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08/16/2000 Agreement Cled( of 11Ie Circul coun Danny L. Kolhage Phone: 805-292-3550 Fax: 805-295-3615 Memnrandum To: Reggie Paros, Director Public Safety Division From: Isabel C. DeSantis, Deputy Clerk ~ C; JY: Thursday, August 31, 2000 Date: At the Board of Governors' of Meeting on August 16, 2000, the contract between Monroe County and A,.dvaAced Data Processing, Inc. for RescUe Ambulance Billing & Related Professional Services, was approved. Attached is a fully-executed duplicate original of the subject document for your handling Should you have any questions concerning this matter please feel free to contact this office. Copies: Finance County Attorney Ate '''Ambulance Billing & Related Services" CONTRACT # Date: Page 1 :J: 0 0 ~ }> 0 ::U('"):.T. J:-. Or-Z ~ l"T1::r::-< n.,..... W 0('"). c:- __::u~ .... 0 ~ ADVANCED DATA PROCESSING. INC. ~('"),- :z - ..::I: FOR RESCUE AMBULANCE BilLING & RELATED PROFESSIONAL SERVtGES> "::" r- c I~ l"T1 _. THIS CONTRACT, hereinafter "CONTRACT OR AGREEMENT", made and entered into this ~day of September, 2000 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 Florida Corporation with principal offices located at 520 NW 165 Street, Suite 201, Miami, Florida 33169, hereinafter referred to as the "CONTRACTOR" , CONTRACT BETWEEN THE COUNTY OF MONROE AND WITNESSETH: WHEREAS, the parties hereto now wish to enter into an agreement, pursuant to which the CONTRACTOR will render those professional services in connection with said project as hereinafter provided; NOW THEREFORE, the parties hereto agree as follows: 1. DEFINITION OF THE PROJECT. The objective of the project is to utilize the services of the CONTRACTOR to provide the COUNTY with ambulance billing and related services. 2. SCOPE OF SERVICES. The CONTRACTOR shall perform and carry out the work tasks presented in CONTRACTOR'S Scope of Work (Exhibit A), as summarized herein, All payments shall be paid directly to 'MONROE COUNTY BOARD OF COUNTY COMMISIONERS' or via "locked-Box" facility as directed by the COUNTY, 3. TIME OF PERFORMANCE. This Contract shall be effective for a two-year period from September 1, 2000 through August 31, 2002, under the terms and conditions contained herein unless otherwise terminated, The COUNTY may, at its option, renew this agreement for two (2) additional one (1) year terms under the then in force terms and conditions by giving notice to CONTRACTOR at least sixty (60) days prior to expiration of the current term. Monroe County's performance and obligation to pay under this contract, is contingent upon an annual appropriation by the Board of County Commission, 4. COMPENSATION AND METHOD OF PAYMENT. The COUNTY reserves the right to request changes in the services within the general scope of the Contract to be performed upon mutual agreement by the COUNTY and CONTRACTOR which shall specify the change ordered and the adjustment of time and compensation required therefore, Agreement Page 1 of 6 " r- /"T1 o ...." o :::0 :::0 ,." n o :::0 o '''Ambulance Billing & Related Services" CONTRACT # Date: Page 2 Any services added to the scope of this Contract by a change order shall be executed in compliance with all other applicable conditions of this Contract, No claim for additional compensation or extension of time shall be recognized unless contained in the duly executed change order, The CONTRACTOR shall provide to the COUNTY a monthly invoice representing fees for the services provided computed as: Seven percent (7%) of all monies collected by CONTRACTOR, excluding Medicaid accounts, during the previous month, Pursuant to Florida Statute 409,913(9), CONTRACTOR will include in the same invoice an amount of $11.40 per Medicaid account for providing all billing services related to such accounts processed in the previous month. The COUNTY shall issue a check for the amount invoiced, minus any disputed amount, within thirty (30) days of receipt and acceptance of the invoice, The COUNTY shall bear the cost of any and all Lock-box services, All other costs incurred by CONTRACTOR in the performance of services as specified herein (including, but not limited to postage, materials, communications and phone costs and, other operating costs) shall be borne by the CONTRACTOR, 5. REPORTS. The CONTRACTOR shall provide the COUNTY with status reports as set forth in Exhibit A and other reports as mutually agreed, The CONTRACTOR shall also provide changes to such reports and ad hoc report requests on a reasonable basis and as mutually agreed, 6. DATA TO BE FURNISHED BY COUNTY. The COUNTY will make available to the CONTRACTOR, for use in performance of services under this Contract, all available reports, studies or any other materials in its possession that may be useful to the CONTRACTOR, All material furnished by the COUNTY will not be disclosed to any party without the COUNTY's prior approval. 7. INDEPENDENT CONTRACTORS. The CONTRACTOR is an independent contractor and not an employee or agent of the COUNTY with the following exception': To the extent necessary to fulfill its billing and collection efforts under the Agreement, the CONTRACTOR is authorized to sign in an administrative capacity for the COUNTY the following types of standard forms and correspondences only: probate filings; letters to patients or their representatives verifying that an account is paid in full; forms verifying the tax-exempt status of the COUNTY; and insurance filings and related forms. The CONTRACTOR has no authority to sign any document that imposes any liability on the COUNTY. 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 Agreement Page 2 of6 '''Ambulance Billing & Related Services" CONTRACT # Page 3 Date: responsible for its own acts and those of its agents and employees during the term of this contract. 8. INDEMNIFICATION. The CONTRACTOR shall indemnify and hold the COUNTY harmless from any and all claims, losses and causes of actions which may arise out of the performance of this Agreement as a result of an act of negligence, of the CONTRACTOR, its employees, agents, representatives, consultants, or its SUBCONTRACTORS, The CONTRACTOR shall pay all claims and losses of any nature whatsoever in connection therewith and shall pay all costs and judgements (including, but not limited to, attorneys' fee and expenses and cost of defense provided on behalf of the COUNTY), that may issue thereon, The above provisions shall survive the termination of this Agreement and shall pertain to any occurrence during the term of this Agreement, even though the claim may be made after the termination hereof, Nothing contained herein is intended nor shall be construed to waive COUNTY's rights and immunities under the common law or Florida Statutes 768,28, as amended from time to time, 9. INSURANCE. The CONTRACTOR shall maintain the following insurance coverage: 1) Worker's Compensation Insurance in compliance with Florida Statutes, Chapter 440 and applicable Federal Acts as they may be amended from time to time; and 2) General Liability insurance in an amount no less than $1,000,000 per occurrence. 3) Coverage for business interruption, destruction of data processing equipment and media, liabilities affecting accounts receivables, contracts and independent contractors and, valuable documents in an amount no less than $100,000 aggregate; 4) Liability coverage for all vehicles whether owned, hired or used in the amount of $500,000; and 5) Professional liability coverage in the amount of $500,000. Where applicable all coverage above shall be amended with MONROE COUNTY BOARD OF COUNTY COMMISSIONERS named as an additional insured. All of the policies of insurance so required to be purchased and maintained shall contain a provision or endorsement that the coverage afforded shall not be canceled, materially changed or renewal refused until at least thirty (30) calendar days written notice has been given to the COUNTY by certified mail. Prior to commencing work, the CONTRACTOR shall provide COUNTY with certified copies of all insurance policies providing coverage as required, Any indemnification provisions in this Agreement are separate and apart and in no way limited by the insurance amounts stated above, The liabilities of the CONTRACTOR under this Agreement shall survive and not be terminated, reduced, or otherwise limited by any expiration or termination of insurance coverages. Agreement Page 30f6 "Ambulance Billing & Related Services" CONTRACT # Page 4 Date: 10. OWNERSHIP OF DOCUMENTS. CONTRACTOR shall be required to work in harmony with other consultants relative to providing information requested in a timely manner and in the specified form. The CONTRACTOR agrees that any and all documents, records, disks, and electronic data produced in the performance of this Agreement shall be the sole property of the COUNTY, including all rights therein of whatever kind except as may otherwise be provided hereinafter. Failure to turn over such documents within seven (7) days of when requested may be cause for the COUNTY to withhold payments due CONTRACTOR or to enforce this clause by legal remedies, 11. ATTACHMENTS. The following named attachments are made an integral part of this Agreement: A, Proposal presented to Monroe County EMS by Advanced Data Processing dated July 6, 2000 (Exhibit A attached hereto and made a part hereof) which includes the Contract with the City of Boca Raton (referenced herein as the "Piggyback"), B, Public Entity Crime Statement and Sworn Ethics Clause Where terms, conditions or scope of services stated in either this Agreement or the above attachments conflict, this Agreement and any superceding Amendments thereof shall prevail. 12. TERMINATION for CAUSE. During the time of this agreement the COUNTY may terminate this Agreement after first giving to CONTRACTOR notice of default and opportunity to cure the default within thirty (30) days after receipt of such notice. In the event the acts constituting default are a violation of law, CONTRACTOR shall be subject to immediate termination of contract, 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 the COUNTY in an amount(s) that 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. 