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HomeMy WebLinkAbout2008-05-13; City Council; 19437; Agreement to provide ambulance billing servicesCITY OF CARLSBAD - AGENDA BILL AB# 19.437 MTG. 05/13/08 DEPT. FIN AGREEMENT TO PROVIDE AMBULANCE BILLING SERVICES DEPT. HEA CITY ATTY. CITY MGR. RECOMMENDED ACTION: Adopt Resolution No. 2008-136 , awarding a multi-year contract for ambulance billing services with Critical Care Specialty Billing, Ltd. and authorizing the Mayor to execute the contract. ITEM EXPLANATION: Firefighter/paramedics in the Fire Department provide necessary advance life support ambulance services to citizens, visitors and businesses within the City of Carlsbad limits and outside these boundaries as defined by applicable mutual aid and automatic aid agreements with neighboring jurisdictions. In Fiscal Year 2006 - 2007, Fire Department paramedics transported approximately 3,560 patients and billed $2,079,000 in net ambulance revenues (gross revenues less Medicare, Medi-Cal and other contractual write downs). For the past twelve years, the City has outsourced its ambulance billing services. This has allowed for quicker collection of payments, improved customer service, improved management reporting and has provided better expertise in government regulations and laws associated with paramedic services and ambulance transport. The City's current contract is expiring in June 2008. Requests for proposals (RFPs) were solicited from seven firms with three responding to the proposal. The proposals were evaluated by a joint Fire/Finance selection team. Using a best value evaluation process the top two vendors were identified. Both of these firms were interviewed by the selection team. The firms were evaluated on technical capabilities, competence and professionalism; previous performance and references, background and related experience of staff; overall cost; and any value-added offerings. Based on these criteria, the team is recommending Critical Care Specialty Billing, Ltd. (CCSB). CCSB is a full service medical and collection company and comes highly recommended from other agencies. They are a local firm, with offices in Oceanside and ties to our two local hospitals. This provides for a high understanding of the County Service Area, local demographics and boundary-drop billing. In addition, it allows for local patients to visit their offices to discuss their invoices. DEPARTMENT CONTACT: Colette Wengenroth 760-602-2430 cweng@ci.carlsbad.ca.us FOR CITY CLERKS USE ONLY. COUNCIL ACTION:APPROVED DENIED CONTINUED WITHDRAWN AMENDED 9-D D D D CONTINUED TO DATE SPECIFIC CONTINUED TO DATE UNKNOWN RETURNED TO STAFF OTHER - SEE MINUTES D D D D Page 2 FISCAL IMPACT: Although cost was not the only criteria factor in the evaluation process, it was a factor. In evaluating the cost several items were considered, the percentage of net collections to be paid to the firm; overall collection rates; and additional charges for extra services. Using these criteria all the companies were competitively priced. The estimated cost to the City is approximately $110,000 per year. This is calculated at 6.5% of the estimated net collections for ambulance billing. The initial term of the agreement is three years with two additional two year options to renew. Sufficient funds are available in the current budget to cover the Fiscal Year 2007 - 2008 cost. Costs for the remaining years will be included in the future years' budgets. ENVIRONMENTAL IMPACT: Pursuant to Public Resources Code Section 21065 and CEQA Guidelines Section 15378, this does not constitute a "project" within the meaning of CEQA and, therefore, does not require an environmental review. EXHIBITS: 1. Resolution No. 2008-136 authorizing the selection of Critical Care Specialty Billing. Ltd. to perform ambulance billing services. 2. Agreement with Critical Care Specialty Billing. Ltd. Exhibit 1 1 RESOLUTION NO. 2008-136 2 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, AUTHORIZING THE 3 SELECTION OF CRITICAL CARE SPECIALTY BILLING, 4 LTD. TO PERFORM AMBULANCE BILLING SERVICES. 5 WHEREAS, there is a need to contract with an ambulance billing service firm to 6 invoice fees to members of the public for emergency billing transport services: and 7 WHEREAS, requests for proposals from ambulance billing service firms have8 been solicited, accepted, and evaluated; and 10 WHEREAS, Critical Care Specialty Billing, Ltd. has been determined to be the 11 most qualified at a reasonable cost; and 12 WHEREAS, sufficient funds are available in the current 2007-08 Operating 13 Budget. 14 NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Carlsbad, California, as follows: 16 1. That the above recitations are true and correct. 17 2. The firm of Critical Care Specialty Billing, Ltd is selected to perform 19 ambulance billing services 20 3. The first term of the agreement is for three years with options to extend 21 the agreement for two additional two-year terms. 22 4. That the Mayor is hereby authorized to execute a contract between the 23 City of Carlsbad and Critical Care Specialty Billing, Ltd. for ambulance billing services. 