HomeMy WebLinkAboutR-2007-183 Advanced Data Processing Inc Fire Dept Billing RESOLUTION NO. 2007-183
A RESOLUTION OF THE CITY OF DANIA BEACH, FLORIDA
AUTHORIZING THE CITY MANAGER TO ENTER INTO AN
AGREEMENT WITH ADVANCED DATA PROCESSING, INC., FOR
RESCUE AMBULANCE BILLING AND RELATED PROFESSIONAL
SERVICES, UNDER AGREEMENT WITH THE CITY OF MIRAMAR,
WITHOUT COMPETITIVE BIDDING AND WITHOUT ADVERTISEMENT
FOR BIDS; PROVIDING FOR CONFLICTS; FURTHER, PROVIDING FOR
AN EFFECTIVE DATE.
WHEREAS, the Charter of the City of Dania Beach, Part III, Article 3, Section 4,
Subsection 0), authorizes the City Manager to purchase supplies, services, equipment and
materials for the city government in amounts in excess of$15,000.00 without competitive bidding
and without advertisement for bids if he is authorized to do so in advance by a resolution adopted
by the City Commission and if such purchases are made pursuant to a competitive bid obtained
within the last twelve (12) months by other governmental agencies such as the federal
government, State of Florida or a Florida county or municipality; and
WHEREAS, the City Manager has determined that medical transport billing services can
be obtained at the least cost to the City by contracting with Advanced Data Processing, Inc., 520
NW 165 Street Road, Suite 201, Miami, Florida 33169, under an Agreement existing between the
City of Miramar and Advanced Data Processing, Inc., executed on June 8, 2007, a copy of which
is attached as Exhibit "A";
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF DANIA BEACH, FLORIDA:
Section 1. That an Agreement between the City of Dania Beach and Advanced Data
Processing, Inc., for Rescue Ambulance Billing and Related Professional Services, under an
Agreement existing between the City of Miramar and Advanced Data Procesing, Inc., executed on
June 8, 2007, is approved and the appropriate city officials are authorized to execute it.
Section 2. That all resolutions or parts of resolutions in conflict with this resolution are
repealed to the extent of such conflict.
Section 3. That this Resolution shall be in force and take effect immediately upon its
passage and adoption.
PASSED and ADOPTED on September 25, 2007.
AT�TQff
MAYOR-CPFMMISSIONER
ATTEST:
L UISE STILSON, CMC
CITY CLERK
APPROVED AS TO FO AND CORRECTNESS:
BY:
T OM J. iNSBRO
CITY ATTORNEY
2 RESOLUTION #2007-183
AGREEMENT BETWEEN
THE CITY OF DANIA BEACH
AND
ADVANCED DATA PROCESSING,INC.
FOR RESCUE AMBULANCE BILLING & RELATED PROFESSIONAL SERVICES.
THIS IS AN AGREEMENT, (the "AGREEMENT"), entered into on ')C°l U3 P, S,
2007 between the CITY OF DANIA BEACH, a Florida municipal corporation, with principal offices
located at 100 West Dania Beach Boulevard, Dania Beach, Florida 33004 (the "CITY"), and
Advanced Data Processing, Inc., a Delaware corporation authorized to do business in Florida, with
principal offices located at 6451 N. Federal Highway, Suite 1002, Ft. Lauderdale, Florida, 33008 (the
"CONTRACTOR").
WHEREAS, the City of Miramar, a municipality in Broward County, in which County
CITY is located, entered into an agreement("Miramar Agreement")with CONTRACTOR dated June
8`",2007; and
WHEREAS, the City of Miramar sought responses from qualified firms to provide medical
billings, collections, and accounts receivable professional services for the City of Miramar's Fire
Rescue Division; and
WHEREAS, the CITY and CONTRACTOR agree that all the terms and conditions of the
Miramar Agreement can be extended to CITY;and
WHEREAS, the parties intend to enter into this Agreement, pursuant to which the
CONTRACTOR will render the professional services to CITY in all respects as provided in the
Miramar Agreement;
NOW THEREFORE, for and in consideration of the mutual covenants and agreements as
set forth in this AGREEMENT,the parties agree as follows:
CONTRACTOR extends to CITY and CITY accepts the same terms, conditions and services
of the Miramar Agreement, a copy of which is attached as Exhibit A and incorporated by this
reference.
