01/06/2009 I I
I AUDIT REPORT OF MONROE COUNTY
CONTRACT BETWEEN THE COUNTY
AND ADVANCED DATA PROCESSING,
INC., FOR RESCUE AMBULANCE
BILLING AND RELATED PROFESSIONAL
SERVICES
January 6,2009
O �`UNT
J��,JvN► Cv'pG . 9 �. •
j
•
s eater
4
''40F COUNTY.
Prepared by:
Internal Audit Department
Clerk of the Circuit Court
Danny L. Kolhage, Clerk
Monroe County,Florida
j I
AUDIT REPORT OF MONROE COUNTY
CONTRACT BETWEEN THE COUNTY AND
ADVANCED DATA PROCESSING,INC., FOR
RESCUE AMBULANCE BILLING AND RELATED
PROFESSIONAL SERVICES
TABLE OF CONTENTS
Page
I. OBJECTIVES AND SCOPE 1
II. METHODOLOGY 1
III. BACKGROUND INFORMATION 2
IV. AUDIT CONCLUSIONS 3
f V. AUDIT FINDINGS
A. ADPI's initial billing to patients is not completed in a timely manner. 4-6
- B. The contract between the County and ADPI does not specify a time frame for
re-filing claims to obtain payments from Medicare, Medicaid or insurance providers 7-8
C. ADPI is not sending out the contractually agreed upon six (6) invoices. 9-10
D.ADPI is not meeting the contractual requirements for the timing of invoices to
self-pay patients/payers. 11-12
E. County is unable to bill and collect on the patients with Medicare and Medicaid
L coverage that were transported on Emergency Medical Air Transport Ambulance. 13
F. The contract does not include a copy of Monroe County's established guidelines for
• negotiated payments. 14
G.ADPI is not providing a monthly Accounts Receivable Aging report to the County. 15
H. County invoicing.and collection process is unnecessarily long. 16-17
VI. EXHIBITS
A. Contract
B. Resolutions
VII.AUDITEE RESPONSES—Advanced Data Processing, Inc.
VIII.AUDITEE RESPONSES—County Administrator's
AUDIT REPORT OF MONROE COUNTY
CONTRACT BETWEEN THE COUNTY AND
ADVANCED DATA PROCESSING, INC., FOR
RESCUE AMBULANCE BILLING AND RELATED
PROFESSIONAL SERVICES
I. OBJECTIVES AND SCOPE
At the request of the Monroe County Clerk of the Circuit Court, the Internal Audit Department has
completed an audit of the contract between the County and Advanced Data Processing, Inc.
(ADPI), for Rescue Ambulance Billing and Related Professional Services. Exhibit A — Contract.
The audit objectives were to assess compliance with the Contract's patient billing and collection
services.
II. METHODOLOGY
A. We interviewed the following personnel to obtain information about the contract between the
County and Advanced Data Processing,Inc.
1. Darryl Hartung,ADPI
2. Camille Dubroff,Monroe County Emergency Services
3. Mike Rice,Monroe County Sheriff's Office
4. Marva Green,Assistant Monroe Clerk of the Court
5. Cynthia Hall,Assistant Monroe County Attorney
i I
B. Internal Audit Department examined the following documents:
1. Contract dated April 20,2005 with Advanced Data Processing, Inc. Exhibit A—Contract.
2. Resolution No. 245A—2006 dated July 19,2006. Exhibit B—Resolutions.
3. Resolution No. 175—2008 dated June 18,2008. Exhibit B—Resolutions.
4. ADPI Policy and Procedures document
5. Emergency Medical Air Transports data ADPI query from November 2006 to July 2008.
6. Ambulance/Ground transport data ADPI query from November 2006 to August 2008.
7. Electronic file confirmations between Monroe County Emergency Services and ADPI.
8. ADPI's EMS Billing Services "Independent Service Auditor's Report on Controls Placed in
r Operation as of October 30,2008."
9. Monroe County Clerk's April 2008 Ambulance accounts receivable file.
—'t C. Internal Audit reviewed the Contract to ensure that patient billing services were being
performed as required by the Contract.
•
D. Internal Audit compared data obtained from ADPI to the requirements of the contract.
1
III. BACKGROUND INFORMATION
On April 20, 2005 a Contract was entered into between Monroe County and Advanced Data
Processing, Inc. ADPI is to perform medical billings and accounts receivable management services
for Monroe County's rescue Ambulance and Emergency Medical Air transports. This audit is based
upon the billing parameters for the self-pay patients/payers set forth within the contract. There are
four categories of payers Medicare, Medicaid, commercial insurance and self-pay that internal audit
tested.
Internal Audit judgmentally sampled twenty-five (25) transports to test whether the contractual
billing parameters were being adhered too. The sample was made up of ten (10) Ambulance and
fifteen (15) Emergency Medical Air transports. Of the fifteen (15) Emergency Medical Air
- transports they included only commercial insurance and self-pay payers. ADPI is unable to bill and
collect the Emergency Medical Air transports with Medicare and Medicaid coverage due to the lack
of a provider number.
I
2
IV. AUDIT CONCLUSIONS
1.ADPI's initial billing to patients is not completed in a timely manner. Out of twenty-five (25)
sampled patients the average time it took to initially bill them was thirty-nine (39) days.
2.The contract between the County and ADPI does not specify a time frame for re-filing claims to
obtain payment from Medicare, Medicaid, or insurance providers. The contract states "As
necessary, Contractor shall re-file Medicare, Medicaid, or Insurance claims to obtain payment."
3.ADPI is not sending out the contractually agreed upon six (6) invoices.
4.ADPI is not meeting the contractual requirements for the timing of invoices to self-pay
- patients/payers.
5. County is unable to bill and collect on the patients with Medicare and Medicaid coverage that
were transported on Emergency Medical Air Transport Ambulance. Without a provider number,
Medicare and Medicaid will not pay on the claims.
6. The contract does not include a copy of Monroe County's established guidelines for negotiated
payments. The contract states that Monroe County guidelines should be utilized by the contractor
(ADPI) when negotiating payment schedules with patients unable to pay in-full when billed.
7. ADPI is not providing a monthly accounts receivable aging report to the County. The contract
has fourteen (14) monthly reports listed and an accounts receivable aging report is not one of them.
8. County invoicing and collection process is unnecessarily long. The contract states that an account
has to be inactive for twelve (12) months or more before a pre-collection letter is sent. If you
consider the invoicing time period of 155-days for self-pay patient/payers, then at a minimum it will
take about 1 1/2 years before a non-performing account even gets a pre-collections letter.
'
3
V. AUDIT FINDINGS
1.ADPI's initial billing to patients is not completed in a timely manner.
Finding:
According to the Contract, Attachment A, Part I. Scope of Work section B. Patient Billing sub-
section 2 "CONTRACTOR shall provide patients with a comprehensive statement/invoice
including a courtesy return payment envelope. The front of the statement shall describe all charges
and payments. The reverse side of the statement shall have clearly marked entry blocks for
information needed to file private insurance claims. CONTRACTOR shall file claims and send an
invoice to all self-pay patient/payers with return envelope and address as specified by MONROE
COUNTY within five (5) days of receipt of incident information." Exhibit A—Contract.
Also according to the Contract, Attachment A, Part I. Scope of Work section C. Patient Filing 1.
"CONTRACTOR shall file all insurance claim forms for all patients based upon information
received from the Run Report and research performed by CONTRACTOR. CONTRACTOR shall
provide prompt submission of required paperwork to Medicare, Medicaid, Insurance Companies or
Third Party Payers for claims, reviews, resubmission, provider agreements and other as required
within 72 hours after receiving the requested "Run Report" from MONROE COUNTY." Exhibit
A—Contract.
Internal Audit sampled twenty-five (25) patient billings that averaged thirty-nine (39) days before
ADPI sent out the first billing. Only one (1) of the sampled billing met the contractually agreed
upon invoicing.
Recommendation(s):
1. The BOCC should ensure that there are policies and procedures in place to monitor compliance
with the Contract.
4
ADPI's Response:
1. The entire billing process is highly dependent on the data received on each run report from the
County. After a run report is received, ADPI performs the necessary review related to determining
service level, coding, medical necessity, and patient signature capture. Upon performing the normal
billing requirements associated with each account,ADPI then focuses attention on reviewing patient
demographic and insurance information. To this extent, some of the patient demographic data is not
accurate and therefore requires further research to obtain correct information related to the patient
name, patient address, patient social security number, patient phone number, etc... In addition to
the sometimes missing or inaccurate patient demographic information, most run reports do not
contain patient insurance information and therefore require further research. ADPI takes a number
of steps to obtain this information including: researching information that may be available at the
hospital the patient was transported to, insurance eligibility checks for Medicare, Medicaid, and
commercial payers, internal ADPI historical patient database lookup, and ultimately patient
statements. All of these efforts are performed when the run report is received but do need time to
be completed. These techniques have been developed over the years and are constantly changing to
accommodate technology and process improvements. It is our goal that the patient would never
receive a statement as we would locate the patient's correct insurance information, file the insurance
claim, and then receive payment in full to close the account. It is our recommendation that our
contract allow for the time it takes to identify correct patient demographic data and insurance
information. ADPI is more than willing to work with the County to determine a proper time frame.
County Administrator's Response:
1. On May 25, 2007 in a Business Update meeting with Darryl Hartung, Cynthia Hall, Brian Parker,
Camille Dubroff and Susie Martenson ADPI explained that they found the need to re-evaluate how
they convert our transports into billable claims for Trauma Star. They found that extra efforts were
needed to find significant billable information for each transport rather than sending out a statement
before a billable party could be located thus resulting in an increase in revenue. I have attached a
copy of a slide with time-frames provided by ADPI which shows how long it could possibly take for
the first statement to be sent with their new process. You will see that it could take in excess of 13
days once they received the file for the first statement to be sent if they are trying to locate billable
information. It was agreed upon at this meeting to go forward with this change not only for our air
transports but also for our ground transports to produce the most revenue we could on every
transport. In the past we have allowed ADPI to make procedure changes,with our verbal approval,
if that means it will increase our collectible revenues. ADPI has been very flexible and willing to
provide whatever changes we have requested for the good of the County.
NO 1'h: The process in which you calculated the 39 days is not spelled out. Was it calculated from
the date of the actual incident or the date that the County sent the file for billing to ADPI? If it is
being calculated from the date of the incident then it should be pointed out that files being sent
from the County to ADPI do not occur daily. In addition, extra delays from the County occur when
the EMS program is down for maintenance/server issues, over weekends, holidays and vacations.
These extra delays should be taken into consideration.
5
The administrative staffs recommendation is to include wording in the contract that reflects verbal
changes which have occurred between the contractor and the County. This can be accomplished by
adding an amendment to the existing contract or placing it in the next extension should the contract
be extended or the next negotiated billing contract. In addition, a review of how much time it in fact
takes to convert calls into billable transports with an allowance for delays on the County billing side
should be conducted and updated in the contract so that a realistic time frame is in place.
The contract, Section I.G provides for monthly reports to be made by ADPI. The County will work
with ADPI to ensure that either currently required reports are modified or a new report is required
to provide sufficient information for County staff to monitor timeliness of billing. The County
should ensure that one of the administrative staff understands his/her job is to review billing
reports, and should be trained as to what to look for in the reports to inform the division director
that the billing agency needs to be contacted to improve performance. The division director should
send written correspondence to the Contractor when performance is not as contracted, and should
keep the County Administrator informed of the responses so that the appropriate action can be
taken at the BOCC level if necessary.
Auditor's Comment:
1. With regard to the County Administrator's comment which states "The process in which you
calculated the 39 days is not spelled out. Was it calculated from the date of the actual incident or the
date that the County sent the file for billing to ADPI?" Internal audit used the date that the County
sent the file for billing to ADPI.
( 6
2. The contract between the County and ADPI does not specify a time frame for re-filing claims to
obtain payments from Medicare,Medicaid, or insurance providers.
Finding:
According to the Contract, Attachment A, Part I. Scope of Work section C. Patient Filing 1.
"CONTRACTOR shall file all insurance claim forms for all patients based upon information
received from the Run Report and research performed by CONTRACTOR. CONTRACTOR shall
provide prompt submission of required paperwork to Medicare, Medicaid, Insurance Companies or
Third Party Payers for claims, reviews, resubmission, provider agreements and other as required
within 72 hours after receiving the requested "Run Report" from MONROE COUNTY.
