Request for Proposals Hospital & Clinic Billing and Revenue Cycle Management Services Rural Health Enterprise
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Request for Proposals Hospital & Clinic Billing and Revenue Cycle Management Services
Rural Health Enterprise
March 2026
1. Project Overview
Rural Health Enterprise (RHE) is soliciting proposals from qualified and experienced vendors to provide comprehensive hospital and clinic billing and revenue cycle management (RCM) services. The objective of this RFP is to identify a partner that can improve billing accuracy, optimize reimbursement, ensure regulatory compliance, enhance overall financial performance, and provide exception value through high quality services.
A priority for RHE is identifying a business partner who can achieve these objectives and while maintaining values aligned with those of our organization. The selected partner must be willing to enter into a master services agreement that includes pricing reflective of the collective NPR of our member hospitals and recognizes the value of the administrative support provided by RHE. The selected vendor will work collaboratively with the hospital revenue cycle and finance teams, as well as RHE.
2. About Rural Health Enterprise, LLP
Rural Health Enterprise ("RHE") is a limited liability company owned by The Rural Collaborative and 24 rural hospitals located in Washington. RHE serves rural public hospital districts across Washington. We bring the power of a collective to over 30 independent health care systems across administrative, financial, and operational service lines. Our high-value, mission critical programs and services offer the benefit of being part of a large system, while still maintaining local, rural independence. Organization core principles include:
Purpose: To strengthen rural health by leveraging our collective power.
Mission: To create independence through interdependence by providing unparalleled value to rural health providers through exceptional services at competitive prices.
Vision: To become the "go to" resource that rural health providers can depend on and enable them to thrive.
We are interested in conducting an independent review of selected revenue cycle partners to determine which organization would provide our hospitals with the best overall financial performance and support. Based on 2025 data, Rural Health Enterprise supports the following statistics across all hospitals:
Total Net Patient Revenue - $2.5B across all TRC members, $65M mean NPR
Current EHR Systems in Use : EPIC Community Connect (13), Oracle/Cerner Community Works (7), Meditech (8), CPSI/Evident (2), and Athena (1)
Hospital data included for analysis is included the 4 excel workbooks Appendix A for the following hospitals:
Lake Chelan Health, Skyline Health, Summit Pacific Medical Center, Whitman Hospital & Health System
3. Scope of Services
The selected vendor will be expected to provide some or all of the following services as indicated in each section. Vendors should clearly indicate which services they provide and describe how each service will be delivered.
Pricing for each service should be based upon the data provided from the 4 hospitals listed above and follow pricing structure outlined in Section 8.
3.1 Patient Access & Front-End Services (optional offering)
Insurance eligibility and benefits verification, including experience with health plan communications via phone, web portal, real-time eligibility, to determine appropriate coverage
Prior authorization support
Medical necessity verification
Admission notifications and authorization management
Patient demographic validation
Financial counseling and point-of-service collection compliant with Washington State charity care regulations
3.2 Coding Services (optional offering)
ICD-10-CM/PCS, CPT, and HCPCS coding
Coding edits and validation
Inpatient, outpatient, and professional coding (for RHC, CAH, Method II, routine professional)
Vendors must demonstrate:
ICD-10-CM/PCS proficiency
APC and MS-DRG optimization expertise
Compliance with CMS, OIG, and payer-specific guidelines
Query management process
Defined coding productivity and/or turnaround time standards
Internal audit program to demonstrate coding accuracy of 95% or higher
If accuracy standards are not met, vendors must provide a formal corrective action process and timeline.
3.3 Charge Capture & Charge Review (optional offering)
Charge entry and validation
Charge reconciliation (describe the level of detail)
Charge description master (CDM) review and maintenance (describe the level of detail)
3.4 Claims Management (required offering)
Claims creation, editing and scrubber management
Timely claims submission, and tracking, including process for prioritization of claims
Electronic and paper claims processing
Clearinghouse management
Rejected and denied claim resolution
Secondary and tertiary billing
Coordination of benefits resolution
Claims must be submitted within defined SLA timeframes, post final coding and charge release.