IN WITNESS OF FOREGOING, the parties have caused this AGREEMENT to be executed
on CG70 lie:R 2007.
CITY OF DA_NIA BE, a Florida
municipal corporation
V a
By: Al
i
Ivan at City Manager
ATTEST:
Louise Stilson,City Clerk
APPROVED AS TO FORM AND CORRECTNESS:
�-y ,-\� X
ThomL J. s i Attorney
CONTRACTOR:
Advanced Data Processing, Inc.
A Delaware Corporation, authorized to do business
in Florida
) P/---
Doug SwPon, President
WITNESSES:
Signature
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Print ame
jah,ren�1fee Ali �acK
Print Name
(CORPORATE SEAL)
STATE OF FLORIDA )
MtVd 5AHE COUNTY )
L3 ro war d
BEFORE ME, on OC IL'&e- 3 2007 personally appeared Doug Shamon, as
President of Advanced Data Processing, Inc., a Delaware corporation, (such person is personally
known to me or produced as identification) and acknowledged
execution of the foregoing Agreement for the use and purposes mentioned in it and that the instrument
is the act and deed of the Contractor.
�n c
Notary I'Alic, State of Florida at Large
My Commission expires:
�•.� ,,, CINDY R.GARDNER
Nolery Public-Slate of Fbdda
Coffw* n Expires May 12,29d9
Cwwguion a DD 429111
'��:+• Bonded By NB"Notary Ann.
AGREEMENT BETWEEN
CITY OF MIRAMAR, FLORIDA
AND
ADVANCED DATA PROCESSING, INC.
FOR RESCUE AMBULANCE BILLING & RELATED PROFESSIONAL SERVICES.
THIS AGREEMENT, hereinafter "AGREEMENT", made and entered into this 8th day of June,
2007 by and between CITY OF MIRAMAR, a Florida Municipal corporation, with principal offices
located at 2300 Civic Center Place, Miramar, Florida 33025 hereinafter referred to as the
"CITY", and Advanced Data Processing, Inc., a Delaware Corporation with principal offices
located at 6451 North Federal Highway, Suite 1002, Fort Lauderdale, Florida 33308, hereinafter
referred to as the"CONTRACTOR".
W ITNESSETH:
WHEREAS, the CITY solicited competitive proposals for the services herein and, as a
result of due diligence the CITY selected CONTRACTOR to provide the required services; and
WHEREAS, the parties hereto now wish to enter into an agreement, pursuant to which
the CONTRACTOR will render those professional services in connection with said project as
hereinafter provided;
NOW THEREFORE, the parties hereto agree as follows:
1. DEFINITION OF THE PROJECT. The objective of the project is to utilize the services of the
CONTRACTOR to provide the CITY with ambulance billing and related services.
2. SCOPE OF SERVICES. The CONTRACTOR shall perform and carry out the work as
defined in"EXHIBIT A — Scope of Work", which is attached hereto. All payments shall be paid
directly to CITY OF MIRAMAR or via Locked-Box facility as directed by the CITY.
3. TIME OF PERFORMANCE. This Agreement shall be effective for a two-year period from
July 1. 2007 through May 31, 2009, under the terms and conditions contained herein unless
otherwise terminated. This AGREEMENT shall renew automatically for a period of three
additional years at the end of the initial tern and any subsequent renewal term unless the
AGREEMENT is terminated in accordance with section "12. TERMINATION". All terns and
conditions hereof shall remain in full force and effect during any renewal term.
