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2009-06RESOLUTION 2009 - 6 COUNCIL MEMBER ABBOTT INTRODUCED THE FOLLOWING RESOLUTION: WHEREAS the City of Blair, Nebraska, has been presented with an Agreement between the City of Blair, Nebraska, and EMS Billing Services, Inc. a copy of said Agreement being attached hereto, marked Exhibit "A" and incorporated by this reference herein; and, NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COUNCIL OF THE CITY OF BLAIR, NEBRASKA, that the Agreement attached hereto, marked Exhibit "A" and by this reference made a part of hereof as though fully set forth herein is hereby approved by the City of Blair, Nebraska. BE IT FURTHER RESOLVED THAT THE MAYOR AND CITY CLERK OF THE CITY OF BLAIR, NEBRASKA, are hereby authorized to execute and deliver, on behalf of the City of Blair, Nebraska, any documents that may be necessary for approval of said agreement. COUNCIL MEMBER ABBOTT MOVED THAT THE RESOLUTION BE ADOPTED AS READ, WHICH SAID MOTION WAS SECONDED BY COUNCIL MEMBER KEPHART. UPON ROLL CALL, COUNCIL MEMBERS STEWART, SHEPARD, KEPHART, FANOELE, ABBOTT, WOLFF, JENSEN AND CHRISTIANSEN VOTING "AYE ", AND COUNCIL MEMBERS NONE VOTING "NAY", THE MAYOR DECLARED THE FOREGOING RESOLUTION PASSED AD ADOPTED THIS 24 DAY OF FEBRUARY, 2009. ATTEST: BRENDA R. WHEELER, CITY CLERK (SEAL) STATE OF NEBRASKA ) ) :ss: WASHINGTON COUNTY ) CITY OF BLAIR, NEBRASKA B 'r► C E. REALPH, MAYOR BRENDA R. WHEELER, hereby certifies that she is the duly appointed, qualified and acting City Clerk of the City of Blair, Nebraska, and that the above and foregoing Resolution was passed and adopted at a regular meeting of the Mayor and City Council of said City held on the 24th day of February, 2009. BRENDA R. WHEELER, CITY CLERK AGREEMENT BETWEEN CITY OF BLAIR AND EMS BILLING SERVICES, INC. �h r THIS AGREEMENT is entered into and effective this �1 of of i Gt.a Irc , 2009, by and between EMS Billing Services, Inc., hereinafter referred to as "EMS Billing ", and City of Blair , hereinafter referred to as "MEDICAL SERVICE PROVIDER." WHEREAS, EMS Billing is engaged in the business of providing billing and collection services for public and private ambulance and rescue squad entities; and WHEREAS, MEDICAL SERVICE PROVIDER is a public and/or private provider of rescue squad and ambulance services in the area commonly known as Blot r RGSeuc..S .1 : and WHEREAS, MEDICAL SERVICE PROVIDER is compensated for its ambulance and rescue squad services by its patients through private payments, private insurance, public insurance, including Medicare and Medicaid, or a combination thereof; and WHEREAS, MEDICAL SERVICE PROVIDER desires to engage and retain the billing services of EMS Billing: IT IS, THEREFORE, AGREED, IN CONSIDERATION OF THE MUTUAL PROMISES, COVENANTS, AND CONDITIONS SET FORTH HEREIN AS FOLLOWS: 1. TERM OF AGREEMENT. EMS Billing shall provide to MEDICAL SERVICE PROVIDER billing services as set forth in detail below, commencing the 3 day of Palo Y k G. r , 2009, and this agreement shall continue until modified in writing, or until terminated. 2. BILLING SERVICES TO BE PROVIDED. EMS Billing will provide the following billing services on behalf of MEDICAL SERVICE PROVIDER as follows: A. Verify all billing information; B. Invoice all private payment patients and all insurance carriers including, but not limited to, public and private health insurance, Medicare, Medicaid, automobile liability carriers, workers' compensation carriers, and homeowner insurance carriers; C. Provide all appropriate HCPCS, ICD9, and condition codes (symptoms /diagnosis codes); D. Prepare and mail invoices to private patients and complete and submit appropriate claim forms to public and/or private insurance carriers or other responsible party; E. Provide to private patients at least three billings reflecting their account balance (if unpaid); F. Coordinate, correspond, and reply to all inquiries from private patients and public and/or private insurance carriers; G. Obtain status reports on claim processing from all public and/or private insurance carriers; H. Provide customer service access during normal business hours, weekends and holidays excluded; I. Provide contract completion for participating agreements with insurance companies based upon information as provided by MEDICAL SERVICE PROVIDER; and act as authorized representative; J. Provide cash posting services; K. Provide to MEDICAL SERVICE PROVIDER itemized details of all debit and credit transactions as well as a year -to -date statistical summary to be provided to MEDICAL SERVICE PROVIDER no later than the 10 business day of the following month. L. EMS Billing provides emergency medical billing services and may assist MEDICAL SERVICE PROVIDER. EMS Billing does not provide legal advice, tax advice, or other professional services other than those specified in items A through K above. 