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Advanced Data Processing Inc. AGREEMENT BETWEEN THE CITY OF MIAMI BEACH AND ADVANCED DATA PROCESSING. INC. FOR RESCUE AMBULANCE BILLING & RELATED PROFESSIONAL SERVICES. '-li THIS AGREEMENT, hereinafter "AGREEMENT", made and entered into this /J day of PUq.i v,oL., 1999 by and between CITY OF MIAMI BEACH, a Florida Municipal Corporation, with principal offices located at 1700 Convention Center Drive, Miami Beach, Florida 33139, hereinafter referred to as the "CITY", and Advanced Data Processing, Inc., a Florida Corporation with principal offices located at 520 NW 165 Street, Suite 201, Miami, Florida 33169, hereinafter referred to as the "CONTRACTOR". WITNESSETH: 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 tasks presented in CONTRACTOR'S Scope of Work (Exhibit A), as summarized herein. All payments shall be paid directly to 'CITY OF MIAMI BEACH' or via "Locked-Box" facility as directed by the CITY. 3. TIME OF PERFORMANCE. This Contract shall be effective for a three-year period from 1\({~1I.' 11l1L , 1999 through J);<:t''''tlk~A , 2002, under the terms and conditions contained herein unless otherwise terminated. The CITY may, at its option, renew this agreement for two (2) additional one (1) year terms under the then in force terms and conditions by giving notice to CONTRACTOR at least sixty (60) days prior to expiration of the current term. 4. COMPENSATION AND METHOD OF PAYMENT. The CITY reserves the right to request changes in the services within the general scope of the Contract to be performed upon mutual agreement by the CITY and CONTRACTOR which shall specify the change ordered and the adjustment of time and compensation required therefore. Any services added to the scope of this Contract by a change order shall be executed in compliance with all other applicable conditions of this Contract. No Agreement Page 1 of 6 -, )L I I ') I ' claim for additional compensation or extension of time shall be recognized unless contained in the duly executed change order. The CONTRACTOR shall provide to the CITY a monthly invoice representing fees for the services provided computed as: Seven percent (7%) of all monies collected by CONTRACTOR, excluding Medicaid accounts, during the previous month. Pursuant to Florida Statute 409.913(9), CONTRACTOR will include in the same invoice an amount of $11.40 per Medicaid account for providing all billing services related to such accounts processed in the previous month. The CITY shall issue a check for the amount invoiced, minus any disputed amount, within thirty (30) days of receipt and acceptance of the invoice. The CITY shall bear the cost of any and all Lock-box services. 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 borne 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. 6. DATA TO BE FURNISHED BY CITY. The CITY will make available to the CONTRACTOR, for use in performance of services under this Contract, 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 party without the CITY's prior approval. 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 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 Agreement Page 2 of 6 CONTRACTOR shall be responsible for its own acts and those of its agents and employees during the term of this contract. 8. INDEMNIFICATION. The CONTRACTOR shall indemnify and hold the CITY harmless from any and all claims, losses and causes of actions which may arise out of the performance of this Agreement as a result of an act of negligence, of the CONTRACTOR, its employees, agents, representatives, consultants, or its SUBCONTRACTORS. 9. INSURANCE. The CONTRACTOR shall maintain the following insurance coverage: 1) Worker's Compensation Insurance in compliance with Florida Statutes, Chapter 440 and applicable Federal Acts as they may be amended from time to time; and 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 receivables, 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 Where applicable all coverage above shall be amended with CITY OF MIAMI BEACH named as an additional insured. All of the policies of insurance so required to be purchased and maintained shall contain a provision or endorsement that the coverage afforded shall not be canceled, materially changed or renewal refused until at least thirty (30) calendar days written notice has been given to the CITY by certified mail. Prior to commencing work, the CONTRACTOR shall provide CITY with certified copies of all insurance policies providing coverage as required. 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. Agreement Page 3 of 6 11. ATTACHMENTS. The following named attachments are made an integral part of this Agreement: A. Contract between Advanced Data Processing, Inc. and the City of Boca Raton dated March 17, 1999 (attached hereto and made a part hereof) B. Scope of Work and Fees (Exhibits A & B of the Boca Raton Agreement attached hereto and made a part hereof) Where terms, conditions or scope of services stated in either this Agreement or the above attachments conflict, this Agreement and any superceding Amendments thereof shall prevail. 12. TERMINATION. During the time of this agreement the CITY may terminate this Agreement either for convenience or for default after first giving to CONTRACTOR thirty (30) days notice. For cases of default, the CONTRACTOR shall be given opportunity to cure the default within the thirty (30) day period. In the event the acts constituting default are a violation of law, CONTRACTOR shall be subject to immediate termination of contract. Upon termination for any case, 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. 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, 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, 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. Agreement Page 4 of 6 14. JURISDICTION, VENUE and CHOICE OF LAW. All questions pertaining to the validity and interpretations of this Contract shall be determined in accordance with the laws of the State of Florida. Any legal action by either party against the other concerning this agreement shall be filed in Dade County, Florida which shall be deemed proper jurisdiction and venue for the action. 15. PIGGYBACK. It is hereby a precondition of any part of this Agreement that the Terms of CONTRACTOR's Agreement with the City of Boca Raton (dated March 17, 1999) shall be extended to the CITY including any modifications, amendments or exclusions for the term of referenced agreement. Effectively, this allows the CITY to piggyback the agreement with the City of Boca Raton. Where the Current Agreement conflicts with the Terms of the Piggyback Agreement, the Terms of the Current Agreement shall prevail. 16. ASSIGNMENT OF CONTRACT. The CONTRACTOR shall not sell, transfer, assign or otherwise dispose of this Contract or any part thereof or work provided therein, or of its right, title or interest therein, unless otherwise provided in the contract, without express prior consent by the CITY. 17. NOTICES. Delivered or mailed to such party at their respective addresses as follows: To the CITY: Ed DelFavero, Chief CITY OF MIAMI BEACH EMS 2300 Pine Tree Drive Miami Beach, FL 33140 To the CONTRACTOR: Paul Franzelas Vice President Advanced Data Processing, Inc. 520 NW 165 Street Road, Suite 201 Miami, Florida 33169 18. 