742-Medical Claims Processor Gr BILLING AND COLLECTION SERVICES AGREEMENT
CITY OF SANFORD FIRE DEPARTMENT
THIS AGREEMENT is made and entered into this c~/'~ day of
~ , 1~, by and between MEDICAL ~ PROCESSORS GROUP,
INC., duly authorized to conduct business in the State of Florida,
whose address is Post Office Box 8063, Jupiter, Florida 33468-8063,
hereinafter called the "CONTRACTOR" and CITY OF SANFORD, a political
subdivision of the State of Florida, whose address is City of
Sanford, 300 N. Park Ave., Sanford, Florida 32771, hereinafter called
the "CITY."
WITNESSETH:
WH~.REAS, the CITY desires to retain the services of a competent
and qualified CONTRACTOR to provide billing and collection services
for the City of Sanford Fire Department; and
WHEREAS, the CITY has requested and received expressions of
interest for the retention of services of CONTRACTORS; and
WHEREAS, CONTRACTOR is competent and qualified to furnish such
professional services to the CITY and desires to provide its
professional services according to the terms and conditions stated
herein,
NOW, THEREFORE, in consideration of the mutual understandings
and covenants set forth herein, CITY and CONTRACTOR agree as follows:
SECTION 1. SERVICES. CITY does hereby retain CONTRACTOR to
furnish professional services and perform those tasks as further
described in the Scope of Services attached hereto and incorporated
heroin as Exhibit A.
SECTION 2. AUTHORIZATION FOR SERVICES. Authorization for
performance of professional services by the CONTRACTOR under this
Agreement shall be in the form of written Notice to Proceed issued
and executed by the CITY.
SECTION 3. FEE C~ZATION AND PAYMENT.
(a) The CITY agrees to compensate CONTRACTOR for the
professional services called for under this Agreement a fee in the
12/22/98
amount of FOUR AND 90/100 DOLLARS ($4.90) per case. CONTRACTOR shall
perform all work required by the Scope of Services but, in no event
shall CONTRACTOR be paid more than the negotiated fee amount per case
stated above.
(b) Payments shall be made to the CONTRACTOR when requested as
work progresses for services furnished, but not more than once
monthly. CONTRACTOR may invoice amount due based on total required
services actually performed and completed. Upon review and approval
of CONTRACTOR'S invoice, the CITY shall, within thirty (30) days of
receipt of the invoice, pay CONTRACTOR the approved amount.
SECTION 4. BILLING AND PAYMENT.
(a) CONTRACTOR shall render to the CITY, at the close of each
calendar month, an itemized invoice, properly dated including, but
not limited to, the following information:
ll} The name and address of the CONTRACTOR;
(2) The Contract Number;
(3) A complete and accurate record of services performed
by the CONTRACTOR, for all services the CONTRACTOR performs during
that month and for which the CITY is billed;
(4) A description of the services rendered in (3) above
with sufficient detail to identify the exact nature of the work
performed; and
(5) Such other information as may be required by this
Agreement or requested by the CITY from time to time.
The original invoice shall be sent to:
Director of Finance
City of Sanford
P.O. Box 1788
Sanford, EL 32772-1788
A duplicate copy of the invoice shall be sent to:
Sanford Fire Department
Emergency Medical Services Battalion Chief
1303 S. French Ave.
Sanford, FL 32771
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(b) Payment shall be made after review and approval by CITY
within thirty (30) days of receipt of a proper invoice from the
CONTRACTOR.
SECTION 5. AUDIT OF RECORDS.
(a) CITY may perform or have performed an audit of the records
of CONTRACTOR after final payment to support final payment hereunder.
This audit would be performed at a time mutually agreeable to
CONTRACTOR and CITY subsequent to the close of the final fiscal
period in which the last work is performed. Total compensation to
CONTRACTOR may be determined subsequent to an audit as provided for
in subsection (b) and of this subsection, and the total compensation
so determined shall be used to calculate final payment to CONTRACTOR.
Conduct of this audit shall not delay final payment as required by
Section 4(b) and this subsection.