13. UNCONTROLLABLE FORCES. Neither the COUNTY nor CONTRACTOR shall be considered to be in default of this Agreement if delays in or failure of performance shall be due to Uncontrollable Forces, the effect of which, by the exercise of reasonable diligence, the non-performing party could not avoid, The term "Uncontrollable Forces" shall mean any event which results in the prevention or delay of performance by a party of its obligations under this Agreement and which is beyond the reasonable control of the non-performing party, It includes, but is not limited to fire, flood, earthquakes, storms, lightning, epidemic, war, riot, civil disturbance, sabotage, and governmental actions. Neither party shall, however, be excused from performance if non-performance is due to forces that are preventable, removable, or remediable nor which the non-performing party could have, with the exercise of reasonable diligence, prevented, prevented, Agreement Page 4 of 6 . "Ambulance Billing & Related Services" CONTRACT # Date: Page 5 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, 14. JURISDICTION, VENUE and CHOICE OF LAW. All questions pertaining to the validity and interpretations of this Contract shall be determined in accordance with the laws of the State of Florida, Any legal action by either party against the other concerning this agreement shall be filed in Monroe County, Florida, which shall be deemed proper jurisdiction and venue for the action, 15. PIGGYBACK. It is hereby a precondition of any part of this Agreement that the Most Favorable Terms of CONTRACTOR's Agreement with the City of Boca Raton (dated March 17, 1999) shall be extended to the COUNTY including any modifications, amendments or exclusions for the term of referenced agreement, Effectively, this allows the COUNTY to piggyback the agreement with the City of Boca Raton, 16. ASSIGNMENT OF CONTRACT. The CONTRACTOR shall not sell, transfer, assign or otherwise dispose of this Contract or any part thereof or work provided therein, or of its right, title or interest therein, unless otherwise provided in the contract, without express prior Gonsent by the COUNTY. 17. NOTICES. Delivered or mailed to such party at their respective addresses as follows: To the COUNTY: Monroe County EMS 490 Sixty-Third Street Marathon, FL 33050 Attn: Teresa Gorentz, Director To the CONTRACTOR: Paul Franzelas Vice President Advanced Data Processing, Inc. 520 NW 165 Street Road, Suite 201 Miami, Florida 33169 18. REPESENTATION AND WARRANTY. CONTRACTOR represents that they have experience and agrees to follow all Federal, State and Local Laws including, but not limited to, Public Records Laws and those laws and statutes applicable to discrimination, Agreement Page 5 of 6 "Rescue Ambulance Billing & Related Services" CONTRACT # Date: Page 6 19. ENTIRE CONTRACT. This Contract contains the entire agreement between the parties, The CONTRACTOR represents that in entering into this Contract it has not relied on any previous oral and/or implied representations, inducements or understandings of any kind or nature. IN WITNESS WHEREOF. the parties hereto have caused these presents to be executed on the day and year first above written: Mol'+iaOE COUNTY SEAL By: Yvonne Harper, Chairperson Lower and Middle Keys Fire and Ambulance District Board of Governors Attest:~.JLQ.. ~~ D.C-. Danny Kolhage. Clerk of the Court '8 - l f.s>- 00 By: <<' l7C' ~f -Ceo. c ~ <:' ~. C-f' Agreement Page 6 of6 O,Yv~rY ~o~~~2E (305) 294-4641 (0 .~,_.....- BOARD OF COUNTY COMMISSIONERS MAYOR Shirley Freeman, District 3 Mayor Pro tern George Neugent, District 2 Wilhelmina Harvey, District 1 Nora Williams, District 4 Mary Kay Reich, District 5 PUBLIC ENTITY CRIME STATEMENT A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list. Attachment: Ambulance Billing Services Contract of September 1, 2000 SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY, FI.ORIDA ETHICS CLAUSE AdVa.",ced. T.:bfo.. t=f.c!:)c.es~i+l~.:...._warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former County officer or employee in voliation of 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 Count --~~ . (signatu Da te : --..-:JMO () STATE OF r COUNTY OF PE~Y APP~ED BEFORE. ME, the undersigned authority, _.1.- --bMz..~..____.________nn_ who, after first being sworn by me, affixed his/her signature (name of individual signing) in the space 2.ffk pr~~' above on this __~L._____day of './ ' A'" .:f1d)}{). J ' P--- ~.____ My commission expires: ~~y P,,~ YVETTE BLAIR. GAllES ~& If, COMMISSION # CC 718204 ~ ~ ?! EXPIRES FEB 19, 2002 "'T~ BONDED THRU OF f\.tI' ATLANTIC BONDING co., INC. CERTIFICATE OF INSURANCE This certifies that ~ STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois o STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois insures the following policyholder for the coverages indicated below: Name of policyholder ADVANCED DATA PROCESSING INC. Address of policyholder 520 NW 165TH STREET RD STE#201 MIAMI, FLA. 33169-6303 Location of operations SAME Description of operations BILLING & COLLECTION SYSTEMS The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subiect to all the terms exclusions, and conditions of those policies. The limits of Iiabilitv shown may have been reduced bv any paid claims. POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date Expiration Date (at beqinninq of Dolicv Deriod) Comprehensive BODILY INJURY AND 98485820-5B Business Liabilitv 03/06/00 03/06/01 PROPERTY DAMAGE This insurance includes: ~ Products - Completed Operations ~ Contractual Liability o Underground Hazard Coverage Each Occurrence $1.000,000 o Personal Injury o Advertising Injury General Aggregate $2,000.000 o Explosion Hazard Coverage Products - Completed o Collapse Hazard Coverage Operations Aggregate $2,000,000 o General Aggregate Limit applies to each project 0 0 EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE Effective Date EXDiration Date (Combined Single Limit) o Umbrella Each Occurrence $ o Other 10/11/99 10/11/01 Aaareaate $ 98KB72387F 04/06/00 04/06/01 Part 1 STATUTORY Part 2 BODILY INJURY Workers' Compensation and Employers Liability Each Accident $100000 Disease Each Employee $100000 Disease - Policy Limit $ 500000 POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date EXDiration Date (at beginning of policy period) 5553289A0159 AUTO 07/01/00 01/01/01 500/500/500 If any of the described policies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder 3 0 days before cancellation. If, however, we fail to mail such notice, no obligation or liability will be imposed on State Farm or its agents or representatives. Name and Address of Certificate Holder MONROE COUNTY BOCC 5100 COLLEGE ROAD RM # 203 KEY WEST, FLA.33040 ADDN INSD. MONROE COUNTY BOCC /' ! Title (l ,CO- Signature of A orized Representative /}C 071 - / Y Ie? )/cX)~(' 558-994 a 2-90 Printed in U,S.A. Date . Advanced Data Pnx:essing Advanced Data Processing Phone 305 945 2260 520 NW 165 Street Road Suite 201 Fax 305 945 6692 Miami, FL 33169 Email AOPadv@aol.com July 6, 2000 MONROE COUNTY Purchasing Office 5100 College Road, Public Service Bldg Cross Wing Room #002 Stock Island, Key West, FL 33040 -,;,:.......ot Dear Purchasing and EMS Director: ~ Subject: EMS Billing & Collections Contract. Boca Raton Piggyback This letter hereby serves as our authorization for you to "Piggyback" our contract with the City of Boca Raton Agreement No. 99-006 adopted under Resolution No. 57-99 dated March 16111, 1999 to provide same Billing and Collection Services for Emergency Medical Transports provided by Monroe County. We therefore extend all most favorable terms and conditions of this agreement to Monroe County. c Respectfully submitted, ~~ I. .~ --. D V Passaro VP Marketing/Operations Advanced Data Processing I"" Exhibit B - Fees Pricing for all services shall be a monthly contingency fee of: Seven (7%) percent of all monies collected in the previous month. Price shall include but not be limited to all stationary, fax, farms, envelopes, mailings, postage, and telecommunications/phone facilities/charges. Price for services does not include the cost of "Lacked-box" service, The "Locked-box" service selected shall be at the sole discretion of the City and shall provide a secure postal address and box far receipt of all correspondence (especially including all insurance and patient payments, correspondence and benefits determination and denials. The "Locked-box" service will on a daily basis perform the following: · Open all mail (except clearly marked returned-mail). · Make a copy of every check and attach copy with original document accompanying each check. · Deposit all receivables into designated City account. · Prepare and provide a daily deposit slip totaling and accounting for all receivables deposited for the identified day. · Mail (daily) to Advanced Data Processing separated bundles of; copies of checks attached to supporting documents, other correspondence and, returned-mail along with deposit slip. · Mail (daily) to City copies of checks and daily deposit slip. · Mail (monthly) to City reconciliation of account. Price shall include adjustment due to increase in cast far postage according to the City's RFP (Section 2-2 E.). Exhibit 8 Page 1 CEFHIFICr\ TE OF INSURANCE, T":~ certifies that X STATE FARM FIRE AND CASUALTY COMPANY. Bloomington, Illinois o STATE FARM GENERAL INSURANCE COMPANY. Bloomington, Illinois in:.ures the following policyholder for the coverages indicated below: Name of policyholder ADVANCED DATA PROCES SING If (-r' Address of policyholder 520 165TH RD STE 201 MIAMI FL 33169 Location cf operations SAME Description of operations ADDITIONAL INSURED: CITY OF BOCA RATON The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is subj eet to all the terms e:<c1usions, and conditions of those policies. The limits of Iiabilitv shown mav have been reduced by any paid claims. POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date Expiration Date (at beainnina of policy period) Comprehensive BODILY INJURY AND 98 48 5820 Business Liabilitv 01/15/99 01/15/00 PROPERTY DAMAGE ! This insurance includes: X Products - Completed Operations ;/ I i X Contractual Liability , o Underground Hazard Coverage Each Occurrence $ t;00 000 , , X Personal Injury i I X ,o..d'lertising Injury General Aggregate $ 1 000 000 I o Explosion Hazard Coverage Products - Completed o Collapse Hazard Coverage Operations Aggregate $ 1 . 