Questions and Answers RFP No. 352606/DS

1. Will the self pay accounts be carried by MD Anderson as active AR at the time of outsourcing (120 days from id of self pay balance) and for the duration of outsourced coverage (6 months), or will the accounts be written off the active aging to a bad debt account, and coverage expectations will be for a collection agency? Answer- Both hospital accounts and physicians invoices are written off to Bad Debt at the time a referral to the collection agency is made, typically on a weekly basis. At that time the responsibility for collection is with the selected agency. 2. The RFP states that multiple vendors can be awarded contract. Is there any general thought as to splitting any of the contracts at this point and if so will vendors be allowed to offer split fee schedules (in the RFP response) as an option? Answer- M.D. Anderson reserves the right to award each respective RFP to multiple respondents. Respondents should formulate their fees based upon this knowledge in the format requested. 3. The Self-Pay RFP outlines the volume for both hospital and physician. Are both s self pay volumes pure self pay and self pay after insurance? Answer-Both. We have patients that are strictly self-pay for the duration of their treatment at MDACC. We also will have patient balances that are due after insurance has paid.

6. What are the terms of self-pay payment arrangements for paying over long term? If term is arranged for >6 months does the vendor keep the account? Answer-If the agency is willing to accept payment arrangements from the patient they may do so. If the arrangement is longer than 6 months, yes, the vendor will be allowed to retain the account to monitor the payment plan. However the account will need to be documented by the agency indicating the terms of the arrangement to prevent any misunderstanding regarding the account return policy. 7. If the self pay account has received the required three statements, and collection activity, is the account returned or kept for the recommended 6 months? Answer-This question is somewhat confusing. Once a self-pay balance has been indicated on the patient account, MDACC will send 2 statements to the patient. If the self pay portion is not paid within that timeframe and internal 90 day collection letter is sent to the patient advising they have 30 days to pay the account to avoid referral to a collection agency. If there is no response in the form of payment or correspondence from the patient, the account is then referred to the collection agency for a period not to exceed 6 months.

8. Can credit card payments be processed via the MD Anderson website or by an onsite representative? Answer-Yes 9. Is it possible to tell us what the current cash collection performance is for each of the 3 RFPs? Answer-Negative 10. What are the Seimens Invision and IDX systems? Answer - These are the patient accounting systems used for hospital/technical billing (Siemens) and physician/professional billing (IDX). 11. Does MDACC require electronic billing for self-pay collections? Answer - We do not bill patients electronically and that would not be a requirement. We would require electronic exchange of information (charges and payments) 12. How many days does MDACC keep a self-pay account before referring to collection agency? Answer - Accounts are placed at 120 days and the patients receive 2 statements and 1 letter. 13.Regarding self-pay accounts, are these accounts in bad debt status that has been written off or are accounts sent prior to going into bad debt status? Answer - The accounts are not adjusted before being placed to the agency. Once at the agency, we do classify them as bad debt for accounting purposes. 14. RE: “Any individual or entity not providing a HUB Report/Plan per attached Rider 104 with this solicitation response that exceeds $100,000…” Is the value of this solicitation expected to exceed $50,000 (for Affirmative Action Requirement)? $100,000 (for HUB Requirement)? Answer -Yes 15. RE: “Contractor will charge a flat rate fee of _____% for all accounts collected.” Is M.D. Anderson requesting a flat rate or fee as a percentage of collections? Answer – Yes. The respondent should supply its contingency fee. 16. RE: Item 17 in Standard Terms & Conditions, where Worker’s Compensation is listed. If a Texas-based agency meets all statutory requirements for insurance coverage under Texas law, including an Occupational Injury/Employer Liability policy with limits of $1,000,000 for both Employer Liability and Employee Benefits, will this coverage be acceptable to meet this requirement? Answer – As long as the policy includes an All States Endorsement and a waiver of all rights of subrogation and other rights against M.D. Anderson. Please note, questions such as these should be addressed by the respective parties legal teams during the negotiation of the contract with an awarded vendor.

