Item G4
BOARD OF GOVERNORS
FIRE AND AMBULANCE DISTRICT 1
AGENDA ITEM SUMMARY
Meeting Date: May 20, 2009
Division:
Emergency Services
Bulk Item: Yes
No X
Department: Fire Rescue
Staff Contact Person: Camille Dubroff X60 1 0
AGENDA ITEM WORDING: Approval of Extension and Amendment Number 1 with Advanced
Data Processing Inc. to provide rescue ambulance billing and related professional services extending
the tenn from June 1, 2009 through May 31, 2010, amending section B2 to amend the time frame that
accounts are sent to collection, amending section B3 to clarify modified payments and settlement
requests, amending Section Cl to clarify re-filing of claims, and amending Section G to add two
additional monthly reports.
ITEM BACKGROUND: The original agreement provides for annual renewals for up to two (2) one-
year periods, with approval of the District's governing Board. We are requesting approval to exercise
the renewal clause for the second one-year period, commencing on June 1, 2009 and ending on May
31,2010 and to amend Attachment A of the agreement to clarify the Scope of Work.
PREVIOUS RELEVANT BOG ACTION: On April 21, 2008 the Board approved the first one-year
period renewal clause from June 1, 2008 through May 31, 2009. On April 20, 2005 the Board approved
to enter into a contract for three (3) years effective June 1, 2005 through May 31, 2008 witb option to
renew for two (2) additional one year periods.
CONTRACT/AGREEMENT CHANGES: Renew Agreement dated April 20,2005 for the second
one-year period effective June 1, 2009 through May 31, 2010. Amend the following sections of
Attaclunent A: Section B2 to change the time frame accounts are sent to collections, Section B3 to
clarify modified payments and settlement requests, Section Cl to clarify a 45-day time frame for re-
filing of claims and Section G to add an Aging Report and a Timeliness of Billing Report.
STAFF RECOMMENDATIONS: Staff recommends approval of this item as written.
---
TOTAL COST: 7% of total collections INDIRECT COST: _BUDGETED: Yes X No
And $11.40 per Medicaid account
COST TO COUNTY: same as above
SOURCE OF FUNDS: Collections from billing
13001 530340 - Ground /11001 530 340 -- Air
REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year
APPROVED BY: County Atty ~~urChaSing _ Risk Managell1ent_
DOCUMENTATION:
Included
x
Not Required
DISPOSITION:
AGENDA ITEM #___
ReVIsed 0 I 109
MONROE COUNTY BOARD OF GOVERNORS
Contract with:
CONTRACT SUMMARY
Advanced Data
Processing Inc. (ADPI)
6/1/2009
5/3 1/2010
Contract PurposelDescription:
Second renewal of agreement dated 4/20/2005 for rescue ambulance billing and related
professional services.
Contract #_
Effective Date:
Expiration Date:
Contract Manager: Camille Dubroff
(Name)
for BOG meeting on
6010
(Ext.)
Emergency Services / Sto 14
(Department/Stop #)
5120/2009
Agenda Deadline: 05/05/2009
Total Dollar Value of Contract: $
Budgeted? y es~
Grant $
County Match: $
NoD
CONTRACT COSTS
7% of total
collections and
$11.40 per Medicaid
Account
Account Codes: 13001530340 Ground /11001530340 Air
Current Year
Portion: $
... - .. ..
----- --- - - --
ADDITIONAL COSTS
Estimated Ongoing Costs: $_/1'1.' For:
(Not included In dollar value above) (eg. maintenance, utilities, janitorial, sa[arie~tc.)
Division Director S-(:/o I~
Risk Management 6' iJCI1
ty \'~~ e:ldl"
O,M.B.lPurC'hasmg ~
County AttOlllCY tJ~
Comments:
OMB Foml Revised 2/27/01 MCP #2
CONTRACT REVIEW
Changes
Need cd
YesO NoB"
YesO NoeL(
YcsO NO~
YesD No~
Date Out
EXTENSION AND AMENDMENT NUMBER 1
TO THE AGREEMENT BETWEEN
MONROE COUNTY, FLORIDA AND
ADVANCED DATA PROCESSING, INC.
This Extension and Amendment Number 1 ("Amendment 1") is made and entered into this _ day
of _,2009, by and between Monroe County, Florida, a political subdivision of the State of Florida
("COUNTY") and Advanced Data Processing, Inc., a corporation organized and doing business in the
State of Florida ("CONTRACTOR").
WITNESSETH:
WHEREAS, the parties hereto entered into an agreement dated April 20, 2005 ("Agreement")
to provide rescue ambulance billing and related professional services; and
WHEREAS, said Agreement provided an option under Article 1 for the COUNTY to renew the
contract for two additional one year terms: and
WHEREAS, the COUNTY has eLected to exercise said option for the continuation of rescue
ambulance billing and related professional services; and
WHEREAS, the parties desire to amend Attachment A of the Agreement in order to clarify the
Scope of Work;
NOW, THEREFORE, the parties agree as follows:
1. The COUNTY eLects to renew the contract for the one additional second year pursuant
to Article 1 ofthe agreement entered April 20, 2005.
2. The effective date of this renewal is June 1,2009 and shall extend through May 31,
2010.
3. Attachment A of the Agreement shall be amended in Section B2 as follows:
B. Patient Billing
2. CONTRACTOR shall provide all self pay patients with a comprehensive
statement/invoice including a courtesy return payment envelope. The front of the
statement shall describe all charges and payments. The reverse side of the statement
shall have clearly marked entry blocks for information needed to file private insurance
claims. CONTRACTOR shall file claims and send an invoice to all self-pay
patient/payors with return envelope and address as specified by MONROE COUNTY
within five (5) days of receipt of incident information. Subsequent invoices to self-pay
patient/payers will be sent at thirty-five (35) day intervals, up to a maximum of six
invoices.
CONTRACTOR shall send one initial statement/invoice to a patient for whom
Medicare, Medicaid, or private insurance (payor) information is available when an
account is filed to the insurance company. These statements will be mailed at 45 days
from filing the insurance claim. Thereafter, CONTRACTOR wiU send a maximum of
six invoices to payor,
1
In the course of time that the six invoices are sent to patient/payor and payment in full
has not yet been received, CONTRACTOR shall provide follow-up on rejected and
inactive claims and establish payor remittance accounts and procedures. In the case of
patients for whom payor information is available, CONTRACTOR at that time shall
resume sending invoices to patient and shall, within fourteen (14) days of receiving a
final decision from the payor, send a maximum offive (5) additional invoices to the
patient every thirty-five (35) days thereafter in an attempt to collect the claim.
Effective October 1, 2009, unless insurance, Medicare, Medicaid or secondary insurance
payment is pending, CONTRACTOR shall on a monthly basis send all eligible accounts
that have not had activity for 210 days or more from the date of service a Pre-Collection
Letter. These accounts have thirty (30) days to respond to the CONTRACTOR. Once
the thirty (30) days have expired, the CONTRACTOR shall send MONROE COUNTY
a list of all accounts along with a complete processing history once collection efforts are
exhausted. These uncollectible accounts will be forwarded by the CONTRACTOR onto
a third party collection agency named by MONROE COUNTY for further attempts at
collecting.
4. Attachment A of the Agreement shall be amended in Section B3 as follows:
B. Patient Billing
3. CONTRACTOR shall negotiate and arrange modified payment schedules for patients
unable to pay the full amount when billed. CONTRACTOR shall not reduce the amount
owed and shall not negotiate settlements. All settlement requests shall be forwarded to
the COUNTY for review, processing and BOARD approval.
