HomeMy WebLinkAbout2004-333I RESOLUTION NO. 2004-333
2
RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN
3 BERNARDINO AUTHORIZING THE CITY OF SAN BERNARDINO FIRE DEPARTMENT
4 TO ENTER INTO A BILLING SERVICES AGREEMENT WITH ADVANCED DATA
PROCESSING, INC. (ADPI) FOR FIRST RESPONDER, PARAMEDIC, AND
5 MEMBERSHIP PROGRAM FEES.
6 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN
BERNARDINO AS FOLLOWS:
7
SECTION 1. Advanced Data Processing, Inc., formerly Allied Information and Services
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Corp., is the best responsible bidder regarding billing services for first responder, paramedic, and
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membership program fees, in accordance with Bid Specification #F 05-008;
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SECTION 2. The Mayor or her designee is hereby authorized and directed to execute on
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behalf of City a Services Agreement with Advanced Data Processing, Inc., a copy of which is
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attached hereto, marked Attachment "A" and incorporated herein by reference as fully as though set
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forth at length;
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SECTION 3. Said agreement will be for collection services for the period of October 1, 2004
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through June 30, 2005 with two one-year renewal options; contingent upon funds being available and
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allocated in the budget;
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SECTION 4. The Purchasing Manager is authorized to issue an annual purchase order to
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Advanced Data Processing, Inc. The annual purchase order is for one year with the option of two one-
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20 year extensions. All other bids are hereby rejected;
21 SECTION 5. The Advanced Data Processing, Inc. Annual Purchase Order shall incorporate by
22 reference this Resolution and Bid Specification #F 05-008 and shall be paid for such services an
23 amount equal to 7% of actual revenue collected.
24 SECTION 6. The authorization to execute the above referenced Agreement and Annual
25 Purchase Order is rescinded if the parties to the Agreement fail to execute it within sixty (60) days of
26 the passage of this Resolution.
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2004-333
RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN
BERNARDINO AUTHORIZING THE CITY OF SAN BERNARDINO FIRE DEPARTMENT
TO ENTER INTO A BILLING SERVICES AGREEMENT WITH ADVANCED DATA
PROCESSING, INC. (ADPI) FOR FIRST RESPONDER, PARAMEDIC, AND
MEMBERSHIP PROGRAM FEES.
I HEREBY CERTIFY that the foregoing resolution was duly adopted by the Mayor and
Common Council of the City of San Bernardino at a i oint regular meeting thereof,
held on the 18th day of October 2004 by the following vote, to wit:
COUNCILMEMBERS AYES
ESTRADA x
LONGVILLE x
MCGINNIS x
KELLEY x
JOHNSON x
MCCAMMACK x
NAYS ABSTAIN ABSENT
v
Rachel G. Clark, City Cler
The foregoing resolution is hereby approved this %9 nr Aay of October 004.
Approved as to
Form and legal content:
JAMES F. PENMAN,
City Attorney
By: r
lalles, Mayor
San Bernardino
2
SERVICES AGREEMENT BETWEEN
CITY OF SAN BERNARDINO
AND
ADVANCED DATA PROCESSING, INC.
FOR FIRST RESPONDER, PARAMEDIC MEMBERSHIP PROGRAM & RELATED
PROFESSIONAL SERVICES.
THIS AGREEMENT, hereinafter "AGREEMENT', made and entered into this 4th day of
October, 2004 by and between CITY OF SAN BERNARDINO, a California Charter City, OW
with principal offices located at 300 North "D" Street, San Bernardino, California 9241 HOPS W.s4,1ac.
hereinafter referred to as the "CITY", and a Delaware
corporation with offices located at 7750 Pardee Lane, Oakland, California 94621,
hereinafter referred to as the "CONTRACTOR".
WITNESSETH:
WHEREAS, CITY has need for billing services for first responder and paramedic
fees;
WHEREAS, CONTRACTOR is competent, experienced and able to perform said
services; and,
WHEREAS, CONTRACTOR has provided the most advantageous and best
responsible proposal for such services;
WHEREAS, the parties hereto now wish to enter into an agreement, pursuant to
which the CONTRACTOR will render those professional services in connection with said
project as hereinafter provided;
NOW THEREFORE, the parties hereto agree as follows:
1. DEFINITION OF THE PROJECT. The objective of the project is to utilize the services
of the CONTRACTOR to provide the CITY with billing services for first responder
paramedic, and membership program fees.
2. SCOPE OF SERVICES. The CONTRACTOR shall perform and carry out the work as
defined in "EXHIBIT B — Scope of Work' and "Exhibit C-Allied Information & Services
Corp. Proposal in Response to RFQ F-05-008 EMS Billing Services, dated May 2004, all
of which are attached hereto and incorporated herein.
Contractor shall not harass or annoy patients or payers in any correspondence or
telephone contacts seeking payment. Contractor shall exercise extreme sensitivity and
be courteous and professional in any communications with patients and payers.
3. TIME OF PERFORMANCE. This Agreement shall be effective for a one year period
with two one-year renewal options from the date first shown above under the terms and
conditions contained herein unless otherwise terminated. This Agreement will
automatically renew for two (2) additional one year periods under the then in force terms
and conditions unless notified otherwise by the CITY within sixty (60) days of the
renewal date.
4. COMPENSATION AND METHOD OF PAYMENT.
Agreement Page 1 of 9
4.01 The CITY reserves the right to request changes in the services within the general
scope of the Agreement to be performed upon mutual agreement by the CITY and
CONTRACTOR that shall specify the change ordered and the adjustment of time and
compensation required therefore. The CITY reserves the right to challenge all or any
part of an invoice.
4.02 Any services added to the scope of this Agreement by a change order shall be
executed in compliance with all other applicable conditions of this Agreement. No claim
for additional compensation or extension of time shall be recognized unless contained in
the duly executed change order.
4.03 The CONTRACTOR shall be paid by the CITY a monthly amount representing fees
for the services provided computed as:
Seven percent (7%) of all monies collected by CONTRACTOR.
The Contractor and the CITY shall agree to increase fees if the United States Postal
Service increases postage, but only to cover additional postage costs. The fee increase
shall be determined on the current postage rate and the new rate increase by cents
value.
4.04 The CITY shall issue a check for the amount invoiced, within thirty (30) days of
receipt and acceptance of an accurate invoice. Contractor will resolve any
disputed amounts within 60 days from the date CITY gives notification.
4.05 CITY, should they elect to participate in any credit card acceptance program,
agrees to assume and be responsible for all costs associated with such program.
4.06 All other costs incurred by CONTRACTOR in the performance of services as
specified herein (including, but not limited to postage, materials, communications
and phone costs and other operating costs) shall be assumed by the
CONTRACTOR.
4.07 The CITY projects that the CONTRACTOR will collect $850,000 for EMS user fees
and $15,000 for paramedic membership fees, if, CONTRACTOR is unable to
collect projected fees CONTRACTOR shall provide to the CITY's designee a
detailed explanation and graphs showing the loss of collections.
5. COLLECTIONS AND DEPOSITS. The CONTRACTOR will collect and deposit
payments to bank institute predesignated by the CITY. If the City would like ADPI to
receive all payments and mailings, ADPI will establish a PO Box in Alameda, CA as the
"mail to" address. Daily ADPI will have a courier pickup all correspondence and
payments from the PO Box and deliver them to the Oakland office where a staff member
will sort the mail to payments and non -payments. All non -payments, such as return mail
or insurance information, will be given to the appropriate department for immediate
handling. All payments will be photo copied and then deposited directly into the City's
bank account. ADPI will only have deposit only access to the City's bank account. All
statements and control of this account will be managed and maintained by the City of
San Bernardino. On the same day of each deposit, ADPI will fax a copy of the deposit
slip notifying the City of the deposit and amount to reconcile with ADPI month end
Agreement Page 2 of 9
reports and bank statements. Along with the monthly reports, ADPI will include an
invoice for our fees based upon the net revenue of the previous month.
6. REPORTS. The CONTRACTOR shall provide the CITY with status reports as set
forth in Exhibit B and included in the Proposal. The CONTRACTOR shall also provide
changes to such reports and ad hoc report requests on a reasonable basis and as
mutually agreed. CONTRACTOR reserves the right to charge an additional fee for any
programming cost associated with ad hoc reports that would require more than a
reasonable amount of time to accomplish.
7. DATA TO BE FURNISHED BY CITY. The CITY will make available to the
CONTRACTOR, for use in performance of services under this Agreement, all available
reports, studies or any other materials in its possession that may be useful to the
CONTRACTOR. All material furnished by the CITY will not be disclosed to any party,
other than as required under the scope of the Agreement, without the CITY's prior
written approval.
8. INDEPENDENT CONTRACTOR. The CONTRACTOR is an independent contractor
and not an employee or agent of the CITY with the following exception:
To the extent necessary to fulfill its billing and collection efforts
under the Agreement, the CONTRACTOR is authorized to sign in an
administrative capacity for the CITY the following types of standard
forms and correspondences only: probate filings; letters to patients or
their representatives verifying that an account is paid in full; forms
verifying the tax-exempt status of the CITY; and insurance filings and
related forms. The CONTRACTOR has no authority to sign any
document that imposes any additional liability on the CITY. A copy of all
such documents signed by the CONTRACTOR in an administrative
capacity for the CITY shall be immediately sent to the CITY's
representative designated in Paragraph 17, Notices, herein.
The CONTRACTOR shall perform work tasks as directed by the Fire Chief or designee,
but for all intents and purposes, CONTRACTOR shall be an independent contractor and
not an agent or employee of the CITY.
In the performance of this Agreement and in hiring and recruitment of employees,
CONTRACTOR shall not discriminate on the basis of race, creed, color, religion, sex,
physical handicap, ethnic background or country of origin.
The CONTRACTOR shall retain full control over the employment, direction,
compensation and discharge of all persons assisting in the performance of service by
CONTRACTOR. The CONTRACTOR shall be fully responsible for all matters relating to
payment of employees, including compliance with Social Security, withholding tax and all
other laws and regulations governing such matters. The CONTRACTOR shall be
responsible for its own acts and those of its agents and employees during the term of
this Agreement.
CONTRACTOR shall not utilize subcontractors in the performance of this Agreement.
The use of subcontractors requires the prior approval of the CITY. Subcontractor shall
be defined as persons who perform billing and accounts receivable management
services substantially similar to those services performed by CONTRACTOR.
Agreement Page 3 of 9
9. INDEMNIFICATION. Both Parties shall indemnify and hold the other party harmless
from any and all claims, losses and causes of actions which may arise out of each
party's performance of this Agreement as a result of an act of negligence or intentional
acts, omissions, or wrongdoings of the parties including their employees, agents,
representatives, consultants, or subcontractors. The Wrongful Party shall pay all
reasonable claims and losses of any nature whatsoever in connection therewith and
shall pay all reasonable costs and judgments (including, but not limited to, attorneys'
fees and expenses incurred at the trial, administrative levels, or on appeal) that may
issue thereon. The above provisions shall survive the termination of this Agreement and
shall pertain to any occurrence during the term of this Agreement, even though the claim
may be made after the termination hereof.
Nothing contained herein is intended nor shall be construed to waive Either Parties
rights and immunities under the common law or applicable State Statutes, as amended
from time to time.
This contract shall not confer rights to third parties in any matters arising out of this
Agreement or any other contract and shall not be construed as consent by the parties to
be sued by third parties in any matter arising out of this Agreement or any other contract.
This contract shall not serve as a waiver of sovereign immunity to which sovereign
immunity may be applicable.
10. INSURANCE. Contractor shall procure and maintain for the duration of the
Agreement, insurance against claims for injuries to persons or damages to property,
which may arise from or in connection with the performance of the work hereunder by
the Contractor, his agents, representatives, employees, or subcontractors. The cost of
such insurance is the responsibility of the Contractor.
10.01 Minimum Limits of Insurance
Contractor shall maintain limits no less than:
a. General Liability: $1,000,000 Combined Single Limit for bodily injury and
property damage per occurrence with a $2,000,000 annual aggregate.
b. Automobile Liability: One Million ($1,000,000.00) Dollars combined single
limit per accident for bodily injury and property damage. (Non -owned, Hired Car).
C. Workers' Compensation Employers Liability: Insurance covering all
employees meeting Statutory Limits in compliance with the applicable state and
federal laws and Employee's Liability with a limit of $500,000 per accident,
$500,000 disease policy limit, $500,000 disease each employee. Waiver of
Subrogation in lieu of Additional Insured will suffice.
d. Professional Liability Insurance, including errors and omissions: for all services
provided under the terms of this agreement with minimum limits of One Million
($1,000,000.00) Dollars per occurrence; or claims made form with "tail coverage"
extending three (3) years beyond the term of the agreement. Proof of "tail
coverage" must be submitted with the invoice for final payment. In lieu of "tail
coverage", Contractor may submit annually to the CITY a current Certificate of
Agreement Page 4 of 9
Insurance proving claims made insurance remains in force throughout the same
three (3) -year periods.
e. Umbrella: $2,000,000 combined single limit for bodily injury and property
damage combined per occurrence and annual aggregate. The coverage shall
provide excess coverage for employer's liability, general liability, including
completed operations and auto liability.
f. Crime Policy: Contractor shall provide a Crime Policy in the amount of
$500,000. Coverage to be provided shall include: Theft — Per Loss Coverage;
Forgery or Alteration; Inside the Premises — Theft of Money and Securities;
Inside the Premises — Robbery or Safe Burglary of Other Property; Outside the
Premises; Computer Fraud; Funds Transfer Fraud; and Money Orders and
Counterfeit Paper Currency.
