Resolution 108-1989
Janes R. Paros, ACA
Division of Public Safety
RESOLUl'ICtiI NO. 108 -1989
A RESOLUl'ION OF THE OOARD OF GOVERNORS OF THE IDWER
AND MIDDLE KEYS FIRE AND AMBt.JI..Al.rn DISTRICl' OF K:NROE
COUNTY, FlORIDA, AUrHORIZIN3 THE CHAIRMAN OF THE OOARD
TO EXEaJTE AN 1IGREEMENT BY AND BE'lWEm THE I..CMER AND
MIDDLE KEYS FIRE AND AMBtJ:r.ANCE DISTRICl' AND D. S. M.
OF THE FIDRIDA KEYS, INC. PERTAINING TO BILLING AND
COLLECTICN SERVICES FOR USER FEES GENERATED BY THE
DISTRICl"S EMERGENCY MEDICAL SERVICES
SYSTEM.
BE IT RESOLVED BY THE OOARD OF GOVERNORS OF THE I..CMER AND MIDDLE KEYS
FIRE AND AMBULANCE DISTRICl' OF MCNROE COONTY, FIORIDA, that the Chairman
of the ~r and Middle Keys Fire and AIrbulance District is hereby
authorized to execute an Agreement by and between the IDwer and Middle Key
Fire and An:bu1ance District and D. S. M. of the Florida Keys, Inc., a copy
of sane being atta~ hereto, pertaining to billing and collection
services for user fees generated by the District's emergency nedical
services system.
PASSED AND ADOPTED by the Board of Governors of the IDwer and Middle
Keys Fire and Anbu1ance District of M:mroe County, Florida, at a regular
meeting of said Board held on the AJ6-tday of h~",wu.j-' A.D. 1911.
OOARD OF OOVERNORS OF THE
I.DWER AND MIIDLE KEYS FIRE AND
AMBULANCE DISTRICl' OF M:NROE
caJNTY, FIORIDA
~~,.~~
By #~~2?
Chairman
(Seal)
Attest: DANNX r... KOLHAGE, Clerk
J1~'U--1.JJ~
C1 .
Approved as to fom and legal
SUfficiency.
By: '---! ~
County
AGREEMENT
This agreerrent, made and entered. into this ~ I~ day of February,
A.D. 1989, between the Lower 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 arrangenent with D.S.M.,
to provide billing and collection services for user fees generated. by
the District I s energency m:rlical services system, and
Whereas, D.S.M. is qualified. and prepared. to render such services,
beginning imnediately upon execution of this agreement, and desires to
render such services to the District in consideration of the
corcpensation 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 agreerrent. These services will be provided. from D.S.M. IS office
in lot)nroe 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
payments 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 energency m:rlical 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, IOOnthly and yearly
basis as specified.:
Daily journal of transactions
SUrrmary of IOOnthly and year-to-date billings and collections by
district and in total combined. with other districts
SUrrmary of accounts by individual debtor
Surrmary 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 I 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
agreerrent.
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
energency medical 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. '!hat 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 agreellEIlt.
.
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 agreellEIlt shall be for a term coomencing on February 17,
1989 and ending on September 30, 1989. Either party can cancel this
agreellEIlt 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 termination of this agreerrent, an audit by an independant
certified public accountant shall be provided and D.S.M. shall have the
duty to pronptly turn over to the District its complete records
relevent to the accounts under this agreerrent 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
day of February, 1989.
Lower and Middle Keys Fire and Ambulance
District
~nroe County, Florida
By:
Mayor/Chainnan
Date:
(Seal)
Attest:
Clerk
By:
Inc.
Date:
Attest:
~~
~. ;P-9
Approved as to form and legal
~sufficiency .
By: Atto*~I'l\J'--~~