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HomeMy WebLinkAboutC-2958 - Paramedic Subscription Program, billing agreement9 July 26, 1993 Council Agenda Item No. 14 TO: Mayor and Members of the City Council FROM: Tim Riley, Fire Chief SUBJECT: PARAMEDIC SERVICES BILLING AGREEMENT C RECOMMENDATION: Authorize the Mayor and the City Council to enter into a Paramedic Services Billing Agreement with Advanced Billing Concepts. DISCUSSION: On March 8, 1993, the City Council adopted Resolution 93 -11 which authorized the Fire Department to implement a paramedic subscription program. The program, since named Fire Medics, commenced July 1, 1993. City staff is administering the enrollment process which runs through September 30, 1993. The Fire Department staff has researched billing procedures and companies for the collection of payments owed by patients not enrolled in the Fire Medics program. The research shows that cities that use billing companies that specialize in medical billing have a higher collection rate. Therefore, the Fire Department recommends that the City enter into a two -year contract with Advanced Billing Concepts. The agreement requires Advanced Billing Concepts to provide initial billing, automated follow -up and delinquent account procedures. Weekly revenue reports will be submitted to the City as well as standard month end reports. As compensation, Advanced Billing Concepts will retain ten percent of all funds collected. The City retains the right to terminate the agreement without cause by giving sixty days written notice of its intention to terminate. py) • PARAMEDIC SERVICES BILLING • c -2q�i This Paramedic Services Billing Agreement ( "Agreement ") between the CITY OF NEWPORT BEACH, a California Municipal Corporation ( "City ") and Advanced Billing Concepts ( "Contractor ") is entered into this ;) � day of � , 1993, and is made with reference to the following: R E C I T A L S WHEREAS, on M yd , the City Council of the City of Newport Beach imjzfler&knted a paramedic subscription fee program pursuant to which non - subscribers are required to pay for paramedic services rendered by the City of Newport Beach; and WHEREAS, the City does not have the staff, capability or experience to bill and collect payments from patients who have received emergency medical services; and WHEREAS, Contractor has the skill, personnel and facilities to provide all of the professional services described in this Agreement. NOW, THEREFORE, in consideration of the Mutual Promises the Parties agree as follows: C O V E N A N T S 1. Contractor's Duties. Contractor shall perform all of the services necessary to bill and collect payment from persons who have received paramedic services from the City in accordance with the following: (a) performance of initial billing procedures, automated follow -up procedures and delinquent account procedures, all as specified in Exhibit "A ", (b) standard services as specified in Exhibit "B "; (c) account reporting in accordance with Exhibit "C"; and (d) such other services as may be specified in this Agreement or attachments. 2. City's Duties. City shall: 01 0 (a) provide Contractor with a completed Emergency Medical Services Report and patient demographics (including insurance information), for each patient who receives paramedic services from the City, but is not a member of the Paramedic Subscription Program. (b) City shall maintain a list of all patients referred to Contractor for billing and, at least monthly, reconcile this list with Contractor's month end reports to ensure that Contractor has received all relevant billing information. 3. Term. The Term of this Agreement shall commence on the Effective Date and continue for two (2) years unless earlier terminated pursuant to express provisions of this Agreement. Upon mutual agreement between the parties, the City may extend this Agreement for successive one year terms on the terms provided herein by so notifying Contractor, in writing, thirty (30) days prior to the expiration of the then current term. 4, compensation. (a) Contractor shall weekly deliver to City an amount equal to Ninety percent (90 %) of all funds Contractor has received on behalf of City during the previous week. These funds shall be transmitted with a weekly report evidencing the total amount of funds Contractor received on behalf of the City during the previous week and the identity of the patients from which funds were received. Contractor shall retain Ten percent (10 %) of the funds in consideration of the services performed pursuant to Section 1. (b) For any additional services requested in writing by City and performed by Contractor, the City shall make payments to Contractor based upon the unit price of all work performed to the satisfaction of the City. City shall not be liable for payment of any additional services, nor shall contractor be obligated to perform any additional services until an executed written request for such additional services has been transmitted from the City to the Contractor. (c) Contractor shall not receive any fees, commissions, or payments in any form whatsoever, from City for the collection of funds from Delinquent Accounts which Contractor has tendered to a Collection Agency. For the purposes of this Agreement, "Collection Agency" shall 0 0 mean any person, group, or entity other than Contractor who receives a fee, commission, or payment for the purposes of collecting amounts due on Delinquent Accounts other accounts receivable. 