CONTRACTOR shall submit secondary insurance provider claims after the primary insurance
provider has paid. As necessary, CONTRACTOR shall re-file Medicare, Medicaid, or Insurance
claims to obtain payment." Exhibit A—Contract.
Recommendation(s):
.1. The BOCC should create an amendment that includes a time frame for re-filing claims for
patients covered by Medicare,Medicaid, or insurance.
ADPI's Response:
1. Re-filing of claims is sometimes necessary when a payer denies a claim. Typically claims are
denied for specific reasons which requires additional research. Once this research has been
completed, the claim is re-filed immediately. It is difficult to determine the time frame associated
with the research as it depends on the reason for the initial payer denial. ADPI is willing to work
with the County to try and determine a proper time frame.
County Administrator's Response:
1. The contract states "As necessary, contractor shall re-file Medicare,Medicaid or Insurance claims
to obtain payments". Insurance claims that are filed receive an Explanation of Benefits (EOB) to
explain if they are approved or denied. A claim is re-filed `as necessary"on a case by case basis.This is
dependent on the outcome of EOB, or after ADPI has been informed that a denial was made to the
claim in error, or when additional information is required to evaluate the claim for payment. The
present contract wording "as necessary" is there to direct ADPI to re-file claims as warranted or as
necessary according to the outcomes of their initial filings. Not all claims will need to be re-filed
which is why the contract is worded as "as necessary".
7
The County is currently in its first renewal period. If the contract is renewed in 2009, an additional
provision should be inserted into the amendment, deleting "As necessary" and replacing it with
"Upon receipt of notice of claim denial,requirement for additional information, and Explanation of
Benefits reflecting underpayment, or other notice requiring submission of documentation to the
third-party provider...." Then after"Contractor shall" there should be added a number of days, for
example"within 45 days of such notice,". The amendment should be a condition of renewal.
, I
II
8
3. ADPI is not sending out the contractually agreed upon six (6) invoices.
Finding:
According to the Contract, Attachment A, Part I. Scope of Work section B. Patient Billing sub-
section 2 "CONTRACTOR shall provide patients with a comprehensive statement/invoice
including a courtesy return payment envelope. The front of the statement shall describe all charges
and payments. The reverse side of the statement shall have clearly marked entry blocks for
information needed to file private insurance claims. CONTRACTOR shall file claims and send an
invoice to all self-pay patient/payers with return envelope and address as specified by MONROE
COUNTY within five (5) days of receipt of incident information. CONTRACTOR shall be
responsible for sending a total of six invoices. CONTRACTOR shall send the second invoice at
thirty-five days, third invoice at sixty-five days, fourth invoice at ninety-five days, fifth invoice at one
hundred twenty-five days and sixth notice at one hundred fifty-five days. In the course of time that
the six invoices are sent to patient/payer, CONTRACTOR shall provide follow-up on rejected and
inactive claims and establish payer remittance accounts and procedures. Unless insurance payment
is pending, CONTRACTOR shall on a monthly basis send all accounts that have not had activity
for twelve (12) months or more a Pre-Collection letter. These accounts have thirty (30) days to
respond to the CONTRACTOR. Once the thirty (30) days has expired, the CONTRACTOR shall
send MONROE COUNTY a list of all accounts along with a complete processing history once
collection efforts are exhausted. These uncollectible accounts will be forwarded by the
CON TRACTOR into a third party collection agency named by MONROE COUNTY for further
attempts at collecting." Exhibit A—Contract.
Based upon the information reviewed, there was no evidence of ADPI sending out the contractually
agreed upon six (6) invoices for the self-pay patient. No self-pay patients that utilized Ambulatory
or Emergency Medical Air Transport Ambulance transportations taking place from November 2006
through July 2008 received more than four (4) invoices. Four (4) separate patients received more
than 4 invoices for payers commercial insurance and Medicaid.
Recommendation(s):
1. The BOCC should ensure that there are policies and procedures in place to monitor compliance
with the Contract.
ADPI's Response:
1. ADPI did find that due to a programming issue only four patient statements were being sent out.
This has since been corrected.
9
_J!
County Administrator's Response:
1. ADPI is aware that the contract states they are to send out six (6) invoices to each patient.
However, due to a programming issue on their end they were only able to send up to four (4)
invoices per patient for a while. They informed County administrative staff of the change and
advised they were working on resolving this. Since then this has been corrected and should be
reflected on all accounts.
The administrative staffs recommendation is a spot check of the newer accounts over the next few
months to determine if this has been remedied. The County administrative staff should have at least
one person's job include monthly review of billing reports, and training should be provided by the
Finance Department as to what to look for in the reports in order that staff can inform the division
director when the billing agency needs to be contacted to improve performance. The division
director should send written correspondence to the Contractor when performance is not as
contracted, and should keep the County Administrator informed of the responses so that
appropriate action can be taken at the BOCC level if necessary.
10
l ��
4. ADPI is not meeting the contractual requirements for the timing of invoices to self-pay
patients/payers.
Finding:
According to the Contract, Attachment A, Part I. Scope of Work section B. Patient Billing sub-
section 2 "CONTRACTOR shall provide patients with a comprehensive statement/invoice
including a courtesy return payment envelope. The front of the statement shall describe all charges
and payments. The reverse side of the statement shall have clearly marked entry blocks for
information needed to file private insurance claims. CONTRACTOR shall file claims and send an
invoice to all self-pay patient/payers with return envelope and address as specified by MONROE
COUNTY within five (5) days of receipt of incident information. CONTRACTOR shall be
responsible for sending a total of six invoices. CONTRACTOR shall send the second invoice at
thirty-five days, third invoice at sixty-five days, fourth invoice at ninety-five days, fifth invoice at one
hundred twenty-five days and sixth notice at one hundred fifty-five days. In the course of time that
the six invoices are sent to patient/payer, CONTRACTOR shall provide follow-up on rejected and
inactive claims and establish payer remittance accounts and procedures. Unless insurance payment
is pending, CONTRACTOR shall on a monthly basis send all accounts that have not had activity
for twelve (12) months or more a Pre-Collection letter. These accounts have thirty (30) days to
respond to the CONTRACTOR. Once the thirty (30) days has expired, the CONTRACTOR shall
send MONROE COUNTY a list of all accounts along with a complete processing history once
collection efforts are exhausted. These uncollectible accounts will be forwarded by the
CONTRACTOR into a third party collection agency named by MONROE COUNTY for further
attempts at collecting." Exhibit A—Contract.
ADPI is not meeting the contractually agreed upon invoicing standards for the self-pay
patients/payers. The table below reflects the average number of days for ADPI to invoice the self-
pay patients/payers.
Contract Standard Sampled Average
1st Invoice Within 5 days of receipt 39 days
of information
2nd Invoice At 35 days 90 days
3rd Invoice At 65 days 131 days
4th Invoice At 95 days 187 days
5th Invoice At 125 days 157 days
6th Invoice At 155 days 197 days
11
Recommendation(s):
1. The BOCC should ensure that there are policies and procedures in place to monitor compliance
with the Contract.
2. ADPI should create and utilize an Accounts Receivable Aging report to enhance the monitoring
and collections of past due accounts. The County should also utilize this aging report with a
number of times billed report to ensure that ADPI is staying current on the billing and meeting the
contractually agreed upon billing terms.
ADPI's Response:
1. This issue relates only to patient statements and is highly dependent again on the data received on
the run report. In addition, if an insurance claim is filed, patient statements are not mailed until the
insurance company responds with payment or further information.
County Administrator's Response:
1. According to the County Administrator's response see the response at number three (3) above.
2. The County is currently in its first renewal period. If the contract is renewed in 2009, additional
provisions should be inserted into the amendment to require the aging report and the number of
times billed report, and should be a condition of renewal. The County is considering going out for
RFP rather than renewing for an additional year.
II
12
5. County is unable to bill and collect on the patients with Medicare and Medicaid coverage that
were transported on Emergency Medical Air Transport Ambulance.
Finding:
ADPI is unable to bill and collect the Emergency Medical Air transports with Medicare and
Medicaid coverage due to the lack of a provider number. Without the provider number, Medicare
and or Medicaid will not pay on the claims. The lack of a provider number is partially due to the
listed owner of the helicopter. The Sheriff's department has hired a third party to obtain a provider
number, allowing the County to bill and collect on the Medicare/Medicaid Emergency Medical Air
Transport Ambulance transports. As of July 15, 2008 there were thirty (30) patients with a balance
due from Medicare/Medicaid totaling$341,394.
Recommendation(s):
1. The BOCC should complete the steps necessary to obtain a provider number for the Emergency
Medical Air Transport Ambulance transports in order to collect on claims to Medicare and
Medicaid.
County Administrator's Response:
1. This only affects air ambulance transports. Ground transports have a provider number and are
being billed.ADPI can not be faulted on these issues, as this is a County problem.
The provider number application process is in the hands of the Monroe County Sheriff's Office and
they are striving to resolve this and obtain our provider numbers for both Medicare and Medicaid.
The contractor can not bill these transports until MCSO obtains Provider numbers for billing. Per a
verbal report from their Chief Financial officer the week of January 12, 2009, the application for
provider number(s) should be completed and filed within a few weeks.
13
6. The contract does not include a copy of Monroe County's established guidelines for negotiated
payments.
Finding:
According to the Contract, section I. Scope of Work sub-section B. Patient Billing 3. "Within
MONROE COUNTY established guidelines, CONTRACTOR shall negotiate and arrange modified
payment schedules for patients unable to pay full amount when billed." Exhibit A—Contract.
The contract states that Monroe County guidelines should be utilized by the contractor (ADPI)
when negotiating payment schedules with patients unable to pay in-full when billed. According to
the Assistant County Attorney there is no document called Monroe County established guidelines.
"Rather the term refers just generally to all Monroe County ordinances, resolutions, and
administrative instructions."
Recommendation(s):
1. The County should consider adopting specific guidelines to be used by the Contractor in
negotiating payment schedules for patients that are unable to pay the full amount when billed.
County Administrator's Response:
1. The contract states that Monroe County guidelines should be utilized by the contractor (ADPI)
when negotiating payments schedules with patients unable to pay in-full when billed. There is no
single document with the name "Monroe County established guidelines". Rather, the term just
generally refers to all Monroe County ordinances, resolutions, and administrative instructions.This
was put into the contract to administer changes made by the County from resolutions and
ordinances that define rate schedules,policies, etc.
ADPI is aware that they are not to negotiate a different amount than what is billed and to date they
have never arranged any settlements. They refer all settlement requests to the Emergency Services
office and we handle on a case by case basis. If Emergency Services and the County Attorney
believe a settlement may be warranted we place these items before the BOCC for a final decision.
While ADPI has the authority to set up payment arrangements per Attachment A section B3, there
are no specific guidelines which establish any restrictions on their arrangements. Since it is
advantageous to the County for them to set up monthly payments to fit the patient's financial
situation until the account is paid in full. A set of guidelines should be established and provided to
the billing contractor.
The administrative staffs recommendation is to add to the contract specific wording to cover these
topics. This can be accomplished by adding an amendment to the existing contract or placing it into
either the next renewal addendum or the next negotiated billing contract.
14
7. ADPI is not providing a monthly accounts receivable aging report to the County.
Finding:
According to the Contract, section I. Scope of Work sub-section G. Monthly Reports "Unless
otherwise indicated, CONTRACTOR shall provide the following reports on a monthly basis as
identified and prescribed by MONROE COUNTY. Monthly reports shall be produced after the
month's closing and provided to MONROE COUNTY no later than the tenth of each month."
Exhibit A—Contract.
The contract has fourteen (14) monthly reports listed and an accounts receivable aging report is not
one of them. The creation and use of such report would help ensure the timely collections of past
due accounts.
Recommendation(s):
1. The County and ADPI create and utilize an accounts receivable aging report to enhance the
monitoring and collections of past due accounts.