/b) The CONTRACTOR agrees to maintain all books, documents,
papers, accounting records and other evidences pertaining to work
performed under this Agreement in such a manner as will readily
conform to the terms of this Agreement and to make such materials
available at CONTRACTOR'S office at all reasonable times during the
Agreement period and for five (5) years from the date of final
payment under the contract for audit or inspection as provided for in
subsection {a) of this Section.
(c) In the event any audit or inspection conducted after final
payment, but within the period provided in subsection (b) of this
Section reveals any overpayment by CITY under the terms of the
Agreement, CONTRACTOR shall refund such overpayment to CITY within
thirty (30) days of notice by the CITY.
SECTION 6. RESPONSIBILITY OF CONTRACTOR.
(a) CONTRACTOR shall be responsible for the professional
quality, technical accuracy and the coordination of all plans,
studies, reports and other services furnished by CONTRACTOR under
this Agreement. CONTRACTOR shall, without additional compensation,
correct or revise any errors or deficiencies in its services.
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3
(b) Neither the CITY'S review, approval or acceptance of, nor
payment for, any of the services required shall be construed to
operate as a waiver of any rights under this Agreement Or of any
cause of action arising out of the performance of this Agreement and
the CONTRACTOR shall be and remain liable to the CITY in accordance
with applicable law for all damages to the CITY caused by the
CONTRACTOR'S performance of any of the services furnished under this
Agreement.
SECTION 7. OWneRSHIP OF DOCUMeNtS. All deliverable reference
data, survey data, and reports that result from the CONTRACTOR'S
services under this Agreement shall become the property of the CITY
after final payment for the specific service provided is made to
CONTRACTOR. No changes or revisions to the documents furnished by
CONTRACTOR shall be made by CITY or its agents without the written
approval of CONTRACTOR.
SECTION 8. TERM. This Agreement shall take effect on the date
of its execution by the CITY and shall run for a period of one (1)
year; and, at the sole option of the CITY, this Agreement may be
renewed for two (2) successive periods not to exceed one (1) year
each.
SECTION 9. TERMINATION.
(a) The CITY may, by written notice to the CONTRACTOR,
terminate this Agreement, in whole or in part, at any time, either
for the CITY'S convenience or because of the failure of the
CONTRACTOR to fulfill CONTRACTOR'S Agreement obligations. Upon
receipt of such notice, the CONTRACTOR shall:
(1) immediately stop all services affected unless the
notice directs otherwise, and
(2) deliver to the CITY all studies, reports, estimates,
summaries, and such other information and materials as may have been
accumulated by the CONTRACTOR in performing this Agreement, whether
completed or in progress.
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4
(b) If the termination is for the convenience of the CITY, the
CONTRACTOR shall be paid compensation for services performed to the
date of termination. CONTRACTOR shall be paid no more than a
percentage of the fee amount per case equivalent to the percentage of
the completion of work contemplated by the Agreement.
(c) If the termination is due to the failure of the CONTRACTOR
to fulfill its Agreement obligations, the CITY may take over the work
and prosecute same to completion by Agreement or otherwise. In such
case, the CONTRACTOR shall be liable to the CITY for reasonable
additional costs occasioned to the CITY thereby. The CONTRACTOR
shall not be liable for such additional costs if the failure to
perform the Agreement arises out of causes beyond the control and
without any fault or negligence of the CONTRACTOR. Such causes may
include, but are not limited to, acts of God or of the public enemy,
acts of the CITY in either its sovereign or contractual capacity,
fires, floods, epidemics, quarantine restrictions, strikes, freight
embargoes, and unusually severe weather; but, in every case, the
failure to perform must be beyond the control and without any fault
or negligence of the CONTRACTOR.
(d) if, after notice of termination for failure to fulfill
Agreement obligations, it is determined that the CONTRACTOR had not
so failed, the termination shall be deemed to have been effected for
the convenience of the CITY. In such event, adjustment in the
Agreement price shall be made as provided in subsection (b) of this
Section.
(e) The rights and remedies of the CITY provided in this
clause are in addition to any other rights and remedies provided by
law or under this Agreement.
SECTION 10. EQUAL OPPORTUNITY EMPLOYMENT. CONTRACTOR agrees
that it will not discriminate against any employee or applicant for
employment for work under this Agreement because of race, color,
religion, sex, age, national origin, or disability and will take
steps to ensure that applicants are employed, and employees are
12/22~8
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treated during employment, without regard to race, color, religion,
sex, age, national origin or disability. This provision shall
include, but not be limited to, the following: employment, upgrading,
demotion or transfer; recruitment advertising; layoff or termination;
rates of pay or other forms of compensation; and selection for
training, including apprenticeship.