4. COMPENSATION AND METHOD OF PAYMENT.
4.01 The CITY reserves the right to request changes in the services within the general scope of
the Agreement to be performed upon mutual agreement by the CITY and CONTRACTOR that
shall specify the change ordered and the adjustment of time and compensation required
therefore.
4.02 Any services added to the scope of this Agreement by a change order shall be executed in
compliance with all other applicable conditions of this Agreement. No claim for additional
compensation or extension of time shall be recognized unless contained in the duly executed
change order.
Page 1 of 12
4.03 The CONTRACTOR shall be paid by the CITY a monthly amount representing fees for the
services provided computed as:
4.03(a) Six and fifty one-hundredths percent (6.50%) of all monies collected by
CONTRACTOR, excluding amounts collected from Florida Medicaid, plus
4.03(b) Ten dollars and fifty-six cents ($10.56) per Florida Medicaid account, whether or
not such account is ultimately paid by Florida Medicaid.
4.03 (c) an amount of seventy-five cents $0.75 per NPP Notice for providing billed
patient required HIPAA-compliant Privacy Notice per Scope of Work(Exhibit A- OPTIONAL)
4.03 (d)A fee to be negotiated and added as a written addendum to this AGREEMENT
upon the mutual agreement of both CITY and CONTRACTOR for the processing and collections
of accounts billed on the City's behalf prior to the starting date for CONTRACTOR(i.e. aged
Accounts Receivables).
Contractor reserves the right to increase these fees if postage is increased by the United States
Postal Service, but only to cover additional postage costs.
4.04 CONTRACTOR shall submit the monthly invoices representing fees for the services
provided to the City of Miramar, ATTN: Accounts Payable, 2300 Civic Center Place, Miramar,
FL 33025. All invoices shall reference the appropriate contract number. The CITY shall issue a
check for the amount invoiced less any disputed amounts, within forty-five (45)days of receipt
and acceptance of an accurate invoice. CITY's obligations hereunder are absolute and
unconditional and not subject to set-off, delay, counterclaim, termination or performance.
Contractor will resolve any disputed amounts within 60 days from the date CITY gives
notification of a dispute.
4.05 The CITY shall bear the cost of any and all Lock-box services. CITY, should they elect to
participate in any credit card acceptance program, agrees to assume and be responsible for all
costs associated with such program. All other costs incurred by CONTRACTOR in the
performance of services as specified herein (including, but not limited to postage, materials,
communications and phone costs and other operating costs) shall be assumed by the
CONTRACTOR.
5. REPORTS. The CONTRACTOR shall provide the CITY with status reports as set forth in
Exhibit A and other reports as mutually agreed. The CONTRACTOR shall also provide changes
to such reports and ad hoc report requests on a reasonable basis and as mutually agreed.
CONTRACTOR reserves the right to charge an additional fee for any programming cost
associated with ad hoc reports that would require more than a reasonable amount of time to
accomplish so long as the CITY is advised in writing of the potential charges prior to preparation
of the ad hoc report.
6. DATA TO BE FURNISHED BY CITY. The CITY will make available to the CONTRACTOR,
for use in performance of services under this Agreement, all available reports, studies or any
other materials in its possession that may be useful to the CONTRACTOR. All material
furnished by the CITY will not be disclosed to any Pa�tY. other than as required
red under the scope
of the Agreement, without the CITY's prior written approval.
Page 2 of 12
7. INDEPENDENT CONTRACTORS. The CONTRACTOR is an independent contractor and
not an employee or agent of the CITY with the following exception:
To the extent necessary to fulfill its billing and collection efforts under the
Agreement, the CONTRACTOR is authorized to sign in an administrative
capacity for the CITY the following types of standard forms and
correspondences only: probate filings; letters to patients or their representatives
verifying that an account is paid in full; forms verifying the tax-exempt status of
the CITY; and insurance filings and related forms. The CONTRACTOR has no
authority to sign any document that imposes any additional liability on the CITY.
