits, and a review of all full balance write-offs. SYSTEMS nr•.SIGN W ESJ- Employee Screening Trusted EMS Billing I Compliance I Maximized Revenue I Patient -Centered Service Systems Design West completes LEIE and SAM database checks for every employee monthly to ensure no employees are listed. Before their start date, all new hires receive a background check and are checked against LEIE and SAM database. SDW affirms that no current employees are included in the QIC's LEIE database. Audits and Audit Results (Confidential) Systems Design West is routinely audited, typically annually, by its clients for all aspects of the revenue cycle management process, from claims coding to payment posting and adjustments. These audits can be performed at SDW, at the client location, or virtually. To date, SDW has never "failed" a client audit where the client requested additional review. For 30+ years Systems Design West has been managing dispute resolution with Medicare, Medicaid and other insurance payors. Payor audits are a routine part of the revenue cycle management process with which SDW has significant experience. Systems Design West regularly provides audit support to its clients in the event of a payor audit. Typically, most are routine audits where we have familiarity with both the auditor and the target to allow us to fine-tune our response and appeals process to ensure maximum success. To date, an SDW client has never failed an audit. Since EMS billing for public agencies is SDW's core business, we have hundreds of comparable projects, including in Montana, where we provided customized, full -service EMS billing services to like agencies. The specifics of our work on similar contracts are detailed in Scope of Project. Systems Design West's clients vary greatly in size, with the majority of a similar size to the City. Given that the City of Kalispell is an average -sized client in an established geography, it will fit seamlessly and successfully into our operations. Systems Design West has decades of demonstrated experience to effectively manage the size and scope of the City of Kalispell's billing needs. The References provided below are all similar and relevant projects to this RFP. SYSTEMS DESIGN Trusted EMS Billing I Compliance I Maximized Revenue i Patient -Centered Service W L'S_I. The below Systems Design West references are all public EMS providers in the western U.S. of similar size for whom SDW has provided the same services that are requested in this RFP. Agency Name Title Addres Telephone E-mail s McCall Fire Amanda District 201 208-315- admin@mccallfire.com Protection Keaveny Admin [7eini)ardLn 7066 District Specialist McCall, ID 83638 Clackamas Rick Division 11306 SE 503-742- rick.huffmsn@clackamasfire.com County FD #1 Huffman Chief Fuller Rd. 2652 Milwaukie, OR 97222 Whatcom Holly Operations PO Box 360-384- hlinville@wcfd7.org County FD 7 Linville Division 1599 0303 Assistant Ferndale. WA 98248 Marysville Chelse Finance 1635 360-363- cmeinnis@mfdrfa.org Fire McInnis Director Grove St. 8509 Department Marysville, WA 98270 SDW provides a wide range of no -cost training, guidance, and consulting to support compliance, optimize billing performance, and strengthen the City's internal processes. During onboarding, we conduct a comprehensive crew documentation review and deliver customized training tailored to the department, using examples from its own PCRS. Training$ are available in person, via live webinar, or as pre-recorded sessions for on -demand access. Our Education Director also hosts regional education events on topics such as HIPAA, payer requirements, Medicare/Medicaid updates, and other EMS revenue cycle topics. No training is required by the City. Ongoing support includes: • Annual training highlighting common documentation issues and best practices for billing success. • Guidance and consulting on setting billing rates, optimizing collections, and tuning accounting procedures. • Training for administrative staff and the Fire Chief on best practices for ambulance billing workflows, reconciliation, and reporting efficiency. • Consulting with the City and Fire Chief on selecting a collection service, including presentation and discussion of pre-collections/soft collections, full collections, and the pros/cons of each approach. • Annual review of the City's Notices of Privacy Practices and patient confidentiality procedures to ensure compliance with current requirements and best practices. SYSTLEI]ESICiN Option 1 Trusted EMS Billing i Compliance I Maximized Revenue I Patient -Centered Service For many reasons, SDW generally establishes its customer contracts on a fixed dollar - per -incident basis instead of a percentage of revenue collected. The flat -fee pricing is $24.00 per billable incident, plus actual postage for invoices and statements sent to patients on behalf of the City. If the City offers non -emergency transportation services, the actual cost of certified mailing for PCS request will be charted separately in the event the PCS was not obtained at the time of transport. If the City does not currently provide non -emergency transports, this cost is not anticipated. A CPI -increase may occur to the fiat -fee pricing only, no more often than annually, with minimum 90 days' written notice. Open accounts transferred from a previous billing agency for additional follow-up will be charged $40.00 per incident. A primary reason for a fixed dollar -per -incident is compliance and best practice. The OIG has stated its opinion 98-01 that third -party entities responsible for billing and coding use a fixed -fee percentage. This is because, as a third -party, we are responsible for the submission of charges to the payor, and a fixed fee removes all financial incentive (i.e. suspicion of fraud) from the third -party entity and the provider for upcoding. This protects both parties from the investigation of fraud, including False Claims Act allegations. For pricing transparency, based on our estimates using SDWs collection rates of other clients, SDW believes the Option 7 to be approximately equivalent to 3.5% of revenue collected, which is a lower price than Option 2. Option 2 While SDW agrees to the flat fee as stated above in Option 1, we would be open to offer the City a second pricing option. For the services named in the RFP, Systems Design West's Total Fee Percentage is a price of 4.5% of revenue collected, Open account prices are the same as Option 1. In either option, service fees related to consumer payments (NSF, chargebacks, returned checks, processing fees) will be borne by the City, although balances are often passed onto the patient.