17. RE: Section 9, Premises Rules Rider, specifically item P, “M. D. Anderson will not be obligated to pay for labor hours supplied by any individual(s) upon whom a background check and records check is not completed or who fails to meet the standards described in this Rider.” Are background checks and record checks required specifically for this contract? Answer – M.D. Anderson requires this for all contracts in which the supplier will have representatives on M.D. Anderson premises. This contract will most likely require an awarded respondent to have representatives on the premises at some point during the contract term. 18. In Section 12, Sample Agreement, Section 5, only Rider 103 (Standard Terms and Conditions) is checked. Is that the only Rider that applies to this contract, or is this document to be used as an example? Answer – This is a sample. Other boxes will be checked when an actual contract is created. 19. How many vendors will be selected as a result of the RFP? Answer – This is currently not known. M.D. Anderson reserves the right to award each respective RFP to more than one respondent. 20. How many vendors are currently providing the requested services? Answer – M.D. Anderson chooses not to provide this business information, as it may be unrelated to the mode of operation going forward. 21. Who are those vendors? Answer – M.D. Anderson chooses not to provide this business information in this forum. 22. How long has each one of those vendors been providing these services? Answer – M.D. Anderson chooses not to provide this business information in this forum. 23. What are the fees of the current vendors? Answer – M.D. Anderson chooses not to provide this business information in this forum. 24. What rate of return/liquidation has M.D. Anderson received over the course of the current contract on an annual basis? Answer – M.D. Anderson chooses not to provide this business information in this forum. 25. What is the term of the contract out to bid? Answer – This has not yet been determined. The contract will most likely be structured as a one-year agreement with a not yet determined number of renewal options built in.

26. When is the estimated contract award date? Answer – The award date is tentatively scheduled for July 10th. M.D. Anderson does not obligate itself to provide an award on this date, and will reserve a prudent amount of time to properly score each response. 27. When is the estimated contract start date? Answer – This is a fluid date dependant upon numerous factors including scoring, negotiation, review by M.D. Anderson Office of General Counsel and more. 28. Will there be any options to extend the awarded contract available to M.D. Anderson? Answer – Most likely, yes. 29. Why is the contract out to bid? Answer – These contracts are being bid out to comply with State guidelines. 30. When was this service last let out for bid? Answer – There are several services and contracts out for bid in this RFP, so there is not one, but multiple dates depending on the contract. 31. What is the term of the contract currently in place? Answer – See #30 32. Has it gone full term? Answer – See #30 33. Were there any options on the current contract available to M.D. Anderson to extend the contract? Answer – Yes 34. Were those options exercised? Answer – In some cases, yes. 35. Will an oral presentation or site visit be part of the selection process? Answer – This is not anticipated at this time, but M.D. Anderson does reserve the right to utilize these selection mechanisms if necessary. 36. Is M.D. Anderson seeking first-party (in M.D. Anderson’s name) or third-party (in contractor’s name as a debt collection agency) collection services? Answer –Third party collection services. 37. If third party, has any first-party extended office services been provided by any other entity on the accounts to be placed? Answer –No 38. If yes, what did those services include?

Answer –NA 39. As a result of answers to questions 35 and 36, are these true self pay accounts, meaning most if not all insurance has been identified and billed already? Answer –Yes 40. Is it correct to assume that these accounts are primary placements, not having been serviced by any other outside collection agency? Answer –Yes 41. What internal collections does M.D. Anderson itself do on the accounts? Answer –There are no internal efforts except for the monthly statements and the internal 90-day collection. 42. Will accounts placed with current agencies be moved to newly awarded contractors? Answer –This may happen depending on the number of new agencies selected. If yes, please provide the following information: a. The total accounts to be moved b. Average account balance (Professional and Facility) c. Average account age d. Age of the oldest account e. Methodology for distributing accounts to new contractor(s) 43. Can M.D. Anderson provide more detail on how proposals will be scored, such as: a. Review Committee members-Yes b. What areas/categories will be scored? Answer – Respondents will be scored on their response to Rider 101 (including Exhibit A), Rider 102 and reference checks. c. Whether a numerical system will be used, and how it will be applied to the various areas/categories? Answer – M.D. Anderson chooses not to provide this business information in this forum. d. Has the same methodology been used in recent prior bids? Answer – Yes, but there have been updates to the requirements M.D. Anderson requires of the respondents and in some cases the manner in which responses will be scored. e. Have there been any changes in how proposal are scored from the last one? Answer – See #43, d 45. Is attendance at the 6/6 prebid conference mandatory? Answer – No.