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. 19. ENTIRE CONTRACT. This Contract contains the entire agreement between the parties. The CONTRACTOR represents that in entering into this Contract it has not relied on any previous oral and/or implied representations, inducements or understandings of any kind or nature. Agreement Page 5 of 6 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 Miami Beach, and the Contractor have executed this Agreement effective as of the date set forth above. CITY: CITY OF MIAMI BEACH, a Florida Municipal Corporation ATTEr{~Ui 1; V r-l( c(~ ROBERT PARCHER CITY CLERK Dated: Ii NEISEN O. KASDIN MAYOR Dated: CONTRACTOR: Advanced Data Processing. Inc. By ~~ ~ i.~'L PAUL FRANZELAS VICE PRESIDENT The remainder of this page left intentionally blank. APPROVED AS TO FORM .& LANGUAGE & fOR EXECUTION 111~!!:-- ~ Agreement Page 6 of 6 Exhibi t A - Scope of ,^'ork .... General Scope Advanced Data Processing will perform all servic~s witn t;,e principal goals of: recovering the greatest amount of fees in the shortest possible time and, g~eatest total amOU:1t with minimizs-d cost to reco'/er. All services wil! be provided as stated in this Proposal. The specifics of such services to be provided are addressed in the following subsections of this proposal. The following are general services requested by the City, which will be performed if awarded such contract: Provide billing and collection services for Emergency Medical Services transport, as required on a case by case basis, with emphasis on accelerated turnaround between services provided and payment recei';ed. The pric8 bid herein shall include all expenses of billing and collection including, but not limited to, stationary, fax, forms, envelopes, mailing, postage and telecommunications/phone facilities/charges. = Ensure that all required documentation and agreements with payors (e.g. Medicare, ~.J'edica;d, Champus, etc.) are filed and maintained and that Fire Rescue is kept apprised of important changes to industry regulations. Provide reasonably necessary training periodically to City Fire Rescue personnel regarding the gathering of necessary information and proper completion of run tickets. Advanced Data Processing in corroboration with other municipalities has already put together a video-based training program for this purpose. Provide prompt submission of Medicare, Medicaid and insurance claims (within 72 hours) after receiving completed run ticket, which shall be Advanced Data Processing's notice to commence the billing/collection service including keeping logs confirming all electronic submissions. Secondary insurance provider claims shall be submitted after the primary insurance provider has paid. Advanced Data Processing shall follow-up on rejected and inactive claims and establish payor remittance accounts and procedures. Utilize most up-to-date knowledge and information with regard to coding procedures, assigning of ICD-9 diagnostic codes and proper preparation of electronic and paper insurance filings to ensure compliance with applicable Federal, State and local regulations. Exhibit A Page 1 Reconcile the number of transports collected with those transmitted to AC'J3;-;Ced Data Processing and contact Fire Rescue to report any discrepa:icies. Advanced Data Processing shall provide a designated liaison for patienUpayor concerns. This person shall be Ms. Beth Kaminer, Sr. Collector. Provide survey questionnaires or mail inserts to patients at the City's request. PrQvide ail customer-related inquiry services and prepare additional third-party claims or patient payment arrangements based on this information exchange. Customer calls will be facilitated as local within Cit"j of Boca Raton through a dedicated "800" toll-free exchange. Facilitate proper security of confidential information and proper shredding of all disposed materials containing such proprietary information. Visit hospitals and/or establish with hospitals arrangement to obtain/verify patient insurance and contact information. Respond promptly to the City and patients on requests for information or records. Treatment as confidential any records of care or treatment of patients solely for the purpose of prOCessing and collecting claims and shall not release any such information in any legal action, business dispute or competitive bidding process. Use of proprietary systems, procedures or techniques as required to achieve higher collection rates and improved cash flow. Maintain appropriate accounting procedures for reconciling all deposits, receivables, billings, patient accounts, adjustments & refunds. Provide timely comprehensive reports facilitating all required aspects of monitoring, evaluating, auditing and managing the services provided and the interface between Fire Rescue and Advanced Data Processing. Process refund requests providing Fire Rescue with documentation substantiating each refund processed. Provide Fire Rescue all unpaid invoices along with the complete processing history once collection efforts are exhausted. Convert all active and inactive files from the prior billing company and maintain such records. Exhibit A Page 2 Specific Scope Compliance ' Advanced Data Processing will provide the above general services with specific compliance as requested by the City of Boca Raton in the RFP : = Assign billing patient numbers providing cross-reference to City of Boca Raton assigned transport numbers. = Responsible for obtaining all necessary rescue and insurance information. = Provide accurate coding of procedures and diagnosis and correlation of rescue documentatioil. Annually make recommendations for fee schedule changes, regularly advise on changes in statutes and industry regulations. = Respond to all patients' requests and inquiries, either written or verbal. Negotiate and arrange modified payment schedules for individuals unable to pay full amount when billed. = Mail requested citizen satisfaction survey. Provide for facilities to permit dial-up access to our system to obtain patient data and billing information. Maintain daily deposit control sheets and original documentation. Submit claims, process statements, post receivables, process refund requests and submit reports within following specified timeframes and frequencies: . File claims & send an invoice to all self-pay patient/payors with return envelope and address as specified by the City within five (5) days of receipt of incident information. Provide prompt submission of Medicare, Medicaid and insurance claims within 72 hours after receiving completed run ticket · Process all third party reimbursements within one-week after receipt of appropriate billing information from primary payor. · Responsible for sending second notices at thirty-five days and third notices at sixty-five days. · Visit hospitals twice (if necessary) to obtain/verify patient insurance and contact information. · Respond within three (3) business days to the City and patients on requests for information or records. Exhibit A Page 3 . Provide specified management reports on monthly basis as identified and prescribed by the City. Monthly reporting is produced after month closing and provided to you no later than the 10th of each month. 