EMS Billing ServicesRESOLUTION NO. 2014 - 8
COUNCILMEMBER KEPHART INTRODUCED THE FOLLOWING RESOLUTION:
WHEREAS, the Mayor and City Council of the City of Blair, Nebraska, may from time
to time as necessary set and establish fees for various services provided by the City; and,
WHEREAS, the City of Blair and EMS Billing Services, Inc. have entered into an
agreement for EMS Billing to provide billing and collection services for the Blair Volunteer Fire
and Rescue Department
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COUNCIL
OF THE CITY OF BLAIR, NEBRASKA, THAT the fees to be billed and collected by EMS
Billing Services, Inc. on behalf of the Blair Volunteer Fire Department are set forth on Exhibit "A"
attached hereto and incorporated by this referenced herein; provided further, that all such rates
shall become effective immediately.
COUNCIL MEMBER KEPHART MOVED THAT THE RESOLUTION BE ADOPTED AS
READ, WHICH SAID MOTION WAS SECONDED BY COUNCIL MEMBER JENSEN UPON
ROLL CALL, COUNCIL MEMBERS SHEPARD, STEWART, KEPHART, RYAN,
CHRISTIANSEN, JENSEN AND HALL VOTING "AYE ", AND COUNCIL MEMBERS
NONE VOTING "NAY ", THE MAYOR DECLARED THE FOREGOING RESOLUTION
PASSED AND ADOPTED THIS 25 DAY OF FEBRUARY, 2014.
CITY OF BLAIR, NEBRASKA
ATTEST:
BRENDA R. WHEELER, CITY CLERK
(SEAL)
STATE OF NEBRASKA )
)ss
WASHINGTON COUNTY )
B Y
J I M S E. REALPH, MAYOR
Billing Rate Schedule 2014
M 5f.- ,
BLAIR RESCUE SQUAD
When determining your billing rate schedule, take into consideration all of
Billing Services, Inc. your expenses including, daily, annual, depreciated and future capital costs.
See expense template on back of this page when determining your new billing rates. Your service may
charge any rate amount appropriate to your service's financial needs. If your current rates are higher
than the new rates below, your rates will not be adjusted. You must sign and provide your effective date
below before the changes will be made.
Please write in the rates you would like to charge under the "NEW DATES" column. **
BLS Non - Emergency Base
BLS Emergency Base
ALS Non - Emergency Base
ALS Emergency Level 1
ALS Emergency Level 2
Specialty Care Transport
I' IRIVIRM
11
1 11
X11 11
1 11
1 11
Mileage 13.00
Assess and Release, No Transport 100.00
Are your ambulance rates set by ordinance?
I 1 11
1177.00
1205.00
1 1 1
20.00
150.00
PC,
KI (1q,r Wptiona0
Yes _ No (If yes, send us a copy of the ordinance.)
Your signature here indicates you reviewed and want to charge the "NEW RATES" indicated above.
Authorized Signature Date
EFFECTIVE DATE: (NEW RATES EFFECTIVE AT THE START OF A GIVEN MONTH)
* *As the billing rates increase, the gross collection percentage will appear less, but monies received will increase.
Business Associate Agreement
Between EMS BILLING SERVICES, INC. and Blair Rescue Squad
This Business Associate Agreement ( "Agreement ") between EMS BILLING SERVICES,
INC. and Blair Rescue Squad ( "Business Associate ") is executed to ensure that Business
Associate will appropriately safeguard protected health information ( "PHI ") that is created,
received, maintained, or transmitted on behalf of EMS BILLING SERVICES, INC. in
compliance with the applicable provisions of 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 "), and with
Public Law 111 -5 of February 17, 2009, known as the American Recovery and
Reinvestment Act of 2009, Title XII, Subtitle D — Privacy, Sections 13400, et seq., the
Health Information Technology and Clinical Health Act, as amended (the "HITECH
Act ") .
A. General Provisions
1. Meaning of Terms The terms used in this Agreement shall have the same meaning as
those terms defined in HIPAA and the HITECH Act.
2. Regulatory References Any reference in this Agreement to a regulatory section means
the section currently in effect or as amended.
3. Interpretation Any ambiguity in this Agreement shall be interpreted to permit
compliance with HIPAA.