ADPI's Response:
1. ADPI can provide an Aging report effective immediately.
County Administrator's Response:
1. This is not a report that the County has ever requested from ADPI but they can easily generate
for us. The administrative staffs recommendation is to discuss the possibilities of adding this
"aging" report to our existing monthly reports or possibly requesting it on a quarterly or yearly basis
from ADPI since this report is very large and a summary aging report may be sufficient in its place.
f This can be accomplished by adding an amendment to the existing contract or placing it into either
the next renewal addendum or the next negotiated billing contract.
j 15
8. County invoicing and collection process is unnecessarily long.
Finding:
According to the Contract, Attachment A, Part I. Scope of Work section B. Patient Billing sub-
section 2 "CONTRACTOR shall provide patients with a comprehensive statement/invoice
including a courtesy return payment envelope. The front of the statement shall describe all charges
and payments. The reverse side of the statement shall have clearly marked entry blocks for
information needed to file private insurance claims. CONTRACTOR shall file claims and send an
invoice to all self-pay patient/payers with return envelope and address as specified by MONROE
COUNTY within five (5) days of receipt of incident information. CONTRACTOR shall be
responsible for sending a total of six invoices. CONTRACTOR shall send the second invoice at
thirty-five days, third invoice at sixty-five days, fourth invoice at ninety-five days, fifth invoice at one
hundred twenty-five days and sixth notice at one hundred fifty-five days. In the course of time that
the six invoices are sent to patient/payer, CONTRACTOR shall provide follow-up on rejected and
inactive claims and establish payer remittance accounts and procedures. Unless insurance payment
is pending, CONTRACTOR shall on a monthly basis send all accounts that have not had activity
for twelve (12) months or more a Pre-Collection letter. These accounts have thirty (30) days to
respond to the CONTRACTOR. Once the thirty (30) days has expired, the CONTRACTOR shall
send MONROE COUNTY a list of all accounts along with a complete processing history once
collection efforts are exhausted. These uncollectible accounts will be forwarded by the
CONTRACTOR into a third party collection agency named by MONROE COUNTY for further
attempts at collecting." Exhibit A—Contract.
1 The contract states that an account has to be inactive for twelve (12) months or more before a pre-
collection letter is sent. If you consider the invoicing time period of 155-days for self-pay
patient/payers, then at a minimum it will take about 1 1 years before non-performing accounts
receive pre-collection letters.
Recommendation(s):
1. The BOCC should shorten the invoicing and pre-collection process.
ADPI's Response:
1. ADPI can work with the County on determining a more appropriate time frame to turnover
accounts for further collection activity.
16
I �
County Administrator's Response:
1. The contract states that an account has to be inactive for twelve (12) months or more before a
pre-collection letter is sent. Comments in the audit report include that if you consider the invoicing
time period of 155-days for self-pay patients/payers, then at a minimum it will take about 1 1/z years
before a non-performing account even gets a pre-collections letter.
The one year time period was put in place to accommodate all collections before transferring the
account to another contractor (the collection agency). Guidelines for write offs set in October of
2001 by Division Director Reggie Paros showed that it can take up to one year to collect from a
patients insurance provider. The County did not want to send accounts to collections before there
was sufficient time to collect from the insurance carriers. This fact still holds true according to
ADPI.
In October of 2001, a procedure for write offs was put in place by Mr. Paros. This procedure states
if there has been no payment or activity for a one-year period, the account could be deemed
uncollectible. According to this procedure, these accounts that were deemed uncollectible were to
be written off and then sent to collections for further collection efforts.
In 2004 this guideline was reviewed and revised. It was agreed that all accounts should be sent to
collections first and then written off after they had been deemed uncollectible by both the billing
agency and the collection agency. The one-year mark remained due to the time frame to collect
from insurance companies.
If the clerk's office recommends a different time frame for accounts to be sent to collections, this
can be accomplished by adding an amendment to the existing contract or placing it into the next
negotiated billing contract.
i . 17
VI. EXHIBITS
EXHIBIT A
CONTRACT
EXHIBIT B
RESOLUTION NO. 175-2008
AND
RESOLUTION NO. 245A-2006
•
Emergency Services
RESOLUTION NO. 175 -2008
A RESOLUTION OF THE BOARD COUNTY
COMMISSIONERS OF MONROE COUNTY,
FLORIDA SUPERSEDING RESOLUTION NO.
245A-2006,AND ADOPTING AN AMENDED FEE
SCHEDULE FOR USE BY THE SPECIAL TAXING
DISTRICT FOR PROVIDING EMERGENCY MEDICAL
AIR TRANSPORT AMBULANCE SERVICES.
I_ WHEREAS, Ordinance No. 050-1987 was passed and adopted by the Board of County
Commissioners of Monroe County,Florida on November 17, 1987;
WHEREAS, in accordance with Section 3 of said Ordinance No. 050-1987, the governing
bodies shall have the right to establish rates of user fees by Resolution;and
WHEREAS, the Board of County Commissioners of Monroe County, Florida previously
adopted Resolution 245A-2006, adopting a fee schedule for use for providing Emergency Medical Air
Transport Services in Monroe County; •
WHEREAS,the Board desires to revise the fee schedule;
NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY,FLORIDA,that,
1. Effective June 18, 2008, Resolution 245A-2006, adopted by the Board of County
Commissioners on July 19,2006,is hereby superseded by this Resolution;and
2. Effective June 18, 2008,the Board adopts the following Fee Schedule for use for providing
Emergency Medical Air Transport Ambulance Services.
Air Ambulance Transport Fee $5500.00
Mileage $ 80.00 per mile
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida,at a regular meeting of said Board held on the 18th day of June ,2008.
7.4
Mayor Mario Di Gennaro Yes s m
O r
Commissioner Dixie Spehar Yes tee,= rr--- `�
• II ssioner George Neugent Yes s" ' t
sioner Charles"Sonny"McCoy Yes •
c�~
•• ioner Sylvia Murphy Yes • ' "�
!' is
• •--- "-*\ ;, 1 BOARD OF COUNTY ; OMMIS NERS
OF MONROE COUNTY,1LORIDA
`
LNur cow' .
Attest:DANNY L.KOLHAGE,Clerk By:
Mayor/Chairperson MONROE COUNTY ATTQ}9NEY
A PROVED AS jORM:
�eputy lerk
CYNTHIA L. HALL.
ASSISTANT COUNTY ATTORNEY
Date
D 05-10-�
Emergency Services
RESOLUTION NO.245A -2006
A RESOLUTION OF THE BOARD COUNTY
COMMISSIONERS OF MONROE COUNTY,
FLORIDA ADOPTLNG A FEE SCHEDULE FOR
USE BY THE SPECIAL TAXING DISTRICT FOR
PROVIDING EMERGENCY MEDICAL AM
TRANSPORT AMBULANCE SERVICES.
WHEREAS, Ordinance No. 050-I987 was passed and adopted by the Board of Counv
Commissioners of Monroe County,Florida on November 17, 1987;
WHEREAS, in accordance with Section 3 of said Ordinance No. 050-1987, the governing
bodies shall have the right to establish rates of user fees by Resolution; and
WHEREAS, the Board of County Commissioners of Monroe County, Florida desires to adopt
the following fee schedule for providing air ambulance service;
NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY,FLORIDA,that the Board hereby adopts the following
Fee Schedule for use for providing Emergency Medical Air Transport Ambulance Services:
Air Ambulance Transport Fee S4500.00
Mileage S80.00 per mile
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida, at a regular meeting of said Board held on tl-ie lei day of :5144 , 2006.
Mayor Charles "Sonny" McCoy yes
Commissioner Dixie Spehar Yes ?ycfb
Commissioner George Neugent _ •- --Yes 04 r
Commissioner David Rice Yes c)• r-
Cpnunissianer Glenn Patton _ Yes C c ca
(S 4L) BOARD OF CO TNTY cilegISSMNEl
OF MONROE C TY, ROI` Ac
Attest: DANNY .-KOLHAGE, Clerk By:
Mayor/Chairperson
MONROE COUNTY ATTORNEY
Deputy Clerx AA PRO ED AS TO FORM:
SI5AN M. GRIME EY
ASSISTANT COUNTY ATTORNEY
T e 17, ?oOt;
•
CONTRACT BETWEEN
1.'c. PR 29 pH 3: 37;HE COUNTY OF MONROE
AND
I• • 'ADVANCED DATA PROCESSING, INC.
ul�IGE: CGL.:,ii';La
FOR RESCUE AMBULANCE BILLING AND RELATED PROFESSIONAL
SERVICES
THIS CONTRACT, hereinafter"CONTRACT OR AGREEMENT" made and entered into this
aU' day of Apr 1.1 , 2005 by and between MONROE COUNTY, a political
subdivision of the State of Florida, with principal offices located at 490 63rd Street, Marathon,
FL 33050, hereinafter referred to as the "COUNTY", and ADVANCED DATA
PROCESSING, INC., a Delaware corporation with principal offices located at 520 NW 165
Street, Suite 201, Miami, Florida 33619, hereinafter referred to as"CONTRACTOR":
WITNESSETH:
WHEREAS, MONROE COUNTY intends to enter into an agreement for the provision of
rescue ambulance billing and related professional services by the CONTRACTOR to
MONROE COUNTY; and,
WHEREAS, the CONTRACTOR represents that it is capable and prepared to provide such
Services:
NOW THEREFORE, in consideration of the promises contained herein, the parties hereto
agree as follows:
ARTICLE 1 -EFFECTIVE DATE
•
The effective date of this Agreement shall be after the approval of MONROE COUNTY Board
of County Commissioners and effective for a three(3)year term from June 1, 2005 through
May 31. 2008, with the option to renew for two(2)additional one year periods, subject to
cancellation as provided herein. MONROE COUNTY'S performance and obligation to pay
under this contract, is contingent upon an annual appropriation by the Board of County
Commissioners.
ARTICLE 2- SERVICE TO BE PERFORMED BY CONTRACTOR
The CONTRACTOR shall perform the services as specifically stated in the Scope of Services
(Attachment A)without requirement for the issuance of any additional work orders. Additional
services may be issued in the form of a Work Order. Each Work order will set forth a specific
Scope of Services, amount of compensation, deliverables and completion date and shall be
subject to the approval of MONROE COUNTY. CONTRACTOR shall perform no additional
services until any applicable Work Order is obtained from MONROE COUNTY and
countersigned by the CONTRACTOR.
ARTICLE 3-COMPENSATION
MONROE COUNTY shall pay CONTRACTOR in accordance with Attachment B,
Compensation for Services, which is attached hereto and incorporated by reference as part of
this Agreement.
1
I i
ARTICLE 4- STANDARD OF CARE
CONTRACTOR shall exercise the same degree of care, skill, and diligence in the performance
of Services as is ordinarily provided by a professional CONTRACTOR, offering services for
local governments in South Florida, under similar circumstances and CONTRACTOR shall, at
no additional cost to MONROE COUNTY, re-perform services which fail to satisfy the
foregoing standard of care.
ARTICLE 5-INDEMNIFICATION
CONTRACTOR shall indemnify and hold harmless MONROE COUNTY, its officers, and
employees from liabilities, damages, losses and costs, including, but not limited to reasonable
attorney's fees, to the extent caused by the negligence, recklessness
ional wrongl
misconduct of CONTRACTOR and persons employed or utilized by CONTRACTORt inf t
he
performance of this agreement. Except as specifically provided herein, this agreement shall not
require the CONTRACTOR to indemnify MONROE COUNTY, its officers, and employees
from any liability, damage, loss, claim, action, or proceeding.
Any costs and expenses, including attorney's fees, appellate, bankruptcy or defense counsel
fees incurred by MONROE COUNTY to enforce this Indemnification Clause shall be borne by
the CONTRACTOR. This Indemnification Clause shall continue indefinitely and survive the
cancellation, termination, expiration, lapse or suspension of this agreement.
ARTICLE 6-INDEPENDENT CONTRACTOR
The CONTRACTOR is an independent contractor and not an employee or agent of MONROE
COUNTY except that CONTRACTOR shall be authorized as an agent as follows: To the
extent necessary to fulfill its billing and collection efforts under this Agreement,the
CONTRACTOR is authorized to execute 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 MONROE COUNTY; and
insurance filings and related forms. The CONTRACTOR has no authority to sign any other
document's except as specifically authorized by MONROE COUNTY.
CONTRACTOR undertakes performance of the Services as an independent contractor and
shall be wholly responsible for the methods of performance. CONTRACTOR shall work
closely with MONROE COUNTY in performing Services under this Agreement.
The CONTRACTOR shall retain full control over the employment, direction, compensation
and discharge of all persons assisting in the performance of service by CONTRACTOR. The
CONTRACTOR shall be fully responsible for all matters relating to payment of employees,
including compliance with Social Security, withholding tax and all other laws and regulations
governing such matters. The CONTRACTOR shall be responsible for its own acts and those
of its agents and employees during the term of this contract. The CONTRACTOR shall not
receive any MONROE COUNTY benefits, stipend or privileges afforded by MONROE
COUNTY employees.