5. Records /Reports. These special provisions shall apply to the records, reports and services provided by Contractor: (a) Funds received by Contractor on behalf of City shall be handled only by specific employees which City shall approve in writing. Contractor employees other than those authorized to receive funds shall work only with duplicate check copies. (b) All reports and records generated by Contractor pursuant to this Agreement shall be maintained at Contractor's central production facility in Fountain Valley for a period of Three (3) years or more. (c) Once an account has been fully paid, all original materials sent by the City will be returned. (d) Computer system back -up shall be performed on a daily basis with all back -up records stored on standard magnetic tape. (e) Records maintained by Contractor shall be deemed confidential and may be released to third parties only upon written authorization from City. 6. coordination of Work. (a) Contractor shall provide the services through a paramedic billing team with at least one bi- lingual billing employee. The paramedic billing team leader shall be Alice Keene or such other team leader as Contractor may designate. The following employees of Contractor are hereby designated as the principals and representatives of Contractor who are authorized to act in its behalf with respect to the work specified in this Agreement and to make all decisions in connection therewith: Cathy Lloyd, Alvar Gonzalez, Alice M. Keene (b) The Contract Officer for the City shall be Vickie Cleary or her designee. Contractor shall assure that the Contract officer is well informed of the progress of collecting all accounts and other matters relating to the 3 performance of services. Contractor shall refer any decisions which must be made by the City to the Contract Officer. Unless otherwise specified herein, any approval of the City required hereunder shall mean the approval of the Contract Officer. 7. Default. (a) Contractor shall be deemed in default in the event Contractor materially and seriously fails to perform any material obligations described herein, or as specified in the "Scope of Services" attached hereto as "Exhibit A." and such failure continues for thirty (30) days after receipt by ABC of written notice of such default; provided, however, if such default is not reasonably curable within said 30 day period, ABC shall not be deemed in default if ABC commences to cure such failure within such 30 day period, and then diligently pursues correction. (b) The City shall be deemed in default hereunder if it fails to pay any sum to which ABC is entitled on its due date, or if the City materially and seriously fails to perform any of the City's material non - monetary obligations hereunder and such failure continues for thirty (30) days after receipt by the City of written notice of such default; provided, however, if any such non - monetary default is not reasonably curable within said 30 day period, the City shall not be deemed in default if City commences to cure such failure within such 30 day period, and then diligently pursues correction. 8. Termination. (a) Notwithstanding the Term specified in Section 3, in the event of any default by either party, the non - defaulting party shall have the option of terminating this Agreement by written notice to the defaulting party at the expiration of the period within which the defaulting party is entitled to cure the default. (b) In the event of termination of this Agreement, City shall be liable to Contractor for all services performed and costs reasonably incurred by Contractor up to the date that the terminating party provides written notification of its intent to terminate. If City serves notice of termination upon Contractor, Contractor shall immediately stop rendering services under this Agreement, unless directed otherwise by City, and shall deliver to City all data, reports, summaries, and all such other in formation 4 and materials as Contractor may have accumulated in performing this Agreement. (c) City shall have the right to terminate this Agreement, without cause, by giving Contractor sixty (60) days written notice of its intention to terminate. In the event of termination pursuant to this subparagraph, City shall be liable to Contractor for all services performed and costs reasonably incurred by Contractor up to the date of termination. 9. Independent Contractor. (a) Contractor is an independent contractor and not an employee of the City. Neither the City nor any of its employees shall have any control over the conduct of the Contractor or of any of Contractor's employees, except as herein set forth and, Contractor expressly warrants not to, in any time or in any manner, represent that Contractor, or any of Contractor's officers, employees or agents, are in any manner officers, employees or agents of the City. It is distinctly understood that said Contractor is and shall at all times remain as to the City a wholly independent contractor, and that Contractor's obligations to the City are solely such as are prescribed by this Agreement. (b) This Agreement contemplates that the Contractor's personal services and those of the Contractor's officers, employees, and agents are a substantial inducement to the City for entering into this Agreement. Nothing in this Agreement shall be construed as preventing Contractor from employing as many employees or subcontractors as Contractor deems necessary for the proper and efficient execution of this Agreement. 