5. Attachment A of the Agreement shall be amended in Section Cl as follows:
C. Patient Filing
1. CONTRACTOR shall file all insurance claim forms for all patients based upon
information received from Run Report and research performed by CONTRACTOR.
CONTRACTOR shall provide prompt submission of required paperwork to Medicare,
Medicaid, Insurance Companies or Third Party Payers for claims, reviews,
resubmission, provider agreements and other as required within 72 hours after receiving
the requested "Run Report" from MONROE COUNTY, provided that accurate and
complete insurance and patient demographic information is provided on the Run Report.
CONTRACTOR shall submit secondary insurance provider claims after the primary
insurance provider has paid within 30 days after receipt of payment from primary
insurer. Upon receipt of notice of claim denial, requirement for additional information,
Explanation of Benefits reflecting underpayment or other notice requiring submission of
documents to the third party provider CONTRACTOR shall within 45 days fe-file
Medicare, Medicaid, or Insurance claims to obtain payment. CONTRACTOR shall
maintain responsibility for obtaining missing or incomplete insurance information.
CONTRACTOR shall process all third party reimbursements within one week after
receipt of appropriate billing information from primary payor.
6. Attachment A of the Agreement shall be amended in Section G to include two
additional reports as follows:
G. Monthly Reports
2
15. Aging Report: On a monthly basis, CONTRACTOR shall provide a report which
lists patients I accounts receivable amounts by age to alert the COUNTY of any slow
paying patients.
16. Timeliness of Billing Report: On a monthly basis, CONTRACTOR shall provide a
report which lists the number of times invoices were sent to each patient. This report
will be used by the COUNTY to verify compliance with Attachment A Section B2 of
the Agreement. It is recognized by COUNTY that if an account is pending payment, the
patient may not yet have received the maximum number of invoices.
7. All other terms and conditions of the contract dated April 20, 2005 shall remain in full
force and effect.
In all other respects, the provisions of the contract between the parties dated April 20, 2005, not
inconsistent herewith shall remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment 1 to be executed the day
and the year first above written.
(SEAL)
Board of Governors, Monroe County, FL
By:
Mayor/Chairman
Date:
ATTEST:
Danny 1. Kolhage, Clerk
By ~~
Represen tlve for
Advanced Data Processing, Inc"!}
Witness: f3,,"i f.. .&.h.....L
Date: M~ ~ .L.Oor
3
RENEWAL AGREEMENT
This AGREEMENT dated the J (p+J.. day of A pri I ,2008, by and between
the Board of Governors of Fire and Ambulance District 1 of Monroe County, Florida, hereinafter called the
"County" and Advanced Data Processing, Inc., hereinafter called the "Contractor".
WITNESSETH
WHEREAS, the parties hereto did enter into an agreement dated April 20, 2005 for rescue ambulance
billing and related professional services; and
WHEREAS, said agreement provided an option to the County to renew the contract for two additional one
year terms; and
WHEREAS, the County has elected to exercise said option for the continuation of rescue ambulance
billing and related professional services; now therefore
IN CONSIDERATION of the mutual convenants and obligations contained herein, the parties agree as
follows:
1. The County elects to renew the contract for the first one additional year pursuant to Article
1 of the agreement entered Apri120, 2005.
2. The effective date of this amendment is June 1, 2008 and shall extend through May 31,
2009, under the same terms and conditions of the contract dated April 20, 2005.
4. All other terms and conditions of the contract dated April 20, 2005 shall remain in full
/~:~~;~{:2roj:9y,~?nd effect.
,0;;S~~:~:~f:~;~:<t~I;\
'i;~C'/ \-;: l~~, \\23 p,<;:'-.\",,\
kqt:~~~st:v@~WiZ~{~. KOLHAGE, CLERK J30ARD OF GOVERNORS,
';"" '\' ^', .~... \ ',j.:~:',('./h ::l FIRE AND AMBULANCE DISTRICT 1
'\~;~~t~M~' ~~;~G; ~ ~ ,e . ~ -d -
,,;t~ DepU:;Clerk . C::MaYOr/C~airman ~_
WITNESS ~'t ,~
Advanced Data Processing, Inc.
~//<<~/~
Aut orized Representative
. II I~
CONTRACT BETWEEN
THE COUNTY OF MONROE
AND
ADVANCED DATA PROCESSING, INC.
FOR RESCUE AMBULANCE BILLING AND RELATED PROFESSIONAL
SERVICES
TIllS CONTRACT, hereinafter "CON1RACT OR AGREEMENT" made and entered into this
,;i'oth day of Apri ~ .2005 by and between MONROE COUNTY, a political
subdivision of the State of Florida, with principal offices located at 490 63rd Street, Marathon,
FL 33050, hereinafter referred to as the "COUNTY", and AnV ANCED DATA
PROCESSING, .INC., a Delaware corporation with principal offices located at 520 NW 165
Street, Suite 201, Miami, Florida 33619, hereinafter referred to as "CONTRACTOR":
WlTNESSETII:
wHEREAS, MONROE COUNTY intends to enter into an agreement for the provision of
rescue ambulance billing and related professional services by the CONTRACTOR to
MONROE COUNTY; and,
WHEREAS, the CONTRACTOR represents that it is capable and prepared to provide such
Services:
NOW THEREFORE, in consideration of the promises contained herein, the parties hereto
agree as follows:
ARTICLE 1- EFFECTIVE DATE
The effective date of this Agreement shall be after the approval of MONROE COUNTY Board
of County Commissioners and effective for a three (3) year term from June I, 20Q5 through
May 31. 2008, with the option to renew for two (2) additional one year periods, subject to
cancellation as provided herein.. MONROE COUNTY'S performance and obligation to pay
under this contract, is contingent upon an annual appropriation by the Board of County
Commissioners:
ARTICLE 2 - SERVICE TO BE :PERFORMED BY CONTRACTOR
The CONTRACTOR sbaH perform the services as specifically stated in the Scope of Services
(Attachment A) without requirement for the issuance of any additional work orders. Additional '
services may be issued in the fonn ofa Work Order. Each Work order will set forth a specific
Scope of Services, amount of compensation, deliverables and completion date and shall be
subject to the approval of MONROE COUNTY. CONTRACTOR shall perform no additional
services until any applicable Work Order is obtained from MONROE COUNTY and
countersigned by the CONTRACTOR.
ARTICLE 3 - COMPENSATION
MONROE COUNTY shall pay CONTRACTOR in accordance with Attachment B,
Compensation for Services, which is attached hereto and incorporated by reference as part of
this Agreement.
1
ARTICLE.$ - STANDARD OF CARE
CONTRACTOR shall exercise the same degree of care. skill, and diligence in the performance
OfSeIVices as is ordinarily provided by a professional CONTRACTOR,. offering services for
local governments in South Florida, under similar circumstances and CONTRACTOR shall, .at
no additional cost to MONROE COUNTY, re-perform services which fail to satisfY the
foregoing standard of care.
ARTICLE 5 - INDEMNmCATION
CONTRACTOR shall indemnity and hold hannless MONROE COUNTY, its officers, and
employees from liabilities,. damage~ losses and COsts, including. but not limited to r~nable
attorney's fees, to the extent caused by the negligence, recklessness or intentional wrongful
misconduct of CONTRACTOR and persons employed or utilized by CONTRACTOR in the
perfonnance of this agreement. Except as specifically provided herein, this agreement shall not
require the CONTRACTOR to indemnify MONROE COUNTY, its officers, and employees
from any liability, damage, loss,. claim, actio~ or proceeding.
Any costs and expenses. including attorney's fees, appellate, bankruptcy or defense counsel
fees incurred by MONROE COUNTY to enforce this Indenmification Clause shall be borne by
the CONTRACTOR This Indemnification Clause shall continue indefinitely and survive the
cancenatio~ tennination, expiration, lapse or suspension of this agreement.