The CONTRACTOR shall retain full control over the employment, direction, compensation and
discharge of all persons assisting in the performance of service by CONTRACTOR. The
CONTRACTOR shall be fully responsible for all matters relating to payment of employees,
including compliance with Social Security, withholding tax and all other laws and regulations
governing such matters. The CONTRACTOR shall be responsible for its own acts and those of
its agents and employees performed pursuant to this Agreement, whether performed prior to,
during or subsequent to the term of this Agreement.
8. INDEMNIFICATION. The CONTRACTOR shall indemnify, defend and hold harmless the
CITY, its elected and appointed officials, employees and agents for any and all suits, actions,
legal or administrative proceedings, claims, damage, liabilities, interest, attorney's fees, costs of
any kind, whether arising prior to the start of activities or following the completion or acceptance,
and in any manner directly or indirectly caused, occasioned or contributed to, in whole or in part,
by reason of any act, error or omission, fault or negligence, whether active or passive, by the
CONTRACTOR, or anyone acting under its direction, control, or on its behalf in connection with
or incident to its performance of this Agreement..
9. INSURANCE. CONTRACTOR shall procure and maintain for the duration of the Agreement,
the following insurance coverage:
1) Workers' Compensation Insurance in compliance with the applicable state and
federal laws
2) General Liability insurance in an amount no less than $1,000,000 per occurrence.
3) Coverage for business interruption, destruction of data processing equipment and
media, liabilities affecting accounts receivable, contracts and independent contractors
and, valuable documents in an amount no less than $100,000 aggregate;
4) Liability coverage for all vehicles whether owned, hired or used in the amount of
$500,000; and
5) Professional Liability-$1,000,000
The policies are to contain, or be endorsed to contain, the following provisions:
a. General Liability and Automobile Liability Coverage (CITY is to be named as
Additional Insured).
1. The CITY, its officers, officials, employees and volunteers are to be covered as
additional insured as respects; liability arising out of activities performed by or on
behalf of the Contractor, including the insured general supervision of the
Contractor, products and completed operations of the Contractor; premises
owned, occupied or used by the Contractor; or automobiles owned, leased, hired
or borrowed by the Contractor. The coverage shall contain no special limitations
Page 3 of 12
on the scope of protections afforded the CITY, its officers, officials, employees or
volunteers.
2. The Contractor's insurance coverage shall be primary insurance as respects
the CITY, it officers, officials, employees and volunteers. Any insurance of self-
insurance maintained by the CITY, its officers, officials, employees or volunteers
shall be excess of the Contractors insurance and shall not contribute with it.
Contractor hereby waives subrogation rights for loss or damage against the
CITY.
3. Any failure to comply with reporting provisions of the policies shall not affect
coverage provided to the CITY, its officers, officials, employees or volunteers.
4. The Contractor's insurance shall apply separately to each insured against
whom a claim is made or suit is brought, except with respect to the limits of the
insurer's liability.
5. Companies issuing the insurance policy, or policies, shall have no recourse
against the CITY for payment of premiums or assessments for any deductibles
with are all at the sole responsibility and risk of Contractor.
b. All Coverage
Each insurance policy required by this clause shall be endorsed to state that
coverage shall not be suspended, voided, canceled by either party, reduced in
coverage or in limits except after thirty (30) days prior written notice by certified
mail, return receipt requested, has been given to the CITY.
Contractor shall furnish the CITY with certificates of insurance and with original endorsements
effecting coverage required by this clause. The certificates and endorsements for eact,,,__ _
insurance policy are to be signed by a person authorized by that insurer to bind coverage on its.
behalf. All certificates and endorsements are to be received and approved by the CITY before
work commences. The CITY reserves the right to require complete, certified copies of all
required insurance policies at any time. All policies (except professional liability) shall be
Occurrence not Claims Made forms. All insurance companies provided shall be rated at least A
VII per Best's Key Rating Guide and be licensed to do business in Florida.