10.02. Deductibles and Self -Insured Retentions
Deductibles or self-insurance shall be maintained in amounts or at levels which are
customary for the size, profile and industry in which CONTRACTOR is employed. No
decreases in coverage can occur without the approval of the CITY.
10.03. Other Insurance Provisions
The policies are to contain, or be endorsed to contain, the following provisions:
a. General Liability and Automobile Liability Coverage (CITY is to be named as
Additional Insured).
1. The CITY, its officers, officials, employees and volunteers are to be
covered as additional insured as respects; liability arising out of activities
performed by or on behalf of the Contractor, including the insured general
supervision of the Contractor; products and completed operations of the
Contractor; premises owned, occupied or used by the Contractor; or
automobiles owned, leased, hired or borrowed by the Contractor. The
coverage shall contain no special limitations on the scope of protections
afforded the CITY, its officers, officials, employees or volunteers.
2. The Contractor's insurance coverage shall be primary insurance as
respects the CITY, it officers, officials, employees and volunteers. Any
insurance of self-insurance maintained by the CITY, its officers, officials,
employees or volunteers shall be excess of the Contractor's insurance
and shall not contribute with it. Contractor hereby waives subrogation
rights for loss or damage against the CITY.
3. Any failure to comply with reporting provisions of the policies shall not
affect coverage provided to the CITY, its officers, officials, employees or
volunteers.
4. The Contractor's insurance shall apply separately to each insured
against whom a claim is made or suit is brought, except with respect to
the limits of the insurer's liability.
5. Companies issuing the insurance policy, or policies, shall have no
recourse against the CITY for payment of premiums or assessments for
any deductibles with are all at the sole responsibility and risk of
Contractor.
b. All Coverage
Each insurance policy required by this clause shall be endorsed to state
that coverage shall not be suspended, voided, canceled by either party,
Agreement Page 5 of 9
reduced in coverage or in limits except after thirty (30) days prior written
notice by certified mail, return receipt requested, has been given to the
CITY.
10.04. Acceptability of Insurers
Insurance is to be placed with insurers with a Best rating of no less than A: VII.
10.05. Verification of Coverage
Contractor shall furnish the CITY with certificates of insurance and with original
endorsements effecting coverage required by this clause. The certificates and
endorsements for each insurance policy are to be signed by a person authorized by that
insurer to bind coverage on its behalf. All certificates and endorsements are to be
received and approved by the CITY before work commences. The CITY reserves the
right to require complete, certified copies of all required insurance policies at any time.
11. OWNERSHIP OF DOCUMENTS. CONTRACTOR shall be required to work in
harmony with other consultants relative to providing information requested in a timely
manner and in the specified form. The CONTRACTOR agrees that any and all
documents, records, disks, and electronic data produced in the performance of this
Agreement shall be the sole property of the CITY, including all rights therein of whatever
kind except as may otherwise be provided hereinafter. Failure to turn over such
documents within thirty (30) days of a written request by CITY may be cause for the
CITY to withhold payments due CONTRACTOR or to enforce this clause by legal
remedies.
12. ATTACHMENTS. The following named attachments are made an integral part of this
Agreement:
A. Business Associate Addendum (Exhibit A attached hereto and made a part hereof)
B. Scope of Work (Exhibit B attached hereto and made a part hereof)
C. Allied Information R Services Corp. Proposal in Response to RFQ F-05-008 EMS Billing
Services, dated May 2004 (Exhibit C attached hereto and made a part hereof)
13. TERMINATION. During the time of this agreement either party may terminate this
Agreement either for convenience or for default after first giving to other party thirty (30)
days written notice.
For cases of default, the CONTRACTOR shall be given opportunity to cure the default
within the thirty (30) day period following such written notice. In the event the acts
constituting default are a violation of law, CONTRACTOR shall be subject to immediate
termination of Agreement.
Upon termination for any cause, the CONTRACTOR shall submit an invoice(s) to the
CITY in an amount(s) representing fees for services actually performed or obligations
incurred to the date of effective termination for which the CONTRACTOR has not been
previously compensated. Upon payment of all sums found due, the CITY shall be under
no further obligation to the CONTRACTOR, financial or otherwise.
For purposes of this section, the notice period begins when the CONTRACTOR receives
written notice from the CITY.
Agreement Page 6 of 9
14. UNCONTROLLABLE FORCES. Neither the CITY nor CONTRACTOR shall be
considered to be in default of this Agreement if delays in or failure of performance shall
be due to Uncontrollable Forces, the effect of which, by the exercise of reasonable
diligence, the non -performing party could not avoid. The term "Uncontrollable Forces"
shall mean any event which results in the prevention or delay of performance by a party
of its obligations under this Agreement and which is beyond the reasonable control of
the non -performing party. It includes, but is not limited to fire, flood, earthquakes, storms,
lightning, epidemic, war, riot, civil disturbance, sabotage, terrorism and governmental
actions.
Neither party shall, however, be excused from performance if non-performance is due to
forces that are preventable, removable, or remediable nor which the non -performing
party could have, with the exercise of reasonable diligence, prevented, removed, or
remedied with reasonable dispatch. The non -performing party shall, within a reasonable
time of being prevented or delayed from performance by an uncontrollable force, give
written notice to the other party describing the circumstances and uncontrollable forces
preventing continued performance of the obligations of this Agreement.
15. JURISDICTION, VENUE and CHOICE OF LAW. All questions pertaining to the
validity and interpretations of this Agreement shall be determined in accordance with the
laws of the State of California. Any legal action by either party against the other
concerning this agreement shall be filed in City of San Bernardino, California, which shall
be deemed proper jurisdiction and venue for the action.
16. ASSIGNMENT OF AGREEMENT. Except to a parent, subsidiary, or affiliate, the
CONTRACTOR shall not sell, transfer, assign or otherwise dispose of this Agreement or
any part thereof or work provided therein, or of its right, title or interest therein, unless
otherwise provided in the Agreement, without express prior consent by the CITY.
17. NOTICES. All notices pertaining to this Agreement shall be delivered or mailed, with
the United States Postal Service, Postage Pre -paid, to such party at their respective
address as follows:
To the CITY:
Larry Pitzer, Fire Chief
City of San Bernardino Fire Department
200 East Third Street
San Bernardino CA 92410
(909) 384-5286
To the CONTRACTOR:
Don Passaro
Vice President
Advanced Data Processing, Inc.
7750 Pardee Lane, Suite 200
Oakland, California 94621
(510) 769-9648
Agreement Page 7 of 9
18. REPRESENTATION AND WARRANTY. CONTRACTOR represents that they have
experience and agrees to follow all Federal, State and Local Laws including, but not limited
to, Public Records laws and those laws and statutes applicable to discrimination.
19. INTEREST OF CONTRACTOR. It is agreed that the CONTRACTOR presently has no
interest and shall not acquire any interest, direct or indirect, which would conflict in any
manner or degree with the performance of the CONTRACTOR'S services under this
Agreement. It is further agreed that in the performance of this Agreement the
CONTRACTOR shall employ no person having any such interest.
20. SEVERABILITY. Should any part, term or provision of this Agreement be by the courts
decided to be illegal or in conflict with any law of the State of California, the validity of the
remaining portions or provisions shall not be affected thereby.
21. Any other language in this Agreement notwithstanding, if the patient/payer is a resident of
the City of San Bernardino and does not have insurance coverage, CONTRACTOR shall not
seek payment from the patient/payer after the initial billing. Likewise, if patient/payer is a
resident of the City of San Bernardino and has Medicare or Medicaid coverage,
CONTRACTOR shall not seek payment from the patient/payer after the initial billing.
22. ENTIRE AGREEMENT. This Agreement contains the entire agreement between the
parties. The CONTRACTOR represents that in entering into this Agreement it has not relied
on any previous oral and/or implied representations, inducements or understandings of any
kind or nature.
Agreement Page 8 of 9
IN WITNESS OF THE FOREGOING, the CITY has caused this Agreement to be
signed by the Mayor, attested by the CITY Clerk, and the Contractor has executed this
Agreement effective as of the date set forth above.
CITY OF SAN BERNARDINO, CALIFORNIA
Date: 0 CIZ6 0?- i l, 20011
ATTEST:
l Q - Ua'tJL (SEAL)
Rachel Clark, City Clerk
Approved as to form:
And legal content:
James F. Penman
City Attorney
By: o
by:
CONTRACTOR: ADPI Wer� Zwc.
,Advance b eeseing,-Inc.
,pKi
U SHAMON
PRESIDENT
BEFORE ME, an officer duly authorized by law to administer oaths and take
acknowledgments, personally appeared Doug Shamon, as President of Advaaneed AD/I (0054, lac.
., a Delaware corporation, and acknowledged execution of the
foregoing Agreement for the use and purposes mentioned in it and that the instrument
is the act and deed of the Contractor.
IN WITNESS OF THE FOREGOING, I �I),?ave set my hand and official seal at in
the State and County aforesaid on �VEMl�CC / .2004.
Notary Publ
•cn }J:f4t
JFiJ4 ,G4 I i
StT4 �LCQ I rtL�
Agreement Page 9 of 9
Exhibit A
A991 w4141.nc Business Associate Addendum
the "Business Associate" (hereinafter referred to
as "ADPI") and City of San Bernardino (hereinafter referred to as City of San Bernardino)
hereby amend the Agreement entered into on October 18 , 2004, ("the Agreement")
by adding the following additional language to the Agreement.
ADPI shall carry out its obligations under this Addendum 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, Sections 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 Billing Services
provided hereunder. In conformity therewith, ADPI agrees that it will:
a. Not use or further disclose PHI except as permitted under this Addendum or
required by law;
b. Use appropriate safeguards to prevent use or disclosure of PHI except as
permitted by this Addendum;
c. To mitigate, to the extent practicable, any harmful effect that is known to ADPI of
a use or disclosure of PHI by ADPI in violation of this Addendum.
d. Report to City of San Bernardino any use or disclosure of PHI not provided for by
this Addendum of which ADPI becomes aware;
e. Ensure that any agents or subcontractors to whom ADPI provides PHI, or who
have access to PHI, agree to the same restrictions and conditions that apply to
ADPI with respect to such PHI;
f. Make PHI available to City of San Bernardino and to the individual who has a
right of access as required under HIPAA within 30 days of the request by City of
San Bernardino regarding the individual;
g. Incorporate any amendments to PHI when notified to do so by City of San
Bernardino;
h. Provide an accounting of all uses or disclosures of PHI made by ADPI as
required under the HIPAA privacy rule within sixty (60) days;
i. Make their 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 ADPI's and City of San
Bernardino's compliance with HIPAA; and
At the termination of the Agreement, return or destroy all PHI received from, or
created or received by ADPI on behalf of City of San Bernardino, and if return is
infeasible, the protections of this Addendum will extend to such PHI.
Exhibit A Page 1 of 2
2. The specific uses and disclosures of PHI that may be made by ADPI on behalf of
City of San Bernardino include:
a. The preparation of invoices to patients, carriers, insurers and others responsible
for payment or reimbursement of the services provided by City of San Bernardino
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 City of San
Bernardino to its patients or to appeal denials of payment for same.
d. Uses required for the proper management of ADPI as business associate.
e. Other uses or disclosures of PHI as permitted by the HIPAA privacy rule.
3. Notwithstanding any other provisions of this Addendum, the Agreement may be
terminated by City of San Bernardino if ADPI has violated a term or provision of
this Addendum pertaining to ADPI's material obligations under the HIPAA privacy
rule, or if ADPI engages in conduct which would, if committed by City of San
Bernardino, result in a violation of the HIPAA privacy rule by City of San
Bernardino.
Exhibit A Page 2 of 2
Exhibit B: Scope of Services
Contractor shall provide complete medical billing and accounts receivable management
services for CITY's first responder, paramedic, and membership program fees in
accordance with the responsibilities outlined below.
Contractor's Responsibilities:
Contractor will provide timely and accurate billing services for emergency medical
treatment utilizing information provided by CITY and information obtained from other
reliable sources including:
All services will be provided as stated in the Proposal. The following is a summary of these
responsibilities:
Provide billing and accounts receivable management services to CITY for first
responder, paramedic, and membership program fees as described in Attachment 1
and incorporated herein as required on a case -by -case basis.