ARTICLE 6. INDEPENDENT CONTRACTOR
The CONTRACTOR is an independent contractor and not an employee or agent of MONROE
COUNTY except that CONTRACTOR sbalI be authorized as an agent as follows; To the
extent necessary to fuIfiU its billing and collection efforts under this Agreement, the
CONTRACTOR is authorized to execute the following types of standard forms and
correspondences only; probate filings; letters to patients or their representatives verifying that
an account is paid in full; forms verifying the tax..exempt status of MONROE COUNTY; and
insurance filings and related forms. The CONTRACT.QR has no authority to sign any other
document's except as specifically authorized by MONROE COUNTY.
CONTRACTOR undertakes perfonnance of the Services as an independent contractor and
shall be wholly responsible for the methods of performance. CONlRACTOR sball work
closely with MONROE COUNTY in perfonning Services under this Agreement.
The CONTRACTOR shall retain full control over the employment, direction, compensation
and discharge of all persons assisting in the perfoffilance 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 CONlRACTOR shall be responsible for its own acts and those
of its agents and employees during the tenn of this contract. The CONTRACTOR shall not
receive any MONROE COUNTY benefits, stipend or privileges afforded by MONROE
COUNTY employees.
ARTICLE 7. COMPLIANCE WITH LAWS
In performance of the SeIVices, CONTRACTOR will comply with applicable regulatory and
other applicable requirements including federa~ state, and local laws, rules regulations, orders,
codes, criteria and standards.
2
ARTICLE 8 -INSURANCE
During the performance of the Services under this Agreement. CONTRACTOR shall procure
and maintain the following insurance polices. and provide originals or certified copies of all
policies, and such coverage sball be written by an insurance company authorized to do business
in Florida
WORKERS COMPENSATION
The CONTRACTOR shall procure and maintain, for the life of this Contract! Agreement,
Worker's Compensation Insurance covering all its employees with limits meeting aU
applicable state and federal laws. This coverage shall include Employer's Liability wi~ limits
meeting all applicable state and federal laws. This coverage shall extend to any agent of
CONTRACTOR that does not have their own Workers' Compensation and Employer's
Liability Insurance. Thirty (30) days notice of canceJIation, lapse or material modification is
required and must be provided to MONROE COUNTY via Certified Mail.
COMMERCIAL GENERAL LIABILITY
The CONTRACTOR shall procure and maint~ for the life of this Contract! Agreement,
Commercial General Liability Insurance. This coverage shall be on an "Occurrence" basis.
Coverage shall include Premises and Operations: Independent Contractors' Products and
Completed Operations and Contractual Liability. This policy shall provide coverage for death,
personal injwy or property damage that could arise directly or indirectly from the performance
oftrus Agreement.
The Minimum Limits of Coverage shall be $1.000.000 per occurrence, Combined Single Limit
for Bodily Injury Liability and Property Damage Liability with a $10,000 deductible.
MONROE COUNTY BOARD. OF COUNTY COMMISSIONERS must be named as an
additional insured. The additional insured requirement is waived if Owners and Contractors'
Protective Coverage is also provided. or required. ~ (30) days written notice must be
provided to MONROE COUNTY via Certified Mail in the event of cancellation.
BUSINESS AUTOMOBILE LlABll..ITY
The CONTRACTOR shall procure and maintain, for the life of the Contract! Agreement,
Business Automobile Liability Insurance.
The minimum limits of coverage shall be $1.000.000 per OCCUrrence, Combined Single Limit
for Bodily injury Liability and Property Damage Liability. This coverage shan be an "Any
Auto" or (<Comprehensive F onn" type policy.
In the event that the CONTRACTOR does not own any vehicles, we will accept hired and 000-
owned coverage in the amounts listed above. In addition, we will require an affidavit signed by
the CONTRACTOR indicating the following:
Advanced Data Processing. Inc;. does not own any vehicles.
In the event we acquire any vehicles throughout the tenn of this Contract/Agreement,
Advanced Data Processing. Inc. agrees to purchase U Any Auto" or Comprehensive Fonn
coverage as of the lfute ofaequisition. n /:'
CONTRACTORSS~namre: ~ V'~
3
Thirty (30) days written notice must be provided to MONROE COUNTY via Certified Mail in
the event of cancellation, lapse or material modification of any coverage required by this
agreement.
PROFESSIONAL LIABll..ITYIERRORS AND OM:MISSIONS INSURANCE
CONTRACTOR shall provide Professional Liability Insurance, including errors and omissions
for all services provided under the terms of this agreement with minimum limits of$l, 000,000
dollars per occurrence; or claims made form with ('tail coverage" extending three (3) years
beyond the term of the agreement. Proof of "nil coverage~' must be submitted with the invoice
for final payment. In lieu of"tail coverage", COntractor may submit annually to MONROE
COUNTY current Certificate of Insurance proving claims made insurance remains in force
throughout the same three (3) year periods.
CRIME POLICY
CONTRACTOR shall provide a Crime Policy in the amount ofSSOO,OOO. Coverage to be
provided shall include the following; Theft - Per Loss Coverage; Forgery or Alteration;
Inside the Premises - Theft of Money and Securities; Inside the Premises - Robbery or Safe
Burglary of Other Property; Outside the Premises; Computer Fraud; Funds Transfer Fraud; and
Money Orders and Counterfeit Paper Currency.
SUPPLEMENTAL PROVISIONS
1. The insurance coverage and conditions afforded by this policy(s) shall not be suspended,
voided, canceled or modified, except after thirty (30) days prior written notice by Certified
Mail Return Receipt Request~ has been given to the MONROE COUNTY department
that originated this contract.
2. Certificates of Insurance meeting the specific required provision specified within this
ContractJ Agreement shall be forwarded to the MONROE COUNTY department that
originated the contract, and approved prior to the start of any work or the possession of
any MONROE COUNTY property or the comniencement of services, as application.
SUBCONTRACTOR'S INSURANCE
The CONTRACTOR shall require each of his SUBCONTRACTORS to take out and maintain
during the life of his subcontract the same insurance coverage's required of the successful
CONTRACTOR. Eacb SUBCONTRACFOR shall furnish to the successful CONTRACTOR _
two copies of the Certificate of Insurance, and successful CONTRACTOR shall furnish one
copy of the Certificate to MONROE COUNTY.
NON-WAIVER OF IMMUNITY
Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County
and the Contractor in this Agreement and the acquisition of any commercial liability insurance
coverage, self-insurance coverage, or local government liability insurance pool coverage shaH
not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract
entered into by the County be required to contain any provision for waiver.
4
ARTICLE 9 - MONROE COUNTY'S RESPONSmILfJI1ES
MONROE COUNTY, during the teoo oftms Agreement, sball:
MONROE COUNTY shall supply the '<Run Report" attached hereto identilied as Exhibit A to
CONTRACTOR with the necessary patient information on a timely basis for t40se patients that
have been transported by FiTe--Rescue Services and in sufficient detail to support diagnosis and
procedure coding and make reasonable efforts to provide patient demographic infonnation
necessary for accurate patient identification including name, address, social security number,
date of birth, and telephone number.
MONROE COUNTY shall provide CONTRACTOR with its approved billing policies and
procedures including fee schedules and collection protocols. MONROE COUNTY shall be
responsible for engaging any third party collection service for uncollectible accounts after
CONTRACTOR has exhausted its collection efforts.
MONROE COUNTY shall make reasonable efforts to timely process refunds identified by
CONTRACTOR fOT account overpayments.
MONROE COUNTY shall provide a Lock Box address to CONTRACTOR and will instruct
Lock Box to forward all Lock Box documents to CONTRACTOR for processing.