'tie print the reports within 24 hOllrs after recDiving the last daj of the month's receivables from the bank. . Provide monthly listing of accounts past due 180-days or more. . Provide Fire Rescue 2.11 unpaid invoices (upon request) along with the comiJlete processing historj once collection efforts are exhausted. . Accounts are retained for a period of one-year. . Process refund requests within the month following an overpayment. Exhibit A-Page 4 Rationale Tr,e follo'//Ing section eX:Jlains the ap:-oach to b:: ta:-<en, Ide,wfJing Its rationale and distinguish in;) cr,a:-a::erlstlcs Acv::11Ged Data Processing prides its;;l; In dC'/2::J9"'~ ops-rat:::>ns ;712:'- :c!s a:ld systems support tailored ,3:'.:eci(cc.::',;/ :~~ ='.,:: :,"-. . - ... . - . . S":"::-',':~.5. Our methods and syst::ms are refined to provid::: maxiiilum efficiencj In the collection of your recei'labl:::s In addition, because of our focus SOI:::'j on serving municipalities in t:--,e area of E~,1S bi~!;ng and col!ections, '.'12 h?'le or.:)'/ided 58 ma"j of cur municipal cl:':O:nt3 s: bo~h t;-12 oi:j anc ,:oun:j 18'1el the follo'I.!.1;;) 0;3::,10, ben::fits IJs:~,g sC,lle of the fnest rnulti-media tools to bring training assistance to the Fire R23cue s:a;f and a,:~;nist,aton in ess::ntic;'s of unc~e;standing the importance of key pat!ent information (cemcgraphic, insu;c;nce an': mec:ical) in the successful billing pmcess. + Standard and Ad Hoc reporting through our proprietary in-house programming providing the essential information for management, administration and accounting of the billing/collection process. Our IBM AS400 & Pentium/PC environment provides state-of-the-art solutions Our reports are not only comprehensive and provide just-the-right information but, VI:: send our reports within 24 hours of receiving last day of the months receivables. Our clients generally get their reports within 1 to 4 working days of the month-end. The following outlines some of the most important distinctions in how we provide such superior services. + Hospital Support - The principal ingredient in effectively maximizing our collection success is having access to medical insurance records from the transported hospitals. Our company with your assistance will maintain a working arrangement with all of the major hospitals in your area. These hospitals will be requested to provide a copy of their patient facesheets or patient demographic and insurance information. The ER facilities will set up a holding tray for facesheets. We send our personnel to the area hospitals to obtain up-to- Exhibit A Page 5 date, validated patient insurance information. Some hospitals provide us on-line access, others provide fax-back or a console on premises. Please note that we perform this with redundancy and that timing is critical in obtaining correct information. 'I'/e do this .:It least {'Nice and update our sjstem, refiling as necessMY. For smaller hospitals, we will arrange to have them provide us such information via fax or phone request. Advanced Data Processing has served several municipalities in Florida and has already established working relationships with a number of hospitals. . Electronic Claims ProcessinCl ~ Medicare, Medicaid & many other carrier claims are precessed by us and submitted e!ectronically to ensure accurate and fast collections. As the f:rst EMS s::rvice company in Florida to electronicalij file ~..ledica:d claims, we continua:ly staj abreast of changes in insurance submission stanc2rds and upgrade our capabilities as such changes require. We were one of the first service companies submitting claims to Medicare in the new "National Standard Format" now supporting Claims Submission, Claims Status, Remittance Advice and Electronic Funds Transfer. We have electronic access via Internet to all Medicare & Medicaid BBS facilities and information updates. We maintain logs of all insurance transmissions and a copy of the confirmation receipt sent by the carrier. Claims not sent electronically are processed on paper using HCFA-1500 forms or special forms provided by the carrier (occasionally required). . In-house Proqramminq & Advanced TechnoloClY - Since all of our computer programming is done 'in-house', we have the ability to immediately modify our computer programs to maintain the state-of-the-art in our collections system and processes. Our expertise upon which the company was originally formed was data processing and accounting based applications requiring custom piOgramming. This enables us to rapidly develop advancements and custom tailor many aspects of our service unlike many of our competitors who employ "off-the-shelf' or "canned" software packages. Such packages restrict the user from changing database layouts, report definition, invoice formats and so forth. We are virtually unrestricted in such facets. In addition, we employ PC-to-Host transfer facilities that enable us to upload/download data to and from our AS400 host or even a customer system. . Automated Patient LinkinCl - When a new patient is entered into the system, the first thing the system does is to determine if the patient has previously been transported. The database is searched for Medicare numbers, Medicaid numbers, and Private Insurance information. If we find this information in our history file, we can immediately use this information to process a claim, thus eliminating the time needed to research patient information. We call this our 'Patient Linkage Feature'. + Automated Payor MonitorinCl & Claim Resubmission - The system monitors all claims having been filed to insurance payors identifying those not having yet paid. These claims are flagged and automatically resubmitted. At a regular interval a trace letter is sent to the responsible carrier if the claim has still not been paid or response received. + Effective Statements - We provide an easy-reading, comprehensive statemenUinvoice to all patients and include for convenience a courtesy return-payment envelope. The front of the statement describes all charges and Exhibit A Page 6 payments. A request on the statement for the patients' Medicare and/or Medicaid number is clearly indicated. The reverse side of the statement has clearly marked entrJ blocks for information needed to file private ins~rance claims. We frequently accommodate our clients with inserts to includ-s in our statement mailing such as questionnaires, comment cards, notices, etc. + Skiptracinq - We use various methods of.Skiptracing to locate patients who have left the area, or patients with invalid billing addresses and phone numbers. For incorrect addresses returned to us by the Post Office, we attempt to obtain a valid update from the hospital. If the r.ospital does not have better address informa:i:Jn, we check these patients