SECTION 11. NO CONTINGENT FEES. CONTRACTOR warrants that it
has not employed or retained any company or persons, other than a
bona fide employee working solely for the CONTRACTOR, to solicit or
secure this Agreement and that CONTRACTOR has not paid or agreed to
pay any persons, company, corporation, individual or firm, other than
a bonafide employee working solely for CONTRACTOR, 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 this provision, CITY shall have the right to
terminate the Agreement at its discretion, without liability, and to
deduct from the Agreement price, or otherwise recover, the full
amount of such fee, commission, percentage, gift, or consideration.
SECTION 12. ASSIGNMENT. This Agreement, or any interest
herein, shall not be assigned, transferred, or otherwise encumbered,
under any circumstances, by the parties hereto without prior written
consent of the opposite party and only by a document of equal dignity
herewith.
SECTION 13. SUBCONTRACTORS. In the event CONTRACTOR, during
the course of the work under this Agreement, requires the services of
any subcontractors or other professional associates in connection
with service covered by this Agreement, CONTRACTOR must secure the
prior written approval of the CITY. If subcontractors or other
professional associates are required in connection with the services
covered by this Agreement, CONTRACTOR shall remain fully responsible
for the services of subcontractors or other professional associates.
SECTION 14. INDEMNIFICATION OF CITY. CONTRACTOR shall
indemnify and hold harmless and defend CITY, its officers, agents,
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and employees from and against any claim, demand or cause of action
of whatsoever kind or nature arising out of, allegedly arising out
of, or related to the performance of services under this Agreement by
CONTRACTOR, its officers, agents or employees.
SECTION 15. INSUi~CE.
(a) General. The CONTRACTOR shall at the CONTRACTOR'S own
cost procure the insurance required under this Section.
(1) The CONTRACTOR shall furnish the CITY with a
Certificate of insurance signed by an authorized representative of
the'insurer evidencing the insurance required by this Section
(Prcfessional Liability, Workers' Compensation/Employer's Liability
and ConLmercial General Liability). The CITY, its officials,
officers, and employees shall be additional named insureds under the
Con~mercial General Liability policy. The Certificate of Insurance
shall provide that the CITY shall be given not less than thirty (30)
day~ written notice prior to the cancellation or restriction of
coverage. Until such time as the insurance is no longer required to
be maintained by the CONTRACTOR, the CONTRACTOR shall provide the
CIT~ with a renewal or replacement Certificate of Insurance not less
thaD thirty /30) days before expiration or replacement of the
inslurance for which a previous certificate has been provided.
~ (2) The Certificate shall contain a statement that it is
being provided in accordance with the Agreement and that the
insurance is in full compliance with the requirements of the
Age m nt. In lieu of the statement the Certificate, the
COLTRACTOR shall, at the option of the CITY submit a sworn, notarized
statement from an authorized representative of the insurer that the
Certificate is being provided in accordance with the Agreement and
that the insurance is in full compliance with the requirements of the
Agreement.
(3) In addition to providing the Certificate of
I~surance, if required by the CITY, the CONTRACTOR shall, within
thirty (30) days after receipt of the request, provide the CITY with
1 W22/98
a certified copy of each of the policies of insurance providing the
coverage required by this Section.
(4) Neither approval by the CITY or failure to disapprove
the insurance furnished by CONTRACTOR shall relieve the CONTRACTOR of
the CONTRACTOR'S full responsibility for performance of any
obligation including CONTRACTOR'S indemnification of CITY under this
Agreement.
(b) Insurance Company Requirements. insurance companies
providing the insurance under this Agreement must meet the following
requirements:
(1) Companies issuing policies other than Workers'
Compensation must be authorized to conduct business in the State of
Florida and prove same by maintaining Certificates of Authority
issued to the companies by the Department of Insurance of the State
of Florida. Policies for Workers' Compensation may be issued by
companies authorized as a group self-insurer by Section 440.57,
Florida Statutes.
