HomeMy WebLinkAbout1991-474
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RESOLUTION 91-474
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RESOLUTION OF THE CITY OF SAN BERNARDINO AUTHORIZING
3 EXECUTION OF AN AGREEMENT WITH ABC ANESTHESIA, INCORPORATED
f\DVANCED BILLING CONCEPTS RELATING TO BILLING SERVICES FOR
PARAMEDIC SUBSCRIPTION PROGRAM.
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THE
DBA
THE
5 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SAN BERNARDINO AS FOLLOWS:
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SECTION 1. The Mayor of the City of San Bernardino is hereby
7 3.uthorized and directed to execute on behalf of said city an
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f\greement with
the ABC
Anesthesia,
Incorporated
DBA
Advanced
9 Billing Concepts a copy of which is attached hereto, marked Exhibit
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"A" and incorporated herein by reference as fully as though set
forth at length.
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SECTION 2. The authorization to execute the above-referenced
13 f\greement is rescinded if the parties to the Agreement fail to
14 axecute it within sixty (60) days of the passage of this
15 resolution.
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I HEREBY CERTIFY that the foregoing resolution was duly
17 ~dopted by the Mayor and Common Council of the City of San
18 Bernardino at a requ1ar meeting thereof, held on the 18th day
19 Jf November
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, 1991, by the following vote, to wit:
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ESOLUTION AUTHORIZING THE EXECUTION OF AN AGREEMENT WITH ABC
ESTHESIA, INC., DBA ADVANCED BILLING CONCEPTS RELATING TO BILLING
ERVICES FOR THE PARAMEDIC SUBSCRIPTION PROGRAM
OUNCIL MEMBERS
AYES
NAYS
ABSTAIN
ABSENT
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ILLY
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UDSLEY
...1L-
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9 OPE-LUDLAM
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city Clerk
The foregoing resolution is hereby approved this
20th day
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NnvpmhP-T I 1991.
pproved as to form
20 nd legal content:
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AMES F. PENMAN
ity Attorney
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City Res. 91-474
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AGREEMENT
2 THIS AGREEMENT, made and entered into this 10th day of
Dec~r ,1991, by and between the CITY OF SAN BERNARDINO, a
3 Charter City ("city"), and ABC ANESTHESIA, INCORPORATED, a
California Corporation doing business as ADVANCED BILLING CONCEPTS,
4 hereinafter referred to as ("Provider").
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WITNESSETH:
WHEREAS, City did accept the proposal of the Provider,
NOW THEREFORE, THE PARTIES HERETO AGREE AS FOLLOWS:
RECITALS
1.
This Agreement is made and entered into with respect to the
following facts:
A.
The city has implemented a paramedic subscription program
for its residents and City currently bills those program
subscribers as well as those who use the paramedic
service but are not subscribers; and,
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That Provider is qualified to provide such billing
services to the City; and, therefore, the city has
elected to engage the services of Provider upon the terms
and conditions hereinafter set forth.
SERVICES
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Provider shall perform those services specified in that
certain proposal dated October 4, 1991, hereinafter called
"proposal", a copy of which Proposal is on file in the Office
of the City Clerk and by this reference incorporated herein
and made a part hereof as though fully set forth herein.
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Performance of the work specified in said Proposal is made an
obligation of Provider under this Agreement, subject to any
changes made subsequently upon the mutual written agreement of
the parties.
SCOPE
The services to be performed by Provider under this Agreement
shall include, but not limited to, those services specified in
Proposal.
FEE
Compensation to Provider for the total services to be rendered
pursuant to this Agreement shall be in an amount of not to
exceed ten percent (10%) of amounts collected by Provider
under the billing program. Said amount shall be deducted
weekly from amounts collected and remitted to City.
EXTRA SERVICES
No extra services shall be rendered by Provider under this
Agreement unless such extra services first shall have been
authorized in writing by the City. Any such services so
authorized shall be paid by the city at the hourly rates set
forth in said Proposal.
PAYMENT BY CITY
Payment for all services rendered pursuant to this Agreement
shall be made in accordance with Paragraph 4 hereof.
