3rd Amendment 03/23/2016 A
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AMY HEAVILIN, CPA
CLERK OF CIRCUIT COURT & COMPTROLLER
jMONROE CUUNTY,FLORIDA
DATE: May 26, 2016
TO: Meri-de J Mercado, W/C Administrator pp
FROM: Cheryl Robertson Executive Aide to the Clerk of Court& Comptroller Vk
At the March 23, 2016 Board of County Commissioner's meeting the Board granted approval and
execution of Item C5 Approval to the Third Amendment of the contract with Employers Mutual, Inc.
(Administrator), to amend the fee charged by the Administrator for medical bill re-pricing from $1.50
per line/$5.50 per bill to a flat rate of$3,500.00 to cover all re-reprising from January 1, 2016 through
the end of the contract, September 30, 2016.
Attached is a duplicate original of the above-mentioned for your handling. Should you have any
questions please do not hesitate to contact this office.
cc: County Attorney
Finance
File
500 Whitehead Street Suite 101,PO Box 1980,Key West,FL 33040 Phone:305-295-3130 Fax:305-295-3663
3117 Overseas Highway,Marathon,FL 33050 Phone:305-289-6027 Fax:305-289-6025
88820 Overseas Highway,Plantation Key,FL 33070 Phone:852-7145 Fax:305-852-7146
THIRD AMENDMENT TO
AGREEMENT FOR ADMINISTRATIVE SERVICES BETWEEN
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
AND
EMPLOYERS MUTUAL INC.
THIS THIRD AMENDMENT, made and entered into this 18th day of February 2016,
by and between Board of County Commissioners of Monroe County ("County"), and Employers
Mutual, Inc., 700 Central Parkway, Stuart, FL 34994, a Florida Corporation ("Administrator")
(collectively,the"Parties").
WHEREAS, on September 16, 2009, the Parties entered in an agreement to engage the
services of Administrator to provide claim administration for workers' compensation and
liability claims; and
WHEREAS,Attachment A to the 2009 Agreement stated that the Administrator's fee for
"medical bill re-pricing" (to reduce the amounts stated on provider's bills to the maximum
amounts allowed by statute)would be "$1.50 per line;"and
WHEREAS, on June 12, 2012, the Parties entered into a First Amendment to the
agreement, to extend the term of the original agreement to run from October 1, 2012 through
September 30, 2015;and
WHEREAS, Attachment A to the First Amendment modified the language on
Attachment A by stating that the fee for medical bill re-pricing would be "$1.50 per line or $5.50
flat-rate per bill (flat-rate excludes hospital bills)"; and
WHEREAS, on April 15, 2015,the Parties entered into a Second Amendment,to extend
the agreement by one more year, through September 30, 2016; and
WHEREAS, the language regarding the fee for medical bill re-pricing on Attachment A
to the Second Amendment was unchanged from the Third Amendment; and
WHEREAS, a question has now arisen between the Parties regarding the language on
Attachment A describing the fee for medical bill re-pricing; and
WHEREAS, the Parties mutually desire to clarify the agreement between them with
regard to the fee to be charged by the Administrator throughout the balance of the contract term,
from January 1, 2016 through September 30, 2016;and
WHEREAS, in lieu of a per-line fee, the County has offered and the Administrator has
agreed that Ascension will charge a flat fee for all medical bills that are re-priced by the
Administrator during the remainder of the contract term.
NOW THEREFORE, in consideration of the mutual promises and considerations,
Parties agree to amend the Agreement as follows:
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I) The language in the second bullet point on Attachment A to Second Amendment
describing the fee to be charged by the Administrator for medical bill re-pricing is removed in its
entirety and replaced with the following:
The Parties agree that in lieu of a per-bill fee, the Administrator will charge a flat
fee of three thousand five hundred dollars ($3,500.00) for any and all medical bill
re-pricing performed by the Administrator, beginning on January I, 2016 and
continuing through the expiration of the current term of the contract, as amended
("Flat Fee"). Beginning on April 1, 2016, the Administrator will no longer add a
per-line or per-bill charge for repricing services. By no later than April 30, 2016,
the Administrator will deliver to the County a statement showing all repricing
charges charged by the Administrator and paid by the County from January 1,
2016 through March 30, 2016. On or before June 15, 2016, the County will then
pay the Administrator an amount equal to the Flat Fee less the repricing charges
paid by the County between January 1, 2016 and March 30, 2016 as shown on the
statement.
2) In all other respects the terms and conditions of the original agreement remain in
full force and effect.
IN WITNESS WHEREOF, the County and Administrator have caused this amendment to
Agreement to be executed as of the first date written above.
EAVILIN, CLERK Board of County Commissioners of Monroe County
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� ns, ' OhelSGYJ By:
079if Clerk Mayo , flea er Carruthers
Employers Mutual, Inc.
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By:
u - w athan Page,
Chief Financial and Operating Officer
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LL! r MONROE COUNTY ATTORNEY
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C -0- A4S 1 r-tm'4 :
NTHIA L. HALL
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ASSISTANT COUNTY ATTORNEY
2 Date 3 ' I - aalb
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ATTACHMENT "A"
MONROE COUNTY
WORKERS'COMPENSATION
THIRD PARTY CLAIMS ADMINISTRATION
WORKERS' COMPENSATION PRICING
Employers Mutual, Inc. (EMI) will perform the Third Party Claims Administration for Monroe
County for the following fee schedule.
EMI will have the workers' compensation claims allocated individually to a lost time and
medical only adjuster. EMI will perform this for an annual fee of$70,918.00
This rate will be guaranteed for a period of one(l) year. The annual fee may be paid in
twelve equal installments.
All pricing is based on a life of contract service agreement
In addition, to the above services Employers Mutual, Inc. will provide the following services at
the stated rate per the request of the Monroe County Board of County Commissioners.
• Medical Bill Re-pricing: 51.50 per line or 85.50 flat-rate per bill
(flat-rate excludes hospital bills)
• Network Access: 25% of savings
• Telephonic Case Management: $85 per hour
• Field Case Management: 595 per hour
• Hospital Bill Audits: 25% of savings
• Subrogation 10% of recovery (cap is negotiable)
Allocated expenses (allocated to the claims files) include those paid to outside firms, such
as contract adjusters, private investigators, surveillance, legal and court reporters.
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