2. CONTRACTOR will maintain current membership roster for the Paramedic
Membership Program. The CONTRACTOR will bill for and maintain any new
Membership Program the CITY may develop as well as renewal notices.
3. Ensure that all required documentation and agreements with payors (e.g. Medicare,
Medicaid, Champus, etc.) are filed and maintained and that the CITY is kept apprised
of important changes to industry regulations.
4. Ensure knowledge of different industry insurance plans and will ensure that every
billable claim is pursued.
5. Provide reasonably necessary training periodically, as requested by CITY, to CITY's
EMS and/or CITY FIRE RESCUE PARAMEDICS personnel regarding the gathering
of the necessary information and proper completion of run tickets. .
6. Provide prompt submission of Medicare, Medicaid and insurance claims after
receiving completed run ticket and corresponding insurance claim information.
Secondary insurance provider claims shall be submitted after the primary insurance
provider has paid.
7. Provide follow-up on rejected and inactive claims.
8. Utilize most up-to-date knowledge and information with regard to coding
requirements and standards, to ensure compliance with applicable Federal, State
and local regulations.
9. Reconcile the number of transports processed with those received.
10. Provide a designated liaison for patient/payor concerns.
11. Provide all customer -related inquiry services and prepare additional third -party claims
or patient payment arrangements based on this information exchange.
12. Provide a toll free telephone number for patients to be answered as designated by
the CITY.
Exhibit B
Page 1 of 5
13. Facilitate proper security of confidential information and proper shredding of all
disposed materials containing such information.
14. Establish arrangements with hospitals to obtain/verify patient insurance and contact
information.
15. Respond to any CITY or patient inquiry or questions promptly
16. Maintain appropriate accounting procedures for reconciling all deposits, receivables,
billings, patient accounts, adjustments and refunds.
17. Provide access to CITY for all requested information in order for CITY to perform
appropriate and periodic audits. Reasonable notice will be given to CONTRACTOR
for any planned audit and will be conducted during normal business hours of
CONTRACTOR
18. Provide timely comprehensive reports facilitating all required aspects of monitoring,
evaluating, auditing and managing the services provided. Process refund requests
and provide the CITY with documentation substantiating each refund requested.
19. Provide CITY all unpaid invoices along with the complete processing history once
collection efforts are exhausted.
Specific Scope Compliance
The CONTRACTOR will provide the specific services:
1. Assign billing patient numbers providing cross-reference to the CITY'S assigned transport
numbers.
2. Maintain responsibility for obtaining missing or incomplete insurance information.
3. Provide accurate coding of medical claims.
4. Make recommendations for fee schedule changes. regularly advise on changes in
statutes and industry regulations.
5. Respond to all patients' requests and inquiries, either written or verbal.
6. Initial invoices will be mailed out within 2 days of receipt of paramedic run tickets. The
following billing cycle will be followed:
Self Pay Cycle:
Initial Invoice
2 days
Second Notice
30 days
Telephone Contact
45 days
First Letter Contact
60 days
Second Letter Contract/
90 days
Second Telephone Contact
Third Letter Contact
120 days
Delinquent Audit/Phone Audit
135 days
Final Demand Notice
150 days
Refer to City Policy
180 days
Exhibit B Page 2 of 5
Insurance Accounts Cycle:
Initial Invoice 2 days
First Follow Up 30 days
Continued Follow Ups 30 days (every)
Special Accounts Cycle:
Installment Follow Up 30 days
Lien/Bankruptcy Follow Up 60 days (every)
Special Program Follow UP 60 days (every
Returned Mail Cycle:
Skip Search Request Hospital Assistance
Billing cycles will be reset upon billing a different payor.
All follow-up work required in order to collect insurance payments, including additional
correspondence and telephone calls, will be performed by the CONTRACTOR and
logged automatically in the patient's ledger.
CONTRACTOR will submit to the CITY documentation of each time they work an
account, whether it is a phone call or correspondence with the patient or insurance
company. A notation will be made on the patient's record of the date and information
learned from the contact person. Information such as mail returned or phone
disconnected, etc., will also be recorded. The CONTRACTOR has a message box on
their statements where the patient will be informed he/she is delinquent, and if no
response, a deadline before collection and then a final demand all in the time frame or
cycles previously defined.
Cash accounts (Self -pay) over 180 days delinquent will be referred to the CITY along
with above documentation of contact and recommendation made for turnover to
collection agency or recommendation for write-off.
A. CONTRACTOR will provide two separate reports to the CITY, one for those
recommended for collection and the other for recommended write-offs. These
reports to be generated twice a month.
B. Both reports will include all information regarding the patient: name, date of service,
employer, reason why account is uncollectible, proof and dates of the
CONTRACTOR's attempts to collect on the account. Upon approval and direction by
the CITY, the CONTRACTOR will reference in billing history the date account is
written -off and reference collection agency assigned to account. The
CONTRACTOR will then return to the CITY accounts to be assigned to outside
collection agency.
7. Negotiate and arrange modified payment schedules for individuals unable to pay full
amount when billed.
8. Retain all accounts for a minimum of six (6) months (unless otherwise specified by
mutual agreement) turning over accounts for which no collection has been made (unless
insurance payment is pending or modified schedules are arranged and show payment
progress).
9. Maintain records in an electronic format that is readily accessible by the CITY personnel
and meets all federal and state requirements for maintaining patient medical records.
Page 3 of 5
10. Maintain daily deposit control sheets and original documentation.
11. CONTRACTOR shall be capable to receive and send data compatible with Healthware
Solutions field data system billing extract software. CONTRACTOR shall be able to
interface or have a link that is capable of downloading or uploading information from the
City's data collection server.
12. Implement and comply with a Compliance Plan consistent with the intent and activities
included in the U.S. Office of Inspector General (OIG) Compliance Program Guidance for
Third Party Medical Billing Companies 63 FIR 70138; (December 18, 1998).
Exhibit B Page 4 of 5
CITrs Responsibilities;
1. CITY will provide Contractor with patient encounter information on a timely
basis and in sufficient detail to support diagnosis and procedure coding.
CITY will also provide patient demographic information necessary for
accurate patient identification including name, address, social security
number, date of birth, and telephone number. Where possible, CITY will
obtain and provide contractor with patient health insurance, auto insurance,
or other insurance information.
2. CITY will provide Contractor with necessary documents required by third
parties to allow for the electronic filing of claims by Contractor on CITY's
behalf.
3. CITY will provide Contractor with its approved billing policies and procedures
including fee schedules and collection protocols. CITY will be responsible for
engaging any third party collection service for uncollectible accounts after
Contractor has exhausted its collection efforts.
4. CITY will timely process refunds identified by Contractor for account
overpayments.
5. CITY will cooperate with Contractor in all matters to ensure proper
compliance with laws and regulations.
Exhibit B Page 5 of 5
EXHIBIT C
Our Job Is To Manage
A Complete Revenue Recovery
For You
PROPOSAL IN RESPONSE TO RFQ F-05-08
EMS BILLING SERVICES
CITY OF SAN BERNARDINO
O PY
EMERGENCY
MEDICAL SERVICES
REVENUE RECOVERY
Submitted by
ALLIED INFORMATION & SERVICES CORP.
May, 2004
May 20, 2004
INFORMATION 8SERVICES City of San Bernardino
N
I o R R 300 N. "D" Street, 0 Floor
San Bernardino, CA 92418
RE: RFQ F-05-08
EMS BILLING SERVICES
Allied Information & Services Corp. (AIS) is pleased to submit the enclosed proposal in
response to the RFQ for EMS Billing Services for the San Bernardino Fire Department.
Our response will demonstrate that AIS has the expertise, experience and resources needed
to work with City to meet and exceed all expectations of revenue and customer service.
our 15 years of exclusively working with Municipal Fire and Finance agencies
ALLIED INFORMATION
.Through
throughout CAliforna with transport and non -transport agencies, AIS has become a
& SERVICES CORP.
recognized leader in the Fire/EMS reimbursement industry. Our recognition comes from
T 50 PARDEE LANE
going beyond the normal scope of service for billing while at the same time implementing
SUITE200
procedures that have resulted in the net revenue increase for each of our clients. Our
OAKLAND, CA U621
recognition and success truly demonstrates the quality and dedication of our staff and
PH 510169.9648
PH 800.700.9648
Services.
FX 510.769.9819
EMS @ AISMED.COM
AIS will be able to immediately implement our services for the San Bernardino Fire
Department. Upon award of the contract, AIS will schedule an in -person implementation
meeting with all necessary Departments of the City at the City's earliest convenience. In
less then 5 days after this meeting, AIS guarantees we will be able to deliver every aspect,
of services proposed.
Fire(EMS today requires more than just a billing service. AIS is confident that our
services and expertise will assist the San Bernardino Fire Department in providing a
comprehensive reimbursement solution. We invite you to contact our references to hear
from them of our dedication and services. AIS welcomes the opportunity to enter into an
agreement and invite you to conduct a site visit at our office at the City's convenience or
an interview to discuss our experience and services in person.
:nt / CEO
Information & Services Corp.
AIS, the compete EMS reimbursement solution!"
Allied Information & Services
Corporation
EMS Billing Services
RFQ F-05-08
TABLE OF CONTENTS
1. PRESENTATION
2
2. EXCEPTIONS / DEVIATIONS
3
3. FIRM CAPABILITIES
A. CUSTOMER SERVICE
6
B. BILLING SERVICE
10
C. REPORTING
17
4. QUALIFICATIONS
A. EXPERIENCE
19
B. REFERENCES
20
EXHIBIT I — CLIENT LETTERS i
EXHIBIT II — SAMPLE REPORTS
EXHIBIT III - PRICE FORM
EXHIBIT IV — NON -COLLUSION AFFIDAVIT iv
Submitted by:
ALLIED INFORMATION & SERVICES CORP.
7750 PARDEE LANE #200
OAKLAND, CA 94621
(800)901-9122
City of San Bernardino Page 1 of 21
Allied Information B Services
Corporation
EMS Billing Services
RFQ F-05-08
PRESENTATION
A. Allied Information & Services Corp
7750 Pardee Lane Suite 200
Oakland, CA 94621
(800)901-9122
B. AIS will perform all work necessary for this project in-house and will not use any
subcontractors to perform our responsibilities to achieve the scope of services for the City
of San Bernardino.
C. AIS acknowledges receipt of Addendum #1 to RFQ F-05-008.
D. Dan Kehoe, Account Manager
7750 Pardee Lane Suite 200
Oakland, CA 94621
(800)901-9122
E. The bid submitted by AIS shall remain valid for a period of not less than 90 days from the
date of submittal.
F. The person signing this page is authorized to legally bind Allied Information & Services
Corp. to the terms of the bid.
Allied Information & Services Corp.
City of San Bernardino Page 2 of 21
Allied Information & Services EMS Billing Services
Corporation PFQ F-05-08
2. EXCEPTIONS / DEVIATIONS
"CONTRACUAL"EXCEPTIONS
1. RECEIPT OF FUNDS
AIS would like to propose, as an option to the City for receiving funds, that AIS will make same
day direct deposit into a City owned and complete controlled bank account. AIS will maintain
deposit only access to a City account and upon the same day of receiving any payments for the City
of San Bernardino, AIS will make same day deposit to the City's account, notify the City of deposit
and post all payments to the appropriate account.
2. COLLECTION TIMEFRAME
AIS would like to propose an alternative collection schedule with a detailed clarification. AIS
propose as an option to the City, an extended timeframe as listed below. Included is a chart
demonstrating the advantage of an extended timeframe.
DAY 30
19T FOLLOW UP
LVERY SO DAY.
FOLLOW -OP
RPCRI
PCR OR BLBCIRtOMC DATA
DAYI
HP RVIEW ItTB
DIAON01;= CODD10
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DAY 3
L39DICAL C`0 9 09
BRIAR .
CONPRNATgN
DAY
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96P MY
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DAY 30
3ND RIVOICE
DA
T61.9PHON. C CON SACT
DAY b0
191LBTfPA COMACT
DAY PO
3ND L6T RCOMACT
SND PSIONE CONTACT
3R L.TTRR LONTAL
DAV 131
. .DIQUENTAUDIT
PHON9 AUDIT
.1.0
PENAL D.MAND
X.I.
DAY 190
R.PERTO
CITY POLICY
=�71®
WSTALLh . SKIP SBMCH
FOLLOW VP REQmssr" 09PITAL
9 FOLV D AST
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City of San Bernardino Page 3 of 21
Allied Information & Services EMS Billing Services
Corporation RFQ F-05-08
AIS utilizes a logical billing cycle, custom -designed for each of our clients. Over our fifteen years
of experience in working with Municipal Fire and EMS Agencies, we've developed the above
billing cycle that generates the best result in revenue maximization. The billing cycle can be
modified to meet any specific needs and requirements of the City of San Bernardino, including
reducing the time frame.
The successful process begins the same day AIS receives the PCRs from the Fire Department
Day 1: Assign appropriate ICD9CM codes to depict the patient's medical condition
accurately.