77. Regarding the Scope of Work Section pertaining to Self-Pay Collections – are the stated quantities the total of all referrals or estimates of what each vendor selected could anticipate? Answer –These are estimates based on the TOTAL average amount of accounts/invoices referred. These are gross numbers. 77. At what age are these Self Pay accounts typically assigned? Answer –120 days.

77. How many vendors does MD Anderson utilize currently for its Self Pay accounts? Answer –See previous response to same question. 77. Is MD Anderson willing to share your existing self pay collection vendor’s fee structures? If so, what are their fees? Answer –Negative 77. How many vendors will MD Anderson be selecting on a go-forward basis? Answer –We reserve the right to award multiple vendors. 77. What is the historical gross liquidation of the Self Pay Accounts at 6 months (of the #1 performer), for both Hospital and Physicians? Answer –See previous response. 77. Regarding 1.1.17.2. Can MD Anderson clarify this requirement and explain what is meant by the 60/40 split? Answer –Previously answered. 77. Regarding 1.1.20. Can MD Anderson clarify these miscellaneous requirements? We assume all of the collection work will be provided off-site, remotely, correct? Answer –It is our understanding that the majority of the collection work will be performed off site. These conditions are included in the RFP as a point of clarification in the event an agency is required or requests to have representation on site. 77. Regarding the structure of the RFP response. Does MD Anderson prefer vendors follow this Scope of Work Rider 101 as it’s response format and just address each requirement? Answer –Actually both, however following the Scope is acceptable. 77. Who is the current Director of Patient Financial Services? Answer –Miriam Flores 77. Does MD Anderson have a Self Pay, Uninsured Discount Policy in effect? If so, what is the policy? Answer –We do have a policy for both but this information is strictly for internal use.

77. Does MD Anderson second place accounts that are closed & returned after 6 months? Answer –No 77. Is the composition of the inventory, self-pay accounts with no third party funding, self-pay after insurance or both? Answer –Both 77. Will accounts be assigned electronically? Answer –Yes 77. 1.1.9 – A vendor cannot guarantee that the patient will put all the requested information on their check since all checks will be going directly to the hospital. How would the vendor have the opportunity to add missing information? Answer –If the information is no provided we have a process internally that will allow us to accept the checks if the information is not provided.

77. 1.1.9 - Do you want the vendor to accept the credit card number and contact the hospital for credit card processing or do you want the vendor to be the clearing point which would include processing the credit card? Answer –The vendor will need to have full credit card capabilities. 77. 1.1.12.1.2 - Is Texas Medicaid excluded? If so, why? What would the "insurance update" consist of? How frequently would it be provided? Answer –Texas Medicaid is excluded from agency referral. Insurance updates consist of any new insurance information that is obtained by the agency in the course of their collection efforts and should be provided to MDACC immediately. 77. Will M.D. Anderson consider alternate pricing based on a percentage of placement volume received? Answer –No 77. In the event our system cannot process Internet payments temporarily, may we process credit card, wire transfers, and/or electronic check payments over the phone? Answer –In the event that the situation is temporary we will work with the agency on a case-by-case basis to insure the payments are accepted and applied. 77. What is the volume range of dollar amounts to be placed with each contractor? Answer –There is no volume range of dollar limits. 77. What is the average balance of accounts to be placed with each contractor? Answer –Hospital is $700.00. Physicians is $144.00.

77. In regards to Rider 101 Section 1.1.1 – what is the expected age of the accounts to be placed? Early out or Bad debt? Answer –120 days for bad debt.

77. In regards to Rider 101 Section 1.1.1 – If placements include bad debt, would accounts be primary or secondary placements? Answer –Primary