electronicallv against the U.S. Post Or.ice's Natior,n! Ch3nga of Address (NCOA) files, whose records are updated quart2;ly. All mailing list companies to keep their lists current use t;'8 UICOA) files. Exhibit A Page 7 Optimized Flow The followi,1g diagram shows t:1e maj8r p3tient billir.g cases Ci~d their now of activities employing the previously mentioned techniques to optimize the billing and collection process. Obviously, the sooner that valid patient information is obtained the auicker and more assured is collection, Accordingly, in cases where less information is initially provided, we do net de!a'/ ~h~ billina ;:;rC'cess waitina for inTi)'r7'2t!On. Instead, a bill is generCited as just one form of patient contact through whic;1, oftentimes, the patients themselves will fi:l-out the appro,oriat-: dat3 on our easy-la-return billing form. This data is used to update the patients' billing i,1rormat:on and a new bi!:ing is generated. Excellent working relationships are maintained with the hospitals to obtain this information and in some cases we provide updated information to the hospitals in reciprocity. The best case should be noted is where the EMS attendants provide the best information obtainable at the time up-front. Although this is sometimes not practical and is understood, the described approach accommodates this in an optimal way. Diagram - Optimized flow Case 1 Case 2 . no phone . VJI iJ phon~ . no fac~shcct lTom Hosp Patient I)ata Pr()~'iclctl . no fJ,:t:$ncct irom Hosp Data Dependent Process visit Hospiul locate pati~nt data visit Hospital update patient dau Exhibit A Page 8 Case 3 . validp~onc .nlo . ,alid faccsh,:et from Hosp Patient Information We utilize four methods for obtaining patient insurance information: We utilize 11':rr"2::0r. cr,J'/ic:?: 'N!:" ::'"12 ~l.jn sh~;:: (& hospital facesheet, if included). This is obtained in ei(:~-2~ t~arj.:c~'i (which we key into our system') or. via e!e'.:tror.:c COrnmU'licat::Jn fr:::m yo:.;r facility ,Q curs. "Ve provide BBS dial-in and we support E-mail transfer as well as most standard media (6250 tape, OIC-80 tape, PC-diskette). We send our personnel to the area hospitals to obtain up-to-date, validated patient i:1surance information. Some hospitals provide us on-line access, others pro'lide fa;(-bac~ or a console on premises. Please note that vie perform this "...ith redundancy and tn3t t:ming is critical in obtaining correct information. ~"/e C;:J {,'lis at least f.'llce ana l:pdate our system, refiling as ne'.:essary. We provide easy to filf out return mail form as an integral part of our invoice statement for the patienUguarantor to provide insurance information. We also directly contact the patienUguarantor where necessary to request such information. · Our system provides a "patient-linkage" feature allowing us to use previously obtained insurance information, if the same patient has been previously transported. If the system finds a "linkage" having valid data from a previous transport, vIe immediately use this to file with their insurance. Hospital Support The principal ingredient in effectively maximizing our collection success is having access to medical insurance records from the transported hospitals. Our company maintains a werking arrangement with all of the major hospitals in your area, Most hospitals will provide a copy of their patient facesheets or patient demographic and insurance information. We understand the importance of rescue personnel availability. Consequently, we have been able to make arrangements with most hospitals to either hold the facesheets for us or to fax them to us. Where ER facilities will set up a holding tray for facesheets, we will send our own personnel to retrieve the facesheets. In addition, our personnel will retrieve required information from their computers. For smaller hospitals, we will arrange to have them provide us such information via fax or phone request. Advanced Data Processing as incumbent vendor to your City has already established a working relationship with most hospitals in your area: . Bethesda Memorial . Boca Raton Community . Delray Community 3\1 JFK Hospital II Holy Cross II Palms West . West Boca Med Center . North Ridge Med Center III Fair Oaks Hospital I:lI 1'1 Broward Med Center The above list is already programmed into our system to submit claims for transport to these facilities, (There may be other facilities to which you occasionally transport. We also have those already in our system), Exhibit A Page 9 Tasks Ad'lanced Data Processing will utilize collected billing information provided by the City as the basis for: o Billing to and collecting from the transported individual, Medicare, Medicaid, insurance companies or, other appropriate third party payors for services provided by the City and maintaining incident-based accounting to assist in this process. o Preparing the required m3~8ger..ent and financial re~orts including information on delinquent accounts for tile Citfs Cinaijsis of the services provided. Advanced Data Processing will provide the following services: o Mail an invoice to each transported individual at the current prevailing rate for transportation services. o File all insurance claim forms for all patients based upon information received from the patient or obtained from research we perform at health care facilities. o Provide required paperwork to Medicare, Medicaid, insurance companies or, third party payors for claims, reviews, resubmission, provider agreements, and other as required. o Mail copies of invoices to patients, Medicare, Medicaid, insurance companies or, other third party payors, when requested. o Mail a series of follow-up invoices to patients and make patient contact as necessary . ORe-file Medicare, Medicaid or insurance claims, as necessary to obtain payment. o Record customer payments from lock box collections. o Prepare periodic management/financial reports. o Negotiate and agree upon modified payout schedules within City-established guidelines for those individuals unable to remit the full initial-billed amount. o Notify the City of past due accounts by providing a listing of such accounts and pertinent detail. o Transition open balance accounts from previous billing agent and process for collection. o Any other services agreed to between the parties, in order to effectively collect all fees. Electronic Claims Bills for which we transmit via Electronic Communications are sent in batch form directly to the carrier providing payment processinq by the carrier within aooroximatel'l 15 days after receipt. Transmission to Medicare employs the most up- to-date National Standard Format and utilizes Medicare's "Medigap" feature to the greatest extent possible. This f~ature provided by Medicare automatically forwards Exhibit A Page 10 secondary payor information to the supplemental insurance carrier ensuring faster payment of the 20% not paid by Medicare. In conjunction with our use of electronic claims processing we support and utilize the following facilities: . Electronic Transmission Logs . Electronic Claims Status . Electronic Reject Status + Electronic Remittance Notification . Electronic Funds Transfer .. Medicare, f\'ed;~aid and other carrier Internet and BSS i:1forlo1ation systems Other carriers are billed via paper HCFA-1500 forms and sent directly to the appropriate insurance carrier. Patient Signature - All indicators on insurance claims for identifying patient signature authorization and signature on file are appropriately set. Signatures are obtained where absolutely necessary. However, rescue medical and transport services are legally viewed as an extension of the hospital/ER facility. Signature authorization obtained by these facilities for treatment applies. In addition, our patient invoice form has a place for providing insurance information and signa~ure authorization. Insurance Reviews - All insurance denials or problem mail are reviewed within 1-3 days of receipt. Wherever these problems can be resolved by phone call they are immediately addressed. All others are processed within the prescribed timeframe providing all appropriate documentation including EOBs, denial letter, run report or corrected information requested by the carrier. All applicable regulations are adhered to especially those of Medicare and Medicaid. Accounts Receivable Merging Accounts - We are able to merge current open accounts from the current billing system at your option. If we take on these accounts, we will do so with review of the account determining the appropriate action to be taken (e.g. refiling, review, rebill, write-off) advising you of status. Data collection & entry - All information pertaining to patients/payors for accounts under our billing/collection whether hard copy or electronic form will be obtained from your office for the purpose of assisting in their collection. Advanced Data Processing will determine the optimum method for information transfer employing electronic or Exhibit A Page 11 CO.~1'~It.:ii;Ca':C;-,.; :: 2~hoc!3 as feasible. Information \....i:1 then be entered and r.:aintained on G...i data processing system to assist in this process. All information wifl be treated as proprietary. Manual data entry is keyed in the most rapid and reliable manner possible. Advanced Data Processing has maintained its original expertise in bulk data entry and data processing and consequently has an advantage in the ability to process large volumes of input data such as patient incident & demographics as well as payment processing. All data received is entered into the system's database within three (3) days after receipt. It is then passed on for immediate verification and bill generation. Information Verification - All processed patient incident and billing/payor information is processed for first stage verification using three methods; 1) automated "front-end edits", 2) "patient-linkage" and, 3) manual review by insurance recovery specialists. Automated "front-end edits" look for certain inconsistencies in information that can be flagged and corrected. Items ranging from complete address, social security & date- of-birth to insurance IDs are checked by the system and flagged either for correction or hospital verification. As previously described, when a new patient is entered into the system, our system's "Patient-linkage" feature determines if the patient has previously been transported. The database is then searched for valid Medicare numbers, Medicaid numbers, and Private Insurance information on which payments have been processed. If we find , this information in our history file, we can immediately use this information to process a claim, thus eliminating the time needed to research patient information. Beyond even these two automated methods used to filter perhaps otherwise "lost" or delayed collections (especially from commercial and Federal payors), we also employ manual methods to further screen the entered fresh billing information. Our insurance recovery specialists review each bill for claim processing. In many cases we can spot invalid insurance information or incomplete data that would result in a rejected claim. This information is corrected either immediately or, after obtaining valid information from a number of sources. In many cases we utilize on-line verification where our Exhibit A Page 12 system automaticai:y, communicates multiple records to the insurance carrier and obtains from the carrier the correct filing identification. In other cases, telephone calling and/or hospital interrogation is employed. Carrier coordination - All coordination and correspondence with insurance carriers will be maintained. We will make every effort to collect all legally collectible amounts writing off only those amounts required by law. Settlements and adjustments (other than Medicare/Medicaid write-ofts due to ma:<:mum a~lowable charge by Law) wil! require t~e autnoriz<ltion of YO'Jr organization. Forms required for subrnission of claims and other forms occasior.ally required by carriers and other payors will be completed and filed by us on behalf of the City. We strictly adhere to all insurance regulations regarding claim submission and recovery especially those of Federal and State programs. Utilizing electronic filing and the Medigap and Medicaid Crossover facilities allow us to increase efficiency in obtaining secondary payments. However, we also review all primary payments for possible manual secondary filing requirements doing so wherever possible. Other amounts - Our insurance processors are trained to take appropriate billing action to obtain payment for other amounts not paid by the insurance carrier deductibles, co-payments, etc.). Using remittance advice and EOB information we will bill the patient for all applicable coinsurance, deductible and non-covered amounts. Account aging - Account activity is maintained and reflected on reports provided which show daily activity for the month and aging of receivables. Accounts updated with valid payments are re-aged showing payment status as current. All accounts are summarized monthly and are reflected within categories showing their status as either current, 30, 60, 90, or 120 days. We utilize this information to focus our inquiry, rebilling and collection efforts on a routine basis. While we are able to provide you with a review of 180-day accounts with potential return of them to the City, we currently perform for all of our clients retaining accounts for 12 months. We do this because we have proven that our system will find insurance information on patients up to the 11 th month for some insurances and collect a significant amount of money that, in most cases, collection agents would not have collected. And, we provide such service at our same basic rate, far lower than that charged by coiiectio:l agents. In fact, many of our clients who also use a collection agency (such as Brevard County) Exhibit A Page 13 have found that, t;-,eir ccllecti::ln company complains of ha"ir.g next-to-nothing to collect on after we're done \v:::, the accounts. Incurred Costs & Supplies - No incidental costs are h:cden in ou~ ~e,,,ice pricing. We provide all forms, reports, statements, envelopes, postage, phone