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CITY SUPERVISION
The Fire Chief of the City of San Bernardino, or his designee,
shall have the right of general supervision of all work
performed by Provider and shall be the city's agent with
respect to obtaining Provider's compliance hereunder. No
payment for any services rendered under this Agreement shall
be made without the prior approval of the Fire Chief, or his
designee.
TERM
The term of this Agreement shall be for one year, commencing
on December 15, 1991, and continuing to and including December
14, 1992.
Upon expiration of the term of this Agreement, city shall have
the right to extend the same for an additional one (1) year
period to and include December 14, 1993. Should City elect to
extend the term of this Agreement, City shall so notify the
Provider in writing thirty (30) days prior to December 14,
1992.
TERMINATION OF AGREEMENT
The City shall have the right to terminate this Agreement upon
giving a thirty (30) day written notice of such termination to
Provider. In the event of such termination, the city
Administrator, or his/her designee, based upon termination,
shall determine the amount of fees to be paid to Provider, for
such finding by the city Administrator, or his/her designee,
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and approved by the San Bernardino Mayor and Common Council,
shall be final and conclusive as to the amount of such fee.
INDEPENDENT CONTRACTOR
Provider shall act as an independent contractor in the
performance of the services provided for in this Agreement and
shall furnish such services in Provider's own manner and
method and in no respect shall Provider be considered an agent
or employee of the City.
NONASSIGNMENT
This Agreement is not assignable either in whole or in part by
Provider within the written consent of City.
INDEMNIFICATION
Provider hereby agrees to, and shall hold city, its elective
and appointive boards, officers, agents, and employees,
harmless from any liability for damage or claims for damage,
for personal injury, including death, as well as from claims
for property damage which may arise from Provider's negligent
acts, errors or omissions under this Agreement. Provider
agrees to, and shall defend City and its elective and
appointive boards, officers, agents and employees from any
suits or actions at law or in equity for damages caused, or
alleged to have been caused, by reason of any of the aforesaid
negligent acts, errors or omissions.
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EOUAL OPPORTUNITY CLAUSE
Provider shall not discriminate in its recruiting, hiring,
promotion, demotion or termination practices on the basis of
race, religious creed, color, national origin, ancestry, sex,
age or physical handicap in the performance of this Agreement
and shall comply with the provisions of the State Fair
Employment Practices Act as set forth in Part 4.5 of the
Division 2 of the California Labor Code, the Federal Civil
Rights Act of 1964, as set forth in Public Law 88-352, and all
amendments thereto; Executive Order 11246; and all
administrative rules and regulations issued pursuant to such
acts and order.
UNAUTHORIZED ALIENS
Provider hereby promises and agrees to comply with all of the
provisions of the Federal Immigration and Nationality Act (8
USCA 1101, et seq.), as amended; and, in connection therewith,
shall not employ unauthorized aliens as defined therein.
Should Provider so employ such unauthorized aliens for the
performance of work and/or services covered by this contract,
and should the Federal Government impose sanctions against the
city for such use of unauthorized aliens, Provider hereby
agrees to, and shall, reimburse City for the cost of all such
sanctions imposed, together with any and all costs, including
attorney's fees, incurred by the city in connection therewith.
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1 AGREEMENT WITH ABC ANESTHESIA, INCORPORATED DBA ADVANCED BILLING
CONCEPTS FOR BILLING SERVICES.
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4 IN WITNESS WHEREOF, the parties have executed this Agreement
5 on the day and year first above written.
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Approved as to form
11 and legal content:
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Attest:
JAMES F. PENMAN,
city Attorney
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Provider
ABC ANESTHESIA, INC. A
California Corporation DBA
ADVANCED BILLING CONCEPTS
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By: ~
Pre dent
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C\l~'1l\
ABC
ADVANCED BIUlNG CONCEPTS
16520 Harbor Blvd., Suite A
rountain \lilley, CA 92708
(714) 839.2787
(213) 594-6789
October 4, 1991
San Bernardino Fire Department
Firestation #10
502 S. Arrowhead
San Bernardino, CA 92346
ATTN: Dana Austin
Dear Dana,
Thank you for this opportunity to provide The City of San Bernardino
with Ambulance Billing Services.