000 000 l o General Aggregate Limit applies to each project 0 0 POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit) o Umbrella EiiCh Occurrence $ o Other Aaareaate $ Part 1 STATUTORY 98 CU 1862 04/04/98 04/04/99 Part 2 BODILY INJURY Workers' Compensation and Employers Liability Each Accident $100 000 Disease Each Employee $100 000 Disease - Policy Limit $ t;00 000 POLICY NUMBER POLICY PERIOD LIMITS OF LIABILITY TYPE OF INSURANCE Effective Date Expiration Date (at beQinninQ of policy periodl 555 3289 59 D AUTO 01/01/99 07/01/99 500/500/500 WILL COVER NON OWNED AND HIRED VEHICLES . . Name and Address of Certificate Holder If any of the descnbed poliCies are canceled before its expiration date, State Farm will try to mail a written notice to the certificate holder 30 days before cancellation. If, however, we fail to mail such notice, no obligation or liability will be imposed on State J~r its agents or rep sell ative . ~'--- rT~Y OF BOCA RATON _ W PALMETTO PARK ROAD oOCA RATON FL 33432 AGENT Title _03/04/99 _Date B. Pattee DADE COUNTY B 1307302810 '106 F600 3 4 5 6 7 8 9 10 11 12 13 '4 15 16 A'" I f 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 1 RESOLUTION NO. 57-9.9 ., A RESOLUTION OF THE CITY OF SOCA RATON AUTHORIZING THE MAYOR AND CITY CLERK TO EXECUTE AN AGREEMENT WITH ADVANCED DATA PROCESSING, INC., FOR THE PURPOSE OF PROVID- ING EMERGENCY MEDICAL TRANSPORTATION BILL- ING SERVICES. WHEREAS, the City of Boca Raton has found it desirable to enter into an agreement with Advanced Data Processing, Inc., for the purpose of providing emergency medical transportation billing services; and WHEREAS. such an agreement has been prepared and a copy thereof is attached hereto; now therefore BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF BOCA RATON: That the Mayor and City Clerk be authorized to execute the agreement with Advanced Data Processing, Inc., a copy of which is attached hereto: PASSED AND ADOPTED by the City Council of the City of Boca Raton this K ~ day of '7u ~ , 1999, CITY OF BOCA RATON, FLORIDA ATTEST: ~~/~~- / Carol G. Hansori, Mayor COUNOL VOTE ~s t!Q. ..,/ v v V ;'SSTAINED ~ HANSON GLASS ABRAMS - - THA~ _ IM1ELCHEL / i:. -. - AGREEMENT FOR PROFESSIONAL SERVICES NO. 99-006 r ~ THIS AGREEMENT made and entered into this /7 ti day of 'lnwrci .19 77, by and between the City of Boca Raton. a municipal corporation of the State of Florida. hereinafter referred co as CITY. and ADV ANCED DATA PROCESSING. INC. hereinafter referred to as CONSULTANT: WHEREAS, the CITY requir~s cen::l.in professional services in connc:ction \vith Medical Transportation Billing Services; and. WHEREAS. the COl'oiSUL T ANT represems that it is capable and prepared to render those services as hereinafter provided: 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 upon execution of the Agreement by the City of Boca Raton and shall remain in effect for a three (3) year term with two (2) one year renewal options, ARTICLE 2 - SERVICE TO BE PERFORMED BY CONSULTANT The CONSULT ANT shall perform those services requested and authorized by the CITY pursuant to the Ex.hibit "A" and the City's RFP 99-006 which are deemed as being attached hereto and made a part thereof providing, however, that if there is any express or implied conflict or inconsistency with this agreement the agreement shall always prevail, as may be specifically designated and additionally authorized by the CITY. Such additional authorizations will be in the form of a Work Order, Each Work Order will set forth a specific Scope of Services, amount of compensation and completion date and shall be approved by resolution of the City Council before the work encompassed by such work order is perfonned, ARTICLE 3 - COMPENSATION The CITY shall pay CONSULT ANT in accordance with Exhibit B, Fee Schedule, which is attached hereto and incorporated by reference as part of this Agreement, ARTICLE 4 - STANDARD OF CARE CONSULTANT shall exercise the same degree of care, skill, and diligence in the performance of the Services as is ordinarily provided by a CONSULT ANT offering services for local goverrunents in South Florida, under similar circumstances and CONSULT ANT shall, at no additional cost to the CITY. re- perform services which fail to satisfy the foregoing standard of care. ARTICLE 5 - INDEMNIFICATION The CONSULTANT hereby acknowledges and confirms that the proposal price includes Indemnification/Hold Harmless. CONSULT ANT shall. in addition to any other obligation to indemnify the CITY and to the fullest extent permitted by law, protect, defend, indemnify and hold h:l.rmless the 1 CITY, their agents, dected officials and employees from and against all claims. actions, liabilities. losses (including economic losses), COSts arising out of any actual or alleged: a). Bodily injury, sickness. disease or death. or injury co or des[~uction of tangible property including [he loss of use resulting therefrom, or any ocher damage or loss arising oue of or resulting. or claimed to have resulted in whole or in part from any actual or alleged act or omission of the CONS UL T ANT. any subconsultant. anyone directly or indirectly employed by any of them. of anyone for whose acts any of them may be liable in the perfonnance of the \VORK; or b). violation of law. starute, ordinance. governmental administration crder, rule. regulation. or infringement of patem rights by CONSULTANT in the perfonn:mce of the \Vork; or c). liens. claims or actions made by the CONSULTANT or any sub consultant under worke~3 comFensatlon acts: disability benetit acts. other employee bend'!c acts or ~ny stamtN)" bar. ,~.ny COSt of expenses, including atromey's fees (including appellate. bankruptcy or patem counsel fees), incurred by the CITY to enforce this a~reement shall be borne by the CONSULT ANT, - . Upon completion of all Services, obligations and duties provided for in this Agreement, or in the event of termination of this Agreement for any reasons, the terms and conditions of this Article shall survive indefinitely, ARTICLE 6 - INDEPENDENT CONTRACTOR CONS UL T ANT undertakes performance of the Services as an independent contractor and shall have control of the work and the manner it is performed. CONSULT ANT shall work closely with the CITY in performing Services under this Agreement. ARTICLE 7 - COMPLIANCE WITH LAWS I:; r~;"~'<Jrn:~nce of the Services, CONSULTANT will comply with applicable regulatory requirements including federal, state, and local laws, rules regulations, orders, codes,criteria and standards, ARTICLE 8 - INSURANCE During the performance of the Services under this Agreement, CONSULTANT shall maintain the following insurance polices, and provide originals or certified copies of all policies. and shall be written by an insurance company authorized to do business in Florida. WORKER' S COMPENSATION The Consultant shall procure and maintain, for the life of this Contract/Agreement, Worker's Compensation Insurance covering all employees with limits meeting all applicable state and federal laws, This coverage shall include Employers' Liability with limits meeting all applicable state and federal laws, This coverage shall extend to any subcontractorthat does not have their own Workers' Compensation and Employer's Liability Insurance, Thirty (30) days notice of cancellation is required and must be provided to the City of Boca Raton via Certified Mail. COMPREHENSIVE GENERAL LIABILITY The Consultant shall procure and maintain, for the life of th~s Contract/Agreement, Comprehensive General Liability Insurance. This coverage shall be on an "Occurrence" basis. Coverage shall include Premises and Operations; Independem Contractors' Products and Completed Operations and Contractual Uability. This policy shall provide coverage for death. personal injury or property damage that could arise directly or indirectly from the performance of this Agreement. 2 Th~ Minimum Limits of Coverag~ shall be 5500.000 per occurrence. Combined Single Limit for Bodily Injury Liability and Property Da'mage Liability with a S 10.000 deductibl-:, " , . I The City of Boca Raton 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 the City of Boca Raton via Certified Mail in the event of cancellation. BUS!NESS AUTOMOBILE LIABILITY The Consultant shall procure and maintain, for the life of the Contractl Agreement, Business Automobile Liability Insurance. The minimum limits of coverage shall be $500,000 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 Consultant 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 Consultant indicating the following: does not own any vehicles. "Company Name" In the event we acquire any vehicles throughout the term of his Contract/Agreement, agrees to purchase" Any Auto" or "Company Name" Comprehensive Form coverage as of the date of acquisition. Consultant's Signature: Thirty (30) days written notice must be provided to the City of Boca Raton via Certified Mail in the event of cancellation, SUPPLEMENT AL PROVISIONS 1. The insurance coverage and conditions afforded by these policies 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 City of Boca Raton's department that originated this contract. 2. Certificates of Insurance meeting the specific required prOViSion specified within this Contract/ Agreement shall be forwarded to the City of Boca Raton Department that originated the contract, and approved prior to the start of any work or the possession of any city property. ARTICLE 9 - CITY'S RESPONSIBILITIES The CITY, during the term of this Agreement, shall: 3 r\. Provid~ the n~:essJ.ry patient information to the CONSULT Ai':T on a weekly b:lsis, for those patients that have been transported by Fire-Rescue Services. B. Comply with all Federal, State and local laws, rules and regulations as applicable to the services being contracted for. C, Agree to use the successful firm for all medical billings exclusively for the service specifkd her~in. as long as the contract agreem::m is in force and the Consul~.lm is not in default of this llgreemem. D, ~1:!.ke reasonable effortS to obtain the proper billing address for all bi1i:!.b!~ p:ltients prior to forwarding to the finn. E. Pay the firm additional fees for any postage increases that may occur during the contract period. However, this fee will only be the actual direct cost of increase. F. Pay the CONSULTANT, in full payment of all work and services performed or rendered hereunder, the amount of seven (7) percent of all sums collected, minus adjustments for overpayments, bad checks and foreign currency exchange rates, The CONSULTANT shall submit an invoice to the CITY on a monthly basis. The City shall pay the invoice in the manner allowed by the Florida Prom? t Payment Act, Florida Statute 218.70, er. seq. ARTICLE 10 - TERMINATION OF AGREEMENT The obligation to continue Services under this Agreement may be terminated for cause by either party upon seven (7) days' written notice of substantial failure by the other party to perform in accordance with the terms hereof through no fault of the terminating party. CITY shall have the right to terminate this Agreement or suspend performance thereof without cause for the CITY's convenience upon fourteen (14) day's written notice to CONSULT ANT, and CONSULTANT shall terminate or suspend performance of Services on a schedule acceptable to CITY. In the event of temlination or suspension for CITY's convenience, CITY shall pay CONSULTANT for all Services performed through the date of notice of termination or suspension, ARTICLE 11 - NONDISCLOSURE OF PROPRIETARY INFORMATION CONSULTANT shall consider all information provided by CITY and an reports, studies, calculations, and other documentation resulting from the CONSULTANT's performance of the Services to be proprietary unless such information is available from public sources, CONSULTANT shall not publish or disclose proprietary information for any purpose other than the performance of the Services without the prior written authorization of CITY or in response to legal process or orders of a court of competent jurisdiction. ARTICLE 12 - UNCONTROLLABLE FORCES Neither the CITY nor CONSULTANT shall be considered to be in default of this Agreement if delays in or failure of performance shall be due to Uncontrollable Forces, the effect of '.','hich, by the ex.ercise of reasonable diligence, the non-performing party could not avoid. The term "Uncontrollable Forces" shall mean any event which results in the prevencion or delay of performance by a party of its obligations under 4 this Agreement and which is beyond the reasonable control of the non-performing party. [t includ~s. but r- is not limited to fire. tloed. earthquakes. stOm1S. Iighming. epidemic. war, riot, civil disturbance. \. sabotage. and governmental actions. Neither party shall. however. be excused from performance if nonperformance is due to forces which are preventable. removable. or remediable and \vhich the non-performing party could have, with the exercise of reasonabk diligence. prevented. removed. or remedied with reasonable disp:ltch, 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 ocher pany d.::scribing che circumstances and ul1comroliJbl.:: forces preveming continued performance of the obligations of this Agreemem. 