service, etc. at no additional cost. Operating costs such as personnel, software, etc. are all borne by Advanced Data Processing. The only exception to this is special questionnaires, surveys, or forms the City may employ in special fashion. vVhile we cha.ge nothing extra fJ. illcludi~;J these in our mailing the City must prol/ide t~e printed materials they rec;uire. Third Party Billing Transmission to Medicare employs the most up-to-date National Standard Format and utilizes Medicare's "Medigap" feature to the greatest extent possible. This feature automatically forwards secondary payor information to the supplemental insurance carrier ensuring faster payment of the 20% not paid by Medicare. All other secondaries to Medicare are manually filed immediately after receipt and posting of the Medicare payment. Other third party payors (especially where auto insurance and private insurance is applicable) are filed sequentially to avoid unnecessary refunds and are filed using proper coordination of benefits. Hardship Cases Occasionally, after all insurance avenues are checked including State Medicaid and local HRS or municipal programs; having found no method of payment for an individual, we may find hardship to exist. Such cases ale submitted to Fire Rescue in writing for final resolution along with appropriate documentation (ie. hospital credit status, credit file information. activity file). Only upon instruction from Fire RescLle will we write-off any amounts or make any adjustments to a bill. This includes when a patient disputes mileage, oxygen, special handling charges or even the bill itself. Case Files We currently process manual hardcopy and electronic format for our clients. While we can continue to process your claims in hardcopy form, we will welcome the opportunity to assist you in electronically transmitting your information to our BBS, which we provide our clients for customer data transfer. Exhibit A Page 14 Non-Deliverable Return Mail , All non-deliverable return mail is processed for obtaining forilarding address, zip code correction, address correction, etc. Returned mail is processed generally within 1-2 weeks. Billing Bill generation & mailing - Bills will be orinted immediatel'! upon completion of . input. verification and editing of the supplied bii:ing inrorri1ation (gsnerallj within 1-3 dajs of receipt) and mailed or communicated to patients/payors. Bills for which we transmit electronically are sent in batch form directly to the carrier providing payment processinq by the carrier within aoproximatel'! 15 days after receipt. Transmission to Medicare employs the most up-to-date National Standard Format and utilizes Medicare's "Medigap" feature to the greatest extent possible. This feature provided by Medicare automatically forwards secondary payor information to the supplemental insurance carrier ensuring faster payment of the 20% not paid by Medicare. Other carriers are billed via paper HCFA-1500 forms and sent directly to the appropriate insurance carrier. Because of the overall volume we process, we are able to batch forms to more popular carriers obtaining faster bulk processing. Self-mailing invoices - Bills to self-pays are printed on a pre-printed invoice and sent in a double window envelope containing a convenient self-mailer. The invoice sent also has a convenient place for the patient to return updated insurance information, which is used to refile on the behalf of the patient. The following figures provide an example of a completed patient bill and paper insurance claim (bill). PatienUpayor data verification - The information collected throughout the process will be verified on a case-by-case basis and updated as required for the purpose of establishing contact with the patient/payor. Follow-up & multiple notices - Phone contact will be made on a routine basis to follow-up on not:ces sent without response or for payments not received. In certain cases, multiple contacts will be made. In no way will harassment be used to force payment. All phone conversations and correspondence are made as a representative of the client. Exhibit A Page 15 Cycle billing - Several cycles are managed by our system to produce maximum collections. Regular (monthly) cycle billing is performed on self-pay accounts and accounts showing a patient pay balance. These cycles handle routine invoicing f:Jr payment arrangements as weli as generation of dunning messages for slow or no- pay accounts. Patient invoices are rebilled up to six (6) times. Other cycles handle rebilling of carriers and billing of secondary/tertiary payors. Medicare, Medicaid and private insurance are billed immediately and given 45-60 days to pay before rebilling. Insura,1ce denials fo; reasons other tha,1 those that can ce resolved are con'/erted to self or pa:;ent pay and begin regular cycle billing. System che:l.;:cir:ts trap bil!s that would be in jeopardy of expiration due tJ i,15urance fi:i:1g lim;tations. Exhibit A Page 16 Deposits Receivables processing - Statements, bills. and electronic claims will be marked with payment address of your choice. It is recommended that a "locked-box" arrangement with the bank of your choice be used (cost for this service is the City's responsibility). The bank then receives all payments and processes them daily directly providing deposits to your account. Records of all payments/deposits are provided directly to the City. Using this method, vIe do not directly handle any receivables. Only the Exp:3nation 0; Benefits (EOB), and copies of checi<s.'money orders are sent to us along with any corresf:ondence (denials, ~rQblems, (, requests for further information). Receivables are generally posted within the same day we receive them. Receivables will be itemized and reconciled against daily bank deposits on a monthly closing basis and provided to you in a comprehensive report format. Receipt Posting Payment processing - All payments will be processed upon receipt from the lock- box facility and posted to the correct patient account (generally within 1-2 days of receipt, never to exceed 7 days). Individual patient accounts are maintained showing all payment amounts, check or money order number (if applica~le) and date of payment and balance owed. Information will be used for the purpose of either rebilling, follow-up or closing of the account. Unidentified payments - On occasion payments are received for which the identity is obscure or not immediately known (Le. account number missing or incorrect, name provided is different than that originally filed, etc.). In these cases the receivable is processed to a suspense account so that processed receivables balance against the bank statement. These item are marked for research by a specialist who, through either database searching andor contact of the original payor. obtains the necessary identification to properly post the item(s). Once the correct patient account has been located, a transfer is made from the suspense account to the appropriate patient account. A documentation trail is provided for such transfers. AR Reconciliation - All accounts will be