I'm sure that you will find that ABC is well qualified for the job at
hand. given our experience and background. While we are the 2nd
largest Full service Medical Billing Agency in Southern California,
we provide our clients with the one on one attention that we feel is
an important part of our success.
We have tried to keep this proposal brief. If there are any
questions, please don't hesitate to call either me or Mary
Boyajian,
What Follows:
1. A short background on ABC,
Loyd our General Manager.
the body of the proposal.
Mary Boyajian the founder, and Cathy
These Resume's have been left out of
2. The proposal, indexed.
3. Samples
Looking Fo~ward to hearing from you,
c_Sirl~
~r ~~z /
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The ABC Story
Advanced Billing Concepts was founded lB years ago by Mary Boyajian,
who remains the company's president. In the beginning, the primary
focus centered around hospital-based physicians. However, over the
years, ABC's capabilities have expanded to accommodate office based
physicians and even entire medical centers and foundations. Today,
ABC is Southern California's second largest full-service medical
billing agency. From individual practices to large facilities, ABC is
ready to meet the challenges of today's medical professionals.
Throughout the years, we have never lost sight of the importance of
maintaining personal client relationships. We get to know each
client, his or her procedures, and even the individual patients as
they become familiar to your billing specialist. This provides us with
the capability to act as an extension of you- following your
procedures and serving to improve the overall efficiency of your
entire billing process.
Personnel
Continuing education at ABC is a way of life. All billing specialists
attend industry seminars that serve to keep them up to date on any
industry policy changes. ABC's reputation has always been one of
expertise. Mary Boyajian is recognized as a leading authority on the
subject of third party billing. The management team at ABC has an
average tenure of nine years. With virtually no management turnover,
each member of the team has the opportunity to become familiar with
every aspect of the billing process, and this overlapping in knowledge
provides for the stable flow of day-to-day business affairs. We're
very proud of our team, and those who lead them. We feel sure that
you will find both their knowledge and dedication to be on the highest
level.
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Mary Boyajian, President
"My philosophy has always been to get to the heart of the problem -and
then solve it."
Mary began her career as a nurse. but found that her real expertise
lay in her business savvy. As President of ABC and its subsidiaries.
she has long been recognized as a highly knowledgeable leader in the
Southern California private practice compensation methods. Mary
possesses a level of expertise in billing, coding, feeing, and
compensation that is unrivaled in Southern California. Today. Mary
still heads ABC on a daily basis.
Mary has participated in. and lectured to, international symposiums on
Medicare and third party billing. with invitations to speak coming
from major universities in Southern California, including UCLA and
USC.
Cathy Loyd, General Manager
"Keeping up with the changing regulations is what makes ABC stand
out. "
Cathy has been with ABC for over 13 years. directly immersed in all
phases of private practice billing. Cathy has learned about and
serviced the changing needs of the Southern California medical
community during her tenure at ABC. As an expert well versed in all
phases of billing from coding and feeing to advanced collection
techniques, Cathy has earned recognition for high level performance.
Utilizing her first hand knowledge, Cathy has implemented many of the
procedures. systems, and policies that enable ABC to consistently
operate at maximum efficiency. She performs as a tenacious manager
who follows through and sees that the job is finished correctly.
James McCaulley, MIS Manager
"Understanding the needs of the end user is the best starting point."
Jim began his career in computers being recruited by IBM soon after
earning his degree. Gaining his tenure as a talented systems analyst
and top notch programmer. Jim went on to establish an enviable track
record in health care data processing management. He came to ABC
after years of health care database management at some of Southern
California's largest corporations. Jim's insight into the needs of
medical groups, along with that rare talent to understand the user's
needs, keeps us ahead of the ever-changing medical billing world.
Robert Hartin, CPA, Controller
"Keep everything in its place and current. and accounting
becomeseasy. "
Bob brings many years of both public and private accounting experience
including having been an instrumental participant at ICN
pharmaceuticals in their growth years. Throughout his career as a
CPA, Bob has developed a keen sense for avoiding unneeded risks. while
maintaining systems that flow at a progressive standard. He is an
integral part of ABC's management team. keeping our accounting systems
running smoothly and witbout error.