Day 1: System Testing — Once all data available is electronically entered into AIS' system,
each data field is tested to insure accuracy of information. This entails spell checking on
common name, address, zip codes, and medical coverage ID format.
Day 1: System assigns financial class (Insurance, Self -pay, Program Membership etc) and
the appropriate pricing from the established "Charge Master".
Day 2: Initial follow-up on billing information and medical coverage.
Day 2: Confirm medical coverage eligibility with third -party payers.
Day 2: Produce itemized billing invoices claims and submit claims electronically via
modem.
Our billing cycle for the City of San Bernardino includes (but not limited to):
• Initial notices sent within two (2) days of receipt of the PCR data.
• Accurate diagnostic coding and pricing.
• Second Invoice within thirty (30) days of receipt of PCR data.
• Initial telephone contact within forty five (45) days of receipt of PCR data.
• Electronic eligibility and claim submission when available.
• Persistent follow-up on all third party payers.
• Persistent and sensitive follow-up on all Self Pay Accounts. Including, but not limited
to; two (2) initial invoices, three (3) follow-up letters and three (3) telephone contacts.
• Extensive search on accounts with insufficient information and return mail.
• Claim submittal to third party payers within two (2) business days of notification and
authorization from patient.
• Balance billing within two (2) business days of initial payment.
• Re -submittal and appeals process for all third party claims from third party payers.
AIS understands the sensitivity of public debts and recommends a 180-day billing cycle that allows
those patients that require the extra time to recover from the medical trauma before taking care of
their financial responsibilities. The billing time -line also allows seniors and disabled persons to
seek assistance for their financial affairs. Contrary to those EMS billing providers that use "hard-
core" collection approach, AIS' approach is sensitive and responsible to the public and has been
proven to be extremely beneficial.
The charts below demonstrate the additional revenue available through the proposed extended
timeframe. The time schedule and revenue collected are actual numbers from two current
Municipal Clients of AIS'. The Chart shows an additional 41.6% of revenue collected beyond 90
days for Provider A from accounts in November 2003. Provider B, for the same time period,
received 29.8% of their revenue beyond 90 days.
City of San Bernardino Page 4 of 21
Allied Information & Services
Corporation
EMS Billing Services
PFQ F-05-08
EMS Provider A
Actual Revenue Distribution by
Account Month
Total %
Revenue
Beyond
beyond
Feb-
Jan-
Dec-
90
Collected
04
04
03
Nov-03
Oct-03
Sep-03
Aug-03
Jul-03
Jun-03
May-03
Apr-03
Apr-03
days
Nov-03
$
0
989
91,933
27,342
18,815
5.394
5.537
4.751
4.282
$159,043
%
0.0
0.6
57.8
17.2
11.8
3.4
3.5
3.0
2.7
41A
Dec-03
$
0
34,914
117,283
35,116
26,055
7,906
4,139
3,503
2,068
6,546
$237,529
%
0.0
14.7
49A
14.8
11.0
3.3
1.7
1.5
0.9
2.8
36.9
Jan-04
$
0
22,691
76,072
37,395
15,322
10,831
1,475
2,415
1,079
1.535
3,646
$172,460
%
0.0
13.2
44.1
21.7
8.9
6.3
02
1.4
0.6
0.9
2.1
42.7
Feb-04
$
0
9.194
91,132
37,991
21,652
8,092
4,618
2.213
2,810
682
682
4,411
$183.477
%
0.0
5.0
49.7
20.7
11.8
4.4
2.5
12
1.5
0.4
0.4
2.4
46.8
EMS Provider B
Actual Revenue Distribution by
Account Month
Total %
Revenue
Beyond
beyond
Feb-
Jan-
Dec-
90
Collected
04
04
03
Nov-03
Oct-03
Sep-03
Aug-03
Jul-03
Jun-03
Ma -03
Apr-03
Apr-03
days
Nov-03
$
0
34,465
48,743
15,918
3,541
6,442
1,017
3,588
4,853
$118,567
%
0.0
29.1
41.1
13A
3.0
5.4
0.9
3.0
4.1
29.8
Dec-03
$
0
28,833
33,822
14,562
4,830
3,852
1,222
1.243
827
2,124
$91,316
%
0.0
31.6
37.0
15.9
5.3
42
1.3
1.4
0.9
2.3
31A
Jan-04
$
0
13.311
36,773
13,449
8,151
1,845
597
267
78
286
2,741
$77,497
%
0.0
17.2
47.5
17.4
10.5
2A
0.8
0.3
0.1
0.4
3.5
35A
Feb-04
$
0
1,297
64,609
13,333
9,339
3,028
1,890
722
82
562
1,399
1,049
$97,309
%
0.0
1.3
66A
13.7
9.6
3.1
1.9
0.7
0.1
0.6
1.4
1.1
97_3
City of San Bernardino Page 5 of 21
Allied Information & Services EMS Billing Services
Corporation RFQ F-05-08
3. FIRM CAPABILITIES
A. CUSTOMER SERVICE
Our customer services are tailored to meet the individual needs and requests of our clients. AIS is
committed to maintaining a high standard of quality customer service.
A.1 PATIENT RELATIONS
AIS provides nationwide toll free "800" numbers designated for the City's patients. The toll free
numbers have a "rolling" feature that allows calls to be answered by any available Account
Representative. The phone numbers are printed on all correspondence along with a unique account
number for each transport. The patients' records are available on-line for real time access and
updating information to our system. The patient's records can be accessed by authorized personnel
using various searches, including but not limited to account number, name, first three letters of
name, date of service, social security number, phone number and date of birth. Our on-line feature
provides up-to-the-minute account information, such as billing and payment history as well as the
medical treatments by the paramedics. All patient contacts and phone conversations are recorded on
the patients' history file. The system electronically time -stamps the contact history with the
Representative's initials. This provides an audit trail and quality control on how a patient's account
was being handled.
Our customer service representatives are trained to be knowledgeable of the patients' needs. Our
staff helps the patients in all aspects of clearing their accounts. For example, we will direct self -pay
patients to available sources of payment, such as auto insurance's medical payment provision, if
City of San Bernardino Page 6 of 21
Allied Information & Services EMS Billing Services
Corporation RFQ F-05-08
applicable. We also help the patients in developing payment plans that fit the patients' financial
capabilities.
In all cases. we exercise extreme sensitivity toward the patients. This sensitivity is tempered with
firmness. The goal of AIS is to approach the patient with a solution rather than using hardcore
collection approaches. Our customer service to patients is tailored to the philosophy of the City of
San Bernardino. We are courteous, positive, professional and helpful to all patients. Our staff is
trained in proper telephone protocols that are customer -service oriented and the legal importance of
confidentiality of patient information. Our bilingual staff is fluent in English, Spanish, Chinese.
Tagalog, and other common second languages. AIS is also a member of Language Line, an
interpretation and translation service with more than 140 languages available to guarantee almost
100% communication regardless of the patients' foreign language. In today's diverse world, proper
communication is more important now than ever before.
A.1.1 SPECIAL ACCOUNTS HANDLING AND SERVICES
Paramedic Membership Program — When a patient is identified as a member of the City's
Membership Program the account will be handled specifically according to the policy of the City.
AIS will be able to include all members into our proprietary software to guarantee 100%
membership program compliance.
AIS has the experience and capability to maintain the Paramedic Membership Program. AIS will
assume the responsibility of new membership subscriptions and maintaining the City Membership
Program including annually assisting / billing members to renew their membership. Upon
completion of the annual renewal process, AIS will forward a detailed report informing the City of
the current membership.
Installments - When it is necessary for the patients to settle their accounts by installments, our
Account Representatives can set up firm plans and agreements with the patients. The agreements
include, per the City's guidelines, the amount of each installment, the number of payments, and the
date that payments are due. The patient will receive a written confirmation and a set of installment
coupons for sending in the payments. This information will be updated in our system to track the
account status. Every thirty days, the installment accounts will be reviewed to insure that
installment promises are kept. When necessary, follow-up telephone calls on late payments are
made to remind the patients of their obligation.
Workers' Compensation Insurance - For accounts that involve work -related illness or injury, our
Account Representatives will work with the patients, their employers, and their insurance carriers to
resolve all Workers' Compensation Insurance issues. The claims will be processed on HCFA 1500
claim forms or via electronic media to the appropriate carriers. Follow-up on these accounts will be
made every thirty days until the accounts are paid.
Automobile Accident Irctims - Patients injured as a result of an automobile accident are often
involved with litigation. These claims are usually paid when the lawsuits are settled. Our
experienced account representatives will file a claim with the auto insurance carrier under the
medical payment provision. This method will avoid waiting for the payment from a settlement that
may take years to resolve.
Liens, Court Subpoenas. and Bankruptcy Filings - If a patient is represented by an attorney in
pursuing a case settlement, AIS will file a lien with the attorney on behalf of the City under the
City of San Bernardino Page 7 of 21
Allied Information & Services EMS Billing Services
Corporation RFQ F-05-08
guidelines provided by the City of San Bernardino. AIS will cooperate and provide all billing
documentation and medical records to the court according to the instructions of the court subpoena
and the applicable laws. If the City retains the custodianship of medical records for its patients, all
subpoenas for medical records are referred to contact the Medical Record Division. When AIS is
informed of the bankruptcy status of an account, our Account Representatives will file a claim with
the bankruptcy court under the guidelines of the bankruptcy court proceeding. These claims are
followed up on a regular basis until payment or settlement is obtained.
At any review point, if an account is no longer qualified in one of the above special groups, the
account will be converted to self -pay status. Payment will be pursued from the patient.
Disputed Claims - If, for any reason, a patient disputes the validity of an account, our Account
Representatives will provide explanations and justifications to validate the account. Our
management and staff are trained to handle all complaints and disagreements effectively and
diplomatically. Ninety-nine percent (99%) of the time, patients are happy and satisfied with the
resolution and arrange payments for the service.
When disputes have any potential public relations impact, our management will involve the City
and work with the public and with the media, when appropriate, to arrange a mutually satisfactory
solution.
When the complaint involves the quality of medical care or services, we will promptly refer the
matter to the Department for review.
A.2 DIRECT PERSONALIZED MANAGEMENT
An Account Manager and a Project Manager will be assigned and dedicated to this project. The
Managers oversee and manage the entire operation to ensure AIS achieves our goals of maximizing
revenue and service delivery excellence. They are committed to exceed the goals and expectations
of the City of San Bernardino and to maintain open communication between AIS and the City of
San Bernardino.
The Manger's Objectives are:
• To ensure the routine project functions are performed in a timely manner.
• To ensure the project team is staffed with experienced and well -qualified personnel.
• To introduce new procedures to the system to enhance revenue.
• To resolve operational and public relations issues.
• To provide all necessary training for in-house staff and any City officials and staff.
• To initiate special projects for on -demand services.
• To maintain constant open communication and understanding between all Departments of
the City and AIS.
• Provide all Monthly, Quarterly, Annual and Ad -Hoc reports requested and required by the
San Bernardino Fire Department.
AIS will work with the City in making recommendations to improve the data collection and billing
processes on a continual basis. When there are issues that require immediate attention and
regulatory changes that have impact, AIS will inform the City and make recommendations upon
request.
City of San Bernardino Page 8 of 21
Allied Information & Services EMS Billing Services
Corporation RFQ F-05-08
Account Manager — Dan Kehoe
Dan has an extensive background in the healthcare industry including an active membership with
the California Medical Billing Association. He has specialized in customer service and account
management for over 13 years and has been dedicated to exceeding his client's expectations while
providing superior customer service and support. Dan has a Bachelor of Science Degree in
Business Administration from St. Mary's College of California. Since joining AIS five years ago,
he has successfully implemented our services with several agencies with no interruption of service,
while achieving an increase to their revenue. In Dan's career in EMS billing and collections, he has
been asked to provide consultation and assistance to Fire Agencies related to start-up transportation
services, revenue projections, modifications and justification of fee schedules and compliance
issues. In this project, he will manage the implementation, training and customer service to ensure
AIS achieves our goals of providing personal and professional customer service to the City, to its
patients and community. He will meet with the Fire Department and the City's administration on a
routine basis to provide information on the project's status and progress and will work with the
Department on special requests, on -demand reports and any training deemed necessary for the
success of the project. Dan will routinely monitor and conduct individual internal audits to assure
AIS is compliant in all aspects or our services, including meeting the timeframes of the billing cycle
and achieving the revenue goals set.
Project Manager - Terence Lo
Terence has been in the EMS billing and collection industry for more than twelve (12) years. He
graduated with a B.A. in Business Administration at California State University of San Francisco.