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 Palm Beach County and the Agreement will be interpreted according to the laws of Florida, ARTICLE 14 - MISCELLANEOUS 14.1 Nonwaiver A \'I~aiver by either CITY or CONSULTANT of any breach of this Agreement shall not be binding upon the waiving party unless such waiver is in writing and signed by the parties 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, 14,2 Severability 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, shall in no way affect the validity or enforceability of any other portion or provision of the Agreement, Any void 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 Agreement from being void should a provision which is of the essence of the Agreement be determined to be void. Political Campaigns During the term of this Agreement, the CONSULT ANT, or any employee or associate, shall not be involved in any political campaign for a City of Boca Raton elective office, nor make financial contributions to any such campaign, ARTICLE 15 - INTEGRATION AND MODIFICATION 5 This Agreem~nt and any exhibits incorporated by reference in this agreemem. is adopted by the CITY and CONSULT ANT as a tinaL complete and exclusive statement of the terms of the Agreemem between the CITY and CONSULTANT. This Agreement supersedes all prior agreemems. comracts. proposals. representations. negotiations. letters or other communications between the CITY and CONSULT ANT pertaining to the Services. whether written or oral. The Agreement may not be moditied unless such modifications are e~'idenced in writing signed by both the CITY and CONSULTANT. The follo\ving documents are made an integral pan of this Agreement: A. RFP No. 99-006 B. Proposal dated December 9, 1998 In the event of any conflict or inconsistency between these documents and this agreement, the agreement shall prevail. ARTICLE 16 - SUCCESSORS AND ASSIGNS The CITY and CONSULTANT each binds itself and its director. officers, partners, successors, executors. administrators, assigns and legal representatives to the other parry to this Agreement and to the partners. successors, executors, administrators, assigns, and legal representatives. The Consultant may only assign, sell or pledge this agreement or it's interest therein if the Consultant first receives the prior written consent of the City Commission, which may be reasonably withheld. Any proposed assignee will have to sign an assumption agreement accepting this agreement's terms and conditions in a form acceptable to the City, ARTICLE 17 - CONTINGENT FEES The CONSULT ANT warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the CONSULTANT 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 CONSULT ANT, any fee, commission, percencage, gift or any other consideration contingent upon or resulting from the award or making of this Agreement. ARTICLE 18 - TRUTH-IN-NEGOTIATIONCERTIFICATE Execution of this Agreement by the CONSULT ANT shall act as the execution of a truth-in-negotiation certificate certifying that the wage rates and costs used to determine the compensation provided for in this Agreement are accurate, complete and current as of the date of the Agreement and no higher than those charged the CONSULTANTS most favored customer for the same or substantially similar service, The said rates and cost shall be adjusted to exclude any significant sums should the CITY determine that the rates ad costs were increased due to inaccurate, incomplete or noncurrent wage rates or due to inaccurate representations of fees paid to outside consultants. The CITY shall exercise its rights under this "Certificate" within one (1) year following payment. ARTICLE 19 - OWNERSHIP OF DOCUMENTS 6 CONS UL T ANT shall be 'required to work in harmony with other consultants relative to providing (." information requested in a timely manner and in the specitled form, Any a.nd all documents. records. disks. original drawings. or other infomlation shall become the property of the CITY upon completion or termination for ie's use and distribution as may be deemed appropriate by the CITY, Failure to turn over such docum~nts with seven (7) days of when requested may be cause for the City to withhold any payments dLl~ Consulcant or to enforce this clause by legal remedies. ARTICLE 20 - NOTICE Any notice. dem::.nd. communication. or request requir~d or permict~d hereunder shall be in \vririn2 and delivered in person or sent by certified mail, postage prepaid as follows: . - As To CITY Bruce W. Silk, Chief Fire/Rescue Services Department City of Boca R'Jton 2333 West Glades Road Boca Raton, Florida 33431 As To CONSULTANT: Paul Franzelas, Vice President Advanced Data Processing, Inc. 520 N.W. 165m Street, Suite 201 Miami, Florida 33169 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,ro, 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 CONSULTANT and CITY. 7 lL\' WITNESS WHEREOF, the City of Boca Raton, :It a regular meeting thereof. by action of the City Council and directing the foregoing be adopted, has caused these presents to be signed by the Mayor, and it's seal to be hereunto affixed. and ADV ANCED DATA PROCESSING, INC. has executed this contract all as of the day and year first above written, Wimess: ~(UL- Approved as to Form and Legal Sufficiency: BY:~' ~k,JJV\ City ttomey ... .j CONSULT ANT Attest: (-Y~<<,~n~ ---- COq)oratesecr.etary / ./' ~/", (Seal) Witness: /7 ~.,dr 4 ~~ q'\(\~ t9 \~, ~ g R~rN\.h~}11\' Approved by City Council on m wr C/h I b CITY OF BOCA RATON ~,. ; ~& . . / 1~/ /, . B'j~~t:Z/~. l 'i2.-J!d/'YU ~ CarolG.Hamon Mayor, Vg4 ~~~re A'~r~ ./' Name: \""' \ I\J ~ Cl ~ tJ?.e \ IlS Title: ~R --e s \ ~ ~''-.l+ Prcsident(or other Duly Authorized Officer) (Attilch ResolutionIBylawofauthorization i f not President) , 1999, Item # 3. r, 8 Exhibit A - Scope of Work General Scope Advanced Data Processing will perform all services with t:'e principal goals of: f = recovering the greatest amount of fees in the shortest possible time and, = gieatest total amOU:lt with minimiz>::d cost to recover. All services will be provided as stated in this Proposal. The specifics of such services to be provided are addressed in the following subsections of this proposal. The following are general services requested by the City, which will be performed if awarded such contract = Provide billing and collection services for Emergency Medical Services transport, as required on a case by case basis, with emphasis on accelerated turnaround between services provided and payment re::ei'led. = The price bid herein shall include all expenses of billing and collection including, but not limited to, stationary, fax, forms, envelopes, mailing, postage and telecommunications/phone facilities/charges. = Ensure that all required documentation and agreements with payors (e.g. Medicare, Medicaid, Champus, etc.) are filed and maintained and that Fire Rescue is kept apprised of important changes to industry regulations. = Provide reasonably necessary training periodically to City Fire Rescue personnel regarding the gathering of necessary information and proper completion of run tickets. Advanced Data Processing in corroboration with other municipalities has already put together a video-based training program for this purpose. = Provide prompt submission of Medicare, Medicaid and insurance claims (within 72 hours) after receiving completed run ticket, which shall be Advanced Data Processing's notice to commence the billing/collection service including keeping logs confirming all electronic submissions. Secondary insurance provider claims shall be submitted after the primary insurance provider has paid. Advanced Data Processing shall follow-up on rejected and inactive claims and establish payor remittance accounts and procedures. = Utilize most up-to-date knowledge and information with regard to coding procedures, assigning of ICD-9 diagnostic codes and proper preparation of electronic and paper insurance filings to ensure compliance with applicable Federal, State and local regulations. Exhibit A Page 1 , ( = Reconcile the number of transports collected with those transmitted to Ad'lanced Data Processing and contact Fire Rescue to report any discrepa!ides. Advanced Data Processing shall provide a designated liaison for patient/payor concerns. This person shail be Ms, Bech Kaminer, Sr, Collector. Provide survey questionnaires or mail inserts to patients at the City's request. = Provide ail customer-related inquiry services and prepare additional third-party claims or patient payment arrangements based on this information exchange. Customer calls will be facilitated as local within Cit'j of Boca Raton through a dedicated "SOO" toll-free exchange. = Facilitate proper security of confidential information and proper shredding of all disposed materials containing such proprietary information, = Visit hospitals and/or establish with hospitals arrangement to obtain/verify patient insurance and contact information. = Respond promptly to the City and patients on requests for information or records. = Treatment as confidential any records of care or treatment of patients solely for the purpose of processing and collecting claims and shall not release any such information in any legal action, business dispute or competitive bidding process. = Use of proprietary systems, procedures or techniques as required to achieve higher collection rates and improved cash flow. ' = Maintain appropriate accounting procedures for reconciling all deposits, receivables, billings, patient accounts, adjustments & refunds. = Provide timely comprehensive