3. COMPENSATION. MEDICAL SERVICE PROVIDER agrees to compensate EMS Billing for its billing services provided above on a monthly basis in an amount equal to fifteen percent (15 %) of amounts actually collected by EMS Billing and/or MEDICAL SERVICE PROVIDER and/or any collection or recovery agency acting on behalf of MEDICAL SERVICE PROVIDER in the previous month. EMS Billing shall invoice MEDICAL SERVICE PROVIDER for its compensation no later than the 10 day of the following month in which payments or insurance proceeds are received, and MEDICAL SERVICE PROVIDER agrees to pay said invoice within 30 days. 3 4. MEDICAL SERVICE PROVIDER DUTIES A. MEDICAL SERVICE PROVIDER is structured and operates in accordance with local, state, and federal statutes B. MEDICAL SERVICE PROVIDER agrees to provide to EMS Billing the information and documents necessary to enroll and keep current or update enrollments with insurance carriers including Centers for Medicare and Medicaid Services (CMS), Medicaid, and Blue Cross.. C. MEDICAL SERVICE PROVIDER agrees to provide to EMS Billing for each rescue squad or ambulance call the information required on these three forms (1) a signed medical necessity form, a sample copy of which is attached hereto and fully incorporated herein, together with (2) the demographic sheet from each hospital or medical care facility to which the patient has been transported, and (3) a completed run report. The completed and signed medical necessity form, demographic sheet, and run report form shall be mailed (postmarked) by MEDICAL SERVICE PROVIDER to EMS Billing on or before the 10 of each month or anytime 30 or more run reports are ready for billing. Reports may be mailed more often and MEDICAL SERVICE PROVIDER is encouraged to do so. A minimum of once a month mailing of run reports on or before the 10 is reauired. Any changes to personnel or squad licensing or equipment must be reported to EMS Billing. Any discrepancy in deposit amount, receipt of deposit, direct payments reported or other questions regarding the squad's monies or invoice must be reported in writing to EMS Billing within 60 days of the date of the report. EMS Billing is not liable or responsible for discrepancies not reported in a timely manner. 5. PAYMENT COLLECTION PROCEDURES. EMS Billing shall provide that payments on all claims shall be made in the name of the MEDICAL SERVICE PROVIDER and claims payments forwarded to EMS Billing. MEDICAL SERVICE PROVIDER agrees to provide EMS Billing a "deposit only" stamp and bank deposit slips. EMS Billing will endorse all payment claims "for deposit only to MEDICAL SERVICE PROVIDER'S bank" and cause all claim payments to be deposited in MEDICAL SERVICE PROVIDER'S account not less than once a month. In the event that MEDICAL SERVICE PROVIDER receives direct payment on claims processed by EMS Billing, then it will immediately notify and mail such payment to EMS Billing so that the payment may be properly recorded. If the MEDICAL SERVICE PROVIDER makes the deposit directly and does not forward payments to EMS Billing, there will be a $25.00 charge per item for researching and recording each check. 6. TERMINATION. This agreement may be terminated by either party giving the other party sixty (60) days written notice of its intent to terminate. During said 60 day period, this agreement shall continue in full force and effect. EMS Billing shall be entitled to compensation at the rate set forth above for all billing services provided during that 60 -day notice period and for any amounts collected at any time by MEDICAL SERVICE PROVIDER as a result of the billing services provided by EMS Billing. Upon notification of termination of contract, MEDICAL SERVICE PROVIDER'S account will immediately be placed on a "cash" basis. Checks received on behalf of the MEDICAL SERVICE PROVIDER will be held in the safe at EMS Billing Services; EMS Billing Services will invoice the MEDICAL SERVICE PROVIDER for the checks being held and any Electronic Fund Transfer's paid to the MEDICAL SERVICE PROVIDER for billings processed by EMS Billing Services. EMS Billing Services will mail the "held" checks upon receipt of payment in full of the invoice for those checks and Electronic Fund Transfers. EMS Billing retains all documents produced during the billing/payment process and those provided for billing and enrollment by the MEDICAL SERVICE PROVIDER. Upon request at termination, copies may be provided to the Medical Service Provider for an additional fee. MEDICAL SERVICE PROVIDER will remove EMS Billing Services as the "Billing Agent" from its Medicare and other provider contracts at the end of the 60 day transition period. 