(2) In addition, such companies other than those
authorized by Section 440.57, Florida Statutes, shall have and
maintain a Best's Rating of "A" or better and a Financial Size
Category of "VII" or better according to A.M. Best Company.
(3) If, during the period which an insurance company is
providing the insurance coverage required by this Agreement, an
insurance company shall: 1) lose its Certificate of Authority, 2) no
longer comply with Section 440.57, Florida Statutes, or 3) fail to
maintain the requisite Best's Rating and Financial Size Category, the
CONTRACTOR shall, as soon as the CONTRACTOR has knowledge of any such
circumstance, immediately notify the CITY and immediately replace the
insurance coverage provided by the insurance company with a different
insurance company meeting the requirements of this Agreement. Until
such time as the CONTRACTOR has replaced the unacceptable insurer
with an insurer acceptable to the CITY the CONTRACTOR shall be deemed
to be in default of this Agreement.
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(c) Specifications. Without limiting any of the other
obligations or liability of the CONTRACTOR, the CONTRACTOR shall, at
the CONTRACTOR'S sole expense, procure, maintain and keep in force
amounts and types of insurance conforming to the minimum requirements
set forth in this Section. Except as otherwise specified in the
Agreement, the insurance shall become effective prior to the
commencement of work by the CONTRACTOR and shall be maintained in
force until the Agreement completion date. The amounts and types of
insurance shall conform to the following minimum requirements.
(1) Workers' Compensation/Employer's Liability.
(A) CONTRACTOR'S insurance shall cover the
CONTRACTOR and its subcontractors of every tier for those sources of
liability which would be covered by the latest edition of the
standard Workers~ Compensation Policy, as filed for use in Florida by
the National Council on Compensation insurance, without restrictive
endorsements. In addition to coverage for the Florida Workers'
Compensation Act, where appropriate, coverage is to be included for
the United States Longshoremen and Harbor Workers' Compensation Act,
Federal Employers' Liability Act and any other applicable federal or
state law.
(B) Subject to the restrictions of coverage found
in the standard Workers' Compensation Policy, there shall be no
maximum limit on the amount of coverage for liability imposed by the
Florida Workers' Compensation Act, the United States Longshoremen's
and Harbor Workers' Compensation Act, or any other coverage
customarily insured under Part One of the standard Workers'
Compensation Policy.
(C) The minimum amount of coverage under Part Two
of the standard Workers' Compensation Policy shall be:
$ 100,000.00 (Each Accident)
$ 500,000.00 (Disease-Policy Limit)
$ 100,000.00 (Disease-Each Employee)
(2) Commercial General Liability.
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(A) The CONTRACTOR'S insurance shall cover the
CONTRACTOR for those sources of liability which would be covered by
the latest edition of the standard Commercial General Liability
Coverage Form (ISO Form CG 00 01), as filed for use in the State of
Florida by the Insurance Services Office, without the attachment of
restrictive endorsements other than the elimination of Coverage C,
Medical Payment and the elimination of coverage for Fire Damage Legal
Liability.
(B) The minimum limits to be maintained by the
CONTRACTOR (inclusive of any amounts provided by an Umbrella or
Excess policy) shall be those that would be provided with the
attachment of the Amendment of Limits of Insurance IDesignated
Project or Premises) endorsement (ISO Form CG 25 01) to a Commercial
General Liability Policy with amount of coverage specified for each
project as follows:
LIMITS
General Aggregate Three (3) Times the
Each Occurrence Limit
Personal & Advertising $300,000.00
Injury Limit
Each Occurrence Limit $300,000.00
(3) Professional Liability Insurance. The CONTRACTOR
shall carry limits of not less than FiVE HUNDRED THOUSAND AND NO/100
DOLLARS ($500,000.00).
(d) Coverage. The insurance provided by CONTRACTOR pursuant
to this Agreement shall apply on a primary basis and any other
insurance or self-insurance maintained by the CITY or the CITY'S
officials, officers, or employees shall be excess of and not
contributing with the insurance provided by or on behalf of the
CONTRACTOR.