10. OWNERSHIP OF DOCUMENTS. CONTRACTOR shall be required to work in harmony
with other consultants relative to providing information requested in a timely manner and in the
specified form. The CONTRACTOR agrees that any and all documents, records, disks, and
electronic data produced in the performance of this Agreement shall be the sole property of the
CITY, including all rights therein of whatever kind except as may otherwise be provided
hereinafter.
11. ATTACHMENTS. The following named attachments are made an integral part of this
Agreement:
A. Scope of Work(Exhibit A attached hereto and made a part hereof)
B. Business Associate Agreement(Exhibit B attached hereto and made a part hereof)
12. TERMINATION. In the event the CONTRACTOR violates any of the provisions of this
Agreement, the City may serve written notice upon the CONTRACTOR of the immediate
termination of this Agreement. The CITY may terminate this Agreement without cause effective
thirty(30)days from date of written notice.
Page 4 of 12
For cases of default, the CONTRACTOR shall be given opportunity to cure the default within the
allotted period following such written notice. In the event the acts constituting default are a
violation of law, CONTRACTOR shall be subject to immediate termination of Agreement.
Upon termination with or without cause, the CONTRACTOR shall submit an invoice(s) to the
CITY in an amount(s) representing fees for services actually performed or obligations incurred
to the date of effective termination for which the CONTRACTOR has not been previously
compensated. Upon payment of all sums found due, the CITY shall be under no further
obligation to the CONTRACTOR, financial or otherwise. In addition, all records and reports of
the CONTRACTOR related to the CITY's patient billing records are the property of the CITY,
and the CONTRACTOR shall send said records and reports to the CITY within thirty (30) days
of termination of this Agreement.
For purposes of this section, the notice period begins when the CONTRACTOR receives written
notice from the CITY.
13. UNCONTROLLABLE FORCES. Neither the CITY nor CONTRACTOR shall be considered
to be in default of this Agreement if delays in or failure of performance shall be due to
Uncontrollable Forces, the effect of which, by the exercise of reasonable diligence, the non-
performing party could not avoid. The term "Uncontrollable Forces" shall mean any event which
results in the prevention or delay of performance by a party of its obligations under this
Agreement and which is beyond the reasonable control of the non-performing party. It includes,
but is not limited to fire, flood, earthquakes, storms, lightning, epidemic, war, riot, civil
disturbance, sabotage, terrorism and governmental actions.
Neither party shall, however, be excused from performance if non-performance is due to forces
that are preventable, removable, or remediable nor which the non-performing party could have,
with the exercise of reasonable diligence, prevented, removed, or remedied with reasonable
dispatch. The non-performing party shall, within a reasonable time of being prevented or
delayed from performance by an uncontrollable force, give written notice to the other party
describing the circumstances and uncontrollable forces preventing continued performance of
the obligations of this Agreement.
14. JURISDICTION,VENUE and CHOICE OF LAW. All questions pertaining to the validity and
interpretations of this Agreement shall be determined in accordance with the laws of the State of
Florida. CONTRACTOR and CITY agree and accept that jurisdiction of any controversies or
legal problems arising out of this Agreement and any action involving the enforcement or
interpretation of any rights hereunder, shall be in the state courts of the Seventeenth Judicial
Circuit Court in Broward County, Florida.
15. ASSIGNMENT OF AGREEMENT. Except to a parent, subsidiary, or affiliate, the
CONTRACTOR shall not sell, transfer, assign or otherwise dispose of this Agreement or any
part thereof or work provided therein, or of its right, title or interest therein, unless otherwise
provided in the Agreement, without express prior written consent by the CITY.