7. MODIFICATION AND ASSIGNMENT. This agreement shall not be modified by either party unless the terms of modification of this agreement are reduced to writing and signed by both parties. Neither party may assign their right, obligations, or benefits under the terms of this agreement without first obtaining the written consent of the other party, which consent shall not be unreasonably withheld. 8. NOTICES. All notices and information required to be provided by either party to the other shall be in writing and transmitted to the other party via courier service or facsimile to the addresses and facsimile telephone numbers set forth under the signature of both parties to this agreement. 9. SEVERABILITY. If any section, portion, or clause of this agreement is deemed to be legally unenforceable, such unenforceability shall not invalidate the remaining provisions of this agreement and such provisions shall remain valid and enforceable against either party. 10. CONSTRUCTION. The terms and provisions of this agreement shall be construed according to the laws of the State of Nebraska 4 11. HIPAA BUSINESS ASSOCIATE ASSURANCES. A. Privacy Rule 1. EMS Billing, in its capacity as a Business Associate, shall carry out its obligations under this Agreement in compliance 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, Section 261, et seq., as amended ( "HIPAA "), to protect the privacy of any personally identifiable protected health information ( "PHI ") that is collected, processed or learned as a result of the Services provided hereunder. In conformity therewith, EMS Billing agrees that it will: (a) Not use or further disclose PHI except as permitted under this Agreement or required by law; (b) Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by this Agreement (c) Mitigate, to the extent practicable, any harmful effect that is known to EMS Billing of a use or disclosure of PHI by EMS Billing in violation of this Agreement. (d) Report to Medical Service Provider any use or disclosure of PHI by EMS Billing in violation of this Agreement. (e) Ensure that any agents or subcontractors to whom EMS Billing provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to EMS Billing with respect to such PHI; (f) Make PHI available to Medical Service Provider and to the individual who has a right to access as required under HIPAA within 30 days of the request by Medical Service Provider regarding the individual; (g) Incorporate any amendments to PHI when notified to do so by Medical Service Provider; (h) Provide an accounting of all uses or disclosures of PHI made by EMS Billing as required under the HIPAA privacy rule within 60 days; (i) Make its internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining Medical Service Provider's compliance with HIPAA; and (j) At the termination of this Agreement, return or destroy all PHI received from, or created or received by EMS Billing on behalf of, Medical Service Provider and if return is infeasible, the protections of this Agreement will extend to such PHI. 2. The specific uses and disclosures of PHI that may be made by EMS Billing on behalf of Medical Service Provider include: (a) The preparation of invoices to patients, carriers, insurers and others responsible for payment or reimbursement of the services provided by Medical Service Provider to its patients; (b) Preparation of reminder notices and documents pertaining to collections of overdue accounts; (c) The submission of supporting documentation to carriers, insurers and other payers to substantiate the health care services provided by Medical Service Provider to its patients or to appeal denials of payment for same. (d) Uses required for the proper management of EMS Billing as a business associate. (e) Other uses and disclosures of PHI that are enumerated within this Agreement. (f) Other uses or disclosures of PHI as permitted by the HIPAA Privacy Rule. B. Security Rule. 1. EMS Billing, in its capacity as a Business Associate, shall carry out its obligations