10. Insurance. The Contractor agrees to compliance with the following minimum insurance requirements not less that five (5) working days prior to the beginning of performance under this Agreement: (a) Workers Compensation insurance to cover his employees as required by the California Labor Code. By execution of the contract by the City, the Contractor shall have agreed to the following "I am aware of, and will comply with Divisions 4 and 5 of the California Labor Code by securing, paying for, and maintaining in full force and effect for the duration of the contract, complete workers compensation insurance. The City, its officers, or F". 11. employees, will not be responsible for any claims in law or equity occasioned by failure of the Contractor to comply with this paragraph. The Contractor shall require all subcontractors similarly to provide such compensation insurance for the respective employees. (b) Comprehensive personal injury and property damage liability insurance, including automobiles, with minimum personal injury liability limits of $500,000.00 per person and $1,000,000.00 per occurrence and property damage limits of $100,000.00 per occurrence. The policies of insurance required under this Agreement shall remain in effect during the term of this Agreement and shall not be canceled without thirty (30) days advanced written notice to City of such intent to cancel. Ownership of Documents. (a) All reports, as well as all original reproducible drawings, plans, studies, memoranda, computation sheets and other documents assembled or prepared by Contractor or Contractor's agents, officers or employees in connection with this Agreement shall be the property of the City and shall be delivered to the City upon termination of this Agreement. Copies of said documents may be retained by Contractor, and may be used by Contractor as examples of Contractor's work product but shall not be made available by Contractor to any individual or organization without the prior written approval of City, except as required by law. (b) Any notices to be given under this Agreement shall be given by enclosing the same in the sealed envelope, postage prepaid, and depositing the same in the United States Postal Service, addressed as follows: If to the Contractor: Advanced Billing Concepts 16520 Harbor Boulevard Suite A Fountain Valley, CA 92708 If to the City: Vickie Cleary, R.N. Newport Beach Fire Department EMS Coordinator 3300 Newport Blvd. P.O. Box 1768 Newport Beach, CA 92658 -8915 (c) This Agreement shall be construed and interpreted as to both validity, and performance of the Parties, in accordance with the laws of the State of California. Cl 0 0 Legal actions concerning any dispute, claim or matter arising out of or in relation to this Agreement shall be instituted in the Superior Court of the County of Orange, State of California, or any other appropriate court in such county, and Contractor covenants and agrees to submit to the personal jurisdiction of such court in the event of such action. (d) All services rendered under this Agreement shall be provided in accordance with the requirements of applicable local, state and federal law. (e) By execution of this Agreement, Contractor warrants that it has thoroughly investigated and considered the work to be performed, as well as how it should be performed, and Contractor understands the difficulties and restrictions attending the performance of the work under this Agreement. 12. Miscellaneous Provisions. (a) Disputes. In the event of any dispute arising under this Agreement, the injured Party shall notify the injuring Party in writing of its contentions by submitting a claim therefor. The injured Party shall continue performing its obligations hereunder so long as the injuring Party cures any default within ninety (90) days after service of the notice, or if the cure of the default is commenced within thirty (30) days after service of said notice and is cured within a reasonable time after commencement; provided that if the default is an immediate danger to the health, safety and general welfare, the City may take immediate action under Section 8.7. Compliance with the provisions of this Section shall be a condition precedent to any legal action, and such compliance shall not waiver of any Party's right to take legal action in the event that the dispute is not cured. (b) Waiver. No delay or omission in the exercise of any right or remedy of a non defaulting Party on any default shall impair such right or remedy or be construed as a waiver. City's consent or approval of any act by Contractor requiring City's consent or approval shall not be deemed to waive or render unnecessary City's consent to or approval of any subsequent act of Contractor. Any waiver by either Party of any default must be in writing and shall not be a waiver of any other default concerning the same or any other provision of this Agreement. 7 9 0 (c) Rights and Remedies are Cumulative. Except with respect to rights and remedies expressly declared to be exclusive in this Agreement, the rights and remedies of the Parties are cumulative and the exercise by either Party of one or more of such rights or remedies shall not preclude the exercise by it , at the same or different times, of any other rights or remedies for the same default or any other default by the other Party. (d) Legal Action. In addition to any other rights or remedies, either Party may take legal action,, in law or in equity, to cure, correct or remedy any default, to recover damages for any default, to compel specific performance of this Agreement, to obtain injunctive relief, or to obtain any other remedy consistent with the purposes of this Agreement. (e) Attorneys' Fees. If either Party commences an action against the other Party arising out of or in connection with this Agreement, the prevailing Party shall be entitled to recover reasonable attorneys' fees and costs of suit from the losing Party. (f) Integration. This