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07-0CT-91
San Bernardino Fire Department
page 1
Request For Proposal . . .
Background & Approach.
Methodology. . . . . .
\lork Plan. . . . . . .
Proposed Services Organizatlon & Staffing.
Related Experience. . . .
Proposed Services Schedule
Cost Data.
Cone I us ion . . . . . . . .
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07-0CT-91
table of contents
page i
07-0CT-91
San Bernardino Fire Department
page 1
1: Request For Proposal
1.1: Background & Approach
San Bernardino Fire Department provides paramedic emergency
services. and will be implementing City owned ambulance
transportation servicesThere is a paramedic subscriber service.
1.1.1:
Our Understanding
Currently The City only bills for its paramedic services,
and is utilizing courtesy ambulance service for this
process. The City is seeking an outside agency to reduce
potential conflicts of interest, increase billing control,
increase revenues, and reduce the ageing of receipts.
1. 1 .2:
Objectives
We seek to increase the recovery rate from present levels,
and decrease the average receivables ageing, In addition
ABC believes that we can be instrumental with the process
of beginning a transportation service. We seek to build a
relationship with The City, resulting in a smooth flow of
information and ideas to benefits both parties.
1. 2:
1. 2.1:
Methodology
Team Approach
The City's work will be handled within our Paramedic
Billing Team. Our existing methods and work plan are
outlined under Work Plan.
1. 2.2:
Controls
From the moment a charge comes into the building to the
co II ect ion of the I ast penny, every deta i 1 is tracked an
accounted for. All reports balance to the penny, and all
charges and receipts are accounted for.For money handling,
the staff works with duplicate check copies only and has to
balance each day. In working with charges, all charges are
tracked within the ABC mainframe computer, and accounted
for from beginning to finish. Reports are stored on-site at
ABC's central production facility in Fountain Valley for 3
years. Once each account has been completely collected on,
the original materials are sent back to The City. At any
time, all can be accounted for.
Disaster Recovery, Security
At Advance Billing Concepts, computer system back-ups
are performed on a daily basis. Data is backed up on
industry standard IBM 9 track magnetic tape. Back-ups
are then transported daily off site to a data storage
vault. Reports are also stored off site in microfiche
form for three years. This system enables us to
continue processing your work immediately after
disaster.
07-0CT-91
Request For Proposal
page 1
07-0CT-91
1.2.3:
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07-0CT-91
San Bernardino Fire Department
page 2
Confidentiality
ABC always maintains the highest confidentiality, and
security. Our personnel are all trained in
confidentiality measures. ABC is well aware of the
laws governing privacy, and uses the information given
to ABC only for the purposes of medical billing and
recovery, within the laws.
Bilingual Personnel
In our Paramedic Team, we maintain bilingual billing
employees.
Location
All work wIll be performed and managed out of our Fountain
Valley central production facility where our Mainframe
computer and management personnel are.
Performance TIme Line
Since ABC does not receive compensation for work done until
we actually get the money in, we have an interest in
working quickly. The actual time line with significant
dates is in the following section. ABC is always looking
for ways to improve our speed, and hence your collection
speed. We utilize computer automation wherever possible.
With our in-house programming department, we are able to
adapt quickly, and devise systems that mean efficiency to
us and our clients. We are the innovators of the auto
'Tracer Form', and were one of the very first agencies to
work with Medicare on Electronic Transmission. This way we
free up valuable labor to get on the phone, and do
collection work, and less 'busy work. 'At ABC, you get the
clout of our volume. By combining many of our client's
delinquent accounts for each delinquent carrier, third
party payers stand up and take notice when we call with a
large volume of late accounts. You get attention you never
thought possible from third party payers.Internally, ABC
uses weekly management reports to stay abreast of our work
flow and maximize performance.
Reporting EmphasIs
In an idea unique among the larger agencies, we involve our
customers in assessing our performance on an on-going
basis. Our standard reports summarize average collection
time, and volume of work for our clients to see.AII detail
is laid out, and we are always open to third party audits,
or review of accounts.