He also attended graduate studies in Systems Administration. Before joining AIS, Terence worked
in various accounting firms in providing auditing and financial services to the public. He has the
extensive knowledge in computer hardware, software, electronic data interfacing between systems,
and electronic claims submission. He works with our clients in designing customized programming
for data extraction and data transfer for various applications including CQI reporting and
management. He has established seamless interface between electronic PCR databases with our
revenue billing system. With more than eleven years of experience in administration, systems
management and project management, Terence will provide high quality systems administration and
programming customization for the Fire Department. As a Project Manager, he provides total
project supervision and on -going training to insure successful application and effectiveness of our
services. He's responsible for the routine documentation, routing and communication between AIS'
in-house units and the associated departments of the City. Daily he will work with the Accounts
Receivable Unit to prepare and handle all daily deposits. Terence will assist to monitor and conduct
individual audits to assure AIS is achieving our goals and compliance.
A.2.1 REGULATORY COMPLIANCE
Our government research analysts monitor all government and billing regulatory polices as well as
any news that may have an impact on revenue. AIS stays abreast of all billing and regulatory
changes affecting reimbursement. As a matter of practice, AIS adjusts the billing processes to
ensure regulatory compliance and provides our clients with the up-to-date information regarding
impact on revenue and policies, so that they can react early and appropriately. Without this built-in
Regulatory Control, a provider may not be in compliance with Federal regulations and is subject to
various fines and penalties including suspension from that program. To date, AIS has been 100%
compliant with all regulations, and will take every step necessary to stay compliant and to have our
clients maintain 100%compliance.
City of San Bernardino Page 9 of 21
Allied Information & Services EMS Billing Services
Corporation RFQ F-05-08
Upon the publication of the Final Rule for HIPAA, AIS compiled a packet for our clients,
explaining the new regulations, recommending action steps, along with a sample Business Associate
Agreement and Notice of Privacy Practices.
A.2.2 REVENUE ENHANCEMENT SERVICES (Value added Services)
To make our service complete as a true EMS Reimbursement Solution, AIS conducts special studies
and programs with respect to EMS on a regular and on an as -needed basis. The special studies and
programs include, but not limited to, the following:
■ Emergency Medical Services (EMS) Fee Schedule Survey — AIS routinely conducts
random Fee Survey to allow our clients to review the current fee schedule. Whenever
requested, AIS is willing to assist with all research and implementation of any rate
increases.
■ Third Party Payers Reimbursement Rates Evaluation - During the New Medicare Fee
Schedule, AIS continually updated each individual transporting client with an estimated
increase/decrease in revenue due to the New Medicare Fee Schedule.
• Revenue Projections — At any point during the contract period AIS will offer revenue
projections that can assist with budgets and impact of changes in industry or rates.
• Demographic Analysis — AIS will assist in reviewing the demographics of patients and
provide a routine payer mix to the City.
• Transport Distribution Studies — AIS has the capability to capture all necessary data
provided to produce various statistical studies.
• Continuous Quality Improvement Data — AIS is currently providing CQI data for many
of our clients and reporting this data for them to the appropriate State or County agency.
• Operations Statistics - AIS has the capability to capture all necessary data provided to
produce various statistical studies.
• Regulatory Compliance — AIS maintains a compliance officer who is dedicated to the
research and monitoring of all government and billing regulatory policies as well as any
news that may have impact on revenue of any of our clients.
• Documentation Training — AIS has experience conducting non -certified documentation
training for our clients.
• Incentive Programs — In the past AIS had implemented a successful incentive program for
proper documentation for the PCR. This program encouraged paramedics to properly
complete the each PCR.
B. BILLING SERVICES
B.I. SUMMARY OF SERVICES
Our service and system is designed to handle all requirements for EMS Billing & Reimbursement
from start -to -finish; from working with field personnel and administration, to receiving the Patient
Care Report (PCR), to processing all claims and invoices, to persistently following -up on all open
accounts, to collecting and posting the payments, to providing the necessary reports routinely and
upon request.
• Routinely receive all PCBs and any supporting documentation from the San Bernardino Fire
Department.
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Corporation RFQ F-05-08
■ Verify receipt of each individual PCR and send confirmation to the Fire Department.
• Screening each individual PCR for level of service, medications administered. and personally
review appropriate ICD9CM diagnosis codes and procedures codes for billing.
■ Setting -up financial categories (e.g. commercial insurance, Self -Pay, Membership, etc.) and
generate appropriate charges from an established, automated "charge master fee schedule".
• Transmitting/transferring billing data electronically or on tape to any/all payers accepting
electronic claim submission.
• Producing and mailing of accurate insurance claims for each unique program/payer accepting
"hardcopy claims".
• Produce and mail initial invoice to self -pay accounts with no third party information, and
requesting third party information or payment in full.
• Research accounts with inadequate billing information, entailing:
- Review current database.
- Contacting receiving hospital to get the needed information from admitting/
registration records.
- Calling patients, family members, and emergency contacts for information.
- Mailing inquiry forms to patients to obtain medical coverage information.
- Perform skip searches when necessary to contact the patient.
• Process all attorney liens, court subpoenas and bankruptcy filing.
• Obtain patient signature and authorization for billing.
■ Produce and mail reminder letters and conduct phone audits on all open accounts according to a
pre -defined timetable.
• Provide nationwide toll -free telephone lines in adequate numbers to accommodate billing
inquiry calls. Handle all calls and correspondence in a timely, professional and courteous
manner.
• Appeal all denied claims from third party payers. If further denial occurs, our trained specialists
will request a hearing to further dispute the denial and "fight" for payment on qualified claims.
■ Performance audit on all accounts deemed delinquent before transferring to the Department for
either write-off or further action by a collection agency depending on the City's policy.
■ Daily process all receipts, correspondence and reports. Provide revenue accounting to the San
Bernardino Fire Department.
• Daily post all payments and adjustments to accounts receivable. Send "cross -over" and balance
billings to responsible parties.
Processing of requests for refunds and reconciling receipts with the Department.
Provide monthly, quarterly, and annual accounting statements to the San Bernardino Fire
Department. Produce detailed reports for Financial, Statistical and CQI, customized to meet the
individual requirements of the City.
• Upon request produce in a timely manner any special "on -request" reports, containing financial,
statistical and/or CQI information.
• On a routine schedule or upon request, AIS will meet with representatives of San Bernardino
Fire and/or Finance to discuss the success of the project and future needs.
When requested, make all books and records available to both internal and external auditors.
• Handle all disputed claims and act as a liaison for the San Bernardino Fire Department.
• Monitor all billing and regulatory changes impacting ambulance reimbursement and adjust our
system to ensure regulatory compliance and update the Department of any such changes and an
explanation of how it will affect the Department and it's patients.
■ Abide all City policies, standards and security regarding the release of any data pertaining to
City or it's patients.
■ Provide continuous training for all in-house staff, including immediate updates of all changes in
the healthcare industry that may have an impact on reimbursement and/or customer service.
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Provide all necessary up -front and on -going training for administration staff and EMS
personnel.
• Apply applicable technology that will improve reimbursement and/or customer service.
Establish a professional and effective relationship with all receiving hospitals.
Provide a complete EMS Reimbursement Solution from start to finish for the City of San
Bernardino and it's patients and citizens.
B.2 RECEIVING PATIENT PRE -HOSPITAL CARE REPORT
AIS is flexible and innovative in receiving PCR data. AIS has contacted Healthware Solutions to
discuss interfacing with their software. During the conversation it was determined that it will be an
easy task to interface with their software and receive all necessary data electronically. Until that
time, AIS will establish a routine system for receiving the paper PCRs that best meets the request of
the San Bernardino Fire Department. At this time we receive PCBs from our clients through
overnight delivery, regular mail, electronically, fax and email.
The data AIS request is the same data currently being captured in the field by the Fire Department.
We do not require any additional documentation or require additional forms to be completed.
B.3 VITAL INFORMATION CAPTURING
AIS maximizes revenues through streamlined services and systems designed to efficiently process
and pursue each claim.
B.3.1 Diagnostic Coding and Billing Charges.
Accurate Diagnostic Coding is a primary key to ensure claim reimbursement. At the point of
receiving the PCR our trained and experienced claim specialists will personally review each PCR
and assign appropriate ICD9CM diagnostic codes to accurately depict the medical conditions of the
patients. All charges are determined by systematic review of the patient care information. Since we
began providing this service to municipal agencies, AIS has processed over 1 million PCRs (close
to 3 million claims) with a successful reimbursement rate of 99.9% on claims with medical
necessity merit and proper medical coverage.
B.3.2 Initial Follow-up on Billing Information and Medical Coverage
The retrieved PCR data is reviewed for completeness, such as addresses and medical coverage
information. AIS will perform all the necessary research to obtain this information for accurate
billing. This entails the search of AIS' comprehensive patient database for recipients of emergency
medical care. This database allows us to perform cross-reference checks and obtain medical
coverage information from patients who received past services. In addition, AIS will establish
successful alliances with receiving hospitals and share patient billing information. Social Security
and the Welfare Indices are queried to obtain the necessary patient or third party payer information.
Employer information about the patient and/or the guarantor is obtained and verified via phone
through the patient and/or employer as soon as the accident or the injury is identified as job -related.
It is crucial to identify the patients' medical coverage as early as possible
The demands placed on paramedics in the field are so great that obtaining the
medical coverage information can often be impractical.
ff%e've made it our job to search for the missing information
and secure reimbursements for the service.
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B.3.4 Financial Classification and Charges from the "Charge Master"
Once the pre -hospital care data is in our database, each data field is tested to ensure accuracy of
information. Spell checking of known streets, cities, states, and common names are performed. Zip
codes for all U.S. possessions and cities are assigned automatically based on address input.
Addresses are verified as actual mailing addresses. Our system will automatically and
electronically assign a unique Financial Class to each transport and group the accounts by "payer"
groups. Our in-house data processing system also generates the appropriate charges according to
the established automated "Charge Master Fee Schedule" from codes assigned our system and
verified by our coding specialists.
B.3.5 Confirmation of Medical Coverage
AIS will utilize our establish contacts with each insurance carrier to confirm each medical coverage
before a claim is submitted. This ensures the coverage validity and the appropriate medical group is
billed. In todav's complex HMO, PPO, Managed Care environment, if a claim is submitted to the
incorrect medical group of the same insurance carrier, it may take triple the time before a claim is
processed. AIS has established efficient procedures in verifying coverage with all third -party
payers, such as Blue Shield, Blue Cross, Aetna and other major insurance carriers.
Through our established relationships with national third party payers
and the well -tested procedures, each medical coverage is confirmed so that
payments are processed immediately without delay.
BA CLAIM
B.4.1 Electronic Claims
Electronic claim submission is used whenever third party pavers accept it. The filing process
insures a higher accounts receivable turnover. Claims submitted electronically can be paid within
fourteen (14) days compared to the thirty to sixty (30 — 60) days turnaround when using paper claim
submission.
B.4.2 Claims, Invoices, Statements, and Reports Production
Whenever electronic claim filing is not possible, AIS will prepare and deliver all statements, billing
forms, financial questionnaires. and reports as required by the City of San Bernardino and as
required by all billing regulatory agencies.
The following reports/documents are produced or prepared upon completion of new account data
entry.
• Invoices to individual without medical coverage information
• Correspondence and Inquiry Forms
• HCFA 1500 form for all insurance carriers that do not accept electronic claims
• Claims Register, and Non -billable Runs Report
The system electronically date stamps each patient account whenever a claim is processed. This
feature provides quality control and a clear audit trail in our billing process.
B.5 BILLING STATEMENTS
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Standard forms, which include the standard mailer, HCFA 1500, are used for preparing claims and
statements in the billing process. AIS also uses customized letters, reminders and demand notice
that are uniquely designed for the City of San Bernardino according to its policies.
Please note that AIS utilizes Electronic Claims Submission to all participating third party payers.
Paper forms are used only when electronic submission is unavailable.
The following are billing statements and form letters currently in use. They may be changed per the
Department's request.
■ New Account Mailer —Initial Invoice
This itemized invoice includes the procedures and the corresponding charges in the front and, a
medical coverage information questionnaire on the back. It is sent to the patient without
medical coverage information on file within three (3) working days of receipt of PCR billing
information. The invoice also includes but is not limited to the invoice number, name and
address of the patient, name of the receiving hospital, date of the invoice, date of service, the
PCR number, payment due date and toll -free telephone number for custom service assistance.
The invoice includes a pre-printed return envelope with the local address and a duplicate page
of the invoice for submitting payment and information.
• Friendly Reminder — Second Invoice
The second invoice contains the same information as the initial invoice and it provides
payment options for resolving the account. It is sent to the patient 30 days after the
Initial Invoice.
• Past Due Notice — V Letter
This letter reminds the patient of the urgency and the past due status of the account. It is sent 60
days after the Initial Invoice.
• Fourth Notice — 2nd Letter
This letter stresses the delinquency of the account and the possibility of collection action. It is
sent 90 days after the Initial Invoice.
• Fifth Notice — Yd Letter
This letter stresses the delinquency of the account and the possibility of collection action. It is
sent 120 days after the Initial Invoice.
• Final Demand
This statement is a formal demand for payment before assigning accounts to "intensive
collection'. The letter provides a warning of further collection activity and any potential legal
remedies. The content of this demand notice is subject to the approval of the Department. It is
sent 150 days after the Initial Statement.
