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
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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.
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PARAMEDIC SERVICES BILLING
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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:
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(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
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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
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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
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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
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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.
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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.
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(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.
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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;..
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APPROVE AS FORM:
H. MURNH4M,
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By:
BILLING CON¢EPTS
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"CONTRACT01Y
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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.
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REPORTING:
WEEKLY:
EXHIBIT "B"
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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.