77. In regards to Rider 101 Section 1.1.12.1.2 – Would MDACC provide access to receive UB92 field locator information to be sent upon request in order for client to submit insurance account with all applicable field information? Answer –Yes 70. I believe MD Anderson stated that the accounts receive a letter in about 30 days after self-pay balance is identified, then a second letter is sent in another 30 days, then a final letter is sent in another 30 days which says that if is the bill is not paid within 30 days, it will be sent to a collection agency…is this correct? Does MD Anderson make any “soft collection” calls during this period of time? Answer –Yes and no we do not perform soft collections except for our internal 90day collection letter. 71. When the accounts are placed with the agency via this RFP, is this the first time they have been placed with an agency? Are the accounts written off to bad debt at this time? Answer –These will be first time placements. Yes, accounts are written off to bad debt. 72. I believe MD Anderson stated that when the accounts are turned over to the collection agency, the agency will be sending out letters on MD Anderson letterhead and would be calling using MD Anderson’s name…is this correct? Answer –No. Each agency will need to use their own letterhead. 73. The historical liquidity of the accounts is an important factor in determining what contingency fee should be bid. The existing agency(ies) have a distinct advantage in knowing this information. Without this liquidity information, other agencies may well bid a higher fee than maybe they would. It would be helpful to give this information to all vendors thereby allowing them to make their lowest possible bid which would be to MD Anderson’s advantage. Answer –Lowest possible bid is not the sole determination in our scoring process. That is why we choose not to provide this information at this time. 74. Should the letters on our letterhead that will be a part of the RFP be directed to you (Dustin Serratt) in the salutation? Answer – Yes.

75. Mandatory training is required for the vendor awarded the contract – are ALL collectors required to attend the training, and if so, how many days/hours will the training last? Answer – This would depend on the number of collectors and supervisor/management. We currently have a PBS Training Group that performs routine training for new employees as well as Business Center staff. In the past these training classes have lasted anywhere from 1 to 3 days. We want to insure that our partners fully understand our work processes prior to pursing collection of our accounts/invoices. 76. How many accounts do you place monthly? Answer – Estimated quantities are: Hospital – 1,700 Physicians – 4,500 77. What is the dollar value of those accounts? Answer – Estimated quantities are: Hospital – $2,000,000 Physicians - $1,300,000

78. What are the historical liquidation rates of the incumbents-by category? Answer – M.D. Anderson chooses not to provide this business information in this forum. 79. What are the fee rates paid to the current incumbents by category? Answer – M.D. Anderson chooses not to provide this business information in this forum. 80. Are you going to provide enriched billing data electronically, and how (UB, 1500, 837, etc.) Answer – Previously answered. 81. Will we bill discovered third party directly, or will you on our behalf? Answer – Previously answered. 82. Will we be permitted to pursue potential Medicaid eligibility on self pay accounts? Answer – No

83. Is this project an "active AR" project or are the accounts considered to be bad debt? Answer – Bad Debt 84. Is it possible for a vendor to bid on all 3 RFP’s, then identify the vendor’s preferred proposal for consideration? Answer –Previously answered. 85. Are these accounts that have no insurance or are accounts with balances remaining after insurance also included? Answer –Both 86. What is the average age at placement? And, is there a difference in age between the professional accounts and the technical accounts? Answer –120 days. No difference between professional and technical accounts. 87. Has there been any prior collection activity on these accounts? If yes, was it inhouse activity only or was another vendor working the accounts previously? Answer –No 88. If this is an "active AR" or "early out" project, is the Contractor expected to work the accounts in their name or the name of M.D. Anderson? Answer –Agency name. 89. For the professional accounts, will there be multiple invoices for each account and will they be clearly identified? Answer –Yes 90. For the hospital accounts, will these be for single visits or will recurring (series) accounts be included? If yes, how will the recurring/series accounts be identified? Answer –Both 91. What data elements will be supplied in the placement file by UTMDACC? Answer –This will be determined after the award has been made and accepted.