• Insurance Co -payment Billing Statement
This statement requests payment for Insurance Balance or supplemental insurance information.
This is sent immediately after the receipt of third party payment.
• Second Insurance Co -payment Billing Statement
This is a reminder statement sent 30 days after First Balance Notice.
• Final Insurance Co -payment Billing Statement
This statement is a final demand for the Balances Due and the possible collection action. This
is sent 60 days after the First Balance Notice.
• Installment Payment Coupons
These coupons are sent to patients who set up installment plans. They ensure regular payments
and proper account credit.
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Return envelopes for patients' responses and/or payment are always enclosed with each of the above
billing statements.
• HCFA 1500
This form is used for submitting paper claims to any third party payer that do not accept
electronic claim submission method.
B.6 FOLLOW-UP ACTIVITIES ON ACCOUNTS RECEIVABLE
AIS takes a pro -active role when it comes to follow-up. Each patient's account is followed
personally from day one until the full payment is posted or it is determined to be delinquent. Each
patient's account is followed from day one until the full payment is posted or it is determined to be
delinquent. The follow-up functions of the project include the following key areas:
B.6.1 Follow-up Billing
All open accounts will receive subsequent reminders according to a cyclical and systematic
schedule. The reminder letters are progressively demanding in nature. The objective is to motivate
the patient to settle the claim early. It requests any information that will help to clear the account
including any third party payer information. They encourage the patients without medical coverage
to pay off the account by installments. In addition to follow-up billing, special correspondences are
sent to target groups to identify the payment sources. The targeted groups include those with
Medicare age and incidents related to automobile accidents.
AIS' billing and persistent follow-up billing processes are designed for the identification of revenue
sources as opposed to "hard-core" collection. AIS recognizes the need to approach public debts
with sensitivity. We temper the collection process and direct our efforts to identifying payment
methods and sources rather than making a "hard-core" demand for payment.
B.6.2 Telephone Contact
In addition to the systematic follow-up billing cycle, telephone calls are placed to open accounts at
45-day intervals. We proved that the combination of scheduled billing reminders and telephone
contacts generate the best result in collecting self pay accounts. Our Account Representatives and
Account Auditors are trained in the collection guidelines based on the Federal Fair Debts Collection
Practices Act and all applicable laws. They are also trained in telephone collection techniques.
They identify different types of non -payers such as "occasional forgetter," "frequent forgetter,"
"forgetter in changed circumstances," and "deliberate non -payer." Proper methods will be used to
handle and motivate the non -payer to pay.
On an established Saturday schedule our Account Auditors will conduct a phone blitz contacting the
patients that have not made an attempt to respond to our mailings or prior phone contacts. Also due
to the time difference between San Bernardino and our main facility in Alameda, California, our
representatives will be able to utilize the 2 hour difference and be able to contact patients in the
evening.
B.6.3 Search for Additional Information
Patient information is very important in ambulance billing. AIS goes the "extra miles" that most
company may not attempt due to the time and energy required or simply lack of "know how" and
experience. When an account is either returned in the mail for wrong address or there is no address,
AIS begins an extensive research effort to locate the correct patient information.
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Corporation RFQ F-05-08
Our first step is towards the receiving hospital. AIS understands the importance of the receiving
hospital and the information they have available. We have the experience and a successful track
record of building relationships with local hospitals to gather additional patient information. We
have been so successful with building some of these relationships, that some hospitals have granted
us electronic access to their patient database at our convenience to extract the necessary patient
billing information.
B.6.4 Third Party Payers Follow-up
Thirty (30) days after the initial billing to third party payers, our Account Auditors will initiate an
audit on all open accounts. Contact will be made to third party payers as to the status of the account
and additional information will be provided to the third party payers if needed. Additional contact
with the patient may be necessary for clearing the account. This process is repeated every 30 days.
Occasionally, third party payer claims are returned for clarification or denial. Our experienced
third -party billing specialists will examine the returned claims and provide the additional
information for re -submission. Accounts that are not eligible for the benefits will be converted,
within guidelines, to self -pay status to resume follow-up and collection activities.
B.6.5 Insurance Balance Billing
Balances on commercial insurance accounts with secondary insurance on file will be billed to the
secondary insurance carrier.
Accounts without secondary insurance will be billed to patients immediately. Patient can take this
opportunity to return the insurance information. Patients will receive additional reminders, on the
same schedule as a self pay account. This allows the patient the opportunity to clear the account
before it is considered delinquent.
B.7 ACCOUNTS RECEIVABLE
AIS will receive all funds and print a detailed receipt of funds collected on the same day of receipt.
These reports will then be forward to the City by mail or fax. Each month AIS will produce
detailed and summary reports showing all payments, refunds, adjustments and billings.
AIS will perform the detailed, day-to-day work as follows:
Receive all payment information or copies of information.
• All revenue documents, check photocopies, Explanation of Medical Benefits, and other
documents are reviewed for account identification. All monies received are identified and
posted to specific accounts on the same day. Along with amount posted, source of payment,
check date, check number, identification number and deposit date are recorded on the patient's
account.
• Electronically scan all payment records for perpetual storage.
Payment without proper identification will be contacted for proper credit.
Receive all non -cash correspondence and research on returned mail.
Overpaid accounts and erroneous payments will be documented with payment history and
submitted to the City for refund approval.
• Returned check will be debited to the patient's account and collection activities will resume.
Any bank fees and return -check fee imposed by the City will be added to the amount due.
Each month, AIS summarizes all bank account activities with reports detailing each payment in the
cycle and submit them to the Department for reconciliation.
City of San Bernardino Page 16 of 21
Allied Information & Services EMS Billing Services
Corporation RFQ F-05-08
B.8 QUALITY CONTROL AND ASSURANCE
Quality assurance mechanisms are regularly introduced to the system at the data entry point to test
the integrity of data entry and the claim processing mechanisms. Accuracy of the claim and the
timelines of billing are tested in this process. Wherever procedural problems are discovered,
changes and corrections are made immediately. Routinely, our auditing personnel will select "live"
accounts for examination. The audit concentrates on the accuracy of diagnostic coding and pricing
to ensure no intentional and unintentional "up -coding and pricing" occurs. If errors are discovered,
the responsible staff will be sanctioned that includes termination. There never has been any cause to
exercise the sanction. Overpayment will be promptly refunded to parties involved.
C. REPORTING
Our accounting staff prepares monthly financial reports using generally accepted accounting
principals to ensure fiscal accountability and full audit compliance.
Reports are crucial for accounting and management. AIS' system features easy access to distinctive
summary and statistical reports. The system extracts all the necessary financial and non -financial
data elements to produce routine and customized reporting. AIS produces various monthly,
quarterly, annual and on -demand reports using the data extracted.
AIS prepares special as -needed and on -demand reports. We conduct special studies on various
aspects in the EMS industry and produce reports in the required format. Our flexibility to produce
on -demand reports in a timely manor has been extremely important and informative for our clients.
With our flexibility and experience, AIS welcomes the opportunity to offer the City of San
Bernardino various financial and non -financial reports. During implementation our Managers will
meet to discuss all reporting requirements, options and create any special reports suggested,
including a detailed reporting identifying members of the City's Paramedic Membership Program.
At any time during the contract the City has the alternative to request any additional report or
modify any existing reports.
AIS uses generally accepted accounting practices and principals for all accounting and reporting.
Annually, as a routine process per our client's internal control policies, AIS works with independent
auditors, such as Arthur Anderson and Deloitte & Touche LLP consulting firms. The result of their
work confirms the integrity of our system and processes and our financial data and reporting is
accurate and with clear audit -trails.
AIS emphasizes concise, informative and analytical reports for routine reporting. This provides the
Administration with a quick reference to the status and progress of the billing and reimbursement
process. The easy -to -read reports can eliminate the lengthy process in interpreting pages and pages
of data for answers. Please review a sample of some reports AIS routinely produces for our clients
in Exhibit II — Sample Reports, further examples available upon requests.
CA REMOTE ACCESS
The remote access module in our system allows clients and offsite offices access to real-time user
information and pre -defined reporting. Access is via a stand-alone PC and a modem with special
access authorization permission. Each user is provided with a unique password that matches its
profile and its level of access. Users are restricted to viewing and printing of information only.
City of San Bernardino Page 17 of 21
Allied Information & Services
Corporation
EMS Billing Services
RFQ F-OS-08
Our Remote Access provides each Client with an opportunity to conduct routine audits to confirm
the integrity and quality of service AIS performs.
ON-LINE PATIENT DATABASE ACCESS
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Patient Billing Information Screen on AIS Mainframe
City of San Bernardino Page 18 of 21
Allied Information & Services
Corporation
EMS Billing Services
RFQ F-05-08
4. QUALIFICATIONS
A. EXPEREINCE
AIS has been actively involved in the EMS industry for over twenty-five (25) years. For the past
fifteen (15) years we've worked exclusively with Municipal agencies providing EMS
reimbursement for over forty (40) Municipal Fire Agencies and Finance Departments throughout
California in such Cities as San Francisco, Sacramento, Big Bear Lake and San Gabriel. We work
closely with each client on an individual basis, providing them with a complete EMS reimbursement
solution focused on public relations and projecting the City's positive image while maximizing their
revenue.
Our operations are centralized in Oakland, CA, where we bill for more than 200,000 EMS responses
per year for our clients and make countless phone contacts to patients, third party payers, hospitals,
and employers annually. With this effort AIS generates over $35 million per year in EMS revenue
for our clients with many of them enjoying a collection rate over 85%.
To achieve the highest standard of customer service and to provide an individualized service that
our clients and their patients deserve, AIS has the best -qualified professionals in our specialized
industry. Through our extensive experience in the industry, AIS has developed a comprehensive in-
house training program that is effective in producing and maintaining our high quality of
professionalism. The quality of our staff is one of the most valuable elements in delivering a
successful service. The current average tenure at AIS is eight (8) years. The 3`d Party Specialists
have tenure in excess of nine (9) years. The management staff has an average tenure of fourteen
(14) years.
Our track record demonstrates that AIS has proven to be more than just an EMS billing service
maximizing revenue. We've used our expertise and experience to work hand -and -hand with each
client in all aspects of EMS billing, such as:
• Provide continuous education and updates to keep our clients informed of the upcoming
changes in the EMS industry and how they will affect them.
• Participate in City Council workshops and meetings to assist with Fee Schedules and
Billing Guidelines and Policies.
• Participate in "town -hall" meetings to discuss EMS billing with the general public.
• Provide workshops for field personnel and administration staff regarding various aspects of
EMS, including Confidentiality and Documentation.
• Routinely produce critical CQI reports for administration analysis and State EMS agency
reporting.
• Provide special studies such as Medicare New Fee Schedule Impact and Revenue
Projection.
• Work with our clients on HIPPA compliance issues such as Privacy Practices, Privacy
Notice, Consent Form and Billing Association Agreement.
• Work with public agencies in expanding from First Responder service to providing a full
Transportation program.
To further assist AIS of staying in the forefront of our constantly changing industry, AIS is an active
member of organizations, such as IAFC, IAFF, American Ambulance Association, and California
Medical Billing Association. We believe it is our responsibility to "stay two steps ahead" of the
changes and to make recommendations where we see room for improvement.
City of San Bernardino Page 19 of 21
Allied Information & Services EMS Billing Services
Corporation RFQ F-05-08
AIS is a highly qualified third party payer liaison. We have the expertise and successful track
record in billing and fighting denials with Medicare, Medicaid. commercial insurance carriers, and
third parry payers throughout the nation. We are an authorized electronic submitter to Medicare,
Medicaid, Blue Cross/Blue Shield, Aetna, and Travelers Medicare. We have electronic, fax, or
paper submission agreements with all the major insurance carriers in the nation. Additionally, AIS
has established arrangements with foreign carvers to bill for the large population of student,
resident, and tourist using EMS services. AIS continually works with all third party payers to
improve the processing and subsequent turnover of accounts receivable.
In summary, AIS employs the highest qualified professionals in our unique and specialized industry
and utilizes the most sophisticated hardware and software. Combine this with our expertise and
experience in offering and delivering comprehensive EMS reimbursement solutions, AIS is ready to
enter into an agreement and offer a complete reimbursement solution for the City of San
Bernardino.
Q
Big Bear Lake Fire Department Client since 2001
Chief John Morley (909) 866-7566
Net Collection Rate: 72%
Services Provided: Full Service EMS billing and collection for non -transport fees for Non -Residents.
Provide detailed monthly, yearly and as requested statistical, financial and CQI
reporting.
Special Note: AIS has a successful track record and an extremely good working relationship with
the Big Bear Lake staff. AIS has established a routine procedure to receive all
ICEAL4 reports for all non-residents. Their fee schedule is a flat rate for response
depending if the patient is a Valley Resident or Non -Resident.