24 25 26 27 « 28 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City Council of the City of Carlsbad on the 13th day of May, 2008, by the following vote to wit: AYES: Council Members Lewis, Kulchin, Hall, Packard and Nygaard. NOES: None. ABSENT: None. ATTEST: LGJRRAIN£)M. wook/city cferk (SEAL) (J AGREEMENT FOR AMBULANCE BILLING AND COLLECTION SERVICES Critical Care Specialty Billing, Ltd. JHIS AGREEMENT is made and entered into as of the " day of _, 20 (3*6. by and between the CITY OF CARLSBAD, a municipal corporation, ("City"), and Critical Care Specialty Billing, Ltd, a limited partnership, ("Contractor"). RECITALS A. City requires the professional services of a billing and collection Contractor that is experienced in the preparation of invoices for emergency ambulance transports being sent to private insurance companies, government agencies and patients; delinquent claim handling; receipts processing; monthly reporting; and other duties as defined under the Scope of Work. B. Contractor has the necessary experience in providing professional services and advice related to emergency ambulance transport billing and collection. C. Selection of Contractor is expected to achieve the desired results in an expedited fashion. D. Contractor has submitted a proposal to City and has affirmed its willingness and ability to perform such work, NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1- SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in attached Exhibit "A", which is incorporated by this reference in accordance with this Agreement's terms and conditions. 2. STANDARD OF PERFORMANCE While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California Area, and will use reasonable diligence and best judgment while exercising its professional skill and expertise. 3. TERM The term of this Agreement will be effective for a period of three (3) years from the date first above written. The City Manager may amend the Agreement to extend it for two (2) additional (2) two year periods or parts thereof in an amount not to exceed two hundred thousand dollars ($200,000) per Agreement year. Extensions will be based upon a satisfactory review of Contractor's performance, City needs, and appropriation of funds by the City Council. In the event the City Council does not appropriate the necessary City Attorney Approved Version #11,28.06 b funds on an annual basis, the Agreement will be terminated. The parties wili prepare a written amendment indicating the effective date and length of the extended Agreement. 4. TJME IS OF THE ESSENCE Time is of the essence for each and every provision of this Agreement. 5 COMPENSATION The total fee payable for the Services to be performed during the Agreement term will be 6.5% of collected revenue, less refunds or adjustments, not to exceed $200,000 dollars ($200,000) per Agreement year. No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. The City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or Services specified in Exhibit "A". Incremental payments, if applicable, should be made as outlined in attached Exhibit "A". 6- STATUS OF CONTRACTOR Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under control of City only as to the result to be accomplished, but wilt consult with City as necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of City for any purposes. The payment made to Contractor pursuant to the Agreement will be the full and complete compensation to which Contractor is entitled. City will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which City may be required to make on behalf of Contractor or any agent, employee, or subcontractor of Contractor for work done under this Agreement. At the City's election, City may deduct the indemnification amount from any balance owing to Contractor. 7- SUBCONTRACTING Contractor will not subcontract any portion of the Services without prior written approval of City. If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor, Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and City. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by City Attorney Approved Version #11,28.06 (J the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by City. 8- OTHER CONTRACTORS The City reserves the right to employ other Contractors in connection with the Services. 9- INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorneys fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The parties expressly agree that any payment, attorney's fee, costs or expense City incurs or makes to or on behalf of an injured employee under the City's self- administered workers' compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 10. INSURANCE Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in connection with performance of the services by Contractor or Contractor's agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to have a current Best's Key Rating of not less than "A-:V". 