reports facilitating all required aspects of monitoring, evaluating, auditing and managing the services provided and the interface between Fire Rescue and Advanced Data Processing. = Process refund requests providing Fire Rescue with documentation substantiating each refund processed. = Provide Fire Rescue all unpaid invoices along with the complete processing history once collection efforts are exhausted. = Convert all active and inactive files from the prior billing company and maintain such records. Exhibit A Page 2 , . Specific Scope Compliance Advanced Data Processing will provide the above general services with specific compliance as requested by the City of Boca Raton in the RFP : r.... t.o = Assign billing patient numbers providing cross-reference to City of Boca Raton assigned transport numbers. = Responsible for obtaining all necessary rescue and insurance information. = Provide accurate coding of proceduies and diagnosis and correlation of rescue documentation. = Annually make recommendations for fee schedule changes, regularly advise on changes in statutes and industry regulations. = Respond to all patients' requests and inquiries, either written or verbal. = Negotiate and arrange modified payment schedules for individuals unable to pay full amount when billed. = Mail requested citizen satisfaction survey. = Provide for facilities to permit dial-up access to our system to obtain patient data and billing information. = Maintain daily deposit control sheets and original documentation. c = Submit claims, process statements, post receivables, process refund requests and submit reports within following specified timeframes and frequencies: · File claims & send an invoice to all self-pay patient/payors with return envelope and address as specified by the City within five (5) days of receipt of incident information, Provide prompt submission of Medicare, Medicaid and insurance claims within 72 hours after receiving completed run ticket . Process all third party reimbursements within one-week after receipt of appropriate billing information from primary payor. · Responsible for sending second notices at thirty-five days and third notices at sixty-five days, . Visit hospitals twice (if necessary) to obtain/verify patient insurance and contact information. . Respond within three (3) business days to the City and patients on requests for information or records. Exhibit A Page 3 · Provide specified management reports on monthly basis as identified and prescribed by the City. Monthly reporting is produced after month closing and provided to you no later than the 10th of each month, We print the reports within 24 hours after rec~ivi:1g the last da:; of tr.a month's receivables from the banI<. . Provide monthly listing of accounts past due 1 SO-days or more, . Provide Fire Rescue all unpaid invoices (upon request) along with the com.:JI~te processing history once collection efforts are exhausted. . Accounts are retained for a period of one-year. . Process refund requests within the month following an overpayment. Exhibit A Page 4 Rationale The following section explains the approach to be taken. identifying its rationale and distinguishing characteristics. Advanced Data Processing prides itself in developing operations r71S:;-,:JC!s and systems support tailored s/:ecifici.:/!/ ::) 5.\,i S ::.....:.: ,.:' ',:-:::;, .:>:.: :,'.:: ,;:..:: &r"j.::n :5. Our methods and systems are refined to provide maximum efficiency in the collection of your receivables In addition, because of our focus solely on serving municipalities in the area of EMS billing and collections. we ha'/e pro'/ided so many of our municipal clients at both the cit"j and county level the follo'l/ing distinct benefits: Using some of the fi,:est multi-media tools to bring training assistance to the Fire R:scue staff and 2Gministration in essentials of understanding the importance of key patient information (demographic, insurance and medical) in the successful billing process, + Standard and Ad Hoc reporting through our proprietary in-house programming providing the essential information for management, administration and accounting of the billing/collection process, Our IBM AS400 & Pentium/PC environment provides state-of-the-art solutions. Our reports are not only comprehensive and provide just-the-right information but, we send our reports within 24 hours of receiving last day of the month's receivables. Our clients generally get their reports within 1 to 4 working days of the month-end. The following outlines some of the most important distinctions in how we provide such superior services. + Hospital Support - The principal ingredient in effectively maximizing our collection success is having access to medical insurance records from the transported hospitals, Our company with your assistance will maintain a working arrangement with all of the major hospitals in your area These hospitals will be requested to provide a copy of their patient facesheets or patient demographic and insurance information. The ER facilities will set up a holding tray for facesheets, We send our personnel to the area hospitals to obtain up-to- Exhibit A Page 5 date, validated patient insurance information. Some hospitals provide us on-line access, others provide fax-back or a console on premises. Please note that we perform this with redundancy and that timing is critical in obtaining correct information, We do this at least twice and update our sjstem, refiling as neceSS:lr/, For smaller hospitals. we will arrange to have them provide us such information via fax or phone request. Advanced Data Processing has served several municipalities in Florida and has already established working relationships with a number of hospitals. . Electronic Claims Processinq - Medicare, Medicaid & many other carrier claims are processed by us and submitted e!ectronically to ensure accurate and fast collections. As the first EMS service company in Florida to electronicaJiI file Medicaid claims, we continually stay abreast of changes in insurance submission standards and upgrade our capabilities as such changes require. We ware one of the first service companies submitting claims to Medicare in the new "National Standard Format" now supporting Claims Submission. Claims Status, Remittance Advice and Electronic Funds Transfer, We have electronic access via Internet to all Medicare & Medicaid 88S facilities and information updates. We maintain logs of all insurance transmissions and a copy of the confirmation receipt sent by the carrier. Claims not sent electronically are processed on paper using HCFA-1500 forms or special forms provided by the carrier (occasionally required). . In-house ProQramminq & Advanced TechnoloQV - Since all of our computer programming is done 'in-house', we have the ability to immediately modify our computer programs to maintain the state-of-the-art in our collections system and processes. Our expertise upon which the company was originally formed was data processing and accounting based applications requiring custom programming. This enables us to rapidly develop advancements and custom tailor many aspects of our service unlike many of our competitors who employ .off-the-shelf' or .canned" software packages. Such packages restrict the user from changing database layouts, report definition, invoice formats and so forth. We are virtually unrestricted in such facets. In addition, we employ PC-to-Host transfer facilities that enable us to upload/download data to and from our AS400 host or even a customer system. . Automated Patient Linkinq - When a new patient is entered into the system, the first thing the system does is to determine if the patient has previously been transported, The database is searched for Medicare numbers, Medicaid numbers, and Private Insurance information. If we find this information in our history file, we can immediately use this information to process a claim, thus eliminating the time needed to research patient information, We call this our 'Patient Linkage Feature'. + Automated Payor MonitorinQ & Claim Resubmission - The system monitors all claims having been filed to insurance payors identifying those not having yet paid. These claims are flagged and automatically resubmitted. At a regular interval a trace letter is sent to the responsible carrier if the claim has still not been paid or response received. + Effective Statements - We provide an easy-reading, comprehensive statement/invoice to all patients and include for convenience a courtesy return-payment envelope, The front of the statement describes all charges and Exhibit A Page 6 payments, A request on the statement for the patients' Medicare and/or Medicaid number is clearly indicated. The reverse side of the statement has clearly marked entry blocks for information needed to file private ins:Jrance claims. We frequently accommodate our clients with inserts to include in O'Jr statement mailing such as questionnaires. comment cards, notices, etc. r-.. , ~ + Skiptracinq - We use various methods of.Skiptracing to locate patients who have left the area, or patients with invalid billing addresses and phone numbers. For incorrect addresses returned to us by the Post Office, we attempt to obtain a valid update from the hospital. If the hospital does not have better address informa:ion, "''Ie check these patients electronicallv against the U.S. Post Office's Nation<ll Change of Address (NCOA) files. whose records are updated quartarly. All mailing list companies to keep their lists current use ti1e (NCOA) files. Exhibit A Page 7 Optimized Flow The following diagram shows the major patient billilig cases a~d their flow of activities employing the previously mentioned techniques to optimize the billing and collection process. Obviously, the sooner that valid patient information is obtained the Quicker and more assured is collection. Accordingly, in cases where less information is initially provided, we do net dela" th-= billina crocess waitina for information. Instead, a bill is generated as just one form of patient contact through which, oftentimes, the patients themselves will fill-out the appropriate data on our easy-to-return billing form. This data is used to update the patients' billing information and a new billing is generated. Excellent working relationships are maintained with the hospitals to obtain this information and in some cases we provide updated information to the hospitals in reciprocity. The best case should be noted is where the EMS attendants provide the best information obtainable at the time up-front. Although this is sometimes not practical and is understood, the described approach accommodates this in an optimal way, Diagram - Optimized flow Case 1 Case 2 . no phon~ . \'~Iil.l ;lhen~ . no f~cesheet ITem Hosp PatieIH Data Pr()\'iclcu . no 13ceshect ITem Hasp D:1ta DepelldC:llt Process visit Hospibl locate patient d~ta visit Hospibl upd~te patient dab Exhibit A Page 8 Case 3 . v~1 id, p~one InlO . v~lid faceshcet ITem Hosp Patient Infonnation We utiiize four methods for obtaining patient insurance in~ormation: . We utilize Inr:r;;-a,ior. piO'lice'= 'l/It:; the: iL," she:?: (& hospital facesheet, if included). This is obtained in eith:, har.jccpy (which we key into our system) or. via e!ectror.ic communication from yOlir facility to curs. We provide BBS dial-in and we support E-mail transfer as well as most standard media (6250 tape. QIC-BO tape, PC-diskette). We send our personnel to the area hospitals to obtain up-to-date, validated patient insurance information. Some hospitals provide us on-line access, others provide fax-back or a console on premises. Please note that we perform this with redundancy and that timing is critical in obtaining correct information. We c::J {his at le3st {Wlce and I.:pdate our system, refiling as necessary. .,.