MONROE COUNTY shall provide for CONTRACTOR to have daily bank baIancereporting
capabilities via internet access with bank.
MONROE COUNTY shall comply and cooperate with CONTRACTOR in all matters to
ensure proper compliance with all Federal, State and local laws rules and regulations as
applicable to the services being contracted for.
ARTICLE 10 - TERMINATION OF AGREEMENT
During the time of this Agreement either party may terminate this Agreement for convenience
by first giving to other party at least thirty (30) days prior Mitten notice. In the event the acts
constituting default are a violation of law, CONTRACTOR shall be subject to immediate
termination. Notwithstanding the pro\lisions above, the COUNTY shall not have any right to
cancel this contract without cause.
Upon termination, the CONTRACTOR shall submit an invoice(s) to MONROE COUNTY in
an amount(s) representing fees for services actually performed or obligations incurred to tire _
date of effective tennination for which the CONTRACTOR has not been previously
compensated. Upon payment of all sums found due, the COUNTY shall be under no funher
obligation to the CONTRACTOR, financial or otherwise.
ARTICLE 11 - NONDISCLOSURE OF PROPRIETARY INFORMATION
CONTRACTOR shall consider all information provided by MONROE COUNTY and aU
reports, studies calculations, and other documentation resulting from the Contractor's
performance of the Services to be proprietary unless such information is available from public
sources or is a public record under Florida law. CONTRACTOR shall not publish or disclose
proprietary infonnation for any purpose other than the performance of the Services without the
prior written authorization of MONROE COUNTY or in response to legal process Of orders of
a court of competent jurisdiction.
5
Public Access. The County and Contractor shall allow and permit reasonable access to, and
inspection of. all documents, papers, letters or other materials in its possession or under its
control, which are public records and which are subject to the provisions of Chapter 119>
Florida Statutes, and made or received by the County and Contractor in conjunction with this
Agreement; and the County shall have the right to unilaterally cancel this Agr~ment upon .
violation of this provision by Contractor.
ARTICLE 12 ~UNCONTROLLABLE FORCES
Neither MONROE 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-perfonning 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 include~ but is. not limited to
fire, flood, earthquakes, storms, lightning, epidemic, war, riot, civil disturbance, sabotage, Acts
of ~d and governmental actions.
Neither party shall, however, be excused from performance if non~performance is due to forces
which are preventable, removable, or remediable and which the non-performing party could
have, with the exercise of reasonable diligence, prevented, removed, or remedied witb
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 oftbis Agreement.
ARTICLE 13 - GOVERNING LAW AND VENUE
This Agreement shall be governed by the laws of the State of Florida. Any and all legal action
necessary to enforce the Agreement will be held in Monroe County and the Agreement will be
interpreted according to the laws ofFIorida.
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Agreement, the County and Contractor agree that venue
will lie in the appropriate court or before the appropriate administrative body in Monroe
County, Florida.
The County and Contractor agree that, in the event of conflicting interpretations of the terms or
a term of this Agreement by or between any of them the issue shall be submitted to mediation
prior to the institution of any other administrative or legal proceeding.
ARTICLE 14 ~ MISCELLANEOUS
14.1 Non Waiver
A waiver by either MONROE COUNTY or CONTRACTOR of any breach of this Agreement
shall not be binding upon the waiving party unless such waiver is in writing and duly signed by
both patties to this agreement. In the event of a written waiver, such a waiver shall not affect
the waiving party's rights with respect to any other or further breach. The making or
acceptance ofa payment by either party with knowledge of the existence ofa default or breach
shall not operate or be construed to operate as a waiver of any subsequent default or breach.
6
14.2Severability
The invalidity, illegality, or unenforceability of any provision of this Agreement, or the
occurrence of any event rendering any portion or provision of this Agreement void or voidable,
shaH in no way affect the validity or enforceability of any other portion or provision of the
Agreement. Any void or voidable provision shall be deemed severed from the Agreement and
the balance of the Agreement shall be construed and enforced as if the Agreement did not
contain the particular portion or provision held to be void. The parties further agree to reform
the Agreement to replace any stricken provision with a valid provision that comes as close as
possible to the intent of the stricken provision.
The provisions of this section shall not prevent the entire Agreement from being held void
soould a provision which is of the essence of the Agreement be detennined to be void by a
court of competent jurisdiction.
14.3 Political Campaigns
During the term of this Agreement, the CONTRACTOR or any employee or associate, shall
not be involved in any political campaign for MONROE COUNTY elective office nor make
financial contribution to any such campaign.
14.4 Contractor Records
Contractor shall maintain all books, records, and documents directly pertinent to performance
under this Agreement in accordance with generally accepted accounting principles: consistently
applied. Each party to this Agreement or their authorized representatives shall have reasonable
and timely access to such records of each other party to this Agreement for public records
purposes during the term of the Agreement and for fOUT years following the termination oftbis
Agreement. If an auditor employed by the County or Clerk: determines that nionies paid to
Contractor pursuant to this Agreement were spent for purposes not authorized by this
Agreement, the Contractor shall repay the monies together with interest calculated pursuant to
Sec. 55.03, FS, running from the date the monies wefe paid to Contractor.
14.5 Attorney's Fees and Costs
The County and Contractor agree that in the event any cause of action or administrative
proceeding is initiated or defended by any party relative to the enforcement or interpretation of
this Agreement, the prevailing party shaIl be entitled to reasonable attorney> s fee~ court cOsts, _
investigative, and out-of-pocket expenses, as an award against the non-prevailing party, and
shall include attorney's fees, courts costs, investigative, and out-of-pocket expenses in
appellate proceedings. Mediation proceedings initiated and conducted pursuant to this
Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and
customary procedures required by the circuit court of Monroe County.
14.6 Binding Effect
The tenns, covenants, conditions, and provisions of this Agreement shall bind and inure to the
benefit of the County and Contractor and their respective legal representatives, successors, and
assigns.
7
14.7 Authority
Each party represents and warrants to the other that the execution, delivery and perfonnance of
this Agreement have been duly authorized by all necessary County and corporate action, as
required by law.
14.8 Claims for Federal or State Aid
Contractor and County agree that each shall be, and is. empowered to apply for, seek, and
obtain federal and state funds to further the purpose of this Agreement; provided that all such
applications. requests. grant proposals, and funding solicitations shall be approved by each
party prior to submission.
14.9 Adjudication of Disputes or Disagreements
County and Contractor agree that all disputes and disagreements shall be attempted to be
resolved by meet and confer sessions between representatives of each of the parties. If no
resolution can be agreed upon within 30 days after the first meet and confer session,. the issue
orissues shall be discussed at a public meeting of the Board of County Commissioners. Iftbe
issue or issues are still not resOlved to the satisfaction of the parties, then any party shall have
the right to seek such relief or remedy as may be provided by this Agreement or by Florida
law.
14.10 Cooperation
In the event any administrative or legal proceeding is instituted against either party relating to
the fonnation, execution, perfonnance. or breach of this Agreement, County and Contractor
agree to participate, to the extent required by the other party, in all proceedings. hearings,
processes, meetings, and other activities related to the substance of this Agreement. or provision
of the services under this Agreement. County and Contractor specifically agree that no party to
this Agreement shall be required to enter into any arbitration proceedings related to this
Agreement.
14.11 Nondiscrimination
County and Contractor agree that there will be no discrimination against any person,. and it is
expressly understood that upon a determination by a court of competent jurisdiction that
discrimination has o~ this Agreement automatically terminates without any further _
action on the part of any party, effective the date of the court order. County or Contractor
agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable,
relating to nondiscrirriination. These include but are not limited to; 1) Title VI of the Civil
Rights Act of 1964 (pL 88-352) which prohibits discrimination on the basis of race, color or
national origin; 2) Title lX of the Education Amendment of 1972, as amended (20 use ss.