10,1 Coverages and Limits. Contractor will maintain the types of coverages and minimum timits indicated below, unless City Attorney or City Manager approves a lower amount. These minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. City, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to. this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense. 10.1.1 Commercial General liability insurance. $1.000.000 combined single-limit per occurrence for bodily injury, persona! injury and property damage. If the submitted policies contain aggregate limits, general aggregate limits will apply separately to the work under this Agreement or the general aggregate will be twice the required per occurrence limit. City Attorney Approved Version #11.28.06 10.1.2 Automobile Liability (if the use of an automobile is involved for Contractor's work for City). $1,000,000 combined single-limit per accident for bodily injury and property damage. .0.1,3 Workers' Compensation and Employer's Liability. Workers' Compensation limits as required by the California Labor Code and Employer's Liability limits of $1,000,000 per accident for bodily injury. Workers' Compensation and Employer's Liability insurance will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this, 10.14 Fidelity Bond/Crime Insurance. Coverage limit in the amount of $100,000. Insurance shall be placed with an insurer that is an admitted carrier in the State of California with a rating in the most recent Best's Key Rating guide of at least A- :VII, OR with a surplus line insurer on the State of California's List of Eligible Surplus Line Insurers (LESLi) with a rating in the latest Best's Key Rating guide of at least A:X. 10.2, Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions: 10.2.1 The City will be named as an additional insured on General Liability. 10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. 10.2.3 The City shall be named as an additional loss payee on Fidelity Bond/Crime Insurance. 10.2.4 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to City sent by certified mail pursuant to the Notice provisions of this Agreement. 10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to City. 10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then City will have the option to declare Contractor in breach, or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Contractor is responsible for any payments made by City to obtain or maintain insurance and City may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement City Attorney Approved Version #11.28.06 10.5 Submission of Insurance Policies. City reserves the right to require, at anytime, complete and certified copies of any or all required insurance policies and endorsements. 11. BUSINESS LICENSE Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time. 12. ACCOUNTING RECORDS Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of City during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement, Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of three (3) years from the date of final payment under this Agreement. 13. OWNERSHIP OF DOCUMENTS All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of City. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to City. Contractor will have the right to make one (1 ) copy of the work product for Contractor's records. 14. COPYRIGHTS Contractor agrees that all copyrights that arise from the services will be vested in City and Contractor relinquishes al! claims to the copyrights in favor of City. 15. NOTICES The name of the persons who are authorized to give written notices or to receive written notice on behalf of City and on behalf of Contractor under this Agreement. For City: For Contractor: Name: Colette Wengenroth _ Name: flllU'/Jlt- //.^uu-u^Wuu^^,™™,.™.™™™ l.._J..JUCBtm™.m: Title: Finance Manager _ Title: Department: Finance _ Company: C/LiTtc/}(- Cttv of Carlsbad _ Address: 3/T& l/tsr/l Address: 1635 Faraday Avenue Phone No. 760 ¥$1 f>S~f( Carlsbad. CA 92008 . Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. City Attorney Approved Version #11.28.06 16. CONFLICT OF INTEREST City will evaluate Contractor's duties pursuant to this Agreement to determine whether disclosure under the Political Reform Act and City's Conflict of Interest Code is required of Contractor or any of Contractor's employees, agents, or subcontractors. Should it be determined that disclosure is required, Contractor or Contractor's affected employees, agents, or subcontractors will complete and file with the City Clerk those schedules specified by City and contained in the Statement of Economic Interests Form 700, Contractor, for Contractor and on behalf of Contractor's agents, employees, subcontractors and consultants warrants that by execution of this Agreement, that they have no interest, present or contemplated, in the projects affected by this Agreement. Contractor further warrants that neither Contractor, nor Contractor's agents, employees, subcontractors and consultants have any ancillary real property, business interests or income that will be affected by this Agreement or, alternatively, that Contractor will file with the City an affidavit disclosing this interest 17. GENERAL COMPLIANCE WITH LAWS Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations. Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that the services required by this Agreement. «. DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 19- DISPUTE RESOLUTION If a dispute should arise regarding the performance of the Services the following procedure will be used to resolve any questions of fact or interpretation not otherwise settled by agreement between the parties. Representatives of Contractor or City will reduce such questions, and their respective views, to writing. A copy of such documented dispute will be forwarded to both parties involved along with recommended methods of resolution, which would be of benefit to both parties. The representative receiving the letter will reply to the letter along with a recommended method of resolution within ten (10) business days, If the resolution thus obtained is unsatisfactory to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The City Manager will consider the facts and solutions recommended by each party and may then opt to direct a solution to the problem. In such cases, the action of the City Manager wifi be binding upon the parties involved, although nothing in this procedure will prohibit the parties from seeking remedies available to them at law. City Attorney Approved Version #11.28,06 20. TERMINATION in the event of the Contractor's failure to prosecute, deliver, or perform the Services, City may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. !f City decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, City may terminate this Agreement upon written notice to Contractor. Upon notification of termination, Contractor has five (5) business days to deliver any documents owned by City and all work in progress to City address contained in this Agreement. City will make a determination of fact based upon the work product delivered to City and of the percentage of work that Contractor has performed which is usable and of worth to City in having the Agreement completed. Based upon that finding City will determine the final payment of the Agreement, Either party upon tendering thirty (30) days written notice to the other party may terminate this Agreement. In this event and upon request of City, Contractor will assemble the work product and put it in order for proper filing and dosing and deliver it to City. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee payable under this Agreement. City will make the final determination as to the portions of tasks completed and the compensation to be made. 21. COVENANTS AGAINST CONTINGENT FEES Contractor warrants that Contractor has not employed or retained any company or person, other than a bona ftde employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee. 22. CLAIMS AND LAWSUiTS By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to City, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act applies to this Agreement and, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor City Attorney Approved Version #11.28.06 on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another Jurisdiction is grounds for City to terminate this Agreement. 23. JURISDICTIONS AND VENUE Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county, 24. SUCCESSORS AND ASSIGNS It is mutually understood and agreed that this Agreement will be binding upon City and Contractor and their respective successors. Neither this Agreement or any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of City, which shall not be unreasonably withheld, 25. ENTIRE AGREEMENT This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. (Remainder of Page Intentionally Left Blank) City Attorney Approved Version #11.28.06 8 26. AUTHORITY The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. I nicipal ifornia (e-mail address) •>, x '•'"•"„ !f required by City, proper notarial acknowledgment of execution by contractor"'/,/n,i^NN must be attached. If a Corporation. Agreement must be signed by one corporate officer from each of the following two groups. *Group A. Chairman, President, or Vice-President **Group B. Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: RONAL ttorney (Remainder of Page Intentionally Left Blank) City Attorney Approved Version #11.28.06 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT Date personally appeared U <&&!. CVNIHMM.mER Comn*ilon*18294St NotnvPubfc-CaMomta San Dtogo County MyComm.Ex|*MDtc7. Place Notary Seal Above who proved to me on the basis of satisfactory evidence to be the person^e^-Trvhose name(s} is/afe-subscribed to the within instrument and acknowledged to me that he/slio/thoy executed the same in his/her/their authorized capacityj(jee)-, and that by his/hetftbeir signature^ on the instrument the person^ or the entity upon behalf of which the person^s^cted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correjz WITNESS, Signatu OPTIONAL Though the information below is not required by law, it may prove v&lxfable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Title or Type of Document Document Date: Signer(s) Other Than Named Capacities) /Claimed by /)/Signer's Name D Individual ^Corporate Officer — Title(s): D Partner — D Limited D General D Attorney in Fact D Trustee D Guardian or Conservator D Other: Signer Is Representing: RIGHT THUMBPRINT OF SIGNER Top of thumb here signer's Name:_ D Individual D