ARTICLE 7- COMPLIANCE WITH LAWS
In performance of the Services, CONTRACTOR will comply with applicable regulatory and
other applicable requirements including federal, state, and local laws, rules regulations, orders,
codes, criteria and standards.
•
2
ARTICLE 8- INSURANCE
During the performance of the Services under this Agreement, CONTRACTOR shall procure
and maintain the following insurance polices, and provide originals or certified copies of all
policies, and such coverage shall be written by an insurance company authorized to do business
in Florida.
WORKERS COMPENSATION
The CONTRACTOR shall procure and maintain, for the life of this Contract/Agreement,
Worker's Compensation Insurance covering all its employees with limits meeting all
applicable state and federal laws. This coverage shall include Employer's Liability with limits
meeting all applicable state and federal laws, This coverage shall extend to any agent of
CONTRACTOR that does not have their own Workers' Compensation and Employer's
Liability Insurance. Thirty(30)days notice of cancellation, lapse or material modification is
required and must be provided to MONROE COUNTY via Certified Mail.
COMMERCIAL GENERAL LIABILITY
The CONTRACTOR shall procure and maintain, for the life of this Contract/Agreement,
Commercial General Liability Insurance. This coverage shall be on an "Occurrence" basis.
Coverage shall include Premises and Operations: Independent Contractors' Products and
Completed Operations and Contractual Liability. This policy shall provide coverage for death,
personal injury or property damage that could arise directly or indirectly from the performance
of this Agreement.
The Minimum Limits of Coverage shall be$1,000,000 per occurrence, Combined Single Limit
for Bodily Injury Liability and Property Damage Liability with a$10,000 deductible.
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS must be named as an
additional insured. The additional insured requirement is waived if Owners and Contractors' •
Protective Coverage is also provided, or required. Thirty(30)days written notice must be
provided to MONROE COUNTY via Certified Mail in the event of cancellation.
BUSINESS AUTOMOBILE LIABILITY
The CONTRACTOR shall procure and maintain, for the life of the Contract/Agreement,
Business Automobile Liability Insurance.
The minimum limits of coverage shall be$1,000,000 per occurrence, Combined Single Limit
for Bodily injury Liability and Property Damage Liability. This coverage shall be an"Any
Auto"or"Comprehensive Form" type policy.
In the event that the CONTRACTOR does not own any vehicles, we will accept hired and non-
owned coverage in the amounts listed above. In addition, we will require an affidavit signed by
the CONTRACTOR indicating the following:
Advanced Data Processing, Inc. does not own any vehicles.
In the event we acquire any vehicles throughout the term of this Contract/Agreement,
Advanced Data Processing, Inc. agrees to purchase "Any Auto"or Comprehensive Form
coverage as of the date of acquisition.
CONTRACTORS Signature:
3
Thirty(30)days written notice must be provided to MONROE COUNTY via Certified Mail in
the event of cancellation, lapse or material modification of any coverage required by this
agreement.
PROFESSIONAL LIABILITY/ERRORS AND OMMISSIONS INSURANCE
CONTRACTOR shall provide Professional Liability Insurance, including errors and omissions
for all services provided under the terms of this agreement with minimum limits of$1, 000,000
- dollars per occurrence; or claims made form with "tail coverage" extending three(3)years
beyond the term of the agreement. Proof of"nil coverage" must be submitted with the invoice
for final payment. In lieu of"tail coverage", Contractor may submit annually to MONROE
COUNTY current Certificate of Insurance proving claims made insurance remains in force
throughout the same three(3)year periods.
CRIME POLICY
CONTRACTOR shall provide a Crime Policy in the amount of$500,000. Coverage to be
provided shall include the following; Theft—Per Loss Coverage; Forgery or Alteration;
Inside the Premises—Theft of Money and Securities; Inside the Premises—Robbery or Safe
Burglary of Other Property; Outside the Premises; Computer Fraud; Funds Transfer Fraud; and
Money Orders and Counterfeit Paper Currency.
SUPPLEMENTAL PROVISIONS
1. The insurance coverage and conditions afforded by this policy(s) shall not be suspended,
voided, canceled or modified, except after thirty(30) days prior written notice by Certified
Mail Return Receipt Requested, has been given to the MONROE COUNTY department
that originated this contract.
2. Certificates of Insurance meeting the specific required provision specified within this
Contract/Agreement shall be forwarded to the MONROE COUNTY department that
originated the contract, and approved prior to the start of any work or the possession of
any MONROE COUNTY property or the commencement of services, as application.
SUBCONTRACTOR'S INSURANCE
The CONTRACTOR shall require each of his SUBCONTRACTORS to take out and maintain
during the life of his subcontract the same insurance coverage's required of the successful
CONTRACTOR Each SUBCONTRACFOR shall furnish to the successful CONTRACTOR
two copies of the Certificate of Insurance, and successful CONTRACTOR shall furnish one
copy of the Certificate to MONROE COUNTY.
NON-WAIVER OF IMMUNITY
Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County
and the Contractor in this Agreement and the acquisition of any commercial liability insurance
coverage, self-insurance coverage, or local government liability insurance pool coverage shall
not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract
entered into by the County be required to contain any provision for waiver.
4
ARTICLE 9-MONROE COUNTY' S RESPONSIBILITIES
MONROE COUNTY, during the term of this Agreement, shall:
MONROE COUNTY shall supply the"Run Report" attached hereto identified as Exhibit A to
CONTRACTOR with the necessary patient information on a timely basis for those patients that
have been transported by Fire-Rescue Services and in sufficient detail to support diagnosis and
procedure coding and make reasonable efforts to provide patient demographic information
necessary for accurate patient identification including name, address, social security number,
date of birth, and telephone number.
MONROE COUNTY shall provide CONTRACTOR with its approved billing policies and
procedures including fee schedules and collection protocols. MONROE COUNTY shall be
-- responsible for engaging any third party collection service for uncollectible accounts after
CONTRACTOR has exhausted its collection efforts.
MONROE COUNTY shall make reasonable efforts to timely process refunds identified by
CONTRACTOR for account overpayments.
MONROE COUNTY shall provide a Lock Box address to CONTRACTOR and will instruct
Lock Box to forward all Lock Box documents to CONTRACTOR for processing.
MONROE COUNTY shall provide for CONTRACTOR to have daily bank balance reporting
capabilities via internet access with bank.
MONROE COUNTY shall comply and cooperate with CONTRACTOR in all matters to
ensure proper compliance with all Federal, State and local laws rules and regulations as
applicable to the services being contracted for.
ARTICLE 10-TERMINATION OF AGREEMENT
During the time of this Agreement either party may terminate this Agreement for convenience
by first giving to other party at least thirty(30) days prior written notice. In the event the acts
constituting default are a violation of law, CONTRACTOR shall be subject to immediate
termination. Notwithstanding the provisions above, the COUNTY shall not have any right to
cancel this contract without cause.
Upon termination, the CONTRACTOR shall submit an invoice(s)to MONROE COUNTY 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 COUNTY shall be under no further
obligation to the CONTRACTOR, financial or otherwise.
ARTICLE 11 - NONDISCLOSURE OF PROPRIETARY INFORMATION
CONTRACTOR shall consider all information provided by MONROE COUNTY and all
reports, studies calculations, and other documentation resulting from the Contractor's
performance of the Services to be proprietary unless such information is available from public
sources or is a public record under Florida law. CONTRACTOR shall not publish or disclose
proprietary information for any purpose other than the performance of the Services without the
prior written authorization of MONROE COUNTY or in response to legal process or orders of
a court of competent jurisdiction.
5
Public Access. The County and Contractor shall allow and permit reasonable access to, and
inspection of, all documents, papers, letters or other materials in its possession or under its
control, which are public records and which are subject to the provisions of Chapter 119,
Florida Statutes, and made or received by the County and Contractor in conjunction with this
Agreement; and the County shall have the right to unilaterally cancel this Agreement upon
violation of this provision by Contractor.
ARTICLE 12 - UNCONTROLLABLE FORCES
NONR h
AgreementNeitherMO if delaysROEC in U or failureTYnor of performanceCONTRACTO shalls all be due
be to Uncontrollableconsideredtobein Forcesdefault, theofthis
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, Acts
of God and governmental actions.
Neither party shall, however, be excused from performance if non-performance is due to forces
which are preventable, removable, or remediable and which the non-performing party could
have, with the exercise of reasonable diligence, prevented, removed, or remedied with
reasonable dispatch. The non-performing party shall, within a reasonable time of being
prevented or delayed from performance by an uncontrollable force, give written notice to the
other party describing the circumstances and uncontrollable forces preventing continued
performance of the obligations of this Agreement.
ARTICLE 13-GOVERNING LAW AND VENUE
This Agreement shall be governed by the laws of the State of Florida. Any and all legal action
necessary to enforce the Agreement will be held in Monroe County and the Agreement will be
interpreted according to the laws of Florida.
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Agreement, the County and Contractor agree that venue
will lie in the appropriate court or before the appropriate administrative body in Monroe
County, Florida.
The County and Contractor agree that, in the event of conflicting interpretations of the terms or
a term of this Agreement by or between any of them the issue shall be submitt
ed to mediation
prior to the institution of any other administrative or legal proceeding.
ARTICLE 14-MISCELLANEOUS
14.1 Non Waiver
A waiver by either MONROE COUNTY or CONTRACTOR of any breach of this Agreement
shall not be binding upon the waiving party unless such waiver is in writing and duly signed by
both patties to this agreement. In the event of a written waiver, such a waiver shall not affect
the waiving party's rights with respect to any other or further breach. The making or
acceptance of a payment by either party with knowledge of the existence of a default or breach
shall not operate or be construed to operate as a waiver of any subsequent default or breach.
6
14.2Severability
The invalidity, illegality, or unenforceability of any provision of this Agreement, or the
occurrence of any event rendering any portion or provision of this Agreement void or voidable,
shall in no way affect the validity or enforceability of any other portion or provision of the
Agreement. Any void or voidable provision shall be deemed severed from the Agreement and
the balance of the Agreement shall be construed and enforced as if the Agreement did not
contain the particular portion or provision held to be void. The parties further agree to reform
the Agreement to replace any stricken provision with a valid provision that comes as close as
possible to the intent of the stricken provision.
The provisions of this section shall not prevent the entire
should a provision which is of the essence of the Agreement determined t obeing held void
court of competent jurisdiction. to be void by a
14.3 Political Campaigns
During the term of this Agreement, the CONTRACTOR or any employee or associate, shall
not be involved in any political campaign for MONROE COUNTY elective office nor make
financial contribution to any such campaign.
14.4 Contractor Records
Contractor shall maintain all books, records, and documents directly pertinent to performance
under this Agreement in accordance with generally accepted accounting principles consistently
applied. Each party to this Agreement or their authorized representatives shall have reasonable
and timely access to such records of each other party to this Agreement for public records
purposes during the term of the Agreement and for four years following the termination of this
Agreement. If an auditor employed by the County or Clerk determines that monies paid to
Contractor pursuant to this Agreement were spent for purposes not authorized by this
Agreement, the Contractor shall repay the monies together with interest calculated pursuant to
Sec. 55.03, FS, running from the date the monies were paid to Contractor.
14.5 Attorney's Fees and Costs
The County and Contractor agree that in the event any cause of action or administrative
proceeding is initiated or defended by any party relative to the enforcement or interpretation of
this Agreement,the prevailing party shall be entitled to reasonable attorney's fees, court costs,
investigative, and out-of-pocket expenses, as an award against the non-prevailing party, and
shall include attorney's fees, courts costs, investigative, and out-of-pocket expenses in
appellate proceedings. Mediation proceedings initiated and conducted pursuant to this
Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and
customary procedures required by the circuit court of Monroe County.
14.6 Binding Effect
The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the
benefit of the County and Contractor and their respective legal representatives, successors, and
assigns.
14.7 Authority
Each party represents and warrants to the other that the execution, delivery and performance of
this Agreement have been duly authorized by all necessary County and corporate action, as
required by law.
14.8 Claims for Federal or State Aid
Contractor and County agree that each shall be, and is, empowered to apply for, seek, and
obtain federal and state funds to further the purpose of this Agreement; provided that all such
applications, requests,grant proposals, and funding solicitations shall be approved by each
party prior to submission.
14.9 Adjudication of Disputes or Disagreements
County and Contractor agree that all disputes and disagreements shall be attempted to be
resolved by meet and confer sessions between representatives of each of the parties. If no
resolution can be agreed upon within 30 days after the first meet and confer session, the issue
or issues shall be discussed at a public meeting of the Board of County Commissioners. If the
issue or issues are still not resolved to the satisfaction of the parties, then any party shall have
the right to seek such relief or remedy as may be provided by this Agreement or by Florida
law.