(e) Occurrence Basis. The Workers' Compensation Policy and
the Commercial General Liability required by this Agreement shall be
provided on an occurrence rather than a claims-made basis. The
Professional Liability insurance policy must either be on an
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occurrence basis, or, if a claims-made basis, the coverage must
respond to all claims reported within three (3) years following the
period for which coverage is required and which would have been
covered had the coverage been on an occurrence basis.
(f) Obligations. Compliance with the foregoing insurance
requirements shall not relieve the CONTRACTOR, its employees or
agents of liability from any obligation under a Section or any other
portions of this Agreement.
SECTION 16. REPRESENTATIVE OF CITY AND CONTRACTOR.
(a) It is recognized that questions in the day-to-day conduct
of performance pursuant to this Agreement will arise. The CITY, upon
request by CONTRACTOR, shall designate in writing and shall advise
CONTRACTOR in writing of one (1) or more CITY employees to whom all
communications pertaining to the day-to-day conduct of the Agreement
shall be addressed. The designated representative shall have the
authority to transmit instructions, receive information and interpret
and define the CITY'S policy and decisions pertinent to the work
covered by this Agreement.
(b) CONTRACTOR shall, at all times during the normal work
week, designate or appoint one or more representatives of CONTRACTOR
who are authorized to act on behalf of CONTRACTOR regarding all
matters involving the conduct of the performance pursuant to this
Agreement and shall keep CITY continually advised of such
designation.
SECTION 17. ALL PRIOR AGREEMENTS SUPERSEDED. This document
incorporates and includes all prior negotiations, correspondence,
conversations, agreements or understandings applicable to the matters
contained herein and the parties agree that there are not
commitments, agreements or understandings concerning the subject
matter of this Agreement that are not contained or referred to in
this document. Accordingly, it is agreed that no deviation from the
terms hereof shall be predicated upon any prior representations or
agreements, whether oral or written.
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SECTION 18. MODIFICATIONS, AMENDMENTS OR ALTERATIONS. NO
modification, amendment or alteration in the terms or conditions
contained heroin shall be effective unless contained in a written
document executed with the same formality and of equal dignity
herewith.
SECTION 19. INDEPENDENT CONTRACTOR. It is agreed that nothing
herein contained is intended or should be construed as in any manner
creating or establishing a relationship of copartners or an agency or
employment relationship between the parties, despite the fact that
the City may direct the contractor in it's work. The CONTRACTOR is to
be and shall remain an independent contractor with respect to all
services performed under this Agreement.
SECTION 20. EMPLOYEE STATUS. Persons employed by the
CONTRACTOR in the performance of services and functions pursuant to
this Agreement shall have no claim to pension, workers~ compensation,
unemployment compensation, civil service or other employee rights or
privileges granted to the CITYIS officers and employees either by
operation of law or by the CITY.
SECTION 21. SERVICES NOT PROVIDED FOR. No claim for services
furnished by the CONTRACTOR not specifically provided for herein
shall be honored by the CITY.
SECTION 22. PUBLIC Pa~CONDS LAW. CONTRACTOR acknowledges
CITY~S obligations under Article 1, Section 24, Florida Constitution
and Chapter 119, Florida Statutes, to release public records to
members of the public upon request. CONTRACTOR acknowledges that
CITY is required to comply with Article t, Section 24, Florida
Constitution and Chapter 119, Florida Statutes, in the handling of
the materials created under this Agreement and that said Statute
controls over the terms of this Agreement.
SECTION 23. NOTICES. Whenever either party desires to give
notice unto the other, it must be given by written notice, sent by
certified United States mail, with return receipt requested,
addressed to the party for whom it is intended at the place last
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specified and the place for giving of notice shall remain such until
it shall have been changed by written notice in compliance with the
provisions of this Section. For the present, the parties designate
the following as the respective places for giving of notice, to wit:
FOR CITY OF SANFORD:
Director of Finance
City of Sanford Finance Department
P.O. Box 1788
Sanford, Florida 32772-1788
FOR CONTRACTOR:
Medical Claims Processors Group, Inc.
Post Office Box 8063
Jupiter, Florida 33468-8063
SECTION 24. RIGHTS AT LAW RETAINED. The rights and remedies
of the CITY, provided for under this Agreement, are in addition to
any other rights and remedies provided by law.