~ i . . We provide easy to fill out return mail form as an integral part of our invoice statement for the patient/guarantor to provide insurance information. We also directly contact the patient/guarantor where necessary to request such information, Our system provides a "patient-linkage~ feature allowing us to use previously obtained insurance information, if the same patient has been previously transported. If the system finds a "linkage" having valid data from a previous transport, we immediately use this to file with their insurance. . Hospital Support The principal ingredient in effectively maximizing our collection success is having access to medical insurance records from the transported hospitals, Our company maintains a working arrangement with all of the major hospitals in your area. Most hospitals will provide a copy of their patient facesheets or patient demographic and insurance information. We understand the importance of rescue personnel availability. Consequently, we have been able to make arrangements with most hospitals to either hold the facesheets for us or to fax them to us, Where ER facilities will set up a holding tray for facesheets, we will send our own personnel to retrieve the facesheets. In addition, our personnel will retrieve required information from their computers. For smaller hospitals, we will arrange to have them provide us such information via fax or phone request. Advanced Data Processing as incumbent vendor to your City has already established a working relationship with most hospitals in y.our area: . Bethesda Memorial . Boca Raton Community . Delray Community . JFK Hospital .. Holy Cross . Palms West . West Boca Med Center . North Ridge Med Center Ia Fair Oaks Hospital II t'l Broward Med Center The above list is already programmed into our system to submit claims for transport to these facilities. (There may be other facilities to which you occasionally transport. We also have those already in our system). Exhibit A Page 9 Tasks Advanced Data Processing will utilize collected billing information provided by the City as the basis for: o Billing to and collecting from the transported individual. Medicare. Medicaid, insurance companies or, other appropriate third party payors for services provided by the City and maintaining incident-based accounting to assist in this process. o Preparing the required management and financial reports including information on delinquent accounts for the Cit'/s analysis of the services provided. Advanced Data Processing will provide the following services: o Mail an invoice to each transported individual at the current prevailing rate for transportation services. o File all insurance claim forms for all patients based upon information received from the patient or obtained from research we perform at health care facilities, o Provide required paperwork to Medicare, Medicaid, insurance companies or, third party payors for claims, reviews, resubmission, provider agreements. and other as required. o Mail copies of invoices to patients. Medicare, Medicaid, insurance companies or, other third party payors, when requested. o Mail a series of follow-up invoices to patients and make patient contact as necessary , ORe-file Medicare, Medicaid or insurance claims, as necessary to obtain payment. o Record customer payments from lock box collections. o Prepare periodic management/financial reports, o Negotiate and agree upon modified payout schedules within City-established guidelines for those individuals unable to remit the full initial-billed amount. o Notify the City of past due accounts by providing a listing of such accounts and pertinent detail. o Transition open balance accounts from previous billing agent and process for collection. o Any other services agreed to between the parties, in order to effectively collect all fees, Electronic Claims Bills for which we transmit via Electronic Communications are sent in batch form directly to the carrier providing payment orocessinq by the carrier within aooroximatel'l 15 days after receipt. Transmission to Medicare employs the most up- to-date National Standard Format and utilizes Medicare's "Medigap" feature to the greatest extent possible. This feature provided by Medicare automatically forwards Exhibit A Page 10 . ' secondary payor information to the supplemental insurance carrier ensuring faster payment of the 20% not paid by Medicare. In conjunction with our use of electronic claims processing we support and utilize the following facilities: .. Electronic Transmission Logs .. Electronic Claims Status . Electronic Reject Status + Electronic Remittance Notification .. Electronic Funds Transfer + Medicare, Medicaid and other carrier Internet and BSS information systems Other carriers are billed via paper HCFA-1500 forms and sent directly to the appropriate insurance carrier. F'! t Patient Signature - All indicators on insurance claims for identifying patient signature authorization and signature on file are appropriately set. Signatures are obtained where absolutely necessary. However, rescue medical and transport services are legally viewed as an extension of the hospital/ER facility. Signature authorization obtained by these facilities for treatment applies. In addition, our patient invoice form has a place for providing insurance information and signature authorization. Insurance Reviews - All insurance denials or problem mail are reviewed within 1-3 days of receipt. Wherever these problems can be resolved by phone call they are immediately addressed. All others are processed within the prescribed timeframe providing all appropriate documentation including EOBs, denial letter, run report or corrected information requested by the carrier, All applicable regulations are adhered to especially those of Medicare and Medicaid. . Accounts Receivable Merging Accounts - We are able to merge current open accounts from the current billing system at your option. If we take on these accounts. we will do so with review of the account determining the appropriate action to be taken (e.g. refiling, review, rebill, write-off) advising you of status. Data collection & entry - All information pertaining to patients/payors for accounts under our billing/collection whether hard copy or electronic form will be obtained from your office for the purpose of assisting in their collection. Advanced Data Processing will determine the optimum method for information transfer employing electronic or Exhibit A Page 11 t co:nmuniCCii::Or.:.: ;-. ;.::tnod3 as feasible. Information wi!! then be entered and maintained on G:Jr data processing system to ass,ist in this process. All information wi!! be treated as proprietary. Manual data entry is keyed in the most rapid and reliable manner possible. Advanced Data Processing has maintained its original expertise in bulk data entry and data processing and consequently has an advantage in the ability to process large volumes of input data such as patient incident & demogra;::hics as well as payment processing. All data received is entered into the system's database within three (3) days after receipt. It is then passed on for immediate verification and bill generation. Information Verification - All processed patient incident and billing/payor information is processed for first stage verification using three methods; 1) automated "front-end edits", 2) "patient-linkage" and, 3) manual review by insurance recovery specialists. Automated "front-end edits" look for certain inconsistencies in information that can be flagged and corrected. Items ranging from complete address, social security & date- of-birth to insurance IDs are checked by the system and flagged either for correction or hospital verification. As previously described, when a new patient is entered into the system, our system's "Patient-Linkage" feature determines if the patient has previously been transported. The database is then searched for valid Medicare numbers, Medicaid numbers, and Private Insurance information on which payments have been processed. If we find . this information in our history file, we can immediately use this information to process a claim, thus eliminating the time needed to research patient information. Beyond even these two automated methods used to filter perhaps otherwise "lost" or delayed collections (especially from commercial and Federal payors), we also employ manual methods to further screen the entered fresh billing information. Our insurance recovery specialists review each bill for claim processing. In many cases we can spot invalid insurance information or incomplete data that would result in a rejected claim. This information is corrected either immediately or, after obtaining valid information from a number of sources. In many cases we utilize on-line verification where our Exhibit A Page 12 system automatically, communicates multiple records to the insurance carrier and obtains from the carrier the correct filing identifica~ion. In other cases, telephone calling and/or hospital interrogation is employed. .i".' f. Carrier coordination - All coordination and correspondence with insurance carriers will be maintained. We will make every effort to collect all legally collectible amounts writing off only those amounts required by law. Settlements and adjustments (other than Medicare/Medicaid write-offs due to maximum a~lowable charge by Law) will require the authorization or you; organization. Forms required for submission of c1a:ms and other forms occasionally required by carriers and other payors will be completed and filed by us on behalf of the City. We strictly adhere to all insurance regulations regarding claim submission and recovery especially those of Federal and State programs. Utilizing electronic filing and the Medigap and Medicaid Crossover facilities allow us to increase efficiency in obtaining secondary payments. However, we also review all primary payments for possible manual secondary filing requirements doing so wherever possible, Other amounts - Our insurance processors are trained to take appropriate billing action to obtain payment for other amounts not paid by the insurance carrier deductibles, co-payments, etc.). Using remittance advice and EOB information we will bill the patient for all applicable coinsurance, deductible and non-covered amounts. Account aging - Account activity is maintained and reflected on reports provided which show daily activity for the month and aging of receivables. Accounts updated with valid payments are re-aged showing payment status as current. All accounts are summarized monthly and are reflected within categories showing their status as either current, 30, 60, 90, or 120 days. We utilize this information to focus OUr inquiry, rebilling and collection efforts on a routine basis. While we are able to provide you with a review of 180-day accounts with potential return of them to the City, we currently perform for all of our clients retaining accounts for 12 months. We do this because we have proven that our system will find insurance information on patients up to the 11 th month for some insurances and collect a significant amount of money that, in most cases, collection agents would not have collected. And. we provide such service at our same basic rate, far lower than that charged by ccliectio:l agent:;, In fact. many of OUr clients who also use a collection agency (such as Brevard County) ExhibitA Page 13 .....