1681-1683. and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504
of the Rehabilitation Act of 1973, as amended (20 use s. 794). which prohibits discrimination
on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 use 58.
6101-6107) which prohibits discrimination on tbe basis cfage; 5) The Drug Abuse Office and
Treatment Act of 1972 (pL 92-255), as amended, relating to nondiscrimination on the basis of
drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (pL 91-616), as amended. relating to nondiscrimination on the basis
ofalcobol abuse or alcoholism; 7) The Public Health Service Act of 1912, 85.523 and 527 (42
use S5. 690dd-3 and 29000-3). as amended, relating to confidentiality of alcohol and drug
8
abuse patent records; 8) Title vm of the Civil Rights Act of 1968 (42 USC s. et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The
Americans with Disabilities Act of 1990 (42 use s. 1201 Note). as maybe amended from time
to time, relating to nondiscrimination on the basis of disability; 10) Monroe County Code eh.
13, Art. VI, prohibiting discrimination on the bases of race, color, sex, religion, disability,
national origin. ancestry, sexual orientation, gender identity or expression, familial status or
age; and 11) any other nondiscrimination provisions in any Federal or state statutes which may
apply to the parties ~o, or the subject matter of, this Agreement.
14.12 Covenant of No Interest
County and Contractor covenant that neither presently has any interest, and shall not acquire
any interest, which would conflict in any manner Of degree with its performance under this
Agreement, and that only interest of each is to perfonn and receive benefits as recited in this
Agreement.
14.13 Code ofEthies
County agrees that officers and employees of the County recognize and win he required to
comply with the standards of conduct for public officers and employees as delineated in
Section 112.313, Florida Statutes, regarding. but not limited to, solicitation or acceptance of
gifts; doing business with one's agency; unauthorized compensation; misuse of public position,
conflicting employment or contractual relationship; and disclosure or use of certain
information.
14.14 No SolicitationIPayment
The County and Contractor warrant that, in respect to itsett: it has neither employed nor
retained any company or person, other than a bona fide employee working solely for it, to
solicit or secure this Agreement and that it has not paid or agreed to pay any person, company,
corporation, individual, or firm., other than a bona fide employee working solely for it, any fee,
commission, percentage, gift, or other consideration contingent upon or resulting from the
award or making of this Agreement. For the breach or violation of the provision, the
Contractor agrees that the County shall have the right to terminate this Agreement without
liability and, at its discretion, to offset from monies OW~ or otherwise recover, the full
amount of such fee, commission, percentage, gift. or consideration.
14.15 Privileges and Immunities
All of the privileges and immunities from liability, exemptions from laws, ordinances, and
rules and pensions and relie( disability, workers' compensation, and other benefits which
apply to the activity of officers, agents, or employees of any public agents or employees of the
County, when perfonning their respective functions under this Agreement within the territorial
limits of the County shall apply to the same degree and extent to the performance of such
functions and duties of such officers, agents, volunteers. or employees outside the territorial
limits of the County.
14.16 Legal Obligations and Responsibilities: Non-Delegation of Constitutional or
Statutory Duties
This Agreement is not intended to, nor shall it be construed as, relieving any participating
entity from any obligation or responsibility imposed upon the entity by law except to the
9
extent of actual and timely performance thereofby any participating entity, in which case tbe
performance may be offered in satisfaction of the obligation or responsibility. Further, this
Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the
constitutional or statutory duties of the County, except to the extent permitted by the Florida
constitution, state statute. and case law.
14.17 Non~Reliance by Non-Parties
No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement
to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service
or program contemplated hereunder, and the County and the Contractor agree that neither the
County nor the Contractor or any agent, officer, or employee of either sbaD have the authority
to inform, counsel, or otherwise indicate that any particular individual or group of individuals,
entity or entities, have entitlements or benefits under this Agreement separate and apart,
inferior to, or superior to the community in general or for the purposes contemplated in this
Agreement.
14.18 Attestations
Contractor agrees to execute such docwnents as the County may reasonably require; to include
a Public Entity Crime Statement an Ethics Statement. and a Drug-Free Workplace Statement
14.19 No Penonal Liability
No covenant or agreement contained herein shall be deemed to be a covenant or agreement of
any member, officer, agent or employee of Monroe County in his or her individual capacity,
and no member, officer, agent or employee of Monroe County shall be liable personally on this
Agreement or be subject to any personal liability or accountability by reason of the execution
cithis Agreement.
14.20 Execution in Counterparts
This Agreement may be executed in any number of counterparts, each of which shall be
regarded as an original. all of which taken together shall constitute one and the same
instrument and any of the parties hereto may execute this Agreement by singing any such
counterpart.
14.21 Section Headings
Section headings have been inserted in this Agreement as a matter of convenience of reference
only, and it is agreed that such section headings are not a part of this Agreement and will not
be used in the interpretation of any provision of this Agreement.
ARTICLE 15. INTEGRATION AND MODlFICATION
This Agreement is adopted by MONROE COUNTY and CON1R.ACTOR as a final, complete
and exclusive statement of the terms of the Agreement between MONROE COUNTY and
CONTRACTOR. This Agreement supersedes all prior agreements, contracts, proposals,
representations, negotiations, letters or other communications between MONROE COUNTY
and CONTRACTOR pertaining to the Services, whether written or oral.
The Agreement may not be modified unless such modifications are evidenced by an
amendment in writing signed by both MONROE COUNTY and CONTRACTOR
10
,"' .
ARTICLE 16 - SUCCESSORS AND ASSIGNS
MONROE COUNTY and CONTRACTOR each binds itself and its director, officers, partners,
successors, executors, administrators, assigns and legal representatives to the other party to this
Agreement.. Any assignment, sale, pledge or conveyance of this contract by CONTRACTOR
must be previously approved in writing by MONROE COUNTY, whose consent will not be
unreasonably withheld.
ARTICLE 17 - CONTINGENT FEES
The CONTRACTOR warrants that it has not employed or retained any company or person,
other than a bona fide employee working solely for the CONTRACTOR to solicit or secure
this Agreement and that it has not paid or agreed to pay any person, company, corporation,
individual or firm, other than a bona fide employee working solely for the CONTRACTOR,
any fee, commission, percentage, gift or any other consideration contingent upon or resulting
from the award or making of this Agreement.
ARTICLE 18 - TRUTH-IN-NEGOTIATION CERTmCATE
Execution of this Agreement by the CONTRACTOR shall act as the execution of a truth-in-
negotiation certificate certifYing that the fees and costs used to determine the compensation
provided for in this Agreement are no higher than those charged to other customers of
CONTRACTOR for the same or substantially similar service, provided that the customer is of
comparable size and demographic.
ARTICLE 19 ~ OWNERSHIP OF DOCUMENTs
CONTRACTOR shall be required to work in harmony with other CONTRACTOR'S relative
to providing information requested in a timely manner and in the specified fonn. Any and all
documents. records, disks, original drawings, or other information shall become the property of
MONROE COUNTY upon completion for its use and distribution as may be deemed
appropriate by MONROE COUNTY. Failure to turn. over such documents within seven (7)
days of when requested may be cause for MONROE COUNTY to withhold any payments due
CONTRACTOR or to enforce this clause by legal remedies.
ARTICLE 20 ~ NOTICE
Any notice, demand, communication, or request required or permitted hereunder shall be !fi
writing and delivered in person or sent by certified mail, postage prepaid as follows:
As To MONROE COUNTY
MONROE COUNTY
FireIR.escue Services Department
490 63rd Street
Marathon, FL 33050
Attention: Chief Clark O. Martin, Jr.