14.10 Cooperation
In the event any administrative or legal proceeding is instituted against either party relating to
the formation, execution, performance, or breach of this Agreement, County and Contractor
agree to participate, to the extent required by the other party, in all proceedings, hearings,
processes, meetings, and other activities related to the substance of this Agreement or provision
of the services under this Agreement. County and Contractor specifically agree that no art to
this Agreement shall be required to enter into any arbitration proceedings related to this party
Agreement.
14.11 Nondiscrimination
County and Contractor agree that there will be no discrimination against any
expressly understood that upon a determination by a court of competent jurisdiction thatd it is
discrimination has occurred, this Agreement automatically terminates without any further
action on the part of any party, effective the date of the court order. County or Contractor
agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable,
relating to nondiscrimination. These include but are not limited to: 1) Title VI of the Civil
Rights Act of 1964(PL 88-352) which prohibits discrimination on the basis of race, color or
national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss.
1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504
of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination
on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss.
6101-6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and
Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of
drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis
of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527(42
USC ss. 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug
8
abuse patent records; 8)Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The
Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time
to time, relating to nondiscrimination on the basis of disability; 10) Monroe County Code Ch.
13, Art. VI, prohibiting discrimination on the bases of race, color, sex, religion, disability,
national origin, ancestry, sexual orientation, gender identity or expression, familial status or
age; and 11)any other nondiscrimination provisions in any Federal or state statutes which may
- apply to the parties to, or the subject matter of, this Agreement.
14.12 Covenant of No Interest
County and Contractor covenant that neither presently has any in
terest, and sha
ll no
t acquire
any interest, which would conflict in any manner or degree with its performance under this
Agreement, and that only interest of each is to perform and receive benefits as recited in this
Agreement.
14.13 Code of Ethics
County agrees that officers and employees of the County recognize and will be required to
comply with the standards of conduct for public officers and employees as delineated in
Section 112.313, Florida Statutes,regarding, but not limited to, solicitation or acceptance of
gifts; doing business with one's agency; unauthorized compensation; misuse of public position,
conflicting employment or contractual relationship; and disclosure or use of certain
information.
14.14 No Solicitation/Payment
-
The County and Contractor warrant that, in respect to itself, it has neither employed nor
retained any company or person, other than a bona fide employee working solely for it,to
solicit or secure this Agreement and that it has not paid or agreed to pay any person, company,
corporation, individual, or firm, other than a bona fide employee working solely for it, any fee,
commission, percentage, gift, or other consideration contingent upon or resulting from the
award or making of this Agreement. For the breach or violation of the provision, the
Contractor agrees that the County shall have the right to terminate this Agreement without
liability and, at its discretion, to offset from monies owed, or otherwise recover,the full
amount of such fee, commission, percentage, gift, or consideration.
14.15 Privileges and Immunities
All of the privileges and immunities from liability, exemptions from laws, ordinances, and
rules and pensions and relief, disability, workers' compensation, and other benefits which
apply to the activity of officers, agents, or employees of any public agents or employees of the
County, when performing their respective functions under this Agreement within the territorial
limits of the County shall apply to the same degree and extent to the performance of such
functions and duties of such officers, agents, volunteers, or employees outside the territorial
limits of the County.
14.16 Legal Obligations and Responsibilities: Non-Delegation of Constitutional or
Statutory Duties
This Agreement is not intended to, nor shall it be construed as, relieving any participating
entity from any obligation or responsibility imposed upon the entity by law except to the
9
extent of actual and timely performance thereof by any participating entity, in which case the
performance may be offered in satisfaction of the obligation or responsibility. Further, this
Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the
constitutional or statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute, and case law.
14.17 Non-Reliance by Non-Parties
No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement
to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service
or program contemplated hereunder, and the County and the Contractor agree that neither the
County nor the Contractor or any agent, officer, or employee of either shall have the authority
to inform, counsel, or otherwise indicate that any particular individual or group of individuals,
entity or entities, have entitlements or benefits under this Agreement separate and apart,
inferior to, or superior to the community in general or for the purposes contemplated in this
Agreement.
14.18 Attestations
Contractor agrees to execute such documents as the County may reasonably require, to include
a Public Entity Crime Statement, an Ethics Statement, and a Drug-Free Workplace Statement.
14.19 No Personal Liability
No covenant or agreement contained herein shall be deemed to be a covenant or agreement of
any member, officer, agent or employee of Monroe County in his or her individual capacity,
and no member, officer, agent or employee of Monroe County shall be liable personally on this
Agreement or be subject to any personal liability or accountability by reason of the execution
of this Agreement.
14.20 Execution in Counterparts
This Agreement may be executed in any number of counterparts, each of which shall be
regarded as an original, all of which taken together shall constitute one and the same
instrument and any of the parties hereto may execute this Agreement by singing any such
counterpart.
14.21 Section Headings
Section headings have been inserted in this Agreement as a matter of convenience of reference
only, and it is agreed that such section headings are not a part of this Agreement and will not
be used in the interpretation of any provision of this Agreement.
ARTICLE 15-INTEGRATION AND MODIFICATION
This Agreement is adopted by MONROE COUNTY and CONTRACTOR as a final, complete
and exclusive statement of the terms of the Agreement between MONROE COUNTY and
CONTRACTOR. This Agreement supersedes all prior agreements, contracts, proposals,
representations, negotiations, letters or other communications between MONROE COUNTY
and CONTRACTOR pertaining to the Services, whether written or oral.
The Agreement may not be modified unless such modifications are evidenced by an
amendment in writing signed by both MONROE COUNTY and CONTRACTOR.
10
r—,
ARTICLE 16- SUCCESSORS AND ASSIGNS
MONROE COUNTY and CONTRACTOR each binds itself and its director, officers, partners,
successors, executors, administrators, assigns and legal representatives to the other party to this
Agreement. Any assignment, sale, pledge or conveyance of this contract by CONTRACTOR
must be previously approved in writing by MONROE COUNTY, whose consent will not be
unreasonably withheld.
• ARTICLE 17- CONTINGENT FEES
The CONTRACTOR warrants that it has not employed or retained any company or person,
other than a bona fide employee working solely for the CONTRACTOR to solicit or secure
this Agreement and that it has not paid or agreed to pay any person, company, corporation,
individual or firm, other than a bona fide employee working solely for the CONTRACTOR,
any fee, commission, percentage, gift or any other consideration contingent upon or resulting
from the award or making of this Agreement.
ARTICLE 18- TRUTH-IN-NEGOTIATION CERTIFICATE
Execution of this Agreement by the CONTRACTOR shall act as the execution of a truth-in-
- negotiation certificate certifying that the fees and costs used to determine the compensation
provided for in this Agreement are no higher than those charged to other customers of
CONTRACTOR for the same or substantially similar service, provided that the customer is of
•
comparable size and demographic.
ARTICLE 19- OWNERSHIP OF DOCUMENTS
CONTRACTOR shall be required to work in harmony with other CONTRACTOR'S relative
to providing information requested in a timely manner and in the specified form. Any and all
documents, records, disks, original drawings, or other information shall become the property
MONROE COUNTY upon completion for its use and distribution as may be deemed of
appropriate by MONROE COUNTY. Failure to turn over such documents within seven(7)
days of when requested may be cause for MONROE COUNTY to withhold any payments due
CONTRACTOR or to enforce this clause by legal remedies.
ARTICLE 20 -NOTICE
Any notice, demand, communication, or request required or permitted hereunder shall be in
writing and delivered in person or sent by certified mail, postage prepaid as follows:
As To MONROE COUNTY
I ,
MONROE COUNTY
Fire/Rescue Services Department
490 63rd Street
Marathon, FL 33050
Attention: Chief Clark O. Martin, Jr.
11
As To CONTRACTOR:
Advanced Data Processing, Inc.
500 NW. 165 Street Road Suite 101
Miami, Florida 33169
Attention: Brad Williams, Vice President, Finance
Notices shall be effective when received at the address specified above. Changes in the
respective addresses to which such notice may be directed may be made from time to time by
any party by written notice to the other party. Facsimile is acceptable notice effective when
received, however, facsimiles received (i.e. printed) after 5:00 p.m. or on weekends or
holidays, will be deemed received on the next business day. The original of the notice must
additionally be mailed as required herein.
Nothing contained in this Article shall be construed to restrict the transmission of routine
communications between representatives of CONTRACTOR and MONROE COUNTY.
IN WITNESS'WHEREOF, MONROE COUNTY Board of County Commissioners, at a
regular meeting thereof, by action of MONROE COUNTY Board of County Commissioners
and directing the foregoing be adopted, has caused these presents to be signed, and it's seal to
be hereunto affixed, and ADVANCED DATA PROCESSING, INC. has executed this contract
all as of the day and year first above written.
i
' - (SEAL)
BOARD OF COUNTY COMMISSIONERS OF
ATTEST: DANNY L. KOLHAGE, CLERK MONROE COUNTY
•
•
Board of overnors / Fire and Ambulance
Distr.' 244 '
By: 0C. �" By: t :
Deputy Clerk Mayor / Chairperson
ADVANC D A PROCESSING, INC.
MONROE COUNTY ATTORNEY . By:
APPROVED AST F¢RM: Doug S aman
"SyZANNE Title: President and CEO
ASSISTANT COyti?'!
Date _ ; - .._ President (or other duly authorized
Officer)
Approved by MONROE COUNTY on Aprl I aO , 2005, Item # H 2.
12
I �
ATTACHMENT A
I. Scope of Work
The CONTRACTOR shall provide MONROE COUNTY with timely and accurate
complete medical billing and accounts receivable management services for MONROE
f--
COUNTY'S rescue ambulance billing services and related professional services in
accordance with the responsibilities outlined as follows:
A. Initial Patient Treatment and Information
1. On a case by case basis, MONROE COUNTY will respond to patients requiring
immediate medical treatment and emergency medical transportation services. Upon treating
each patient, MONROE COUNTY shall provide the CONTRACTOR with patient information
identified on the"Run Report" attached hereto as Exhibit A. CONTRACTOR shall be solely
responsible for retrieving insurance information and any additional patient information which
was not identified on the"Run Report" provided by MONROE COUNTY. CONTRACTOR
shall utilize"Run Report"information and any additional information retrieved by
CONTRACTOR to file proper patient billing and insurance information. CONTRACTOR shall
establish arrangements with hospitals to obtain/verify patient insurance and contact
information. CONTRACTOR shall contact the U.S. Post Office's National Change of Address
(NCOA)files or other similar services to obtain the correct billing addresses and phone
numbers for patients that have left the area, or whom have invalid information.
2. CONTRACTOR shall reconcile the number of patients that are transported for
emergency medical services with those received. The CONTRACTOR shall report
discrepancies to MONROE COUNTY within three (3)business days of receipt.
3. As requested by MONROE COUNTY, CONTRACTOR shall provide MONROE
COUNTY'S Fire Rescue Services Paramedics Personnel with training on the gathering of
necessary information to be adhered on Run Reports for the purpose of assisting
CONTRACTOR with the proper submission and processing of patient data.
B. Patient Billing
1. CONTRACTOR shall mail an invoice to each patient for emergency
transportation service at current rates set forth by MONROE COUNTY as follows:
$500.00 for Basic Life Support(BLS)
$500.00 for Advance Life Support One(ALSI)
$600.00 for Advance Life Support Two(ALS2)
$200.00 for Stand by(Special Event)
$9.00 per mile
The aforementioned rates shall be subject to change at MONROE COUNTY'S
j ! discretion at any time throughout the teen of the agreement, MONROE COUNTY agrees to
notify CONTRACTOR a minimum of seven(7)days prior to any rate changes.
2. CONTRACTOR shall provide patients with a comprehensive statement/invoice
including a courtesy return payment envelope. The front of the statement shall describe all
charges and payments. The reverse side of the statement shall have clearly marked entry blocks
13
r-�
for information needed to file private insurance claims. CONTRACTOR shall file claims and
send an invoice to all self-pay patientlpayors with return envelope and address as specified by
MONROE COUNTY within five(5) days of receipt of incident information.