South Lake Tahoe Fire Department Client since 2001
Fire Chief Mike Chandler (530) 542-6167
Services Provided: Full Service EMS billing and collection for non -transport fees for Residents and
Non -Residents. Provide detailed monthly, yearly and as requested statistical,
financial and CQI reporting.
Special Note: AIS has a successful track record and an extremely good working relationship with
both the Citv Finance and Fire Department. We've assisted the City in various
studies including review offee schedule. AIS is also in the process to
electronically receive all PCR data from the Fire Department.
El Centro Fire Department
Client since 1996
Battalion Chief Tim Reel (760) 337-4530
Services Provided: Full Service EMS billing and collection for non -transport fees for Residents and
Non -Residents. Provide detailed monthly, yearly and as requested statistical,
financial and CQI reporting.
Special Note: AIS has a successful track record and an extremely good working relationship with
both the City Finance and Fire Department We've assisted the City in various
studies including review offee schedule. Due to the City's proximity to the border,
AIS developed special bilingual notices.
City of San Bernardino Page 20 of 21
Allied Information & Services EMS Billing Services
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City of San Gabriel Fire Department Client since 2000
Battalion Chief Mike Terry (626) 308-2885
Service Provided: Full Service EMS billing and collections for 911 Emergency transports, non -
transports and first responder services. Provide detailed monthly, yearly and as
requested statistical and financial reporting.
Special Note "Our revenue recovery has almost tripled from our in-house program and vour
monthly reports have been very useful, as they include data that is tailored to our
needs. Though your office is on the other end of the State, it seems that you drop
everything and make our needs a priority, reporting back in hours, rather than
days. "
Lakeside Fire Protection District Client since 2002
Division Chief Andy Parr (619) 390-2365
Services Provided: Full Service EMS billing and collection for transport and non -transport fees.
Provide detailed monthly, yearly and as requested statistical, financial and CQI
reporting
Special Note: 'AIS has been truly a full service medical billing firm with excellent billing
practices... Dan Kehoe and his staff at AIS have provided unmatched
responsiveness, information and courtesy to myself, my staff and our citizens i
customers on every contact".
City of Stockton Fire Department Client since 2002
Division Chief David Hafey (209) 937-8965
Net Collection Rate: 85%
Services Provided: Full Service EMS billing and collection for transports fee. Provide detailed
weekly, monthly, yearly and as requested statistical, financial and CQI
reporting.
Special Note: AIS has worked with the City of Stockton through the entire process of
researching and implementation Ambulance Transport. AIS maintains a
constant level of premium service to the City of Stockton in all aspects of
EMS reimbursement.
City of Palo Alto Fire Department Client since 2002
Battalion Chief Niles Broussard (650) 329-2220
Net Collection Rate: 85%
Services Provided: Full Service EMS billing and collection for transports fee. Provide detailed
monthly, yearly and as requested statistical, financial and CQI reporting.
Special Note: Within the first year of our services, the City's revenue has had an over
90% increase in revenue.
Along with these references, we've enclosed letters written to AIS by our clients in Exhibit I Client Letters.
Additional references are available upon request.
City of San Bernardino Page 21 of 21
Allied Information & Services
Corporation
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EXHIBIT I
CLEINT LETTERS
• San Francisco Fire Department
a City of Palo Alto Fire Department
• Lakeside Fire Protection District
• City of San Gabriel Fire Department
City of San Bernardino
SAN FRANCISCO 0FIRE DEPARTMENT
698 Second Street
San Francisco, CA 94107
Christine Ragan, CFO
Tel: 415/558-3445
Fax: 415/558-3454
May 4, 2004
Mr. Patrick Ho
President and CEO
Allied Information and Services Corp.
7750 Pardee Lane, Suite 200
Oakland, CA 94621
Re: Internal Audit of Child Support Services Case #0058518
Dear Mr. Ho,
My staff and I have received copies of your letter dated 22 April, 2004.
I wanted to take this opportunity to thank you for your prompt attention to this matter.
Your responsiveness to our requests, questions and needs has always been immediate and
complete. We appreciate that aspect of our relationship with Allied Information and
Services, and we look forward to continuing that level of quality relationship.
cer y,
ne TT Ragan\7
Chief Financial Officer
cc: Gary Massetani, Deputy Chief, Administration
Andy Zanoff, Captain, EMS Division
Enrico Delara, Principal Accountant
City of Palo Alto
Fire Department
July 11, 2003
To Whom It May Concern,
It is with pleasure that the Palo Alto Fire Department (PAFD) recommends Allied
Information Services, Inc. (AIS) as a provider of ambulance billing services. Until March
2002 PAFD billed our ALS ambulance service in-house with average revenue collection
success. In the hope of increasing our revenue collections, AIS was awarded a contract
with the City of Palo Alto beginning April 2002.
In the first year of our business relationship with AIS, PAFD has achieved above average
revenue collections. Key to this significant increase is the professionalism, expertise and
flexibility of AIS' employees. Dan Kehoe and Jennifer Ho, to name a few, represent the
courteous, high caliber personnel PAFD has come to know and rely on at AIS.
A city government such as Palo Alto's often has unique service requirements. AIS has
done an outstanding job of meeting the City's needs for reporting, research and general
guidance in all facets of ambulance billing and transport. AIS staff is readily available
and prompt to respond to any inquiries PAFD may have.
AIS' customer service personnel extend this same helpful and considerate attention to
PAFD's transported patients. Our patients are pleased with the knowledgeable assistance
they receive when calling AIS with questions about a bill. PAFD appreciates AIS'
positive representation of our organization to our community.
Based on our current productive and encouraging experience, PAFD looks forward to
having AIS provide outsource billing services for our new BLS transport program. We
have no doubt that AIS will achieve the same excellent success as they do with our ALS
billing.
It is without reservation that I recommend AIS as an exemplary provider of ambulance
outsource billing services. Should you have any questions, please feel free to call my
office 650-329-2615.
S* cerely,
Daniel R. Lindsey
Battalion Chief — EMS
Palo Alto Fire Department
DRL.jmsc
P.O.Box 10250
Palo Alto, CA 94303
650.329.2184
650.327.6951
Lakeside Fire Protection District
12365 PARKSIDE ST.
LAKESIDE, CA 92040-3006
BUSINESS (619) 390-2350 FIRE CHIEF
FAX 1619) 443-1568 THOMAS N. ACE
Tuesday. February 17. 2004
I o whom it may concern.
I his letter is to recommend Allied Information and Services (A.I.S.) as a medical billing
vendor for your agency.
For more than 25 years my agency has been providing an ALS transport service to our
unincorporated San Diego County community under a County contract. For those 25
years the County has used a number of different billing firms with varied success. Two
years ago our agency received a separate contract to provide ALS service to a
neighboring community where we would be required to perform billing services
ourselves.
Dan Kehoe and all of the folks at A.I.S. were helpful, cooperative and assisted us in all of
the facets of our new billing service. A.I.S. consistently provided needed and necessary
reports. updates, and assistance to our agency. Some of the reports cone at our request
while others arc provided by A.I.S. in a "for your information" format providing new and
interesting outlooks on our service. 'I hey have also kept us informed, (and out of
trouble). on HIPPA. Medi-Care and Medi-Cal updates and pitfalls. Their cooperation
and assistance continues today as it was on the first day.
For our agency; A.I.S. has been truly a full service medical billing firm with excellent
billing practices that get good results. Moreover, Dan Kchoc and his staff at A.I.S. have
provided unmatched responsiveness, information and courtesy_ to myself, my staff and
our citizens/customers on every contact.
And that County contract... A.I.S. now has that one ton.
I am proud to recommend A.I.S. for a medical billing firm for your agency. If you should
have further questions feel free to contact me at the information listed below.
Sincerely.
1
h
Andy Parr
Division Chief for EMS and Disaster Preparedness
Lakeside Fire Protection District
619-390-2369 x433
andyparr(a:_Iakesidel ire.con7
• Cily Willi A Miwion • Founded 1771 •
June 2, 2003
Mr. Dan Kehoe
Account Manager
Allied Information and Services Corp.
7750 Pardee Lane, Suite 200
Oakland, CA 94621-1424
Dan,
I just wanted to take a moment to thank you for the great service we have received since
contracting with your firm two years ago. Our revenue recovery has almost tripled from
our in-house program and your monthly reports have been very useful, as they include
data that is tailored to our needs. Most of all, I'd like to thank you for being so
responsive to researching data that we occasionally request. Though your office is on the
other end of the State, it seems that you drop everything and make our needs a priority,
reporting back in hours, rather than days. Since it has made my job coordinating our
EMS program so much easier, I look forward to a long business relationship with your
company.
Sincerely,
Michael Terry
Fire Battalion Chief
Pie Deparlmen61303 South Del Mar Avenue, San Gabnel, California • Mail: P.O. Box 00. San Gabnel, California 91778-0130
818-308-2880 . FAX 818-280-6474 .
Allied Information & Services
Corporation
EMS Billing Services
RFQ: F-0S-08
EXHIBIT II
SAMPLE REPORTS
For your review, the following reports are examples of current reports AIS produces for our
clients. The numbers used are for illustration purposes only.
Financial Reports
• Collection By Financial Class
• Billing Activity Summary
• Activities Summary
• Accounts Receivable Aged Trial Balance
• Cash Receipts Summary
• Ambulance Revenue Distribution (12 Month Running Total)
• Billing Register
• Detailed Account Receivables Report
Statistical Reports
• Monthly Chief Complaint Summary Report per Unit
• Individual Unit Monthly Chief Complaint Summary
• Monthly Response Summary per Unit
• Response Volume — Hours of the Day
• Response Volume by Day by Unit
• Incidents by Age Group
CQI Reports
• Monthly Medication & Supplies Usage Report
• Quarterly Intervention Report
• Paramedic Summary
• Monthly I.V. Attempts & Successful Rate by Paramedic
• Monthly I.V. Attempts & Successful Rate Summary
• Monthly Intubation Attempts & Successful Rate by Paramedic
• Monthly Intubation Attempts & Successful Rate Summary
City of San Bernardino
CITY OF SAN BERNARDINO - EMS BILLING
MANAGEMENT SUMMARY REPORT
COLLECTION - BY FINANCIAL CLASS
PERIOD: 3/1/2004 to 3/31/2004
MANAGEMENT REPORT #1
FINANCIAL
COLLECTION
FISCAL YEAR
CLASS
CURRENT MONTH
TO -DATE
INSURANCE
$68, 722.95
$824,675.40
SELF PAY
$8,910.06
$106,920.70
REFUND
($120.00)
($600.00)
BANK
RETURNED ITEMS
($50.00)
($100.00)
TOTAL NET COLLECTION
$77,463.01
$930,896.10
Collection by Rnancial Oass
CITY OF SAN BERNARDINO - EMS BILLING
MANAGEMENT SUMMARY REPORT
BILLING ACTIVITY SUMMARY
FOR THE MONTH ENDED: 03/31/2004
FINANCIAL
CLASS
MANAGEMENT REPORT #2
# OF INVOICED
ACCOUNTS AMOUNT
SELF PAY 39% 149 60% $64,350.42
INSURANCE 26% 99 40% $42,900.28
TOTAL BILLABLE 100% 248 100% $107,250.70
NON -BILLABLE ACCOUNTS
AUTHORIZED WRITEOFF
0
$0.00
BAD ADDRESS
0
$0.00
INCOMPLETE ADDRESS
0
$0.00
TOTAL NON -BILLABLE
0
$0,00
TOTAL SERVICE 248 $107,250.70
Billing Activity Summary
CITY OF SAN BERNARDINO - EMS BILLING
MANAGEMENT SUMMARY REPORT
ACTIVITIES SUMMARY
REPORT AS OF 3/31/2004
MANAGEMENT REPORT #3
# of Acct. AMOUNT
Accounts Balance as of 02/29/2004
(Invoiced less partial payment) 1,325 $572,320.50
Billing Activity
Accounts billed in Mar-2004 382 $165,001.08
Collection (payment)
Payments net of refunds in Mar-2004 ($114,974.11)
# accounts paid in full (244)
Accounts return for cancellation
Identified Bad Address (1) ($431.94)
Accounts write-off (2) ($863.88)
Write-off recovery $0.00
Billing adjustment for payment limits
Accounts balance as of 03/31/2004
(Invoiced less partial payment) 1,335 $553,775.35
Activities Report
CITY OF SAN BERNARDINO - EMS BILLING
MANAGEMENT SUMMARY REPORT
ACCOUNTS RECEIVABLE AGED TRIAL BALANCE
REPORT AS OF: 3/31/2004
MANAGEMENT REPORT#4
# OF A/R BALANCE
AGE ACCOUNTS
CURRENT
30 DAYS
60 DAYS
90 DAYS
120 DAYS
150 DAYS AND OVER
TOTAL
382 $165,001.08 30%
335 $144,699.90 26%
257 $111,008.58 20%
165
$71,270.10
13%
109
$32,916.91
6%
87
$26,878.78
5%
1,335 $553,775.35 100%
Accounts Receivable Aged Trial Balance
CITY OF SAN BERNARDINO - EMS BILLING
Cash Receipts Summary
For the Month of
Deposit
Total
Date
Receipts
Self -pay
Insurance
03/01/04
6,970.92
1,684.54
5,286.38
03/02/04
200.00
200.00
03/04/04
2,201.59
2,201.59
03/05/04
10,070.67
1,199.22
8,871.45
03/08/04
2,591.64
388.74
2,202.90
03/10/04
0.00
03/12/04
11,468.60
11,468.60
03/15/04
9,635.44
757.82
8,877.62
03/16/04
431.94
431.94
03/17/04
388.74
388.74
03/19/04
2,853.78
1,557.96
1,295.82
03/23/04
7,860.15
150.00
7,710.15
03/24/04
863.84
863.84
03/25/04
1,036.64
1,036.64
03/29/04
16,617.18
1,546.40
15,070.78
03/30/04
4,441.88
4,441.88
77,633.01 8,910.06 68,722.95
Bank Returns (50.00)
Refunds (120,00)
Net $77,463.01
Cash Receipts Summary
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SAN BERNARDINO FIRE DEPARTMENT
MONTHLY CHIEF COMPLAINT SUMMARY REPORT PER UNIT
FOR THE MONTHEND MARCH 2O04
Chief Complaint
Unit 1
Unit 2
Unit 3
Unit 4
Total
Count
%
ABDOMINAL PAIN
11
14
15
9
49
12.8%
BURNS
1
2
1
8
12
3.1%
C.P.R.