11
As To CON'l'RACTOR:
Advanced Data Processing, Inc.
500 NW. 165 Street Road Suite 101
Miami, Florida 33169
Attention: Brad Williams, Vice President, Finance
Notices shall be effective when received at the address specified above. Changes in the
respective addresses to which such notice may be directed may be made from time to tiIl1e by
any party by written notice to the other party. Facsimile is acceptable notice effective when
received, however, facsimiles received (Le. printed) after 5:00 p.m. or on weekends or
holidays, will be deemed received on the next business day. The original ofthe notice must
additionally be mailed as required herein. .
Nothing contained in this Article shall be construed to restrict the transmission of routine
communications between representatives of CONTRACTOR and MONROE COUNTY.
IN WITNESS WHEREOF, MONROE COUNTY Board of County Commissioners, at a
regular meeting thereof, by action of MONROE COUNTY Board of County Commissioners
and directing the foregoing be adopted, has caused these presents to be signed, and it's seal to
~be ~~~.!I~~l?;~.xed. and AnV ANCED DATA PROCESSING, INC. has executed this contract
.)~:a~~n~ti.tlY' '~p.d year first above written.
~~~,..,~ ""': U{/ /'""3" ell \:, ..,
J ''''.... .P...., ,..;, / -:: '.
_'. P';.. I /' ,
\~~~~~~ k%}~'! ' :"., :"!i BOARD OF COUNTY COMMISSIONERS OF
\(\~~1{~.~Wt'. p~ L. KOLHAGE. CLERK MONROE COUNTY .
~\.~ ~",;-' ~;: ..,../ Board of Governors/Flre and Ambulance
~~C. ~ B/iatZ'. ')1t-< L.L
----- ,......-"
Deputy Clerk Mayofl / Chairpers~n
ADV~~TAPROCESSING' INe.-
By: ~ ----
ug Shaman
Title: President and CEO
President (or other duly authorized
Officer)
Approved by MONROE COUNTY on A'PY;/ ;<0
~ 2005. Item # )-) 2
12
A ITACHl\.1IEN'f A
1. ScoDe oiWork
The CONTRACTOR shall provide MONROE COUNTY with timely and accurate
complete medical billing and accounts receivable management services for MONROE
COUNTY'S rescue ambulance billing services and related professional serVices in
accordance with the responsibilities outlined as follows:
A Initial Patient Treatment and Information
L On a case by case basis, MONROE COUNTY will respond to patients requiring
immediate medical treatment and emergency medical transportation services. Upon treating
each patient, MONROE COUNTY shall provide the CONTRACTOR with patient infonnation
identified on the "Run Report" attached hereto as Exhibit A CONTRACTOR shall be solely
responsible for retrieving insurance information and any additional patient infonnation which
was not identified on the "Run Report" provided by MONROE COUNTY. CONTRACTOR
shall utilize "Run Report" information and any additional information retrieved by
CONTRACTOR to file proper patient billing and' insurance information. CONTRACTOR shall
establish arrangements with hospitals to obtain/verify patient insurance and contact
information. CONTRACTOR shall contact tbe U.S. Post Office~s National Change of Address
(NCOA) files or other similar services to obtain the correct billing addresses and phone
numbers for patients that have left the area, or whom have invalid information.
2. CONTRACTOR shall reconcile the number of patients that are transported for
emergency medical services with those received. The CONTRACTOR shall report
discrepancies to MONROE COUNTY witWu three (3) business days of receipt.
3. As requested by MONROE COUNTY, CONTRACTOR shall provide MONROE
COUNTY'S Fire Rescue Services Paramedics Personnel with training on the gathering of
necessary information to be adhered on Run Reports for the purpose of assisting
CONTRACTOR with the proper submission and processing of patient data.
B. Patient Billing
1. CONTRACTOR shall mail an invoice to each patient for emergency
transportation service at current rates set forth by MONROE COUNTY as follows:
$500.00 for Basic Life Support (BLS)
$500.00 for Advance Life Support One (ALSI)
$600.00 for Advance Life Support Two (ALS2)
$200.00 for Stand by (Special Event)
$9.00 per mile
The aforementioned rates shall be subject to change at MONROE COUNTY'S
discretion at any time throughout the tenn of the agreement, MONROE COUNTY agrees to
notifY CONTRACTOR a minimum of seven (7) days prior to any rate changes.
2. CONTRACTOR shall provide patients with a comprehensive statement/invoice
including a courtesy return payment envelope. The front of the statement shall describe all
charges and payments. The reverse side of the statement shall have clearly marked entry blocks
13
for infonnation needed to file private insurance claims. CONTRACTOR shall file claims and
send an invoice to all selfMpay patientfpayors with return envelope and address as specified by
MONROE COUNTY within five (5) days of receipt of incident information.
CONTRACTOR shall be responsible for sending a total of six invoices. CONTRACTOR
shall send the second invoice at thirty-five days~ third invoice at sooy-five days,.fourth invoice
at ninety-five days~ fifth invoice at one hundred twenty-five days and sixth notice at one
hundred fifty-five days. In the course of time that the six invoices are sent to patient/payor,
CONTRACTOR shall provide follow-up on rejected and inactive claims and establish payor
remittance accounts and procedures. Unless insurance payment is pending, CONTRACTOR
shall on a monthly basis send all accounts that have not had activity for twelve (12)
months or more a Pre.-CoUection Letter. These accounts have thirty (30) days to respond to the
CONTRACTOR. Once the thirty (30) days has expired, the CONTRACTOR shall send
MONROE COUNTY a list of all accounts along with a complete processing history once
collection efforts are exhausted. These uncollectible accounts will be forwarded by the
CONTRACTOR onto a third party collection agency named by MONROE COUNTY for
furth.er attempts at collecting.
3. Within MONROE COUNTY established guidelines; CONtRACTOR sball
negotiate and arrange modified payment schedules for patients unable to pay full amount when
billed.
4. CONTRACTOR shall process refund requests within the month following an
overpayment and provide MONROE COUNTY with documentation substantiating each refund
requested.
5. Where CONTRACTOR has found no method of payment for a patient after all
insurance avenues are exhausted including State Medicaid and local HRS or municipal
programs, such cases will be submitted to MONROE COUNTY in writing for final resolution
along with appropriate documentation (i.e. hospital credit status, credit tile infonnatioll,
activity file). At the instruction of MONROE COUNTY, CONTRACTOR shall write off any
amounts or make any adjustments to a bill, including, but not limited to; patient disputes
regarding mileage, special handling charges or the bill in its entirety.
6. CONTRACTOR shall provide MONROE COUNTY with real-time read only
electronic look-up aqcess of CONTRACTOR'S patient data and billing information system,
CONTRACTOR shall provide the facilities to receive patient billing infonnation from -
MONROE COUNTY electronically. CONTRACTOR- This may be done through email or
other method that meets Patient Privacy requirements.
C. Patient Filing
1. CONTRACTOR shall file all insurance claim fonns for all patients based upon
infonnation received from the Run Report and research performed by CONTRACTOR
CONTRACTOR shall provide prompt submission of required paperwork: to Medicare,
Medicaid, Insurance Companies or Third Party Payors for claims, reviews, resubmission,
provider agreements and other as required within 72 hours after receiving the requested "Run
Report" from MONROE COUNTY. CONTRACTOR shall submit secondary insurance
provider claims after the primary insurance provider has paid. As necessary, CONTRACTOR
shalt re-file Medicare, Medicaid or Insurance claims to obtain payment. CONfRACTOR
shan maintain responsibility for obtaining missing or incomplete insurance information.
