02/21/1989 Agreement
AGREEMENT
This agreement, made and entered into this ~/5-r day of February,
A.D. 1989, between the ~r and Middle Keys Fire and Ambulance
District of Monroe County, Florida, hereinafter referred to as the
"District", and D.S.M. of the Florida Keys, Inc., hereinafter referred
to as "D.S.M.", and
Whereas, the District desires to enter into an arrangement with D.S.M.,
to provide billing and collection services for user fees generated by
the District's emergency rredical services system, and
Whereas, D.S.M. is qualified and prepared to render such services,
beginning irnnediatel y upon execution of this agreement, and desires to
render such services to the District in consideration of the
corrpensation agreed to herein, and
Whereas, D.S.M. possesses all the necessary licenses required to engage
in the business of billing and collection services in the State of
Florida, now, therefore,
Be it understood that in consideration of the mutual covenants,
premises and representation herein, the parties hereto agree as
follows:
1. That D.S.M. will provide the billing and collection of charges
for emergency medical services on an ongoing basis during the term of
this agreement. These services will be provided from D.S.M. 's office
in Monroe County, Florida.
2. That D.S.M. shall create and maintain records of each patient
account which accurately reflect the charges made against and the
payrrents made into such accounts for emergency medical services.
3. That D.S.M. shall provide to patients suitable for self pay
and/or forwarding as necessary to other third party payors, statements
of charges in customary form which accurately reflect the services
rendered by emergency rredical services and the charges made for such
services. D.S.M. shall also provide for the automatic electronic
transmission of claims to all major insurance providers through its
computer billing system.
4. That D.S.M. shall make four (4) attempts within a 120 day period
after receipt of charge tickets to bill for services rendered to
patients as follows:
Initial bill (within three (3) working days)
First Notice (30 days hence)
Second Notice (60 days hence)
Third Notice (90 days hence)
5. That D.S.M. shall provide accounting, statistical, and follow-up
data for patient accounts. D.S.M. shall provide to the District the
following customary financial reports on a weekly, monthly and yearly
basis as specified:
Daily journal of transactions
Sunmary of monthly and year-to-date billings and collections by
district and in total combined with other districts
Sunmary of accounts by individual debtor
Sunmary of aged accounts receivable, aged as follows:
30 days, 60 days, 90 days and 120 days or older
6. That D.S.M. agrees that all appropriate records will be open for
inspection by designated individual or firm representing the District's
interest during normal business hours.
7. That the District will arrange for a lock-box collection system
at a financial institution providing these services: cost of services
to be borne by D.S.M.
8. That D.S.M. agrees to provide office facility and telephone for
timely response to patient inquiries regarding accounts subject to this
agreement.
9. That D.S.M. shall make requests for reconsideration and appeals
of adverse determinations by third party payors as may be submitted in
good faith.
10. That the District agrees to pay promptly to D.S.M. upon
submission of proper invoices, on a monthly basis, fees in the amount
of 13-1/2% of gross dollars collected on patient's accounts for the
services described in the preceeding sections of this agreement.
11. At the conclusion of 120 days from date of initial billing,
D. S.M. will coomence third party collection agency procedures, through
Diversified System Management's collection agency division. In
compliance with FDCPA and applicable state and local laws and
regulations, the agency will collect the bad debts of the District's
emergency ItEdical services system.
12. The District agrees to pay promptly to D.S.M. upon submission of
proper invoices, fees in the amount of 22% of gross dollars collected
on patient's accounts through D.S.M.'s third party collection agency
procedures.
13. That D.S.M. agrees to engage the services of an independant
certified public accountant to provide an annual audit report to
coincide with the fiscal year of the Districts. The cost of same will
be borne by D.S.M.
14. If and when there are postal increases over the existing rate,
the parties will renegotiate the fees stipulated in sections 10 and 12
of this agreement.
15. The District agrees to provide to D.S.M. 's office, charge tickets
of services rendered on a weekly basis and in condition suitable for
entry into D.S.M.'s computer billing system.
16. This agreement shall be for a term corrmencing on February 17,
1989 and ending on September 30, 1989. Either party can cancel this
agreement without cause by giving 30 days written notice to the other
indicating their desire to terminate same.
17. Upon termination of this agreement, D.S.M. shall have the right
to the applicable percentage of gross dollars collected on patient's
accounts for a period of 60 days after the last action was taken on a
patient account.
18. Upon termina tion of this agreement, an audit by an independant
certified public accountant shall be provided and D.S.M. shall have the
duty to promptly turn over to the District its complete records
relevent to the accounts under this agreement after settlement of any
monies due. Such records shall be in good business order and current
to the date of turn over.
19. Upon approval by both parties this agreement will be modified by
addendum if and when the District desires to expand the billing and
collection services provided under this agreement.
In witness whereof, the parties hereto executed this agreement on the
~/~ t day of February, 1989.
Lower and Middle Keys Fire and Ambulance
District
MJnroe County, Florida
By: ~~4~
Mayor/Chairman
Date:
~ -,JI / -8''1
(Seal)
Attest =nANNY 1.. KOLHAGE, Clerk:
~..L,e~,?~~
Clerk i
D.S.M. of the Flori Keys, Inc.
By:
ident
c:L~7/r-7
/ /
Date:
Attest:
t& e. ?~
Approved as to form and legal
sufficiency.
By: Attorne;~S;~-rl/' --'