Page 5 of 12
16.NOTICES. All notices pertaining to this Agreement shall be delivered or mailed to such party
at their respective address as follows:
To the CITY:
City of Miramar
ATTN: Procurement Manager
2300 Civic Center Place
Miramar, FI. 33025
Phone: (954)602-3053
Fax: (954)602-3483
With a COPY to:
Jamie Alan Cole, Esq.
Weiss Serota Helfman Pastoriza Cole & Boniske, P. L.
200 East Broward Boulevard, Suite 1900
Ft. Lauderdale, Florida 33301
Phone: (954)763-4242
Fax: (954) 764-7770
To the CONTRACTOR:
Brad Williams
Vice President, Finance
Advanced Data Processing, Inc.
6451 North Federal Highway, Suite 1002
Fort Lauderdale, Florida 33308
17. REPESENTATION AND WARRANTY. CONTRACTOR represents that they have
experience and agrees to follow all Federal, State and Local Laws including, but not limited to,
Public Records Laws and those laws and statutes applicable to discrimination.
18. SEVERABILITY. Should any part, term or provision of this Agreement be by the courts
decided to be illegal or in conflict with any law of Florida, the validity of the remaining portions or
provisions shall not be affected thereby.
19. ENTIRE AGREEMENT. This Agreement contains the entire agreement between the
parties. The CONTRACTOR represents that in entering into this Agreement it has not relied on
any previous oral and/or implied representations, inducements or understandings of any kind or
nature.
20. REQUEST FOR PROPOSALS. CONTRACTOR and CITY acknowledge that this
Agreement is the result of the CITY's Request for Proposals ("RFP") # 07-12-03, as amended
by Addendum Numbers 1-5. RFP#07-12-03, as amended by Addendum Numbers 1-5, and the
CONTRACTOR's proposal submitted in response thereto are incorporated herein in their
entirety. In the event of a conflict between the terms and conditions contained in this
Agreement and the terms and conditions contained in RFP #07-12-03 or the CONTRACTOR's
proposal submitted in response thereto, the terms and conditions that are more favorable to the
CITY shall prevail.
(Signature page to follow)
Page 6 of 12
IN WITNESS OF THE FOREGOING, the CITY has caused this Agreement to be signed by its
CITY Manager, attested by the CITY Clerk with the corporate seal of the City of Miramar, and
the CONTRACTOR has executed this Agreement effective as of the date set forth above.
ATTEST:
CITY FLORIDA
BY: By:
ette M. McLeary, Ci lerk Robert Payton, City Manager
APPR ED AS TO FORM AND /
CORRECTN SS: Date: ��3�a�
Weiss Serot Ifman Pastoriza
Cole & Bo <e, P.L., City Attorney
CONTRACTOR
Advanced Data Processing, Inc.
A{Deeellaware Corporation
.FIJ! /'/./'e:I' Jib
BRAD WILLIAMS,
VICE PRESIDENT AND SECRETARY
(CORPORATE SEAL)
STATE OF FLORIDA
BROWARD COUNTY
BEFORE ME, an officer duly authorized by law to administer oaths and take
acknowledgments, personally appeared Brad Williams, as Vice President and Secretary of
Advanced Data Processing, Inc., a Delaware corporation, and acknowledged execution of the
foregoing Agreement for the use and purposes mentioned in it and that the instrument is the
act and deed of the Contractor.
IN WITNESS OF THE FOREGOING, I have set my hand and official seal at
in the State and County aforesaid on N)a.y 31 2007.
( "4 �. A 1'
Notary Public, State of Florida
My Commission expires:
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Exhibit A: Scope of Services
Contractor shall provide complete medical billing and accounts receivable
management services for CITY's ambulance services in accordance with the
responsibilities outlined below.
Contractor's Responsibilities:
Contractor will provide timely and accurate billing services for emergency medical
treatment and transport services utilizing information provided by CITY and information
obtained from other reliable sources including:
All services will be provided as stated in the Proposal for Billing and Collection Services for
Ambulance Services submitted to the CITY on February 23, 2007. The following is a summary of
these responsibilities:
1. Provide billing and accounts receivable management services to CITY as required on
a case-by-case basis.