Work Plan
Defining Transfer of Information and Controls
Since ABC has many years of experience in the field of
Paramedic and Ambulance billing, we understand that
sometimes good patient demographic information yan be hard
to obtain. Throughout the years, we have found that a good
working relationship with the fire department is our best
Request For Proposal
page 2
07-0CT-91
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07-0CT-91
San Bernardino Fire Department
page 3
tool. ABC will work The City's personnel including
providing training and batching materials to ensure a
smooth flow of complete information to ABC. The
information needed includes; reason for pickup,
origination, destination, miles, Emergency Medical Services
Report, charge detail, patient demographics & insurance,
patient subscription information, and hospital face sheet.
A system to control and ensure that the transfer of all
runs has been received and acknowledged should be
implemented. The ABC standard month end reports offer a
simple method to review charge activity for a given
calendar month. (see attached samples) We suggest that The
City keep a simple log of volume of charges by date
transferred to ABC, and reconcile once a month with our
month end reports. This ensures that all charges have been
entered into ABC's mainframe IBM computer and entered into
the bil ling-follow-up procedures outlined under the
Proposed Services Schedule Section.
Initial Billing Procedures
The day that batches are received in house, they are logged
into the "ABC Tracking System." Within 2 working days;
Batches are prepared for billing; Charge and ICD coding is
applied, as well as insurance carrier information. Within 3
working days, charge detail is then entered into ABC's
Mainframe computer, and printed bills are produced. If
some of the charges are missing sufficient billing
information, they will be held out of the batch and noted
in the ABC tracking System. Within 5 working days, bills
are mailed out with proper attachments. Missing
Information is requested from The City or the admitting
hospital in either in writing or verbally as requested by
The City Within 7 working days, the patient is sent an
initial statement, unless the missing information is
patient address. This Initial statement lets the patient
know immediately that we are billing the insurance carrier
and what they owe. The initial statement can have a
message specific to The City as requested as well.
Automated Follow up procedures
Each Month, unless otherwise requested by The City, the
patient gets a monthly statement with messages specific to
a financial class under the name of The City Of San
Bernardino. Verbiage just for The City of San Bernardino
can be added to statements if desired. All correspondence
is sent out with post office regulation "Address Correction
Requested," We pay the post office fees for the
corrections, updates our records immediately and send new
statements to the patient(s) as appropriate. If the
Patient is a "skip" and leaves no forwarding address,
tracing is attempted at ABC, and The City is notified for
possible referral to a licensed collection agency. If
there is no payment activity 45 Calendar days after Initial
billing, red ABC tracer forms with attachments are
Request For Proposal
page 3
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07-0CT-91
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07-0CT-91
San Bernardino Fire Department
page 4
automatically generated and mailed to third party payers.
For cash accounts. a statements urging contact are sent.
Tracer Sample attached.
Delinquent Account Procedures
15 days after tracers are sent. if there is no payment
response from carriers. the ABC mainframe computer
generates reports by carrier and phone calls are made.
Patients are involved and encouraged to complain to
carriers who are not paying, and reminded that they are
ultimately liable for charges incurred. After 3 patient
statements, cash accounts are called, and individual
letters are sent. In at least 180 days from date of
billing, or as soon as our collection efforts are
exhausted, delinquent accounts are referred to The City of
San Bernardino for direction as to further action.
Collection Accounts
If The City chooses, ABC will refer the delinquent account
to a licensed collection agency of their choosing. ABC
does not earn any fees on funds received from accounts
referred out to a collection agency, or other party. ABC
does maintain a working relationships with collection
agencies and can recommend and provide guidance in this
area. ABC does not own or participate financially in any
collection agency as we feel it is a conflict of interest.
Our goal is our customer's satisfaction.
Reporting
lIeekly
ABC provides weekly revenue reports as standard. lie
also deliver requests for direction on collection
accounts and requests for information on a weekly
basis.
Monthly
Standard month end reports are attached here. ABC
reports and balances to the penny, all activity
including: charges posted, receipts, write offs, exact
cost of services, and a recap of weekly revenue
reports. Additionally, standard reports include;l.
Management analysis of credit and debit adjustments to
help determine where the write offs are going.2.
Management analysis and ageing of receipts to view
ABC's performance and demographic characteristics of
receipts.3. Aged accounts receivable summary to view
and analyze outstanding accounts receivable by age and
finullcial class.