14
CONTRACTOR shall process all third party reimbursements within one week after receipt of
appropriate billing information Horn primary payor.
2. CONTRACTOR shall utilize the most u~to-date knowledge and information
with regard to coding requirements and standards and proper preparation of electronic and
paper insurance filings to ensure compliance with applicable Federal, State and local
regulations.
D. Maintaining Records
1. CONTRACTOR shall maintain records in an electronic fonnat that is readily
accessible by MONROE COUNTY and meets all federal and state requirements for
maintaining patient medical records.
2. CONTRACTOR shall maintain appropriate accounting procedures for
reconciling all deposits, receivables, billings, patient accounts, adjustments and refunds.
3. CONTRACTOR shall facilitate proper security of confidential information and
further shred and dispose of materials containing such information.
4. CONTRACTOR shall implement and comply with a Compliance Plan consistent
with the intent and activities included in the U.S. Office of Inspector General (OIG)
Compliance Program Guidance for Third Party Medical Billing Companies 63 FR 70138;
(December 18, 1998).
5. CONTRACTOR shall retain all accounts for a minimum of twelve (12) months
(unless otherwise specified by mutual agreement).
6. CONTRACTOR shall ensure that all required documentation and agreements
with payors (e.g. Medicare, Medicaid, Champus, etc.) are filed and maintained and that
MONROE COUNTY is kept apprised of important changes to industry regulations.
7. CONTRACTOR shall be knowledged of different industry insurance plans and
shall ensure MONROE COUNTY that every billable~ claim is pursued accordingly by
CONTRACTOR.
8. CONTRACTOR shall advise MONROE COUNTY on statutes and industry
regulations which would affect emergency transportation service rates.
E. Customer SeIVice:
1. CONTRACTOR shall provide a toll free telephone number for patients with
CONTRACTOR'S own facilities and workforce. CONTRACTOR'S toll free telephone
number must he a dedicated phone number only for accounts from MONROE COUNTY.
CONTRACTOR shall provide a designated liaison for patient/payor concerns.
2. CONTRACTOR shall conduct aU written and verbal communication in the most
professional manner. The CONrRACTOR shall never in any way represent themselves in a
way that might be interpreted as intimidating or threatening.
3. CONTRACTOR shall respond within three (3) business days of any verbal or
written requests made by Patients and/or MONROE COUNTY for information or records.
CONTRACTOR shalt assist patients that are not able to speak the English language.
Difficult calls such as, but not limited to: special insurance issues, taxpayer questions, irate
15
calls shall be bandied in a professional manner by a supervisor employed with
CONTRACTOR'S finn.
4. CONTRACTOR shall provide all customer inquiry services and prepare
additional third-party claims or patient payment arrangements based on this information
exchange.
5. At MONROE COUNTY'S request, CONTRACTOR shall provide survey
questionnaires or mail inserts to patients. CONTRACTOR shall mail requested citizen
satisfaction surveys.
6. CONTRACTOR shall provide for facilities to pennit dial-up access to retrieve
patient data and hilling information.
F. Audits
1. CONTRACTOR shall provide access to MONROE COUNTY for aU requested
information in order for MONROE COUNTY to perform appropriate and periodic audits.
MONROE COUNTY will provide CONTRACTOR with reasonable;: notice for any planned
audit and CONTRACTOR shall conduct audit during nonnaJ business hours.
G. Monthly Reports
Unless otherwise indicated, CONTRACTOR shall provide the following reports on a
monthly basis as identified and prescribed by MONROE COUNTY. :Monthly reports shall
be produced after the month's closing and provided to MONROE COUNTY no later than the
tenth of each month.
1. Ambulance Unit Report: On a monthly basis, CONTRACTOR shall provide a
report of number of calls and gross billed by ambulance unit for the current period.
2. Ambulance New Billing R~Q[I;: CONTRACTOR shall produce a report
showing all billing (new charges) processed alpha sorted by Last Name and summarized total
billing for period. CONTRACTOR shall add column-for date received from MONROE
COUNTY. .
3. Ambulance Payment Report: CONTRACTOR shall provide a batch oriented
listing of all payments processed including check number and type of payment (self pay,
Medicare, Medicaid, private insurance).
4. Gross Collection Statistics Summary: CONTRACTOR shall provide a running
summary ofInterfacility transactions including monthly amount billed, collected, Percentage
collected, number of Accounts and Gross Billed .
5. Schedule of Transport Charges & Collections: CONTRACTOR shall provide a
running month summary of charge, payment and adjustments for the closingmonth period
showing gross and net collection percentages for each period. Information provided shall be for
last five fiscal years only,
6. Report of Accounts Receivable: CONTRACTOR shan provide a summary for
period ending of Accounts Receivable showing gross billing, payments received/processed,
reflected write-ofTs and adjustments, reversals and ending balance.
16
7. Monthly Billing and Collection Summary: CONTRACTOR shall produce a
report showing receivables as applied to month running or original billed month, Information
provided shall be for last five fiscal years only.
8. Insljrance Receivable Report: CONTRACTOR shall provide a summary of billed
month the number of patient bills having an outstanding insurance balance.- :rhis will show
the balance and number of bills outstanding by class.
9. Collection by Financial Class: CONTRACTOR shall provide a running month
summary for the closing month period of collections by Payor Class (Self-Pay, Medicare,
Medicaid and Private Insurance). CONTRACTOR shall denote billiog numbers for each
category and total. Information provided shall be for last five fiscal years only.
10. Collection Schedule: CONTRACTOR shall provide a running summary of
collected amounts to include monthly, fiscal and cumulative amounts.
11. Ambulance Billing Adiustments-Write Offs-Reversals: CONTRACTOR shall
provide a running summary showing all adju$nents, write~ffs and reversals from Medicare,
Medicaid and InsuranCe.
12. Report of Accounts Receivable Removed: CONTRACTOR shall provide a report
showing Accounts sent to Collections with Original Amount Billed, Payments made. Adjusted
Amounts and Balance owed. These accounts will have had no activity for 12 months or more.
This report will only be provided on the months that the CONTRACTOR sent accounts to
collections.
13. Report by Incident Date: CONTRACTOR shall provide a report by account detail
of all accounts outstanding to include Original Amount billed, Adjusted Amount, and Balance
due.
14. Monthly Refund Schedule: CONTRACTOR shall provide a report by account
detail of associated payments reflecting an overpaym~nt and necessary refund to be processed.
II. Health Insurance Portability aDd Accountability Act of 1996 (HIPAA)
The CONTRACTOR shall comply with the privacy regulations pursuant to Public Law
104-191 of August 21, 1996, known as the Health Insurance Portability and
Accountability Act of 1996, Subtitle F - Administrative Simplification, Sections 261, et
seq., as amended (''HIP AA"), to protect the privacy of any personally identifiable -
protected health information ("PHI") that is collected, processed or learned as a result of
the Billing Services provided hereunder.
A. CONTRACTOR shall not use or further disclose Pill except as permitted herein or
required by law.
B. CONTRACTOR shall use appropriate safeguards to prevent use or disclosure ofPffi
except as permitted herein.
C. CONTRACTOR shall mitigate, to the extent practicable. any harmful effect that is
known to CONTRACTOR, its agents or subcontractors of a use or disclosure of PIll by
the CONTRACTOR, its agents or subcontractors.
17
D. CONTRACTOR shall report to MONROE COUNTY any use or disclosure of PHI
not provided for by this Agreement of which the CONTRACTOR, its agents or subcontractors
become aware.
E. CONTRACTOR shall ensure that any agents or subcontractors to whom the
CONTRACTOR provide PIll or who have access to Pm. agree to the same restrictions and
conditions that apply to the CONTRACTOR with respect to such PIll.