2. Ensure that all required documentation and agreements with payors (e.g. Medicare,
Medicaid, Champus, etc.)are filed and maintained and that the CITY is kept apprised
of important changes to industry regulations.
3. Ensure knowledge of different industry insurance plans and will ensure that every
billable claim is pursued.
4. Provide reasonably necessary training periodically, as requested by CITY, to CITY's
Emergency Medical personnel regarding the gathering of the necessary information
and proper completion of run tickets.
5. Provide prompt submission of Medicare, Medicaid and insurance claims after
receiving completed run ticket and corresponding insurance claim information.
Secondary insurance provider claims shall be submitted after the primary insurance
provider has paid.
6. Provide follow-up on rejected and inactive claims.
7. Utilize most up-to-date knowledge and information with regard to coding
requirements and standards, to ensure compliance with applicable Federal, State
and local regulations.
8. Reconcile the number of transports processed with those received
9. Provide a designated liaison for patienUpayor concerns.
10. Provide all customer-related inquiry services and prepare additional third-party claims
or patient payment arrangements based on this information exchange.
I i. Provide a toll free telephone number for patients to be answered as designated by
the CITY.
12. Facilitate proper security of confidential information and proper shredding of all
disposed materials containing such information.
Page 8 of 12
13. Establish arrangements with hospitals to obtainfverify patient Insurance and contact
information.
14. Respond to any CITY or patient inquiry or questions promptly
15. Maintain appropriate accounting procedures for reconciling all deposits, receivables,
billings, patient accounts, adjustments and refunds.
16. Provide access to CITY for all requested information in order for CITY to perform
appropriate and periodic audits. Reasonable notice will be given to CONTRACTOR
for any planned audit and will be conducted during normal business hours of
CONTRACTOR
17. Provide timely comprehensive reports facilitating all required aspects of monitoring,
evaluating, auditing and managing the services provided. Process refund requests
and provide the CITY with documentation substantiating each refund requested.
18. Provide CITY all unpaid invoices along with the complete processing history once
collection efforts are exhausted.
Specific Scope Compliance
The CONTRACTOR will provide the specific services:
1. Assign billing patient numbers providing cross-reference to the CITY'S assigned transport
numbers.
2. Maintain responsibility for obtaining missing or Incomplete insurance information.
3. Provide accurate coding of medical claims.
4. Make recommendations for fee schedule changes and regularly advise on changes in
statutes and industry regulations.
5. Respond to all patients' requests and inquiries, either written or verbal.
6. Negotiate and arrange modified payment schedules for individuals unable to pay full
amount when billed.
7. Retain all accounts for a minimum of twelve (12) months (unless otherwise specked by
mutual agreement) and after (12) months turn over accounts for which no collection has
been made (unless insurance payment is pending).
8. Provide for facilities to permit real-time read only electronic look-up access by CITY to
CONTRACTOR'S system to obtain patient data and billing information.
9. Maintain records in an electronic format that is readily accessible by the CITY personnel
and that meets all federal and state requirements for maintaining patient medical records.
10. Maintain daily deposit control sheets and original documentation
11. Create, implement and comply with a Compliance Plan consistent with the intent and
activities included in the U.S. Office of Inspector General (OIG) Compliance Program
Guidance for Third Party Medical Billing Companies 63 FR 70138;(December 18, 1998).
Page 9 of 12
CITY's Responsibilities:
1. CITY will provide Contractor with patient encounter information on a timely
basis and in sufficient detail to support diagnosis and procedure coding.
CITY will also provide patient demographic information necessary for
accurate patient identification including name, address, social security
number, date of birth, and telephone number. Where possible, CITY will
obtain and provide contractor with patient health insurance, auto insurance,
or other insurance information.