reconciled to reflect accurate balances outstanding against payments received and posted. Write-offs will also be posted where your office has provided prior agreement. Exhibit A Page 17 Rebilling and payment arrangements - Rebilling will be performed for accounts where partial payments are made or accounts where re';lular payments have been arranged. Details of such arrangements will be noted on the account. Receivables are processed and posted to individual accounts at which time the status of the account is updated. These updates control the way in which the account must be subsequently processed ranging from c1osingpaid-in-full accounts to filing seconda;y, refiling and invoicing or rebilling customers. Refunds and returned checks - Refunds are ~enera!ly processed on a monthly basis. Refund requests are presented to the City in a report format with suppoli.;.....g documentation provided. Checks returned as NSF can be processed in a manner determined by the City. Generally, the bank provides a copy of the check and, we will attempt to collect the amount directly from the customer. Posting adjustments are made accordingly as a reversal entry and reflected on the month-end reporting. Reporting - All collections activity will be summarized and posted on a monthly basis. Reports are provided by the 10th of each month. Specific reports provided are identified in a later section. Audit Because we have focused on performing billing and collecting for municipalities, we are most familiar with the requirements for their audits and can fully comply with such requests. In fact, because of such familiarity we can often assist in providing insight to help correct discrepancies and errors. We will cooperate with all such reasonable requests for audit. Professional Billing/Accounting Procedures Advanced Data Processing began as a provider of data processing based accounting services as one of the founders holds an Accounting degree. All processes are performed using generally accepted accounting methods and principles (GAAP). Receivables including Electronic Funds Transfers are balanced against bank deposits to assist your accounting department in reconciling their accounts. This ensures efficient and accurate billing, collection and account management reconciling to all payments, patient accounts, deposits, refunds, adjustments, billing placements and statistics. Exhibit A Page 18 It is we::. :~'J:ing here that we a~e 0.1€: 0; verI few companies that report collection sta~i5tics in a correct manner. That is, we reoor. receivables collected aqainst the month within which the charqe was oriqinallv billed. This is the only way to produce actual collection percentages. Other companies attempt to mask their performance using what seem to be simpler methods. Maintenance of Records We maintain all payment records for the pe~iod speci~ed by t;,e City. These records are kep~ intact with co;:ies of Explanation of Benefi,s (::03s) th2~ accompany most insurance payments. These are filed by cash receipt date and kept in chronological sequence along with deposit reconciliation. Copies of specific documents can be provided to the City upon request. All records are considered the property of City of Boca Raton and will be turned over upon completion or termination of the contract. Patient Calls Phone service - Our collection ability is dependent on availability. Consequently, we provide toll-free "800' numbers to our clients for beth patient calling and calls from the City personnel to us. We will not only provide three toll-free lines but will also provide rotary capability to available lines improving call response times and availability. Phone lines specific to your customer requirements will be allocated with the number clearly provided on all bills, invoices and correspondence. Included will be a facility providing toll-free access. We absorb all phone costs as part of the basic service we provide. Support & availability - Phone lines specific to your customer requirements will be allocated with the number clearly provided on all bills and invoices. Included will be a facility providing toll-free access. Facilities and attendants are provided to ensure calls are not blocked. Rather, someone is available to answer calls Monday thru Friday (excluding Holidays) from 8:00 a.m. to 5:00 p.m. In addition, we have people calling self-pays/no-pays two nights a week until 8 p.m. and on most Saturdays 'ti1 2.pm.. Statistics on phone activity are reviewed monthly to ensure proper level of phone availability is maintained. Facilities and attendants are provided to ensure calls are not blocked. Rather, someone is available to answer calls Monday thru Friday (excluding Holidays) from Exhibit A Page 19 8:00 a. m to 5:00 p.m. Statistics o'n phone activity are reviel,'1ed monthly to ensure proper level of phone availability is maintained. Customer Communications Philosophy - Our client history shows "We are focused on our client's success improving their cash flow through constant innovation yet proven means and, providing the hig:'est service levels attainable with professional respect by both the client and the community." Advanced Data Processing conducts all written and verbal communication always in the most professional manner. We emphasize helpfulness towards the customer and respect referencing ourselves as a representative of your organization and never as collectors or, in any way that might be interpreted as intimidating or threatening. Multi-ethnic operators are employed to facilitate most frequent language requirements. In addition, difficult calls are passed to a supervisor more skilled in handling irate callers, special insurance issues, taxpayer questions, etc. A significant aspect of our ability to achieve high collection levels is our customer service perspective. Records On a special incident basis requests for records (e.g. run report) will be forwarded to Fire Rescue for processing & response regardless of source of request (i.e. insurance, patient, attorney, etc.). In the case. of insurance requests, we might expect you would have us forward the information to the insurance carrier for claims processing. Alternatively, we could provide you with the appropriate filing material for your forwarding. If you desire, we can accommodate billing the requester/patient special handling charges for obtaining copies of records. Education Client Training - Using some of the finest multi-media tools to bring training assistance to the Fire Rescue staff and administration we provide education aids and assistance in essentials of understanding the importance of key patient information (demographic, insurance and medical) in the successful billing process. We have produced a training video especially for this purpose. Exhibit A Page 20 Attendant Training - Advanced Data Processing provides training and a stable environment for its attendants. They are skilled in 'understanding all aspects of insurance applicable to EMS transport billing so as to be helpful toward the customer and efficient in processing charges and insurance claims. They are also trained