Monthly Specific to Ambulance Services
In addition to standard ABC reports, Ambulance
accounts can elect to receive management reports on
run statIstics developed Just for ambulance
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Request For Proposal
page 4
07-0CT-91
San Bernardino Fire Department
page 5
This reporting provides;
1. Summary reporting by destination showing number
of trips.
2. Number of types of trips (dry run. normal run,
cancelled run), minutes, and miles by unit.
Annual
ABC reports accumulate annual revenue, write off and
charge figures adjusted to your fiscal year.
AddItionally management analysis of ageIng of
receivables and analysis of credit and debit
adjustments are accumulated on a year to date basis.
It is ABC's standard policy to make improvement
suggestIons as they become viable.
1.4: Proposed Services Organization & Staffing
Our billing specialists are divided into team units with each team
having one leader who reports directly to upper management. Each
team handles a particular specialty, hospital based or office
based, primary or secondary physicians. You will retain the same
team and primary contact throughout your affiliation with ABC.
This management style helps to soften any unexpected personnel
problems. It means that your work doesn't stop if someone falls
Ill, or is called away for other reasons.
1.4.1: Your Main Contact
Our paramedic Team is led by AlIce M. Keene. Before Alice
and her husband moved to Orange County in 1984, Alice had
put in over a decade of service managing a large Midwestern
manufacturer's medical insurance claims department. Her
past experience along with passing ABC's 90 day training
school with flying colors, makes Alice a valuable asset to
the ABC billing Team. A hard worker, Alice has
consistently won the ABC attendance awards since her
beginning at ABC. Reporting directly to Cathy Loyd our
general manager, Alice oversees a team of 4 clerical
people. Three of the people have had to pass the ABC
training program as well.
1.4.2: Expected Man Hours Needed
The paramedic team IS a four person team. At ABC, we do
what is needed to perform the job properly and do not
'cream' the good work. We seek to inspire our teams with
the pride to follow through, and rewards that come with
attentive work, and good performance. While we expect The
City's current paramedic billing to need 30 hours of
clerical work and 5 hours of supervisor/manager work each
month, we do not provide limits to the proper completion of
a Job. With over 50 employees, we have the resources
needed to take care of any ups or downs in the work
flow.Once The CIty has begun transportation services, we
expect increased clerical and supervisory needs to manage
07-0CT-9l
Request For Proposal
page 5
07-0CT-91
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07-0CT-91
San Bernardino Fire Department
page 6
The City's needs.
Related Experience
ABC has been performing Medical Related billing since its inception
over 18 years ago. Today we are southern California's 2nd.
largest full service medical billing agency. We have been
performing Ambulance billing and collections for over 5 years now.
Ambulance billing clients can be found in the attached reference
listing.
Proposed Services Schedule
Standard ABC Services
Coding - The CPT and lCD codes used in billing will be
determined from the information provided on the batch
billing information.
*Consultation - Expert fee and coding consultations are
made avallable.
*Complete all insurance, patient, and other third party
billing, including any required data processing for
billing, collecting and reporting.
*Provide for the electronic submission (ECS) of all
Medicare, Medi-Cal, Blue Cross, Blue Shield, (and other
third party payors, where available), claims, which
expedites processing, hence faster payment.
*Prepare patient balance bills and post payments to their
accounts.
*Constantly track the status of every claim and provide
easy-to- read quantitative monthly reports which will show
accumulated accounts receivable and collections.
*In the event of a denied claim, ABC will react immediately
by reviewing the claim in question for discrepancies,
consulting with the practice, and opening an inquiry into
the justification for denial.
*Use diligence and best efforts to collect all balances -
additional collection efforts of chronically delinquent
accounts to be mutually agreed upon - on a case-by-case
basIs.
*Deposit funds directly into The ABC Trust account within
three days of receipt.
*Weekly forward a report reflecting all payments, refunds,
adjustments and balances.
Request For Proposal
page 6
07-0CT-91
San Bernardino Fire Department
page 7
1.6.2: Additional Services at No Extra Cost
ABC will provide training of City personnel to increase
awareness of billing needs and increase recovery, and
billing volume. If requested ABC will track dry runs and
mutual aid runs.