3.5 Denials Management (required offering)
Denials resolution
Root cause analysis
Appeals preparation and submission
Denials prevention strategies
Reporting on denial trends
Collaboration with upstream departments to resolve operational issues creating denials
3.6 Payment Posting (required offering)
Electronic remittance advice (ERA) set up
ERA posting
Manual payment posting
Refund processing
Daily/Monthly balancing reports
3.7 Accounts Receivable (A/R) Follow-Up (required offering)
Insurance A/R follow-up/resolution
Credit Balance Resolution
Patient A/R follow-up related to insurance or self-pay responsibilities
3.8 Patient Billing & Customer Service (optional offering)
Patient statements and billing inquiries
Facility discounts
Call center services (if applicable)
Tracking and resolution of patient billing complaints
Financial counseling support
Payment plans and collections coordination
Charity Care (processing and determination)
Bad debt identification and reporting
Oversight and coordination of collection agency(ies)
3.9 Reporting & Analytics (required)
Standard and customized revenue cycle financial reporting
Defined Key performance indicators (KPIs)
Realistic goal setting, including a clear roadmap for achieving performance targets
Performance dashboards and benchmarking that include:
oWeekly - Unbilled accounts, claim submissions compared to gross revenue
oMonthly - Root cause analysis of claim edits and denial trends, standard AR benchmark KPIs including, revenue, cash and accounts receivable trending
oQuarterly - Payer scorecards (contract management)
Monthly executive summary prepared by leadership, providing insight into the current status of accounts receivable, key performance drivers and actions taken to meet and/or maintain performance metrics.
3.10 Compliance & Regulatory Support (required services)
Compliance resources committed to each hospital, as well as vendor compliance structure and hot line reporting or reporting mechanisms
Internal Audit and Compliance programs, including engagement of third parties to audit compliance of RCM programs.
HIPAA compliance, including timing of last HIPAA risk assessment
CMS and payer regulation compliance, including any prior investigations and/or enforcement actions and any lawsuits filed/settlements paid in the past 3 years regarding violation of state/federal laws or regulations regarding RCM services
Fraud, waste, and abuse prevention programs
Compliance continuing education and training resources provided to your employees
3.11 Contract Management (required service)
Maintain a contract matrix for billing and patient access team reference
Analyze payments against contracted reimbursement terms
Underpayment identification and recovery
Zero balance account reviews
Payer mix trends with expected financial impacts
Identify opportunities for contract renegotiation or improvement
4. Vendor Qualifications
Vendors must provide sufficient information to demonstrate experience, organizational capacity, and financial stability. Vendors must provide the following information:
Company overview and history
Experience with Critical Access Hospitals (CAH) and Rural Health Clinics (RHC)
Number of CAH and RCH clients served in the last 2 years.
Number of employees and clients
Healthcare certifications (AAPC, AHIMA, etc.)
Ownership structure and financial stability
Minimum of three CAH client references, include length of engagement
Experience serving organizations in Washington state
Case studies from similar rural healthcare clients
5. Technology & Security
Proposals must demonstrate robust technology capabilities and compliance with healthcare security standards. The selected vendor must provide accurate, timely, and secure reporting, as well as maintain the confidentiality and integrity of all patient and organizational data. Proposals should include the following information:
Experience with EHR/ERP systems and software used
Indicate if all claims and denial tasks are handled directly within the host EHR or within a proprietary system
Use of AI or automation in coding, claims processing, denials management, and patient billing
If proprietary technology used to complete work, describe how it improves revenue cycle services
Integration capabilities with existing EHR systems
Ability to deliver custom reports in electronic format suitable for analytics and operational oversight
Data ownership policies
Cybersecurity safeguards protecting PHI and financial data, including HIPAA and HITECH compliance
Business Associate Agreement (BAA) requirements
Business continuity and disaster recovery plans, including breach notification procedures. Disclosure of any material breaches.
6. Staffing Model & Customer Support
The vendor must demonstrate ability to provide transparent oversight, timely updates, and actionable insights to optimize revenue cycle performance. Proposals should include the following information:
Account management and staffing structure roles and number of FTE's per hospital
Workflows and account prioritization
Software specific experience
Rebadge or leaseback options for hospital staff
Onshore vs. offshore staffing (if applicable)
Staff training and ongoing education
Staff turnover rates
Communication plan, including timeliness of communicating issues
Customer support procedures, issue resolution
Maximum account-to-staff ratios defined
Monitoring of staff level performance
Ramp-up timeline for new staff before assigned account responsibilities
Demonstrate the ability to scale operations to support the addition of new hospital clients without negatively impacting service quality or performance standards, ensuring that expansion of services or onboarding of additional clients does not result in reduced service levels, processing delays, or diminished performance for participating hospitals.
7. Implementation & Transition Plan
Vendors must provide a comprehensive implementation plan that ensures a smooth transition with minimal operational disruption. Vendors should provide a detailed description of:
The implementation approach, including governance and contingency plans. The plan should demonstrate the ability to minimize disruption, maintain billing continuity, and achieve operational readiness by go-live.
Proposed tasks, milestones, deliverables and implementation timeline detailing steps from contract signature to implementation
Assessment and evaluation tools used to track deliverables
Data requirement and migration approach
Data reconciliation process
Parallel process testing
Staff training and knowledge transfer
Availability of short-term billing staff during implementation and post go-live to support the transition
Risk mitigation and contingency strategies
Go-live criteria, support and post live stabilization
8. Pricing & Fee Structure
Vendors must provide a transparent and comprehensive pricing proposal covering all the "required" services within the defined scope.