2. CITY will provide Contractor with necessary documents required by third
parties to allow for the electronic filing of claims by Contractor on CITY's
behalf.
3. CITY will provide Contractor with its approved billing policies and procedures
including fee schedules and collection protocols. CITY will be responsible for
engaging any third party collection service for uncollectible accounts after
Contract has exhausted its collection efforts.
4. CITY will timely process refunds identified by Contractor for account
overpayments.
5. CITY will provide a Lock Box address to Contractor and will instruct Lock Box
to forward all Lock Box documents to Contractor for processing.
6. CITY will provide CONTRACTOR with Daily Bank Balance Reporting
capabilities via the bank's designated web site.
7. CITY will cooperate with Contractor in all matters to ensure proper
compliance with laws and regulations.
Page 10 of 12
Exhibit B
Business Associate Addendum
CONTRACTOR the "Business Associate" and CITY hereby add the following
additional language to the Agreement.
1. CONTRACTOR shall cant'out its obligations under this Addendum in
compliance with the privacy regulations pursuant to Public Law 104-191 of
August 21, 1996, known as the Health Insurance Portability and Accountability
Act of 1996, Subtitle F—Administrative Simplification, Sections 261, at seq., as
amended("HIPAA"), to protect the privacy of any personally identifiable
protected health information ("PHI")that is collected, processed or learned as a
result of the Billing Services provided hereunder. In conformity therewith,
CONTRACTOR agrees that it will:
a. Not use or further disclose PHI except as permitted under this Addendum or
required by law;
b. Use appropriate safeguards to prevent use or disclosure of PHI except as
permitted by this Addendum;
c. To mitigate, to the extent practicable, any harmful effect that is known to
CONTRACTOR of a use or disclosure of PHI by CONTRACTOR in violation of
this Addendum.
d. Report to CITY any use or disclosure of PHI not provided for by this Addendum
of which CONTRACTOR becomes aware;
e. Ensure that any agents or subcontractors to whom CONTRACTOR provides PHI,
or who have access to PHI, agree to the same restrictions and conditions that
apply to CONTRACTOR with respect to such PHI;
f. Make PHI available to CITY and to the individual who has a right of access as
required under HIPAA within 30 days of the request by CITY regarding the
individual;
g. Incorporate any amendments to PHI when notified to do so by CITY;
h. Provide an accounting of all uses or disclosures of PHI made by CONTRACTOR
as required under the HIPAA privacy rule within sixty(60)days;
1. Make their internal practices, books and records relating to the use and
disclosure of PHI available to the Secretary of the Department of Health and
Human Services for purposes of determining CONTRACTOR's and CITY's
compliance with HIPAA; and
j. At the termination of the Agreement, return or destroy all PHI received from, or
created or received by CONTRACTOR on behalf of CITY, and if return is not
feasible, the protections of this Addendum will extend to such PHI.
Page 11 of 12
2. The specific uses and disclosures of PHI that may be made by CONTRACTOR
on behalf of CITY include:
a. The preparation of invoices to patients, carriers, insurers and others responsible
for payment or reimbursement of the services provided by CITY to its patients;
b. Preparation of reminder notices and documents pertaining to collections of
overdue accounts;
c. The submission of supporting documentation to carriers, insurers and other
payers to substantiate the health care services provided by CITY to its patients or
to appeal denials of payment for same.
d. Uses required for the proper management of CONTRACTOR as business
associate.
e. Other uses or disclosures of PHI as permitted by the HIPAA privacy rule.
3. Notwithstanding any other provisions of this Agreement or Addendum, the
Agreement may be terminated by CITY if CONTRACTOR has violated a term or
provision of this Addendum pertaining to CONTRACTOR's material obligations
under the HIPAA privacy rule, or if CONTRACTOR engages in conduct which
would, if committed by CITY, result in a violation of the HIPAA privacy rule by
CITY.
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