CONTRACTOR shall be responsible for sending a total of six invoices. CONTRACTOR
shall send the second invoice at thirty-five days, third invoice at sixty-five days, fourth invoice
at ninety-five days, fifth invoice at one hundred twenty-five days and sixth notice at one
hundred fifty-five days. In the course of time that the six invoices are sent to patient/payor,
CONTRACTOR shall provide follow-up on rejected and inactive claims and establish payor
remittance accounts and procedures. Unless insurance payment is pending, CONTRACTOR
shall on a monthly basis send all accounts that have not had activity for twelve (12)
months or more a Pre-Collection Letter. These accounts have thirty(30) days to respond to the
CONTRACTOR. Once the thirty(30)days has expired, the CONTRACTOR shall send
MONROE COUNTY a list of all accounts along with a complete processing history once
collection efforts are exhausted. These uncollectible accounts will be forwarded by the
CONTRACTOR onto a third party collection agency named by MONROE COUNTY for
further attempts at collecting.
3. Within MONROE COUNTY established guidelines, CONTRACTOR shall
negotiate and arrange modified payment schedules for patients unable to pay full amount when
billed.
4. CONTRACTOR shall ro p cess refund requests within the month following an
overpayment and provide MONROE COUNTY with documentation substantiating each refund
requested.
5. Where CONTRACTOR has found no method of payment for a patient after all
insurance avenues are exhausted including State Medicaid and local HRS or municipal
programs, such cases will be submitted to MONROE COUNTY in writing for final resolution
along with appropriate documentation(i.e. hospital credit status, credit file information,
activity file). At the instruction of MONROE COUNTY, CONTRACTOR shall write off any
amounts or make any adjustments to a bill, including, but not limited to; patient disputes
regarding mileage, special handling charges or the bill in its entirety.
6. CONTRACTOR shall provide MONROE COUNTY with real-time read only
electronic look-up access of CONTRACTOR'S patient data and billing information system.
CONTRACTOR shall provide the facilities to receive patient billing information from
MONROE COUNTY electronically. CONTRACTOR- This may be done through email or
other method that meets Patient Privacy requirements.
C. Patient Filing
1. CONTRACTOR shall file all insurance claim forms for all patients based upon
information received from the Run Report and research performed by CONTRACTOR.
CONTRACTOR shall provide prompt submission of required paperwork to Medicare,
Medicaid, Insurance Companies or Third Party Payors for claims, reviews, resubmission,
provider agreements and other as required within 72 hours after receiving the requested "Run
Report" from MONROE COUNTY. CONTRACTOR shall submit secondary insurance
provider claims after the primary insurance provider has paid. As necessary, CONTRACTOR
shall re-file Medicare, Medicaid or Insurance claims to obtain payment. CONTRACTOR
shall maintain responsibility for obtaining missing or incomplete insurance information.
14
CONTRACTOR shall process all third party reimbursements within one week after receipt of
appropriate billing information from primary payor.
2. CONTRACTOR shall utilize the most up-to-date knowledge and information
with regard to coding requirements and standards and proper preparation of electronic and
paper insurance filings to ensure compliance with applicable Federal, State and local
regulations.
D. Maintaining Records
1. CONTRACTOR shall maintain records in an electronic format that is readily
accessible by MONROE COUNTY and meets all federal and state requirements for
maintaining patient medical records.
2. CONTRACTOR shall maintain appropriate accounting procedures for
reconciling all deposits, receivables, billings, patient accounts, adjustments and refunds.
3. CONTRACTOR shall facilitate proper security of confidential information and
further shred and dispose of materials containing such information.
4. CONTRACTOR shall implement and comply with a Compliance Plan consistent
with the intent and activities included in the U.S. Office of Inspector General (OIG)
Compliance Program Guidance for Third Party Medical Billing Companies 63 FR 70138;
(December 18, 1998).
5. CONTRACTOR shall retain all accounts for a minimum of twelve(12) months
(unless otherwise specified by mutual agreement).
6. CONTRACTOR shall ensure that all required documentation and agreements
with payors(e.g. Medicare, Medicaid, Champus, etc.)are filed and maintained and that
MONROE COUNTY is kept apprised of important changes to industry regulations.
7. CONTRACTOR shall be knowledged of different industry insurance plans and
shall ensure MONROE COUNTY that every billable claim is pursued accordingly by
CONTRACTOR.
8. CONTRACTOR shall advise MONROE COUNTY on statutes and industry
regulations which would affect emergency transportation service rates.
E. Customer Service:
1. CONTRACTOR shall provide a toll free telephone number for patients with
CONTRACTOR'S own facilities and workforce. CONTRACTOR'S toll free telephone
number must he a dedicated phone number only for accounts from MONROE COUNTY.
CONTRACTOR shall provide a designated liaison for patient/payor concerns.
2. CONTRACTOR shall conduct all written and verbal communication in the most
professional manner. The CONTRACTOR shall never in any way represent themselves in a
way that might be interpreted as intimidating or threatening.
3. CONTRACTOR shall respond within three(3) business days of any verbal or
written requests made by Patients and/or MONROE COUNTY for information or records.
CONTRACTOR shall assist patients that are not able to speak the English language.
Difficult calls such as, but not limited to: special insurance issues, taxpayer questions, irate
15
calls shall be handled in a professional manner by a supervisor employed with
CONTRACTOR'S firm.
4. CONTRACTOR shall provide all customer inquiry services and prepare
additional third-party claims or patient payment arrangements based on this information
exchange.
5. At MONROE COUNTY'S request, CONTRACTOR shall provide survey
questionnaires or mail inserts to patients. CONTRACTOR shall mail requested citizen
satisfaction surveys.
6. CONTRACTOR shall provide for facilities to permit dial-up access to retrieve
patient data and billing information.
F. Audits
1. CONTRACTOR shall provide access to MONROE COUNTY for all requested
information in order for MONROE COUNTY to perform appropriate and periodic audits.
MONROE COUNTY will provide CONTRACTOR with reasonable notice for any planned
audit and CONTRACTOR shall conduct audit during normal business hours.
G. Monthly Reports
Unless otherwise indicated, CONTRACTOR shall provide the following reports on a
monthly basis as identified and prescribed by MONROE COUNTY. Monthly reports shall
be produced after the month's closing and provided to MONROE COUNTY no later than the
tenth of each month.
1. Ambulance Unit Report: On a monthly basis, CONTRACTOR shall provide a
report of number of calls and gross billed by ambulance unit for the current period.
2. Ambulance New Billing Report: CONTRACTOR shall produce a report
showing all billing(new charges)processed alpha sorted by Last Name and summarized total
billing for period. CONTRACTOR shall add column for date received from MONROE
COUNTY. •
3. Ambulance Payment Report: CONTRACTOR shall provide a batch oriented
listing of all payments processed including check number and type of payment (self pay,
Medicare, Medicaid, private insurance).
4. Gross Collection Statistics Summary: CONTRACTOR shall provide a running
summary of Interfacility transactions including monthly amount billed, collected, Percentage
collected, number of Accounts and Gross Billed .
5. Schedule of Transport Charges& Collections: CONTRACTOR shall provide a
running month summary of charge, payment and adjustments for the closingmonth period
showing gross and net collection percentages for each period. Information provided shall be for
last five fiscal years only.
6. Report of Accounts Receivable: CONTRACTOR shall provide a summary for
period ending of Accounts Receivable showing gross billing, payments received/processed,
reflected write-offs and adjustments, reversals and ending balance.
16
I s
7. Monthly Billing and Collection Summary: CONTRACTOR shall produce a
report showing receivables as applied to month running or original billed month. Information
provided shall be for last five fiscal years only.
8, Insurance Receivable Report: CONTRACTOR shall provide a summary of billed
month the number of patient bills having an outstanding insurance balance. This will show
the balance and number of bills outstanding by class.
9. Collection by Financial Class: CONTRACTOR shall provide a running month
summary for the closing month period of collections by Payor Class (Self-Pay, Medicare,
Medicaid and Private Insurance). CONTRACTOR shall denote billing numbers for each
category and total. Information provided shall be for last five fiscal years only.
10. Collection Schedule: CONTRACTOR shall provide a running summary of
collected amounts to include monthly, fiscal and cumulative amounts.
11. Ambulance Billing Adjustments-Write Offs-Reversals: CONTRACTOR shall
provide a running summary showing all adjustments, write-offs and reversals from Medicare,
Medicaid and Insurance.
12. Report of Accounts Receivable Removed: CONTRACTOR shall provide a report
showing Accounts sent to Collections with Original Amount Billed, Payments made, Adjusted
Amounts and Balance owed. These accounts will have had no activity for 12 months or more.
This report will only be provided on the months that the CONTRACTOR sent accounts to
collections.
13. Report by Incident Date: CONTRACTOR shall provide a report by account detail
of all accounts outstanding to include Original Amount billed, Adjusted Amount, and Balance
due.
14. Monthly Refund Schedule: CONTRACTOR shall provide a report by account
detail of associated payments reflecting an overpayment and necessary refund to be processed.
H. Health Insurance Portability and Accountability Act of 1996(HIPAA)
The CONTRACTOR shall comply with the privacy regulations pursuant to Public Law
104-191 of August 21, 1996, known as the Health Insurance Portability and
Accountability Act of 1996, Subtitle F—Administrative Simplification, Sections 261, et
seq., as amended ("HIPAA"), to protect the privacy of any personally identifiable
protected health information("PHI")that is collected, processed or learned as a result of
the Billing Services provided hereunder.
A. CONTRACTOR shall not use or further disclose PHI except as permitted herein or
required by law.
B. CONTRACTOR shall use appropriate safeguards to prevent use or disclosure of PHI
except as permitted herein.
C. CONTRACTOR shall mitigate, to the extent practicable, any harmful effect that is
known to CONTRACTOR, its agents or subcontractors of a use or disclosure of PHI by
the CONTRACTOR, its agents or subcontractors.
17
•
D. CONTRACTOR shall report to MONROE COUNTY any use or disclosure of PHI
not provided for by this Agreement of which the CONTRACTOR, its agents or subcontractors
become aware.
E. CONTRACTOR shall ensure that any agents or subcontractors to whom the
CONTRACTOR provide PHI or who have access to PHI, agree to the same restrictions and
conditions that apply to the CONTRACTOR with respect to such PHI.
F. CONTRACTOR shall make PHI available to MONROE COUNTY and to the
individual who has a right of access as required under HIPAA within 30 days of the request by
MONROE COUNTY regarding the individual.
G. CONTRACTOR shall incorporate ally amendments to PHI when notified to do so by
MONROE COUNTY.
H. CONTRACTOR shall provide an accounting of all uses or disclosures of PHI made
by the CONTRACTOR its agents or subcontractors as required under the HIPAA privacy rule
within sixty(60) days.
I. CONTRACTOR shall make their internal practices, books and records relating to the
use and disclosure of PHI available to the Secretary of the Department of Health and
Human Services for purposes of determining the CONTRACTOR'S, its agents' and
subcontractors' and MONROE COUNTY'S compliance with HIPAA.
J. CONTRACTOR shall at the termination of the agreement, return or destroy all PHI
received from, or created or received by the CONTRACTOR, its agents or subcontractors
on behalf of MONROE COUNTY and if return is infeasible, ensure that the protections of
this Agreement will extend to such PHI.
K. The specific uses and disclosures of PHI that may be made by the CONTRACTOR,
its agents or contractors on behalf of MONROE COUNTY include:
1. Preparation of invoices to patients, carriers, insurers and others responsible for
payment or reimbursement of the services provided by MONROE COUNTY to its patients.
2. Preparation of reminder notices and documents pertaining to collections of
overdue accounts.
3. The submission of supporting documentation to carriers, insurers and other
payers to substantiate the health care services provided by MONROE COUNTY to its patients
or to appeal denials of payment for same.
4. Other uses or disclosures of PHI as permitted by the HIIPAA privacy rule.
5. Mail HIPAA Notice of Privacy Practices to all emergency transport patients
within the timeframe allowed under the HIPAA and FIIPAA rules.
6. Mail subpoenas, attorney's requests to Fire Rescue immediately upon receipt
18
li
ATTACHMENT B
I. Compensation for Services
The CONTRACTOR shall provide to MONROE COUNTY a monthly invoice
representing fees for the services provided computed as:
A. Seven percent (7%)of all monies collected by the CONTRACTOR, excluding
Medicaid accounts, during the previous month. In compliance with Florida Statute 409.913
(9), the CONTRACTOR shall 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.
t D. Price shall include but not be limited to; all stationery, fax forms, envelopes, mailings,
postage and. telecommunications/phone facilities/charges.