under this Agreement in compliance with the Security 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 ( "HIPAA "), regarding the security of electronic protected health information ( "e- PHI ") that is received as a result of the Services provided hereunder. In conformity therewith, EMS Billing agrees that it will: (a) Implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits on behalf of the covered entity as required in the regulations; (b) Ensure that any agent of EMS Billing, including a subcontractor, to whom it provides such information, agrees to implement reasonable and appropriate safeguards to protect protected health information; and (c) Report to the Medical Service Provider any security incident of which it becomes aware. c. Notwithstanding any other provisions of this Agreement, this Agreement may be terminated by Medical Service Provider, in its sole discretion, if Medical Service Provider determines that EMS Billing has violated a term or provision of this Paragraph pertaining to EMS Billing's obligations as a Business Associate of Medical Service Provider, or if EMS Billing engages in conduct which would, if committed by Medical Service Provider, result in a violation of the HIPAA privacy rule or HIPAA security rule by Medical Service Provider. 12. COMPLIANCE. A. EMS Billing will conduct its activities and operations in compliance with all state and federal statutes, rules and regulations applicable to billing activities. B. Medical Service Provider shall conduct its activities, operations and documentation in compliance with all applicable state and federal statutes, rules and regulations. Medical Service Provider expressly represents and warrants that it is under no legal impediment to billing or receiving reimbursement for its services. 5 C Each party is responsible for monitoring and ensuring its own compliance with all applicable state and federal laws and regulations pertaining to billing and reimbursement for its services. However, either party which becomes aware of a violation of any such state or federal laws or regulations or of a questionable claim or claim practice agrees to notify the other party within thirty (30) days so the other party may appropriately address the matter. D The parties represent that they are not the subject of any actions or investigations pertaining to its participation in or standing with any state or federal health care program, are not subject to exclusion from any state and/or federal health care program, and that no persons providing services for which reimbursement is sought were at the time such services were rendered excluded from any state or federal health care program. E. The parties recognize that this Agreement is at all times subject to applicable state, local, and federal laws and shall be construed accordingly. The parties further recognize that this Agreement may become subject to or be affected by amendments in such laws and regulations or to new legislation or regulations. Any provisions of law that invalidate, or are otherwise inconsistent with the material terms and conditions of this Agreement, or that would cause one or both of the parties hereto to be in violation of law, shall be deemed to have superseded the terms of this Agreement and, in such event, the parties agree to utilize their best efforts to modify the terms and conditions of this Agreement to be consistent with the requirements of such law(s) in order to effectuate the purposes and intent of this Agreement. In the event that any such laws or regulations affecting this Agreement are enacted, amended or promulgated, either party may propose to the other a written amendment to this Agreement to be consistent with the provisions of such laws or regulations. In the event that the parties do not agree on such written amendments within thirty (30) days of receipt of the proposed written amendments, then either party may terminate this Agreement without further notice, unless this Agreement would expire earlier by its terms. Signed thisi5 day of 1— €rucc,r_ , 2009. EMS BILLING SERVICES, INC. Leslie L. Vaughn, Jr., President 6907 North 102 Circle Omaha, Nebraska 68122 Phone: (877)367 -9111 Email: lesliena,emsbillineservices.com Correspondence to: PO Box 641880 Omaha, NE 68164 6 MEDICAL SERVICE PROVIDER, N Signature: Name: Title: Address: Phone: Fax: Email: bat r, res� -ue, 9 S Eo +rY► -, Cl -I-►., Adrv,►hLs -Vrc or .-d 1g S . 110 S Ek ,►r N GGarbo? 41) z, /4 2,6 - LI j ci i go t /42c. 4 (cs rocis-for r" ®ct .bla'r. ne...