SECTION 25. COMPLIANCE WITH LAWS AND REGULATIONS. In
providing all services pursuant to this Agreement, the CONTRACTOR
shall abide by all statutes, ordinances, rules, and regulations
pertaining to, or regulating the provisions of, such services,
including those now in effect and hereafter adopted. Any violation
of said statutes, ordinances, rules, or regulations shall constitute
a material breach of this Agreement, and shall entitle the CITY to
terminate this Agreement immediately upon delivery of written notice
of termination to the CONTRACTOR.
SECTION 26. CONFLICT OF INTEREST.
ia) The CONTRACTOR agrees that it will not engage in any
action that would create a conflict of interest in the performance of
its obligations pursuant to this Agreement with the CITY or which
would violate or cause others to violate the provisions of Part III,
Chapter 112, Florida Statutes, relating to ethics in government.
(b) The CONTRACTOR hereby certifies that no officer, agent or
employee of the CITY has any material interest, (as defined in
Section 112.312(15}, Florida Statutes, as over 5%}, either directly
or indirectly, in the business of the CONTRACTOR to be conducted
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here, and that no such person shall have any such interest at any
time during the term of this Agreement.
(c) Pursuant to Section 216.347, Florida Statutes, the
CONTRACTOR hereby agrees that monies received from the CITY pursuant
to this Agreement will not be used for the purpose of lobbying the
Legislature or any other State or Federal Agency.
SECTION 27. DELINQUENT ACCOUNTS.
(a) CONTRACTOR hereby agrees to collect delinquent accounts
currently outstanding under the City's prior collection arrangement
with prior contractors. As consideration for collection of these
outstanding delinquent accounts, CONTRACTOR will be paid 5 and 1/2%
of the amount CONTRACTOR recovers from these outstanding accounts.
This payment arrangement is only applicable to accounts outstanding,
and does not apply to customer accounts billed by CONTRACTOR pursuant
to this agreement.
IN WITNESS WHEPaOF, the parties hereto have made and executed
this Agreement for the purposes stated heroin.
ATTEST: MEDICAL PROC SSORS GROUP, INC.
_ ~ EL
t~ {Q S, Secretary dent
,<CS~POmTSSEAL) Date: d/ ZE , 6 Iqqq
ATTEST: CITY COMMISSION
JAN DOUGHERTY Larry Dale,
City Clerk Mayor
City of Sanf6rd, Florida City of Sanford, Florida
For the use and reliance of As authorized for execution
Approved as to form and at i
Legal sufficiency. regular meeting.
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CITY Attorney
Attachment
Exhibit A, Scope of Services
\SFD 98 BILLING AND COLLECTION SERVICE$ AGREEMENT.dOC
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BILLING AND COLLECTION SERVICES FOR THE CITY OF SANFORD FIRE
DEPARTMENT
SCOPE OF SERVICES
City of Sanford, Florida (CITY) desires to enter into a contract with an experienced and qualified firm
(Agency) to:
1. Provide billing and collection services for Fire Department Emergency Medical Services
transport, as required on a case by case basis, with an emphasis on an accelerated
turnaround between services provided and payments received. The price proposal shall
include all expenses of billing and collection including, but not limited to, stationary, forms,
envelopes and postage.
2. Provide reasonably necessary training to appropriate CITY Fire Department personnel
regarding the gathering of necessary information and proper completion of run reports.
3. Provide prompt submission of Medicare, Medicaid, and insurance claims within ten (10)
business days after receiving the completed run ticket, which shall be the Agency's notice to
commence the billing/collection service. Secondary insurance provider claims shall be
submitted within ten (10) business days after the primary insurance provider has paid.
Agency shall follow-up promptly on rejected and inactive claims and establishes payer
remittance accounts and procedures.
4. Reconcile the number of transport collected with those transmitted to the Agency. The
Agency shall contact City Finance Department within twenty-four (24) hours of receipt to
report any discrepancies.
5. Agency shall provide a designated liaison for patient/payer concerns.
6. Provide survey questionnaires to patients at the CITY's request.
7. Provide all customer-related inquiry services and prepare additional third party claims based
on this information exchange.