Corporate Officer — Title(s): D Partner — D Limited D General D Attorney in Fact D Trustee D Guardian or Conservator D Other: Signer Is Representing:. RIGHT THUMBPRINT OF SIGNER Top of thumb here ©2007 National Notary Association • 9350 De Soto Ave., RO. Box 2402 • Chatsworth, CA 91313-2402• www.NationalNotary.org Item #5907 Reorder:Call Toll-Free 1 -800-876-6827 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT Dafe personally appeared CYNTHIA M. TVIER Commission * 1529458 Notary Pubfc - CoJtomta San Diego County My Comm. Expire! Dec 7.2008 Place Notary Seal Above who proved to me on the basis of satisfactory evidence to be the person(s)-whose name^is/afe-subscribed to the within instrument and acknowledged to me that he/abe/they executed the same in his/her/their authorized capacity^es), and that by his/hef/toeir signature^s)-on the instrument the persorafsj, or the entity upon behalf of which the person^S) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and corre WITNESS'rrtfCPiand artcr^fficial seal. Signati OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document c Title or Type of Document: Document Date: Signer(s) Other Than Named Above? Capacity(ies) Claimed by Signer(s) Signer's Nam D Individual ^jDorporate Officer — Title(s): 7 * Signer's Name:_ D Partner — D Limited D General D Attorney in Fact D Trustee D Guardian or Conservator D Other: Signer Is Representing: RIGHT THUMBPRINT OF SIGNER Top of thumb here D Individual D Corporate Officer — Title(s): D Partner — D Limited D General D Attorney in Fact D Trustee D Guardian or Conservator D Other: Signer Is Representing: RIGHTTHUMBPRINT OF SIGNER Top of thumb here © 2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • www.NationalNotary.org Item #5907 Reorder: Call Toil-Free 1 -800-876-6827 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 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. CONTRACTOR responsibilities: Provide billing and accounts receivable management services to CITY required on a case-by-case basis. Ensure that all required documentation and agreements with payers (e.g. Medicare, Medicaid, etc.) are filed and maintained and that the CITY is kept apprised of important changes to industry regulations. Ensure knowledge of different industry insurance plans and will ensure that every billable claim is pursued. Provide reasonably necessary training periodically, make recommendations for fee schedule changes, and regularly advise the CITY on changes in statutes and industry regulations. 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. Provide follow-up on rejected and inactive claims. 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. Reconcile the number of transports processed with those received. Provide a designated liaison for patient/payer concerns. Provide all customer-related inquiry services and prepare additional third- City Attorney Approved Version #04.01.02 10 111 party claims or patient payment arrangements based on this information exchange. Provide a toll free telephone number for patients to be answered. Facilitate proper security of confidential information and proper shredding of all disposed materials containing such information. Establish arrangements with hospitals to obtain/verify patient insurance and contact information. Respond to any CITY or patient inquiry or questions promptly. Maintain appropriate accounting procedures for reconciling all deposits, receivables, billings, patient accounts, adjustments and refunds. Patients will be instructed to make all payments payable to the City of Carlsbad. Payments received at the CONTRACTOR'S office will be deposited to the bank specified by the CITY, The CITY will provide the CONTRACTOR with bank deposit slips. 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. Provide coordination and support to the CITY for any related audits by outside agencies such as the Centers for Medicare and Medicaid. 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. Retain all accounts for a minimum of 120 days (unless otherwise specified by mutual agreement) and turn over accounts to the CITY'S collection agency all accounts for which no collection has been made (unless insurance payment or payment plan is pending). Maintain records in an electronic format that is readily accessible by the CITY'S personnel and meets all federal and state requirements for maintaining patient medical records. Maintain daily deposit control sheets and original documentation. Implement and comply with a Compliance Plan consistent with the intent City Attorney Approved Version #04,01.02 11 n and activities included in the U.S. Office of Inspector General (OIG) Compliance Program Guidance for Third Party Medical Billing Companies. Maintain HtPAA and Business Associate Agreements with the CITY as required by Saw. Fee of 6.5% is calculated on collected revenue, minus any refunds or adjustments. This fee also covers all expenses relating to: the assumption of old accounts receivable; credit card processing fees; and the preparation, addressing and mailing of Customer Service Surveys and Notices of Privacy Practices. City Attorney Approved Version #04.CH .02 12