~ { have found that, their collection company complains of having next-to-nothing to collect on after we're done wit:' the accounts. Incurred Costs & Supplies - No incident31 costs are hlcden in our s~;"ice pricing. We provide all forms, reports, statements, envelopes, postage, phone service, etc. at no additional cost. Operating costs such as personnel, software, etc. are all borne by Advanced Data Processing. The only exception to this is special questionnaires, surveys, or forms the City may employ in special fashion, v"hile we charge nothing extra for including these in our mailing, the City must provide the printed materials they require, Third Party Billing Transmission to Medicare employs the most up-to-date National Standard Format and utilizes Medicare's "Medigap. feature to the greatest extent possible, This feature automatically forwards secondary payor information to the supplemental insurance carrier ensuring faster payment of the 20% not paid by Medicare. All other secondaries to Medicare are manually filed immediately after receipt and posting of the Medicare payment. Other third party payors (especially where ,auto insurance and private insurance is applicable) are filed sequentially to avoid unnecessary refunds and are filed using proper coordination of benefits. Hardship Cases Occasionally, after all insurance avenues are checked including State Medicaid and local HRS or municipal programs; having found no method of payment for an individual, we may find hardship to exist. Such cases are submitted to Fire Rescue in writing for final resolution along with appropriate documentation (Le. hospital credit status, credit file information, activity file). Only upon instruction from Fire Rescue will we write-off any amounts or make any adjustments to a bill. This includes when a patient disputes mileage, oxygen, special handling charges or even the bill itself. Case Files We currently process manual hardcopy and electronic format for our clients. While we can continue to process your claims in hardcopy form, we will welcome the opportunity to assist you in electronically transmitting your information to our 885, which we provide our clients for customer data transFer. Exhibit A Page 14 Non-Deliverable Return Mail All non-deliverable return mail is processed for obtaining forwarding address, zip code correction, address correction, etc. Returned mail is processed generally within 1-2 weeks. C.', Billing Bill generation & mailing - BiBs will be orinted immediatel'! upon completion of input, verification and editing of the supplied biiiing information (generally within 1-3 days of receipt) and mailed or communicated to patients/payors. Bills for which we transmit electronically are sent in batch form directly to the carrier providing payment processinq bv the carrier within aporoximatelv 15 days after receipt. Transmission to Medicare employs the most up-to-date National Standard Format and utilizes Medicare's "Medigap" feature to the greatest extent possible. This feature provided by Medicare automatically forwards secondary payor information to the supplemental insurance carrier ensuring faster payment of the 20% not paid by Medicare. Other carriers are billed via paper HCFA-1500 forms and sent directly to the appropriate insurance carrier. Because of the overall volume we process, we are able to batch forms to more popular carriers obtaining faster bulk processing. Self-mailing invoices - Bills to self-pays are printed on a pre-printed invoice and sent in a double window envelope containing a convenient self-mailer. The invoice sent also has a convenient place for the patient to return updated insurance information, which is used to refile on the behalf of the patient. The following figures provide an example of a completed patient bill and paper insurance claim (bill). Patient/payor data verification - The information collected throughout the process will be verified on a case-by-case basis and updated as required for the purpose of establishing contact with the patient/payor, Follow-up & multiple notices - Phone contact will be made on a routine basis to follow-up on notices sent without response or for payments not received. In certain cases, multiple contacts will be made. In no way will harassment be used to force payment. All phone conversations and correspondence are made as a representative of the client. Exhibit A Page 15 Cycle billing - Several cycles are managed by our system to produce maximum collections. Regular (monthly) cycle billing is performed on self-pay accounts and accounts showing a patient pay balance. These cycles handle routine invoicing for payment arrangements as well as generation of dunning messages for slow or no- pay accounts. Patient invoices are rebilled up to six (6) times. Other cycles handle rebilling of carriers and billing of secondary/tertiary payors. Medicare, Medicaid and private insurance are billed immediat;ly and given 45-60 days to pay before rebilling. Insurance denials for reasons other than those that can be resolved are converted to self or pati;nt pay and begin regular cycle billing. System checkpoint3 trap bil!s that would be in jeopardy of expiration due to insurance filing limitations. Exhibit A Page 16 Deposits Receivables processing - Statements, bills, and electronic claims will be marked with payment address of your choice. It is recommended that a "locked-box" arrangement with the bank of your choice be used (cost for this service is the City's responsibility). The bank then receives all payments and processes them daily directly providing deposits to your account. Records of all payments/deposits are provided directly to the City. Using this method, we do not directly handle any receivables, Only the Exp!3nation of Benefits (EOB), and copies of checks/money orders are sent to us along with any correspondence (denials, problems, &. requests for further information). Receivables are generally posted within the same day we receive them, Receivables will be itemized and reconciled against daily bank deposits on a monthly closing basis and provided to you in a comprehensive report format. "--'. f Receipt Posting Payment processing - All payments will be processed upon receipt from the lock- box facility and posted to the correct patient account (generally within 1-2 days of receipt, never to exceed 7 days). Individual patient accounts are maintained showing all payment amounts, check or money order number (if applicable) and date of payment and balance owed. Information will be used for the purpose of either rebilling, follow-up or closing of the account. Unidentified payments - On occasion payments are received for which the identity is obscure or not immediately known (Le. account number missing or incorrect, name provided is different than that originally filed, etc.), In these cases the receivable is processed to a suspense account so that processed receivables balance against the bank statement. These item are marked for research by a specialist who, through either database searching andor contact of the original payor, obtains the necessary identification to properly post the item(s). Once the correct patient account has been located, a transfer is made from the suspense account to the appropriate patient account. A documentation trail is provided for such transfers. AR Reconciliation - All accounts will be reconciled to reflect accurate balances outstanding against payments received and posted. Write-offs will also be posted where your office has provided prior agreement. Exhibit A Page 17 ( Rebilling and payment arrangements - Rebilling will be performed for accounts where partial payments are made or accounts w~ere regular payments have been arranged. Details of such arrangements will be noted on the account. Receivables are processed and posted to individual accounts at which time the status of the account is updated. These updates control the way in which the account must be subsequently processed ranging from closing ,paid-in-full accounts to filing secondarj, reflling and invoicing or rebilling customers. Refunds and returned checks - Refunds are ~enerally processed on a monthly basis. Refund requests are presented to the City in a report format with support:ng documentation provided. Checks returned as NSF can be processed in a manner determined by the City. Generally, the bank provides a copy of the check and, we will attempt to collect the amount directly from the customer. Posting adjustments are made accordingly as a reversal entry and reflected on the month-end reporting. Reporting - All collections activity will be summarized and posted on a monthly basis. Reports are provided by the 10th of each month, Specific reports provided are identified in a later section. Audit Because we have focused on performing billing and collecting for municipalities, we are most familiar with the requirements for their audits and can fully comply with such requests. In fact, because of such familiarity we can often assist in providing insight to help correct discrepancies and errors. We will cooperate with all such reasonable requests for audit. Professional Billing/Accounting Procedures Advanced Data Processing began as a provider of data processing .based accounting services as one of the founders