1.6.3: DelIvery Service
ABC will provide Delivery service to and from The CIty.
1.6.4: Attendance at Meetings
ABC proposes meetings every other month. We realize that
at first more meeting may be indicated, however our
experience tells us that matters of importance are best
handled on the phone immediately, and that meetings are
usually good for constructive changes in policy and for
verbal reporting.
1.6.5: Start-Up
ABC is currently ready to begin providing service to The
City of San Bernardino. We require a 1 week lead time to
begin operations. This time is needed to set-up the
transfer of information and fulfil the necessary paperwork
requirements for Medicare and Medi-Cal.
1.7: Cost Data
For all services and reports listed;
10% of Amounts caused to be received by ABC
Note that we do not charge on accounts referred to outside agencies
such as a collection agency.
If The City Desires Custom reports; Custom Programming Work $50./
HourThis Price Schedule IS Valid for 90 Days
1.8: Conclusion
ABC appreciates understands and appreciates the challenges of faced
in today's complicated and changing medical compensation market.
Keeping ahead of a constantly changing set of rules while still
handling municipal concerns can be more than a full time job.At ABC
we are committed to working not merely as your billing "vendor",
but as an extension of your service - the extension that
specializes in third party billing and accounts receivable
management.ABC has years of experience at performing in the area of
ambulance billing. We are large enough to accept the work without
it being a significant impact. We have the existing staff,
materials, computers, systems, and experience to make the
transition a success. We are a company that was built in Orange
County and we understand the area.Given The opportunity, we will
prove to a valuable addition to the paramedic operation.Thank you
for the opportunity to review this matter. If you have any
questions, please feel free to call either Al Gonzalez or Mary
Boyajian at (714) 839-2787.
07-0CT-91
Request For Proposal
page 7
ADVANCED UlLLlN(; CONCEl'fS
The Following Month End Report Samples
Contain some randomly selected live data.
Patient names, as well as
ABC client names have been blacked out.
These reports are intended only to provide a working example
of print arrangements. summary data Calculations.
detail and emphasis of reporting.
Neither actual performance.
nor actual volume assUF..ptlons
can be made from the following samples.
,j.
"
.
ABC
lG520 Harbor Blvd., Sulle A
Foullwln \hllg.', CA 92708
(714) 8:\U.2787
(213) 5U4.678U
nlllU';U )/1/,/';1 lr'.Ju.f.','
DAlE 3/~
PRACtICE_
1\ C '- U V I. I
"" K '- " '- I , i\ I) .... l..
. FOR TIl~ PERIOD OF
2/01/91 T1IRU 2/20/91
CURRENT PERIOD OF
2/01/91 TIIRU 2/20191
TEAR TO DATE PERIOD
1/01/91 TIIRU 2/20/91
ACCOUNTS RECEIVAOlE
OPENING BALANCE 202,700.90 302,207.36
PLUS CHARGES 301.00 253,021.27
PLUS CIIARGE ADJUSTMENT 105.24 7,690.05
MINUS RECEIPTS 5,044.0/. 105,353.16
MINUS CREDIT ADJUSTMENTS 2,033.60 1!l3,O47.30
ACCOUNTS RECEIVABLE
HlD I NG BALAt./CE 275,390.22 275,390.22
This Executive Summary of ABC's Standard Month
End Rports provides a quick method of tracking
performance and volume numbers.
Since this report was created with random data,
the current month lIas no real activity.
Note that the Year To Date period is adjusted to.
your fiscal year.
,\.
I
t:
.,.