B. Obligations of Business Associate
Business Associate agrees that it will:
1. Not use or further disclose PHI other than as permitted or required by this Agreement or as
required by law;
2. Use appropriate safeguards and comply, where applicable, with the HIPAA Security Rule
with respect to electronic protected health information ( "ePHI "), to prevent use or
disclosure of PHI other than as provided for by this Agreement;
3. Report to EMS BILLING SERVICES, INC. any use or disclosure of PHI not provided for
by this Agreement of which it becomes aware, including any security incident (as defined
in the HIPAA Security Rule) and any breaches of unsecured PHI as required by 45 CFR
§ 164.410;
4. In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), ensure that any
subcontractors that create, receive, maintain, or transmit PHI on behalf of Business
Associate agree to the same restrictions, conditions, and requirements that apply to
Business Associate with respect to such information;
5. Make PHI in a designated record set available to EMS BILLING SERVICES, INC, and to
an individual who has a right of access in a manner that satisfies EMS BILLING
SERVICES, INC.'s obligations to provide access to PHI in accordance with 45 CFR
§ 164.524;
6. Make any amendment(s) to PHI in a designated record set as directed or agreed to by the
EMS BILLING SERVICES, INC. pursuant to 45 CFR § 164.526;
7. Maintain and make available to EMS BILLING SERVICES, INC. or an individual who
has a right to an accounting of disclosures as necessary to satisfy EMS BILLING
SERVICES, INC.'s obligations under 45 CFR § 164.528;
8. To the extent that Business Associate is to carry out any of EMS BILLING SERVICES,
INC.'s obligations under the HIPAA Privacy Rule, Business associate shall comply with
the requirements of the Privacy Rule that apply to EMS BILLING SERVICES, INC. when
it carries out that obligation.
9. Make its internal practices, books, and records relating to the use and disclosure of PHI
received from, or created or received by Business Associate on behalf of EMS BILLING
SERVICES, INC., available to the Secretary of the Department of Health and Human Services
for purposes of determining compliance with HIPAA and the HITECH Act; and
10. If EMS BILLING SERVICES, INC. is subject to the Red Flags Rule (found at 16 CFR
681.1 et seq.), assist EMS BILLING SERVICES, INC. in complying with its Red Flags
Rule obligations by: (a) implementing policies and procedures to detect relevant Red Flags
(as defined under 16 C.F.R. §681.2); (b) taking all steps necessary to comply with the
policies and procedures of EMS BILLING SERVICES, INC.'s Identity Theft Prevention
Program; (c) ensuring that any agent or third party who performs services on its behalf in
connection with covered accounts of EMS BILLING SERVICES, INC. agrees to
implement reasonable policies and procedures designed to detect, prevent, and mitigate the
risk of identity theft; and (d) alerting EMS BILLING SERVICES, INC. of any red flag
incident (as defined by the Red Flag Rules) of which it becomes aware, the steps it has
taken to mitigate any potential harm that may have occurred, and provide a report to EMS
BILLING SERVICES, INC. of any threat of identity theft as a result of the incident.
C. Permitted Uses and Disclosures by Business Associate
The specific uses and disclosures of PHI that may be made by business associate on behalf of
EMS BILLING SERVICES, INC. include uses and disclosures:
1. Necessary to perform the services that Business Associate has been engaged to perform on
behalf of EMS BILLING SERVICES, INC.;
2. Required by law;
3. That would not violate the Privacy Rule if done by EMS BILLING SERVICES, INC..
4. Necessary for the proper management and administration of Business Associate or to carry
out the legal responsibilities of Business Associate, provided the disclosures are required
by law, or business associate obtains reasonable assurances from the person to whom the
information is disclosed that the infonmation will remain confidential and used or further
disclosed only as required by law or for the purposes for which it was disclosed to the
person, and the person notifies Business Associate of any instances of which it is aware in
which the information is used or disclosed in a manner that might constitute breach of
unsecured PHI.
1. Term The Term of this Agreement shall be for the same duration as the billing services
contract.
2. Termination by EMS BILLING SERVICES, INC. EMS BILLING SERVICES, INC.
may terminate this Agreement if EMS BILLING SERVICES, INC. determines that
Business Associate has violated a material term of the Agreement.
3. Termination by Either Party Notwithstanding any other provisions of this Agreement, if
either party knows of a pattern of activity or practice of the other party that constitutes a
material breach or violation of the other party's obligations under this Agreement, that
party shall take reasonable steps to cure the breach or end the violation, as applicable, and,
if such steps were unsuccessful either: terminate the Agreement, if feasible.
4. Return or Destruction of PHI At the termination of this Agreement, Business Associate
shall return or destroy all PHI received from, or created or received by Business Associate
on behalf of EMS BILLING SERVICES, INC. and retain no copies of such PHI. If return
or destruction is infeasible, the protections of this Agreement will extend to such PHI.
Agreed to this day of , 2014.
EMS BILLING SERVICES, INC.
am
Its:
Date:
B lair Rescue Squad
By: M CA f
Its: C �.
O
Date: 9