8. Implement a collection system involving a minimum of three (3) invoices and a follow-up
campaign of up to twenty-four (24) telephone attempts to collect all private pay accounts with
outstanding balances, including required co-payments and deductibles assessed by
Medicare, Medicaid, HMO's or private insurance. Records of telephone calls and contacts
shall be maintained and any payment on an account shall reset this cycle. Returned mail
accounts are exempt from the above-required subsequent mailings. The CITY reserves the
right to approve the invoice format.
9. Attempt to collect all balances due for services rendered as well as attempt to asses patient's
ability to repay the debt, and if necessary, extend time payments, all subject to such policy
guidelines as the CiTY may establish.
10. Process requests for refunds through CITY on a weekly basis and provide City Finance
Department with documentation of each refund processed.
11. Provide to City Finance Department all unpaid invoices along with the complete processing
history once collection efforts are exhausted. At the termination of the agreement, Agency
shall turn over a{l existing information in its possession concerning existing unpaid accounts.
Such information shall be transmitted by an electronic medium (E-mail, magnetic tape or
diskette) reasonably acceptable to City Finance Department.
12. The Agency shall provide sufficient personnel to process all billing/run tickets in a timely,
efficient and effective manner and shall respond promptly to the CITY and patients on
requests for information or records.
13. Agency shall use any confidential 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 other than disputes with
the CITY over billing services.
14. Any procedures described in this scope of services represents a minimum effort required by
the CiTY of the Agency and shall not limit the Agency's use of its proprietary accounts
receivable and billing and collections systems, including modifications as required by major
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payer groups, or its usual and customary practices. This agreement shall require a minimum
standard of 60% of gross collection success rate.
15. The following reports shall be prepared and submitted (Reference Attachment A):
Reports Freauency
· Current period review by service date Monthly
· Accounts receivable aging by payer class Monthly
· Billing report by run number and invoice number Monthly
· Accounts receivable summary aged trial balance Monthly
· Payments by deposit date recap Weekly/Monthly
· Aged cash receipt report Monthly
· Posted change listing Daily
· Accounts status report Monthly
· Adjustments report by category Daily/Monthly
· Daily cash receipt recap by deposit Daily/Monthly
· Collection by Payee Group Monthly
· Collection report by month of service Monthly
· Itemized materials billing report Weekly/Monthly
16. Agency must be Health Claims Adjuster
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ATTACHMENT A
CITY OF SANFORD FIRE DEPARTMENT
EMS BILLING & COLLECTION PROPOSAL REQUIREMENTS
Brief description of reports to be prepared and submitted:
1. Current period review by Service Date:
Report should present the Current period Transport by Date and Run Number to include
Number of Miles and Transport Charges. Will identify the type of service provided as ALS,
BLS, Auto Accident, Cardiac, etc.
2. Account Receivable Aging by Payer Class:
Report should include Invoice Number, Run number, Patient Name, Insurance Company
Name, Medicare, Medicaid, Direct Patients, etc.
3. Billing Report by Run Number and Invoice Number:
Report should include the Run Number making reference to the Invoice Number. Should
include break down of charges.
4. Account Receivable Summary Aged Trial Balance:
Report should include invoice number, run number, original amount due, balance due, aged
as follows, 30, 60, 90, 120, 180-day minimum.
5. Payment by Deposit date Recap:
Report should balance with the daily deposit received at the bank. Should make reference to
the invoice number, Run Number, or date of service payer class, etc.
6. Aged Cash Receipt Report:
Same as above but will reference to the date of the transport to age the cash receipt based
on the date of the invoice.
7. Posted Change Listing:
This report will give a detail of any changes done to the invoice like, increase of the invoice,
credits and reasons.
8. Accounts Status Report:
This report will provide a history of collections efforts and contacts, payment plans, etc.
9. Adjustments Report by Category:
This report will consist of any adjustments to the accounts like Medicare, Medicaid
allowances, wdte off of accounts by category, Credits, Debits, etc.
10. Daily cash Receipt Recap by Deposits:
This report should balance with the Daily deposits in the bank. Should include Invoice
Number, Run Number, Client Name, Check Number, etc.
11. Collection By Payee Group:
This report will be made by payee class like Medicare, Medicaid, Pdmary and Secondary
Insurance company, Direct Patients, etc.
12. Collection report by Month of Service:
This report will make reference to the daily deposit and the date the service was provided.
13. Itemized Materials Billing Report:
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6~