Agreement represents the entire understanding of the City and the Contractor. No prior oral or written understanding shall be of any force or effect with respect to those matters covered in this Agreement. This Agreement may not be altered, amended or modified except in writing by both Parties hereto. (g) Amendment. This Agreement may be amended at any time by the written mutual consent of the Parties. No amendment shall be effective unless written and signed by the Parties. (h) Corporate Authority. The persons executing this Agreement on behalf of the Parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said Parties and that by doing so, the parties hereto are formally bound to the provisions of this Agreement. F3 Ll IN WITNESS WHEREOF, the Parties hereto have caused this Agreement to be executed on the day and year first written above. CITY OF NEWPORT BEACH ( "CITY "), A Municipal Corporation ATTEST: WANDA RAGGIO, C CLERK;.. r 7` APPROVE AS FORM: H. MURNH4M, kr\paramed.agt\7 -7 -93 E By: BILLING CON¢EPTS i "CONTRACT01Y i ' EXHIBIT "A" INITIAL BILLING PROCEDURES: The day that batches are received in house, they are logged into the "ABC Tracking System." Within two working days, batches are prepared for filling, charge and ICD coding is applied, as well as insurance carrier information. Within three working days, charge detail is then entered into ABC's Mainframe computer, and printed bills are produced. If some of the charges are missing sufficient billing information, they will be held out of the batch and noted in the ABC Tracking System. Within five working days, bills are mailed out with proper attachments. Missing information is requested from the City or the admitting hospital in either writing or verbally. Within seven working days, the patient is sent an initial statement, unless the missing information is a patient address. This initial statement lets the patient know immediately that we are billing the insurance carrier and what they owe. The initial statement can have a message specific to the City as well. AUTOMATED FOLLOW -UP PROCEDURES: Each month, unless otherwise requested by the City, the patient gets a monthly statement with messages specific to a financial class under the name of the City of Newport Beach. Verbiage just for the City can be added to statements if desired. All correspondence is sent out with post office regulation "Address Correction Requested." We pay the post office fees for the corrections, update our records immediately and send new statements to the patient(s) as appropriate. If the patient is a "skip" and leaves no forwarding address, tracing is attempted at ABC, and the City is notified for possible referral to a licensed collection agency. If there is no payment activity 45 calendar days after initial billing, red ABC tracer forms with attachments are automatically generated and mailed to third party payers. For cash accounts, statements urging contact are sent. Tracer sample is attached. DELINQUENT ACCOUNT PROCEDURES: Fifteen (15) days after tracers are sent, if there is no payment response from carriers, the ABC Mainframe computer generates reports by carrier and phone calls are made. Patients are involved and encouraged to complain to carriers who are not paying, and reminded that they are ultimately liable for charges incurred. After three patient statements, cash accounts are called, and individual letters are sent. In at least 180 days from date of billing, or as soon as our collection efforts are exhausted, delinquent accounts are referred to the City for direction as to further action. r� REPORTING: WEEKLY: EXHIBIT "B" 0 ABC shall provide weekly revenue reports as standard. We also deliver requests for direction on collection accounts and requests for information on a weekly basis. MONTHLY: ABC shall provide standard month end reports. ABC reports shall reflect all activity including, charges posted, receipts, write -offs, exact cost of services, and a recap of weekly revenue reports. Additionally, standard reports shall include: 1. Management analysis of credit and debit adjustments to help determine where the write -offs are going. 2. Management analysis and ageing of receipts to view ABC's performance and demographic characteristics of receipts. 3. Aged accounts receivable summary to view and analyze outstanding accounts receivable by age and financial class. EXHIBIT "C" STANDARD ABC SERVICES: * In the event of a denied claim, ABC will react immediately by reviewing the claim in question for discrepancies, consulting with the practice, and opening an inquiry into the justification for denial. * Use best efforts to collect all balances -- additional collection efforts of chronically delinquent accounts to be mutually agreed upon - -on a case -by -case basis. * Deposit funds directly into the ABC Trust Account within three (3) days of receipt. * Forward a weekly report reflecting all payments, refunds, adjustments and balances. * Coding - -the CPT and ICD codes used in billing will be determined from the information provided on the batch billing information. * Complete all insurance, patient, and other third party billing, including any required data processing for billing, collecting and reporting. * Provide for the electronic submission (ECS) of all Medicare, Medi -Cal, Blue Cross, Blue Shield claims (and other third party payors, where available), which expedites processing and a faster payment. * Prepare patient balance bills and post payments to their accounts. * Constantly track the status of every claim and provide easy -to -read quantitative monthly reports which will show accumulated accounts receivable and collections.