in how to provide maximum assistance to the customer and when to transfer the call to a supervisor for handling difficult situations. We maintain a multi-ethnic staff to handle ca::s in languages other than English. Our exception reporting system allows us to view th:: work completed by an individual for a given day. This allows the supervisor to review the work (specific accounts) on which an operator has worked. This assists i~ training and on-going qualitj improvement. Exhibit A Page 21 Remote Acces::.; Information Download - We provide access to our system facilities for the purpose of electronically sending us your transport data and billing information. This access is convenient and easy to use via an FTP/lnternet Site maintained for us under arrangement. We provide you a username and password for access and you can deposit your information any time convenient to you. Technical Data FOimat - We have provided t:-J;s tiPS service for 2 number of clients supporting various data fOima~3 for their respective sj's:ems. V/e can coo,-dinate with your systems people for support of any format the} might require or provide a sample of formats we already support. Exhibit A Page 22 Reports - Management Information Advanced Data Processing prides in providing essential statistics in concise easy-to-understand format. These reports provide our client with the same insight we use to manage and increase the efficiency of their collections. Monthly reporting is produced after month closing and provided to you no later than the 10th of each month. 'Ne print the reports within 24 hours aher receiving the last day of the month's receivables from the bank. All reporting ""ill be in the manner as requested by the City. The following a,e major reports I,',e produce as a sample for the City's evaluation: o Collection Statistics - Summary o Collection Statistics - by Payor Class o Collection Statistics - Gross/Net Computation o Account activity - Monthly Billing Report (Charges) o Account activity - Monthly Payment Report (Receivables) o Billing & Collections - Summary to Date, Monthly Running o Accounts Receivable - Summary o Monthly Refund Schedule o Insurance Report - # of Bills with Outstanding Balance by Class In addition to the above reports, Advanced Data Processing will provide the following: · All account numbers will be cross-referenced to City's incident numbering. · Other reports as requested by the City. Ad Hoc Reports Advanced Data Processing prides in providing essential statistics in concise easy-to- understand format. However, we do understand that special requirements come up on occasion. In response to such situations, we can provide ad hoc reporting either from the AS400 environment or in the PC environment without limitation since we are on our own proprietary software. Exhibit A Page 23 Reports - Management Information (cont'd) The following section provides a brief explanation of major reports provided and concludes with an example of each. Samples are provided (as shown in the proposal submission) are not necessarily complete nor are they all live data. Confidential information such as names, contact and 10 information is obscured to protect confidentiality. 1. Collection Statistics ~ Summary Provides a running month summary of charge, payment and adjustments fJr the closing month period showing gross and net collection percentages for each period. Summari:es totals fJr each type activit'j and computes average coilectkms for both gross and net. Note: All payment activity is ref/ected against the original month billed in order to reflect true collection percentages. 2. Collection Statistics - by Payor Class Provides a running month summary for the closing month period of collections by Payor Class (Self-Pay, Medicare, Medicaid, and Private Insurance). The report also shows for each running month the mix or, % of total collected against that month's billings for each class. Also shows # of accounts billed and total # of accounts. Summarizes total amounts collected by class and % of total. 3. Collection Statistics - Gross/Net Computation Shows overall monthly computation of gross collection percentages providing # of accounts billed and accounts not billable. Total amounts are summarized. 4. Account activity - Monthly Billing Report (Charges) Shows all billing (new charges) processed alpha sorted by Last Name and summarized total billing for period. 5. Account activity - Monthly Payment Report (Receivables) Provides a batch oriented listing of all payments processed including check number and type of payment (self pay, Medicare, Medicaid, private insurance). Report reconciles against bank deposit and ties back to EOB detail for secondary filing, refund processing and adjustments. 6. Billing & Collections - Summary to Date, Monthly Running Show receivables as applied to "original billed month". 7. Accounts Receivable - Summary Provide summary for period ending of Accounts Receivable showing gross billing, payments received/processed, reflected write-offs and adjustments, reversals and ending balance. Exhibit A Page 24 8. Monthly Refund Schedule Report provides by account detail of associated payments reflecting an overpayment and necessary refund to be processed. ' 9. Insurance Report - # of Bills with Outstanding Balance by Class Provides summary showing by running (billed) month the number of patient bills having an outstanding balance. Shows balance and number of bills outstanding by class. 10. Payment Report - % of Bills Showing Payment Provides for each billing month total patients, number ha'ling made no payments, number and percentage having made payment Exhibit A Page 25 Exhibit B - Fees Pricing for all services shall be a monthly contingency fee of: Seven (7%) percent of all monies collected in the previous month. Price shall include but not be limited to all stationary, fax, forms, envelopes, mailings, postage, and telecommunications/phone facilities/charges. Price for services does not include the cost of "Locked-box" seNice. The "Locked-box" service selected shall be at the sole discretion of the City and shall provide a secure postal address and box for receipt of all correspondence (especially including all insurance and patient payments, correspondence and benefits determination and denials. The "Locked-box" service will on a daily basis perform the following: · Open all mail (except clearly marked returned-mail). · Make a copy of every check and attach copy with original document accompanying each check. · Deposit all receivables into designated City account. · Prepare and provide a daily deposit slip totaling and accounting for all receivables deposited for the identified day. · Mail (daily) to Advanced Data Processing separated bundles of; copies of checks attached to supporting documents, other correspondence and, returned-mail along with deposit slip. · Mail (daily) to City copies of checks and daily deposit slip. · Mail (monthly) to City reconciliation of account. Price shall include adjustment due to increase in cost for postage according to the City's RFP (Section 2-2 E.). Exhibit 8 Page 1