E. Price for services does not include the cost of"Locked-box" service. The COUNTY
shall bear the cost of the Locked-box.
The"Locked-box service selected shall be at the sole discretion of MONROE
COUNTY 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:
1. Open all mail (except clearly marked returned-mail).
2. Make a copy of every check and attach copy with original document
accompanying each check.
3. Deposit all receivables into designated MONROE COUNTY account.
4. Prepare and provide a daily deposit slip totaling and accounting for all
receivables deposited for the identified day.
5. Mail (daily)to the CONTRACTOR separated bundles of; copies of checks
attached to supporting documents, other correspondence and, returned-mail along with
deposit slip.
6. Mail (daily)to MONROE COUNTY copies of checks and daily deposit slip.
rTh
7. Mail (monthly)to MONROE COUNTY reconciliation of account.
F. CONTRACTOR shall maintain daily deposit control sheets and original
documentation.
19
*IRE FIRE RESCUE REPORT
Run Number:
Monroe County Fire Rescue
Patient Name:
490 63rd Street Marathon,FL 33050
Date of Service:
9fSCUF Phone#(305)289-6004
Documented By:
Shift: Nature of Call: Outcome:
Station: Location: Received:
Rescue: Level of Care: Dispatched:
Unit ID: Destination:
Crew#1: Enroute:
Crew#2: Arrive:
Crew#3:
Pt Contact:
IPt.Transported: Depart:
At Dest:
At Scene Loaded Miles
Resp Delay: it Dest Mileage: OTHER TIMES
Injury Time.
Trauma Alrt:
Name: Phone:
SSN: Home Address:
DOB:
Sex:
Weight: Mailing Address:
Patient Found:
Chief Complaint:
Cause of Injury:
Relevant Past History:
Medications:
II
Effort
rime BP Pulse SPO2 ETCO2 Cap Refill ECG Respiratory
GCS Rate Left Right
• f 4
Printed on:01/07/2005 at 12:22
fIRF ,HIKE RESCUE REPORT
4'',4
Run Number:
4 Monroe County Fire Rescue
! 490 63rd Street
Phone#(305)Marathon,FL 33050 Patient Name:
Date of Service:
289-6004
Documented By:
1
Body Area Assesame,�nt
i Ar Assessment
I
I
\ I I•:R\ I:\ I IONS
Tlmg Treatment Description
Further Details
\ kW? kURI.:
SI(.\ k I I l2t:S
Time Tvoe Disclaimer
I, ,authorize any holder of medical or other information about me to release to the Social Security
Aaministration and Health Care Financing Administration or its intermediaries or carriers,or any private insurance
company any information needed for this or a related medical claim.
I permit a copy of this authorization to be used in place of the original and request payment of medical insurance
benefits to the party who accepts assignment. I personally guarantee payment of any charges not covered by health care
benefits. According to Medicare regulations,your ambulance transport and related services are subject to review under
the Medicare program. The purpose of this review is to determine whether or not your transport and related services
meet the guidelines for Medicare payment. If it is determined,under the Medicare Program guidelines that your
transport and related services were not medically necessary,or that non-covered services were provided to you,then,
please be advised that you are personally responsible for payment of the transport or the non-covered services.
Furthermore,I hereby acknowledge that I have been provided with a copy of Monroe County's Notice of Privacy
Practices on this date.
Signature
-
Printed on:01/07/2005 at 12:22
i E i RE FIRE RESCUE REPORT
�, Run Number:
,� , Monroe County Fire Rescue
p Patient Name:
\406= 490 63rd Street Marathon,FL 33050
Date of Service:
Phone#(305)289-6004 Documented By:
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIEMIIMZIZIIIIIMIIIIIIIIIIIIIIIIIIIIIIII
Time Tvoe Disclaimer
IBC OA Review 1 have reviewed this report for completeness and accuracy.
Signature
Crew# Crew 1 Name Certification! Signature Crew# Crew 2 Name Certification Signature
I
:rew# Crew 3 Name Certification Signature
I
I
I
I
3 4
Printed on:01/07/2005 at 12.22
rillir r IRE RESCUE REPORT
Run Number:
Monroe County Fire Rescue
4 I ' 490 63rd Street Marathon, FL 33050
Date of Service:
Phone#(305)289-6004 Documented By:
Guarantor Address
SSN
Relation
I- ---.-__-__ Send Bill To
----- -- -------- - -------
Insured? Employed? Work Related?
Insurance — —Insurance State
Policy Number
Company Insured's Name
4 f4
Printed on:01/0712005 at 12:22
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY,FLORIDA
ETHICS CLAUSE
tOGIc� kit a n
J warrants that he/it has not employed, retained
or otherwise had act on his/its behalf any former County officer or employee in violation of
r-�
Section 2 of Ordinance No. 10-1990 or any County officer or employee in violation of
Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County
may, in its discretion,terminate this contract without liability and may also, in its discretion,
deduct from the contract or purchase price, or otherwise recover,the full amount of any fee,
commission, percentage, gift, or consideration paid to the former County officer or employee.
(signature)
Date: J-2.4-/S
11
STATE OF F Cr i (l N-
COUNTY OF I i I I .I - PaPail Q.
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
--9 tit() s h(k. yr nri who, after first being sworn by me,affixed his/her
qq signature(name of individual signing) in the space provided above on this 2 �I day of
r( I CL(ch 20 V'
•
(� L) .:✓nt'•, JENNWER WIL 6FRGER� �uBow'Sf�of+NOTARY P
Fbtida
:41t —:91 C��j DO 376006
#
My commission expires: Off)(.Q fl'\VA,V i . (; 0' Bonded National . . ,yam
OMB - MCP FORM#4
Client#: 16916 ADPIHOL
ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
4/27
PRODUCER @005
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wachovia Insurance Serv-AT,GA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4401 Northside Pkwy,Suite 400 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
Atlanta,GA 30327-3078 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
770 850-0050
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: St Paul Fire&Marine Insurance Co 24767
ADPI Holding,Inc. INSURER B: Illinois Union Insurance Company 27960
520 NW 165th Street Road; Suite 201
Miami, FL 33169-6303 INSURERC:
INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
1 1 POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1 !NM AUU'L
— LTR NSRC TYPE OF INSURANCE POUCY NUMBER DATE(MM//Dp yy)E PDATE(iiiXaRokrIAT
LIMITS
A X GENERALLIABIUTY TT06800034 06/30/04 06/30/05 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY PREM SES E oocu°nce) $250,000
CLAIMS MADE D OCCUR MED EXP(Any one person) $1 Q,QQQ
PERSONAL&ADVINJURY $1,000,000
—
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000
-- -1 POLICY n jECa n LOC
A X AUTOMOBILE LIABILITY TT06800034 06/30/04 06/30/05
_ ANY AUTO CEOMB dent)ED INGLE LIMIT =1,000,000
ALL OWNED AUTOS
—
SCHEDULED AUTOS . I BPer personODILY INJURY) $
1 r1\ j ,X HIRED AUTOS (
BODILY INJURY
X NON-0WNED AUTOS t '� (Per accident) $
Y' X Hired Car PD $1000 Copmp '
Deductibles: $1,000 Coll PROPERTY DAMAGE
(Per accident) $
SIC 1 GARAGE LIABILITY (t AUTO ONLY-EA ACCIDENT- RANYAUTO { l._'I `-iS• t.,,, -- $
). OTHER THAN EA ACC $
"
t ';i,,.wOONLY: AGG $
A ^E�XCESS/UMBRELLA L ABIIJTY TT06800034 06/30/04 06/30/05 EACH OCCURRENCE $2,000,000
^ 'OCCUR CLAIMS MADE AGGREGATE $2,000,000
DEDUCTIBLE
$
X RETENTION $10,0000 $
A W
WORKERS COMPENSATION AND VA6810771 06/30/04 06/30/05 X I TORY LIM17S I I ER $
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000
OFFICER/MEMBER EXCLUDED?
II yes.descr be under E.L.DISEASE-EA EMPLOYEE $500,000
I �� SPECIAL PROVISIONS below
B OTHER Errors& E.L.DISEASE-POLICY LIMIT $500,000
BM120009844 10/10/04 06/30/05 Limit: $2,000,000
Omissions
Retemntion: $25,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Monroe County Board of County Commissioners is included as additional
-- insured.as respects general and auto liability coverage as required by written
contract with the above named insured.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
__ Monroe County Board of County
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL an DAYS WRITTEN
Commissioners NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
P.O.Box 1026 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Key West,FL 33041-1026 REPRESENTATIVES.
AUTHORIZED REPRESENT TN
For WIS by: '/d %Y'Re', -.
ACORD 25(2001/08)1 of 2 #S629361/M567567
MJS01 0 ACORD CORPORATION 1988
r-
i
VII. AUDITEE RESPONSES —
Advanced Data Processing, Inc.
n
intermedix
vyvI N;A'! 5:h ..e
• February 2, 2009 S'i;e 102
Monroe County, Clerk of the Circuit Court
Attn: Mr. Mark Albury, Director of Internal Audit
500 Whitehead Street, Suite 101
Key West, FL 33040
VIA EMAIL
Subject: Draft Preliminary Audit Report
Dear Mr.Albury,
ADPI is in receipt of your preliminary audit findings report and have provided for the appropriate
responses below. We appreciated the opportunity to review your findings and the ability to provide
feedback on each of the related topics noted in your draft response.ADPI looks forward to working with
the County to resolve these issues both internally and contractually.
Finding#1:ADPI's initial billing to patients is not completed in a timely manner.
Response: The entire billing process is highly dependent on the data received on each
run report from the County. After a run report is received,ADPI performs the necessary review
related to determining service level, coding, medical necessity, and patient signature capture.
Upon performing the normal billing requirements associated with each account, ADPI then
focuses attention on reviewing patient demographic and insurance information. To this extent, •
some of the patient demographic data is not accurate and therefore requires further research to
obtain correct information related to the patient name, patient address, patient social security
number, patient phone number, etc... In addition to the sometimes missing or inaccurate patient
demographic information, most run reports do not contain patient insurance information and
therefore require further research. ADPI takes a number of steps to obtain this information
including: researching information that may be available at the hospital the patient was
transported to, insurance eligibility checks for Medicare, Medicaid, and commercial payers,
internal ADPI historical patient database lookup, and ultimately patient statements. All of these
efforts are performed when the run report is received but do need time to be completed. These
techniques have been developed over the years and are constantly changing to accommodate
technology and process improvements. It is our goal that the patient would never receive a
statement as we would locate the patient's correct insurance information, file the insurance claim,
and then receive payment in full to close the account. It is our recommendation that our contract
allow for the time it takes to identify correct patient demographic data and insurance information.
ADPI is more than willing-to work with the County to determine a proper time frame.
Finding#2: The contract between the County and ADPI does not specify a time frame for re-
filing claims to obtain payments from Medicare, Medicaid, or insurance providers.
Response: Re-filing of claims is sometimes necessary when a payer denies a claim.
Typically claims are denied for specific reasons which requires additional research. Once this
research has been completed, the claim is re-filed immediately. It is difficult to determine the time
frame associated with the research as it depends on the reason for the initial payer denial. ADPI
is willing to work with the County to try and determine a proper time frame.
intermedix
Finding#3: ADPI is not sending out the contractually agreed upon six(6) invoices. 5'� NW '°' " , =`
Suite 102
Response: ADPI did find that due to a programming issue only four patient statements''''"
were being sent out. This has since been corrected.
Finding #4:ADPI is not meeting the contractual requirements for the timing of invoices to self-
pay patients/payers.
Response: This issue relates only to patient statements and is highly dependent again
on the data received on the run report. In addition, if an insurance claim is filed, patient
statements are not mailed until the insurance company responds with payment or further
information.
Finding# 5: County is unable to bill and collect on the patients with Medicare and Medicaid
coverage that were transported on Emergency Medical Air Transport Ambulance.
Response: N/A
•
Finding#6: The contract does not include a copy of Monroe County's established guidelines for
negotiated payments.
Response: N/A
•
Finding#7:,ADPI is not providing a monthly accounts receivable aging report to the County.
Response:ADPI can provide an Aging report effective immediately.
Finding#8: County invoicing and collections process is unnecessarily long.
Response: ADPI can work with the County on determining a more appropriate time
frame to turnover accounts for further collection activity.
Again, we appreciate being able to provide Monroe County the best billing services in the industry and
we look forward to continuing our mutually rewarding relationship well into the future.
If you have any questions please call me at 305-459-0653.