Pricing must clearly identify and separate any optional services or add-on services
If available, vendors should include tiered service options (e.g. Basic, Enhanced, or Premium), along with a detailed description of each level
Pricing may vary based upon organizational size, scope of services and/or EHR platform
Pricing proposals must include performance-based incentives and penalties tied to KPIs
Vendors must include group purchasing pricing that reflects anticipated growth in RHE membership volume
Pricing proposal must be submitted in the excel document provided for each of the 4 hospitals in Appendix A.
The pricing proposal must clearly define the following components
Fee model structure (e.g. percentage of collections, flat fee, per unit pricing or hybrid model)
Base fees, including any monthly minimums
Performance-based incentives and penalties tied to KPIs
Implementation and/or transition fees
Ongoing/Recurring service fees
Optional or add-on services pricing
Rebadge or leaseback staffing costs
Short-term or temporary staffing options
Contract terms, including termination and cancellation provisions
Contract length and renewal terms and conditions
RHE group purchasing discounts based upon anticipated membership growth
9. Performance Metrics & Service Level Agreements (SLAs)
Vendors must provide clear SLAs and performance guarantees with definitions and thresholds for each metric, including measurement frequency, reporting mechanisms, and any performance guarantees or penalties for non-compliance. Metrics should include all aspects of the revenue cycle operations, including but not limited to:
Accounts Receivable Metrics:
Gross Days in A/R
A/R aging
DNFB Days
Clean claim acceptance rate
Initial denial rate
Cash collections as a percentage of net revenue
Point of service collections
Total cost to collect - contracted and inhouse
Credit balance day in AR
Denial rate
Operational Timeline Metrics
Timeliness of required reporting
Claims submission timeliness
Coding turnaround time
Denial follow-up intervals
Payment posting timeliness
Accounts receivable follow up timelines
10. Proposal Submission Requirements
Executive Summary
Detailed Scope of Services Response
Vendor qualifications & References (minimum of three CAHs, including length of engagement)
Technology & Security Overview
Staffing Model
Implementation & Transition Plan
Pricing Proposal - use hospital data workbook
Performance Metrics, Service Level Agreement & Benchmarks
Sample Reports
11. Evaluation Instructions & Criteria
Vendors must provide direct responses to all questions and requirements outlined in this RFP. While detailed answers are expected, responses should be concise and focused, providing sufficient information to demonstrate the vendor's capabilities and compliance without unnecessary attachments or supplemental materials. Wherever possible, answer the question directly rather than referring to external documents. Supporting documentation (e.g., sample reports, workflow diagrams) may be included only when it adds clarity or substantiates your response. Responses will be evaluated based on completeness and relevance of information, accuracy and alignment with RCM best practices, and evidence of experience and capability in CAH and RHC settings.
Virtual Presentation
Dependent upon the Selection Committee's evaluation, vendors may be requested to prepare an oral presentation virtually. The presentation should be less than 90 minutes, inclusive of Q & A. Sufficient notice to allow scheduling and preparation will be provided. Note the scheduled week of presentations in the timeline provided.
Proposals will be evaluated based on:
Scope and quality of services - 15%
Experience and qualifications - 15%
Technology, security & compliance - 15%
Staffing & Customer Support - 10%
Implementation & Transition Plan -10%
Pricing and value - 15%
Performance Metrics & Outcomes - 20%
12. RFP Timeline
RFP Issued: March 19, 2026
Vendor Questions Due: March 24, 2026
Consolidated responses provided: March 27, 2026
Proposal Submission Deadline: April 17, 2026, 5 pm PST
Finalist Presentations: April 27 - April 30, 2026
Final Vendor Selection: May 29, 2026
13. Terms & Conditions
RHE reserves the right to reject any or all proposals
All costs incurred in proposal preparation are the responsibility of the vendor
Confidentiality requirements apply to all submitted materials
Compliance with all applicable federal, state, and local regulations, as well as local hospital internal revenue cycle related policies.
Execution of a HIPAA Business Associate Agreement
RHE master services agreement, inclusive of program support administration fee
Submission of proposal indicates acceptance of the conditions outlined in this RFP
More than one finalist may be selected, final award determined by negotiated contract terms with RHE.
14. Contact Information
All questions and proposals must be submitted through Valify. Please submit one electronic PDF copy by Close of Business (5 PM PST) on Friday, April 17, 2026.
Unauthorized vendor contact with RHE member hospital staff may result in disqualification.
Proposals may be withdrawn or modified in writing prior to the proposal submission deadline. Communication not related to RFP questions and proposal submittal should be directed to:
Name: Leslie Hiebert
Title: CEO
Email: leslie@ruralhealthenterprise.com
Phone: 564-209-5169