F. CONTRACTOR shall make Pill available to MONROE COUNTY and to the
individual who has a right of access as required under HIP AA within 30 days of the request by
MONROE COUNTY regarding the individual.
G. CONTRACTOR shall incorporate ally amendments to PHI when notified to do so by
MONROE COUNTY.
II. CONTRACTOR shall provide an accounting of all uses or disclosures ofPID made
by the CONTRACTOR its agents or subcontractors as required under the HIP AA privacy rule
within sixty (60) days.
L CONTRACTOR shall make their internal practices, books and records relating to the
use and disclosure ofPID available to the Secretary ofthe Department of Health and
Human Services for purposes of determining the CONTRACTOR'S, its agents' and
subcontractors' and MONROE COUNTY'S compliance with HIP AA.
1. CONTRACTOR shall at the termination of the agreement, return or destroy all pm
received from, or created or received by the CONTRACTOR, its agents or subcontractors
on behalf of MONROE COUNTY and if return is infeasible, ensure that the protections of
this Agreement will extend to such pm.
K. The specific uses and disclosures ofPID that may be made by the CONTRACTOR,
its agents or contractors on behalf of MONROE COUNTY include:
1. Preparation of invoices to patients, carriers, insurers and others responsible for
payment or reimbursement of the services provided by MONROE COUNTY to its patients.
2. Preparation of reminder notices and documents pertaining to collections of
overdue accounts.
3 _ The submission of supporting documentation to carriers, insurers and other _
payers to substantiate the health care services provided by MONROE COUNTY to its patients -
or to appeal denials of payment for same.
4. Other uses or disclosures of PIll as permitted by the lillPAA privacy rule.
s. Mail HIP AA Notice of Privacy Practices to all emergency transport patients
within the timeframe allowed under the HIP AA and FTIP AA rules.
6. Mail subpoenas, attorney's requests to Fire Rescue immediately upon receipt
18
AITACBMENT B
L Compensation for Services
The CONTRACTOR shall provide to MONROE COUNTY a monthly invoice
representing fees for the services provided computed as:
A Seven percent {7%} of all monies collected by the CONTRACTOR excluding
Medicaid accountSje during the previous month. In compliance with Florida Statute 409.913
(9). the CONTRACTOR shall include in the same invoice an amount of $11.40 per Medicaid
account for providing all billing services related to such accounts processed in the previous
month.
D. Price shall include but not be limited to; all stationery, fax forms7 envelopes,. mailings.
postage and. telecommunications/phone facilities/charges.
p. Price for services does not include the cost of "Locked-box" service. The COUNTY
shall bear the cost of the Locked~box.
The "Locked-box service selected shall be at the sole discretion of MONROE
COUNTY and shall provide a secure postal address and box for receipt of all correspondence
(especially including all insurance and patient payments, correspondence and benefits
determination and denials). The "Locked-box" service will on a daily basis perform the
following:
1. Open all mail (except clearly marked returned-mail).
2. Make a copy of every check and attach copy with original document
accompanying each check.
3. Deposit all receivables into designated MONROE COUNTY account.
4. Prepare and provide a daily deposit slip totaling and accounting for all
receivables deposited for the identified day.
5. Mail (daily) to the CONTRACTOR separated bundles of; copies of checks
attached to supporting documents7 other colTespondence and,. returned-mail along with
deposit slip.
6. Mail (daily) to MONROE COUNTY copies of checks aJ,ld daily deposit slip.
7. Mail (monthly) to MONROE COUNTY reconciliation of account.
F. CONTRACTOR shall maintain daily deposit control sheets and original
documentation.
19
FIRE RESCUE REPORT
Monroe COUIllty Fire ]Rescue
490 63rd Street Marathon, FL 33050
Run Number:
Patient Name:
Date of Service:
Shift: Nature of Call: Received:
Station: Location: Dispatched:
Level of Care:
Rescue: Destination:
Unit ID: I Enroute:
Crew #1: Arrive:
Crew #2:
Crew #3: Pt Contact:
Pt. Transported: Depart:
At Desl:
At Scene Loaded Miles
Rap Detay: It Dest Mileage:
Nama:
SSN:
DaB:
Sex:
Weight:
PhDne:
Homo Addrosa:
Mailing Addresa:
Patient Found:
Chief Complaint:
Catlse of InJu!)':
Relevant Past Hllto!)':
MedicatIons:
Tlmo !!f
f.!!!JJ!
!If.Q1 m.Q! ell" Refill
~
~
1:9fi.
RIRht
l of 4
;
FIRE RESCUE REPORT
Monroe County Fire Rescue
490 63rd Street Marathon, FL 33050
Phone# (305) 289.6004
Run Nu"mber:
Patient Name:
Date of Service:
Documented By:
II
Bodv Area
A$$ossmel1t
Bow Area
AS!lossment
..
I!!!!J.
he!
DrllChdmer
I,. , authorize lUly holder of medical or other information about me to release to the Soolal Security
Administration IIlld Health CM'C Financing Administration or Its intemJ.ediaries or carriers, or any private insurance
company MY infonnation needed for thb or a related mwlcal claim.
I permit Il eopy of this authorization to be used In place of the original and request payment of medic III illsunmcll _
benefits to the party who accepts assignment. I persoIUllly gunrantee payment of any charges not covered by health care
benefits. Accotding la MwiclltC regulations, your ambulance !:ransport and related services are subject to review under
the Medicare program.. The pUlpose of this review is to delennine wbetheror not YOUr transportlUld related services
meet the guidelines for MedicDl'c payment. lfit is determined, under the Medicare Program guidelines that your
tnlnsport and related services were not medically necessuy, or that non-covered services were provided to you, then,
plellSC be advised that you are personally responsible for payment of the !:ramport or the non-covered services.
Furthennore, I hereby acknowledge that I have been provided with a eopy of Monroe County's Notice of Privacy
Practices on this date.
Slgnaturo
; of 4
..:._'
FIRIE RESCUE lllEPOR'f
Monr@e County Fnre Rescue
490 63rd Street Marathon, FL 33050
Run Number:
Patient Name:
Date of Service:
Time
!.YJli2
Be QA Review
Plsclalmer
I hllve reviewed this report fat' completeness and IICCuracy.
SIgnature
~ Crow 3 Name CQrtlflcatlon Slgnaturo
of 4
t:)...;'"t""'~ nnr n1 '(\"1Mn(\~..... l"'lo."'''''
FIRE RESCUE REPORT
Monroe COlllnty Fire Rescue
490 63rd Street
Marathon, FL 33050
Run Number:
Patient Name:
Date of Service:
Guarantor
Address
SSN
Relation
Send Bill To
Insured?
Insurance
Insurance
Company
Employed?
Worlt Related?
State
Insured's Name
Polley NumbfJr
4 nf 4
Printed on: 01107/2005 at 12":22
~ijfF;! Il'0J Jti1i1l'J~~
!rEI ~~ ~ill~
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
Enncs CLAUSE
Do~ ShA-rno 1\
warrants that he/it has not employed, retained
or otherwise had act on his/its behalf any former County officer or employee in violation of
Section 2 of Ordinance No. 10-1990 or any County officer or employee in violation of
Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County
may, in its discretion, terminate this contract without liability and may also, in its discretion,
deduct from the contract or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to the former County officer or employee.
~)
Date: .1-2-'1-8$
STATE OF
F\ori'd~
rrYI OJYl \ -- D ClU Q.
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
yOu. 3 .5 h (l VY\ m who, after first being sworn by me, affixed his/her
signature (name of individual signing) in the space provided above on this --2L day of
rn CLr ch .20 DS.
My commission expires:
1 D Of;
OMB - MCP FORM #4