Sincerely,
• DARRYL HARTUNG •DIRECTOR OF CLIENT SERVICES
ADPI-Intermedix
VIII. AUDITEE RESPONSES —
County Administrator's
1�
BOARD OF COUNTY COMMISSIONERS
Mayor George Neugent,District 2
Mayor Pro Tern Sylvia J.Murphy,District 5
.:; �` ' IGrn Wigington,District 1
'r" Heather Carruthers,District 3
- Mario Di Gennaro, District 4
Monroe County - 43‘-,SZ,,:
Board of County Commissioners
Office of the County Administrator
The Historic Gato Cigar Factory
1100 Simonton Street, Suite 205 • `' K`
Key West,FL 33040 -A di, c
(305)292-4441—Phone
(305)292-4544-Fax
January 23, 2009
Mark Albury
Director of Internal Audit
Monroe County Clerk's Office
500 Whitehead St.
Key West, Fl. 33040
RE: Draft Preliminary Audit Report—ADPI
Dear Mr. Albury:
I have reviewed the audit report and worked with County staff to prepare the responses. While the bulk of
the information contained in the County's responses was provided by Camille Dubroff, a member of the
Emergency Services administrative staff, I have conferred with Chief James Callahan and County
Attorney Suzanne Hutton to ascertain that we have responded to the areas of concern. The County's
responses are attached hereto.
We have not incorporated responses from ADPI or the Sheriff's Office as it is my understanding that you
sent them separate letters requesting answers and they are independent contractors in this matter.
Some of the issues noted in the audit report do not provide sufficient detail to ascertain if the comments
were based on thorough knowledge of the processes involved. In such instances, we have posed questions
which if answered may better enable the County to take appropriate corrective action. Further, it is
recogni7ed that there are areas within the responsibilities of County personnel for which some of the
1 processes need to be improved, and we have noted suggested changes in our response.
Where the noted problem has been beyond the control of County staff;but of which we have been aware,
we have noted the cooperative spirit with which we have worked with ADPI and the Sheriffs Office to
resolve. The County will continue to work on those problems, as noted below.
Upon review of your final audit report,the County administration will draft policy revisions for approval
by the BOCC and take such other administrative action as deemed necessary and feasible to correct the
problems.
I look forward to reading your final report and will take up the issues with staff at that time. Accordingly,
please copy Ms. Hutton and Chief Callahan on the final report, so that they can work with staff to take
corrective actions.
Sincerel ,
oman astesi
County Administrator
Cc:
James Callahan
Camille Dubroff
Darryl Hartung
Suzanne Hutton
Michael Rice
COUNTY'S RESPONSES TO
MONROE COUNTY INTERNAL AUDIT DEPARTMENT
AUDIT CONCLUSIONS FINDINGS AND RECOMMENDATIONS FOR ADVANCED DATA
PROCESSING INC. (ADPI)
1. ADPI's initial billing to patients is not completed in a timely manner.
Recommendation: The BOCC should ensure that there are policies and procedures in place to monitor
compliance with the contract.
RESPONSE: On May 25, 2007 in a Business Update meeting with Darryl Hartung, Cynthia Hall, Brian
Parker, Camille Dubroff and Susie Martenson ADPI explained that they found the need to re-evaluate how
they convert our transports into billable claims for Trauma Star. They found that extra efforts were needed
to find significant billable information for each transport rather than sending out a statement before a
billable party could be located thus resulting in an increase in revenue. I have attached a copy of a slide
with time-frames provided by ADPI which shows how long it could possibly take for the first statement to
be sent with their new process. You will see that it could take in excess of 13 days once they received the
file for the first statement to be sent if they are trying to locate billable information. It was agreed upon at
this meeting to go forward with this change not only for our air transports but also for our ground
transports to produce the most revenue we could on every transport. In the past we have allowed ADPI to
make procedure changes, with our verbal approval, if that means it will increase our collectible revenues.
ADPI has been very flexible and willing to provide whatever changes we have requested for the good of
the County.
NOTE: The process in which you calculated the 39 days is not spelled out. Was it calculated from the date
of the actual incident or the date that the County sent the file for billing to ADPI? If it is being calculated
from the date of the incident then it should be pointed out that files being sent from the County to ADPI do
not occur daily. In addition, extra delays from the County occur when the EMS program is down for
maintenance/server issues, over weekends, holidays and vacations. These extra delays should be taken into
consideration.
The administrative staff's recommendation is to include wording in the contract that reflects verbal
changes which have occurred between the contractor and the County. This can be accomplished by adding
an amendment to the existing contract or placing it in the next extension should the contract be extended or
the next negotiated billing contract. In addition, a review of how much time it in fact takes to convert calls
into billable transports with an allowance for delays on the County billing side should be conducted and
updated in the contract so that a realistic time frame is in place.
The contract, Section I.G provides for monthly reports to be made by ADPI. The County will work with
ADPI to ensure that either currently required reports are modified or a new report is required to provide
sufficient information for County staff to monitor timeliness of billing. The County should ensure that one
of the administrative staff understands his/her job is to review billing reports, and should be trained as to
what to look for in the reports to inform the division director that the billing agency needs to be contacted
to improve performance. The division director should send written correspondence to the Contractor when
performance is not as contracted, and should keep the County Administrator informed of the responses so
that the appropriate action can be taken at the BOCC level if necessary.
1
2. The contract between the County and ADPI does not specify a time frame for re-filing claims to
obtain payment from Medicare, Medicaid, or insurance providers.
Recommendation: The BOCC should create an amendment that includes a time frame for re-filing claims
for patients covered by Medicare, Medicaid, or insurance.
RESPONSE: The contract states"As necessary, contractor shall re-file Medicare, Medicaid or Insurance
claims to obtain payments". Insurance claims that are filed receive an Explanation of Benefits (EOB)to
explain if they are approved or denied. A claim is re-filed "as necessary" on a case by case basis. This is
dependent on the outcome of EOB, or after ADPI has been informed that a denial was made to the claim in
error, or when additional information is required to evaluate the claim for payment. The present contract
wording "as necessary" is there to direct ADPI to re-file claims as warranted or as necessary according to
the outcomes of their initial filings.Not all claims will need to be re-filed which is why the contract is
worded as "as necessary".
The County is currently in its first renewal period. If the contract is renewed in 2009, an additional
provision should be inserted into the amendment, deleting "As necessary" and replacing it with"Upon
receipt of notice of claim denial, requirement for additional information, and Explanation of Benefits
reflecting underpayment, or other notice requiring submission of documentation to the third-party
provider...." Then after"Contractor shall" there should be added a number of days, for example"within
45 days of such notice,". The amendment should be a condition of renewal.
3. ADPI is not sending out the contractually agreed upon six(6) invoices.
Recommendation: The BOCC should ensure that there are policies and procedures in place to monitor
compliance with the Contract.
RESPONSE: ADPI is aware that the contract states they are to send out six (6) invoices to each patient.
However, due to a programming issue on their end they were only able to send up to four (4) invoices per
patient for a while. They informed County administrative staff of the change and advised they were
working on resolving this. Since then this has been corrected and should be reflected on all accounts.
The administrative staff's recommendation is a spot check of the newer accounts over the next few months
to determine if this has been remedied. The County administrative staff should have at least one person's
job include monthly review of billing reports, and training should be provided by the Finance Department
as to what to look for in the reports in order that staff can inform the division director when the billing
agency needs to be contacted to improve performance. The division director should send written
correspondence to the Contractor when performance is not as contracted, and should keep the County
Administrator informed of the responses so that appropriate action can be taken at the BOCC level if
necessary.
4. ADPI is not meeting the contractual requirements for the timing of invoices to self-pay
patients/payers.
Recommendations:
1) The BOCC should ensure that there are policies and procedures in place to monitor compliance
with the Contract.
2
RESPONSE: See above#3
2) ADPI should create and utilize an Accounts Receivable Aging report to enhance the monitoring
and collections of past due accounts. The County should also utilize this aging report with a
number of times billed report to ensure that ADPI is staying current on the billing and meeting the
contractually agreed upon billing terms.
RESPONSE: The County is currently in its first renewal period. If the contract is renewed in 2009,
additional provisions should be inserted into the amendment to require the aging report and the number of
times billed report, and should be a condition of renewal. The County is considering going out for RFP
rather than renewing for an additional year.
5. County is unable to bill and collect on the patients with Medicare and Medicaid coverage that
were transported on Emergency Medical Air transport Ambulance.
Recommendation: The BOCC should complete the steps necessary to obtain the provider number for the
Emergency Medical Air Transport Ambulance transports in order to collect on claims to Medicare and
Medicaid.
RESPONSE: This only affects air ambulance transports. Ground transports have a provider number and
are being billed. ADPI can not be faulted on these issues, as this is a County problem.
The provider number application process is in the hands of the Monroe County Sheriffs Office and they
are striving to resolve this and obtain our provider numbers for both Medicare and Medicaid. The
contractor can not bill these transports until MCSO obtains Provider numbers for billing. Per a verbal
report from their Chief Financial officer the week of January 12, 2009,the application for provider
number(s) should be completed and filed within a few weeks.
6. The contract does not include a copy of Monroe County's established guidelines for negotiated
payments.
Recommendation: The County should consider adopting specific guidelines to be used by the Contractor
in negotiating payment schedules for patients that are unable to pay the full amount when billed.
RESPONSE: The contract states that Monroe County guidelines should be utilized by the contractor
(ADPI) when negotiating payments schedules with patients unable to pay in-full when billed. There is no
single document with the name "Monroe County established guidelines". Rather,the term just generally
refers to all Monroe County ordinances, resolutions, and administrative instructions. This was put into the
contract to administer changes made by the County from resolutions and ordinances that define rate
schedules,policies, etc.
ADPI is aware that they are not to negotiate a different amount than what is billed and to date they have
never an arranged settlements. They refer all settlement requests to the Emergency Services office and we
g Y
handle on a case by case basis. If Emergency Services and the County Attorney believe a settlement may
be warranted we place these items before the BOCC for a final decision.
3
While ADPI has the authority to set up payment arrangements per Attachment A section B3,there are no
specific guidelines which establish any restrictions on their arrangements. Since it is advantageous to the
County for them to set up monthly payments to fit the patient's financial situation until the account is paid
in full. A set of guidelines should be established and provided to the billing contractor.
The administrative staff's recommendation is to add to the contract specific wording to cover these topics.
This can be accomplished by adding an amendment to the existing contract or placing it into either the next
renewal addendum or the next negotiated billing contract.
7. ADPI is not providing a monthly account receivable aging report to the County.
Recommendation: The County and ADPI create and utilize an accounts receivable aging report to enhance
the monitoring and collections of past due accounts.
RESPONSE: This is not a report that the County has ever requested from ADPI but they can easily
generate for us. The administrative staffs recommendation is to discuss the possibilities of adding this
"aging"report to our existing monthly reports or possibly requesting it on a quarterly or yearly basis from
ADPI since this report is very large and a summary aging report may be sufficient in its place. This can be
accomplished by adding an amendment to the existing contract or placing it into either the next renewal
addendum or the next negotiated billing contract.
8. County invoicing and collection process is unnecessarily long.
Recommendation: The BOCC should shorten the invoicing and pre-collection process.
RESPONSE: The contract states that an account has to be inactive for twelve (12) months or more before a
pre-collection letter is sent. Comments in the audit report include that if you consider the invoicing time
period of 155-days for self-pay patients/payers, then at a minimum it will take about 1 V2 years before a
non-performing account even gets a pre-collections letter.
The one year time period was put in place to accommodate all collections before transferring the account
to another contractor(the collection agency). Guidelines for write offs set in October of 2001 by Division
Director Reggie Paros showed that it can take up to one year to collect from a patients insurance provider.
The County did not want to send accounts to collections before there was sufficient time to collect from the
insurance carriers. This fact still holds true according to ADPI.
In October of 2001, a procedure for write offs was put in place by Mr. Paros. This procedure states if there
has been no payment or activity for a one-year period,the account could be deemed uncollectible.
According to this procedure, these accounts that were deemed uncollectible were to be written off and then
sent to collections for further collection efforts.
In 2004 this guideline was reviewed and revised. It was agreed that all accounts should be sent to collections first
and then written off after they had been deemed uncollectible by both the billing agency and the collection
agency. The one-year mark remained due to the time frame to collect from insurance companies.
If the clerk's office recommends a different time frame for accounts to be sent to collections,this can be
accomplished by adding an amendment to the existing contract or placing it into the next negotiated billing
contract.
-i 4