holds an Accounting degree. All processes are performed using generally accepted accounting methods and principles (GAAP). Receivables including Electronic Funds Transfers are balanced against bank deposits to assist your accounting department in reconciling their accounts. This ensures efficient and accurate billing, collection and account management reconciling to all payments, patient accounts, deposits, refunds, adjustments, billing placements and statistics. Exhibit A Page 18 It is wer c" notmg here that we are one o~ very few companies that report collection statistics in a correct manner, That is, we reoort receivables collected aaainst the month within which the charae was oriainallv billed. This is the only way to produce actual collection percentages. Other companies attempt to mask their performance using what seem to be simpler methods. {. Maintenance of Records We maintain all payment recoids for the period specified by the City. These records are kept intact with copies of Explanation of Benefits (:::085) th",t accompany most insurance payments. These are filed by cash receipt date and kept in chronological sequence along with deposit reconciliation. Copies of specific documents can be provided to the City upon request. All records are considered the property of City of Soca Raton and will be turned over upon completion or termination of the contract. Patient Calls Phone service - Our collection ability is dependent on availability. Consequently, we provide toll-free "SOO. numbers to our clients for both patient calling and calls from the City personnel to us. We will not only provide three toll-free lines but will also provide rotary capability to available lines improving call response times and availability. Phone lines specific to your customer requirements will be allocated with the number clearly provided on all bills, invoices and correspondence, Included will be a facility providing toll-free access. We absorb all phone costs as part of the basic service we provide, { Support & availability - Phone lines specific to your customer requirements will be allocated with the number clearly provided on all bills and invoices. Included will be a facility providing toll-free access, Facilities and attendants are provided to ensure calls are not blocked, Rather, someone is available to answer calls Monday thru Friday (excluding Holidays) from 8:00 a.m. to 5:00 p.m. In addition, we have people calling self-pays/no-pays two nights a week until 8 p.m. and on most Saturdays 'til 2.pm.. Statistics on phone activity are reviewed monthly to ensure proper level of phone availability is maintained. Facilities and attendants are provided to ensure calls are not blocked. Rather, someone is available to answer calls Monday thru Friday (excluding Holidays) from Exhibit A Page 19 8:00 a.m. to 5:00 p.m. Statistics on phone activity are reviewed monthly to ensure proper level of phone availability is maintained. Customer Communications Philosophy - Our client history shows "We are focused on our client's success improving their cash flow through constant innovation yet proven means and, providing the highest service levels attainable with professional respect by both the client and the community." Advanced Data Processing conducts all written and verbal communication always in the most professional manner. We emphasize helpfulness towards the customer and respect referencing ourselves as a representative of your organization and ~ as collectors or, in any way that might be interpreted as intimidating or threatening. Multi-ethnic operators are employed to facilitate most frequent language requirements. In addition, difficult calls are passed to a supervisor more skilled in handling irate callers, special insurance issues, taxpayer questions, etc. A significant aspect of our ability to achieve high collection levels is our customer service perspective. Records On a special incident basis requests for records (e.g. run report) will be forwarded to Fire Rescue for processing & response regardless of source of request (i.e. insurance, patient, attorney, etc.). In the case of insurance requests, we might expect you would have us forward the information to the insurance carrier for claims processing. Alternatively, we could provide you with the appropriate filing material for your forwarding. If you desire, we can accommodate billing the requester/patient special handling charges for obtaining copies of records, Education Client Training - Using some of the finest multi-media tools to bring training assistance to the Fire Rescue staff and administration we provide education aids and assistance in essentials of understanding the importance of key patient information (demographic, insurance and medical) in the successful billing process. We have produced a training video especially for this purpose. Exhibit A Page 20 Attendant Training - Advanced Data Processing provides training and a stable environment for its attendants. They are skilled in 'understanding all aspects of insurance applicable to EMS transport billing so as to be helpful toward the customer and efficient in processing charges and insurance claims, They are also trained in how to provide maximum assistance to the customer and when to transfer the call to a supervisor for handling difficult situations, We maintain a multi-ethnic staff to handle caiis in languages other than English, Our exception reporting system allows us to view ~he work completed by an individual for a given day. This allows the supervisor to review the work (specific accounts) on which an operator has worked. This assists in training and on-going qualitj improvement. ('" Exhibit A Page 21 (- Remote Acces::; Information Download - We provide access to our system facilities for the purpose of electronically sending us your transport data and billing information. This access is convenient and easy to use via an FTPllnter:iet Site maintained for us under arrangement. We provide you a username and password ror access and you can deposit your information any time convenient to you. Technical Data FOimat - We have provided t;,is type service for a number of clients supporting various data fOima~s for their respective sJs~ems. INs can coordinate with your systems people for support of any format the} might require or provide a sample of formats we already support. Exhibit A Page 22 Reports - Management Information Advanced Data Processing prides in providing essential statistics in concise easy-to-understand format. These reports provide our client with the same insight we use to manage and increase the efficiency of their collections. Monthly reporting is produced after month closing and provided to you no later than the 10th of each month, We print the reports within 24 hours after receiving the last day of the month's receivables from the bank, All reporting will be in the manner as requested by the City. The following 2ie major reports we produce as a sam;Jle for the City's evaluation: (. o Collection Statistics - Summary o Collection Statistics - by Payor Class o Collection Statistics - Gross/Net Computation o Account activity - Monthly Billing Report (Charges) o Account activity - Monthly Payment Report (Receivables) o Billing & Collections - Summary to Date, Monthly Running o Accounts Receivable - Summary o Monthly Refund Schedule o Insurance Report - # of Bills with Outstanding Balance by Class In addition to the above reports, Advanced Data Processing will provide the following: · All account numbers will be cross-referenced to City's incident numbering, · Other reports as requested by the City. Ad Hoc Reports Advanced Data Processing prides in providing essential statistics in concise easy-to- understand format. However, we do understand that special requirements come up on occasion. In response to such situations, we can provide ad hoc reporting either from the AS400 environment or in the PC environment without limitation since we are on our own proprietary software. Exhibit A Page 23 Reports - Management Information (cont'd) The following section provides a brief explanation of major reports provided and concludes with an example of each, Samples are provided (as shown in the proposal submission) are not necessarily complete nor are they all live data. Confidential information such as names, contact and 10 information is obscured to protect confidentiality. 1, Collection Statistics. Summary Provides a running month summary of charge, payment and adjustments f.Jr the closing month period showing gross and net collection percentages for each period. Summari:es totals for each type activity and computes average collections for both gross and riet. Note: All payment activity is reflected against the original month billed in order to reflect true collection percentages. 2, Collection Statistics. by Payor Class Provides a running month summary for the closing month period of collections by Payor Class (Self.Pay, Medicare, Medicaid, and Private Insurance). The report also shows for each running month the mix or, % of total collected against that month's billings for each class. Also shows # of accounts billed and total # of accounts. Summarizes total amounts collected by class and % of total. 3. Collection Statistics - Gross/Net Computation Shows overall monthly computation of gross collection percentages providing # of accounts billed and accounts not billable. Total amounts are summarized. 4, Account activity - Monthly Billing Report (Charges) Shows all billing (new charges) processed alpha sorted by Last Name and summarized total billing for period. S, Account activity. Monthly Payment Report (Receivables) Provides a batch oriented listing of all payments processed including check number and type of payment (self pay, Medicare, Medicaid, private insurance). Report reconciles against bank deposit and ties back to EOB detail for secondary filing, refund processing and adjustments. 6. Billing & Collections - Summary to Date, Monthly Running Show receivables as applied to "original billed month". 7. Accounts Receivable. Summary Provide summary for period ending of Accounts Receivable showing gross billing, payments received/processed, reflected write-ofts and adjustments, reversals and ending balance. Exhibit A Page 24 ( ,. 8, Monthly Refuna Schedule Report provides by account detail of associated payments reflecting an overpayment and necessary refund to be processed. . . C" 9. Insurance Report - # of Bills with Outstanding Balance by Class Provides summary showing by running (billed) month the number of patient bills having an outstanding balance. Shows balance and number of bills outstanding by class, 10. Payment Report - % of Bills Showing Payment Provides for each billing month total patients, number having made no payments, number and percentage having made payment Exhibit A Page 25