92. Is the "Comment" report a weekly download of all Contractor notes? If not, can we get clarification of what is required? Answer –Yes weekly download of all Contractor notes. 93. With regards to the "check number" on Contractor invoice, since the Contractor will not receive patient payments directly, is this number the check number for the Contractor's remittance? Or, is this a data element that UTMDACC will furnish in their payment file provided to the Contractor? Answer –Previously answered. 94. With regards to the requirement that all checks be made payable to UTMDACC, can UTMDACC support the use of a bar code on the remittance slip? The bar code would contain the relevant patient information required by UTMDACC. Answer –Yes 95. Clarification please, shouldn't sentence 2 of section 1.1.11 read as follows; "…any amount which becomes uncollectible and which is lost…"? The use of 'or' gives the sentence an entirely different meaning from the use of 'and'. Answer –No or is correct. 96. What specific data elements are required to be provided in the "insurance update" mentioned in paragraph 2 of section 1.1.12.1.2? Answer –Cert number, group number, employee ID, employer, billing address, authorization phone number etc. Insurance update information is pretty standard throughout the industry. 97. What would be the timing requirement for submitting the "insurance update", is that as found (real time), daily, weekly, etc? Answer –Previously answered. 98. In the third paragraph of section 1.1.12.1.2 there is a statement that seems to contradict the first paragraph re payment to the Contractor for a payment received from an insurance company. Can this be clarified? Answer –The third sentence means that if an insurance payment is posted to an account that has been referred for collections, the agency cannot claim a fee if they did not file the claim for the payment. This usually results in payments due to denial reversals. 99. With regards to the filing of insurance claims by the Contractor; is it intended that the Contractor would not be permitted to submit a claim via the UTMDACC electronic claim system (using the custom UTMDACC edits)? See also paragraph 1.1.20.2 and the reference to "software required to process claims". Please clarify the process UTMDACC desires to implement with regard to the filing of insurance claims by the Self Pay collection vendor.

Answer –This means that we cannot grant the agency access to our own internal billing systems. However the agency should have software that would allow them to bill out of their system. 100. Can the phrase, "60/40 split" be clarified? And, how would the guarantor "specify"? Answer –This means that if a patient is paying the balance due, if they do not designate a specific account or invoice then upon receipt of the payment MDACC will divide the payment with application of 60% to the hospital account and 40% to the physician invoice. 101. Will the placement files contain accounts that have both facility and professional charges on the same account? If yes, how will they be identified? From 1.1 it appeared that these would be separate accounts. Answer –the medical record number will identify these. 102. Is there a minimum account balance that will be placed? Answer –No 103. What is meant by the term "routine skip trace"? And, does the definition of "all accounts" mean "all accounts regardless of balance"? Answer –Routine skip trace refers to bad addresses that are discovered in the collection process or accounts MDACC refers that have been returned by the Post Office due to a bad address. 104. What is the "corrective information" that is required as referenced in section 1.1.19? Answer –New address when discovered. 105. Can we get clarification with regards to the requirement that "Contractor will provide…"statement in section 1.1.20? Normally, in a collection project such as this there is no cost to the client except for the agreed upon fee, the cost of connectivity to allow us connectivity into and access to the client's systems and the cost of providing minimal space for one of our staff to obtain copies of documents, etc. Answer –These conditions are placed in the RPF as a matter of clarification to avoid any confusion after the bid has been awarded. 106. Will we be required to provide our own billing forms (UB-92 and HCFA) even if a claim is generated at UTMDACC? Answer –If you have to refile the claim you will need to provide your own forms unless you use our print images. 107. Will UTMDACC provide space (but nothing else) for any Contractor staff that might need to be on-site to facilitate the work on this project? Answer –Yes but the number of staff will be limited due to space restrictions.

108. Will UTMDACC provide the ability for the Contractor to connect to both the Siemens and the IDX systems. Will UTMDACC provide any necessary training to the Contractor staff? Answer –Yes on both questions. 109. Is UTMDACC expecting a specific and/or unique response from the Contractor to each or some of the "Scope of Work" requirements? For instance, for 1.1.15, are specific employees to be named or do we provide an estimate of the number of employees to be assigned to the project? Are examples of letters (1.1.5) to be provided in the response? Do we need to explain, for each of the Scope of Work requirements, how, when, what, and where each requirement would be met? Answer –Previously answered. 110. Is there any objection to a Bidder adding additional clarifying comments to any or all of the Scope of Work items? Answer – Yes. Please do not alter or qualify the scope of work unless you are submitting an alternate proposal. 111. Are we correct in our understanding that all pages of all riders and attachments are to be "initialed" by the Bidder (the signer)? Answer – Yes, that is correct. 112. Is there an expected or anticipated "Cap Amount"? If yes, what is that? Answer – This will not be determined until bids are evaluated and M.D. Anderson has selected the appropriate number of vendors we wish to award the bid to. 113. Do we need to complete the Notice provision in our response or provide the information in an attachment? Answer – No, this will be done when compiling the contract documents with the awarded vendor(s).