9
6
4
10
29
7.6%
CERVICAULUMBAR PAIN
2
4
4
5
15
3.9%
CHEST PAIN
12
9
11
12
44
11.5%
CHILDBIRTH
2
0
1
1
4
1.0%
CRITICAL TRAUMA
15
20
24
13
72
18.8%
DECREASED LOC
0
2
2
1
5
1.3%
DIABETIC EMERGENCY
4
8
3
7
22
5.8%
DIFFICULTY BREATHING
24
12
19
16
71
18.6%
FALL
4
2
6
3
15
3.9%
OVERDOSE
2
1
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1
4
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SEIZURE
3
9
4
5
21
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STROKE
1
5
2
11
19
5.0%
Grand Total
90
94
96
102
382
100.0%
Monthly Chief Complaint Summary per Unit
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Page 1 of 1
SAN BERNARDINO FIRE DEPARTMENT
MONTHLY MEDICATION AND SUPPLIES USAGE REPORT"
PERIOD: MARCH 2O04
Medication
Count
ACTIVATED CHARCOAL
60
ALBUTEROL
288
50% DEXTROSE
52
ATROPINE
136
BENADRYL
12
CALCIUM CHLORIDE
4
DIAZEPAM
8
DOPAMINE
4
EPINEPHRINE (1:1000)
48
EPINEPHRINE (1:10000)
108
FUROSEMIDE
56
GLUCAGON
12
LIDOCAINE HCL
32
MORPHINE SULFATE
88
NAXLOXONE HYDROCHLORIDE
16
NITROGLYCERIN
528
SODIUM BICARBONATE
6
VERAPMIL
4
SALINE & APPLIANCES
2068
CERVICAL COLLAR
615
DEFIBRILLATION SUPPLIES
48
EKG ELECTRODES
2450
HANDHELD NEBULIZER
228
OXYGEN CANNULA
1383
OXYGEN MASK
1497
RESTRAINTS
10
TRAUMA DRESSING
18
* Based on drug, medication & supplies interpreted from PCR's and billed to patients.
MEDICATION AND SUPPLIES USAGE
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Page 1 of 40
SAN BERNARDINO FIRE DEPARTMENT
PARAMEDIC SUMMARY
MONTHEND MARCH 2O04
Paramedic #13
CHIEF COMPLAINT
Total
ABDOMINAL PAIN
7
BURNS
0
C.P.R.
5
CERVICAL/LUMBAR PAIN
2
CHEST PAIN
5
CHILDBIRTH
1
CRITICAL TRAUMA
4
DECREASED LOC
2
DIABETIC EMERGENCY
5
DIFFICULTY BREATHING
11
FALL
9
OVERDOSE
0
SEIZURE
3
STROKE
5
TOTAL VOLUME
59
TOTAL TRAUMA
12
TOTAL PEDIATRIC
6
TOTAL MEDICAL
41
TOTAL AMA
3
Paramedic #21
CHIEF COMPLAINT
Total
ABDOMINAL PAIN
5
BURNS
0
C.P.R.
3
CERVICAL/LUMBAR PAIN
1
CHEST PAIN
3
CHILDBIRTH
1
CRITICAL TRAUMA
5
DECREASED LOC
3
DIABETIC EMERGENCY
2
DIFFICULTY BREATHING
9
FALL
7
OVERDOSE
1
SEIZURE
4
STROKE
2
TOTAL VOLUME
46
TOTAL TRAUMA
9
TOTAL PEDIATRIC
4
TOTAL MEDICAL
34
TOTAL AMA
7
Paramedic Summary
SAN BERNARDINO FIRE DEPARTMENT Paget of 18
MONTHLY I.V. ATTEMPTS & SUCCESSFUL RATE BY PARAMEDIC
PERIOD: MARCH 2O04
Paramedic No.
Total
5
IV Attempt
4
IV Success
4
20
IV Attempt
2
IV Success
2
23
IV Attempt
39
IV Success
38
27
IV Attempt
1
IV Success
1
43
IV Attempt
10
IV Success
10
52
IV Attempt
3
IV Success
2
56
IV Attempt
3
IV Success
3
57
IV Attempt
6
IV Success
5
75
IV Attempt
9
IV Success
9
86
IV Attempt
1
IV Success
1
147
IV Attempt
28
IV Success
25
157
IV Attempt
10
IV Success
9
164
IV Attempt
21
IV Success
21
165
IV Attempt
2
IV Success
1
167
IV Attempt
19
IV Success
18
193
IV Attempt
45
IV Success
41
211
IV Attempt
8
IV Success
8
212
IV Attempt
3
IV Success
2
214
IV Attempt
22
IV Success
19
215
IV Afterript
3
IV Success
2
217
IV Attempt
7
IV Success
7 _
220
IV Attempt
12
IV Success
11
I.V. ATTEMPTS SUCCESSFUL RATE BY MEDICS
Page 1 of 1
SAN BERNARDINO FIRE DEPARTMENT
MONTHLY I.V. ATTEMPTS AND SUCCESSFUL RATE SUMMARY
PERIOD: MARCH 2O04
1) Successful Rates:
No. of Aftempi
No. of Patients with
Successful Attempt
No. of Patients with
Un-successful Attempt
Total
1
1290
322
1612
2
354
110
464
3
56
11
67
3+
10
2
12
1710
1 445
1 2155
2) Total No. of I.V. Attempted: 2864
3) Total No. of Patients where an I.V. was attempted: 2155
4) Total No. of I.V. at TKO: 1465
MONTHLY I.V. ATTEMPTS SUCCESSFUL RATE SUMMARY
SAN BERNARDINO FIRE DEPARTMENT Page 1 of 15
MONTHLY INTUBATION ATTEMPTS & SUCCESSFUL RATE BY PARAMEDIC
PERIOD: MARCH 2O04
Paramedic #
Total
5
OTI Attempt
4
OTI Success
3
NTI Attempt
0
NTI Success
0
CRIC Attempt
0
CRIC Success
0
20
OTI Attempt
2
OTI Success
2
NTI Attempt
0
NTI Success
0
CRIC Attempt
1
CRIC Success
1
23
OTI Attempt
3
OTI Success
3
NTI Attempt
1
NTI Success
1
CRIC Attempt
0
CRIC Success
0
52
OTI Attempt
2
OTI Success
2
NTI Attempt
1
NTI Success
1
CRIC Attempt
0
CRIC Success
0
75
OTI Attempt
5
OTI Success
4
NTI Attempt
1
NTI Success
1
CRIC Attempt
0
CRIC Success
0
147
OTI Attempt
2
OTI Success
2
NTI Attempt
1
NTI Success
1
CRIC Attempt
0
CRIC Success
0
_
167
OTI Attempt
4
OTI Success
4
NTI Attempt
1
NTI Success
1
CRIC Attempt
0
CRIC Success
0
INTUBATION ATTEMPTS SUCCESSFUL RATE BY MEDIC
Page 1 of 1
SAN BERNARDINO FIRE DEPARTMENT
MONTHLY INTUBATION ATTEMPTS AND SUCCESSFUL RATE SUMMARY
PERIOD: MARCH 2O04
1) Successful Rates:
No. of Patients with
No. of Patients with
Type
Successful Attempt,,
Un-successful Attempt
Total
OTI
72
14
86
NTI
28
7
35
CRIC
1
0
1
MONTHLY INTUBATION ATTEMPTS SUCESSFUL RATE SUMMARY
Allied Information & Services
Corporation
EMS Billing Services
RFQ: F-05-08
EXHIBIT III
PRICE FORM
City of San Bernardino iii
PRICE FORM
Please list prices on this sheet and enclose in a separate envelope for
evaluation. Failure to complete this price form may result in an incomplete
bid.
City is requesting a quote for cost of service, base on a percent of total
collections.
1. Vendor agrees to be compensated for such services an amount equal to
seven percent (7%) of bill collections.
(Yes No
Or
2. Vendor purposes to be compensated for such services an amount equal to:
% of bill collections (please state percentage).
3. Please list any additional charges.
PRICE FORM
REQUEST FOR PROPOSALS: RFP F-05-008
DESCRIPTION OF RFP: EMS Billing Services
BIDDER'S NAME/ADDRESS: /LG.Zt=o n n .q Asa d
NAME/TELEPHONE NO. OF
AUTHORIZED REPRESENTATIVE
ANNUAL PURCHASE ORDER
Effective on or about July 1, 2004 through June 30, 2005 plus two single year options,
for City's partial requirements, on an as -needed basis, with no guaranteed usage for
EMS Billing Services.
Option year one, if exercised, shall be effective July 1, 2005 through June 30, 2006.
Option year two, if exercised, shall be effective July 1, 2006 through June 30, 2007.
Actual option year pricing shall be negotiated with the successful Bidder(s) prior to
exercising of any given option year. Option years shall become effective only upon
issuance by the City of a duly authorized Purchase Order.
Please provide detailed Firm Fixed Price cost information in the spaces provided below,
and any other incidental or additional costs required to complete the Technical
Specification requirements.
Are there any other additional or incidental costs that will be required by your,firm in
order to meet the requirements of the Technical Specifications? Yes /(No)
(circle one). If you answered "Yes", please provide detail of said additional co s:
Please indicate any elements of the Technical Specifications that cannot be met by your
firm.
Have you included in your bid all informational items and forms as requested? Yes /
No . (circle one). If you answered "No", please explain:
This offer shall remain firm for 90 days from RFP close date.
Terms and conditions as set forth in this RFP apply to this bid.
Cash discount allowable % days; unless otherwise stated, payment terms
are: Net thirty (30) days.
In signing this bid, Bidder warrants that all certifications and documents requested
herein are attached and properly completed and signed.
From time to time, the City may issue one or more addenda to this RFP. Below, please
indicate all Addenda to this RFP received by your firm, and the date said Addenda
was/were received.
Verification of Addenda Received
Addenda No: 1Received on:�
Addenda No: Received on:
Addenda No: Received on:
AUTHORIZED SIGNATURE:
PRINT SIGNER'S NAME AND TITLE
DATE SIGNED:
COMPANY NAME & ADDRESS:
PHONE: (c,) 4(, 4t0
S- (a - 2 von{ --
I Tk4al(6i al Fe �a j
oi-k(aud, , r' cw z-I
FAX: (S(c)76q-e(ooi
IF SUBMITTING A "NO BID", PLEASE STATE REASON(S) BELOW:
Allied Information & Services
Corporation
EMS Billing Services
RFQ: F-05-08
EXHIBIT I
NON -COLLUSION AFFIDAVIT
City of San Bernardino iv
NON - COLLUSION AFFIDAVIT
TO: THE COMMON COUNCIL, CITY OF SAN BERNARDINO
In accordance with Title 23, United States Code, Section 112, the undersigned hereby states,
under penalty of perjury:
That he/she has not, either directly or indirectly, entered into any agreement,
participated in any collusion, or otherwise taken action in restraint of free
competitive bidding in connection with RFP F-05-008.
Business Name _AIIIe? G-0 1f'.( Lo L —arr
Business A ressaT—Z5o
Signature of bidd r X___
`G�---------
Place of Residence
_1��'
Subscribed and sworn before me this _____--_ day of ______-- — , 20
Notary Public in and for the County of _ �� _4 '%— Statte of
California.
My commission expires _-/--"� --- �)
20
,PATRICIA S. HARSTADZ
COMM. # 1282008 <
NOTARY PUBLIC - CALIFORNIA
ALAMEDACOUNTY
My Cortm Expires OCT 27, 2004 y