. .:
PAGE
H01050 5/1~/91 17.51.26
O^'E 2/0~
PR^CIICE_
MOUTHlY ACKNO~lEDGEMEHT OF CHARGES
2/01/91 111RU 2/28/91
^CC1
IUMOER
. J09105050001
009105160001
009105570001
039041.770001
039044770001
009045470001
009045470001
009045470001
009045790001
009045790001
009045790001
009045800001
009045800001
009045800001
009045830001
009045830001
00904 583000 1
009045850001
009045850001
009045850001
009045870001
009045870001
009045870001
009045890001
009045890001
009045900001
009045900001
009045900001
009045930001
009045930001
009045930001
009045940001
09045940001
009045940001
009045950001
009045950001
009045950001
0090(.5970001
009045970001
009045970001
009045980001
009045980001
009045980001
009046000001
009046000001
009046000001
009046010001
009046010001
P^ II EN1
FC
SERVICE
0^1E
05 2/10/90
05 2/11/90
05 2/ 15/90
10 12/10/90
10 12/10/90
50 12/16/90
50 12/16/90
50 12/16/90
57 12/18/90
57 12/18/90
57 12/18/90
57 12/10/90
57 12/18/90
57 12/18/90
10 12/19/90
10 12/19/90
10 12/19/90
" 12/ 19/90
" 12/19/90
" 12/19/90
50 12/19/90
50 12/19/90
50 12/19/90
" 12/19/90
" 12/19/90
67 12/19/90
67 12/19/90
67 12/19/90
53 12/19/90
53 12/19/90
53 12/19/90
90 12/20/90
90 12/20/90
90 12/20/90
10 12/20/90
10 12/20/90
10 12/20/90
90 12/20/90
90 12/20/90
90 12/20/90
50 12/20/90
50 12/20/90
50 12/20/90
53 12/20/90
53 12/20/90
53 12/20/90
50 12/20/90
50 12/20/90
,.'
. . ?~:
';
CH^RGE
.01
.01
.01
350.00
7.50
350.00
30.00
16.75
350.00
22.50
16.75
350.00
30.00
16.75
350.00
37.50
16.75
350.00
7.50
16.75
350.00
7.50
16.75
350.00
7.50
350.00
22.50
16.75
350.00
22.50
16.75
350.00
22.50
16.75
350.00
22.50
16.75
350.00
37.50
16.75
350.00
15.00
16.75
350.00
15.00
16.75'
350.00
7.50
This Sample Report
has had the names of
the patients covered.
To illustrate how the
report is arranged;
a broad range of
service dates were
included
The Report is arranged
by service date.
Each line item is listed
separately, for auditing
purposes.
The $.01 charges are for
dry run tracking
HB1050 5t1I!j91 17.51.26 HUN I Ii L i\ I.. r,.' .-.'
O^lE 2/_' 2/01/91 T.l\RU 2/28/91 --
. .
PR^Cll C(
^CCT SERVICE
HUMBER PATlEUT FC DATE CH^RGE
101,6010001 50 12/20/90 16.75
"9046030001 10 12/20/90 350.00
009046030001 10 12/20/90 7.50
009046060001 55 12/20/90 350.00
009046060001 55 12/20/90 7.50
009046060001 55 12/20/90 16.75
009046070001 90 12/21/90 350.00
009046070001 90 12/21/90 7.50
009046070001 90 12/21/90 16.75
009046080001 53 12/21/90 350.00
009046080001 53 12/21/90 15.00
009046080001 53 12/21/90 16.75
009046100001 10 12/21/90 350.00
009046100001 10 12/21/90 37.50
009046100001 10 12/21/90 16.75
0090',6120001 52 12/21/90 350.00
009046120001 52 12/21/90 22.50
009046270001 90 12/ 22/90 350.00
009046270001 90 12/22/90 15.00
009046340001 90 12/22/90 350.00
009046340001 90 12/22/90 15.00
009046340001 90 12/22/90 16.75
0090/,6360001 52 12/22/90 350.00
009046360001 52 12/22/90 15.00
009046390001 10 12/ 22/90 350.00
009046390001 10 12/22/90 15.00
009046450001 50 12/23/90 350.00
009046450001 50 12/23/90 7.50
009046460001 52 12/23/90 350.00
009046460001 52 12/23/90 7.50
009046460001 52 12/23/90 16.75
009046530001 10 12/23/90 350.00
09046530001 10 12/23/90 15.00
J09046560001 10 12/23/90 350.00
009046560001 10 12/23/90 15.00
009046560001 10 12/23/90 16.75
009046200001 10 12/24/90 350.00
009046200001 10 12/24/90 15.00
009046600001 67 12/24/90 350.00
009046600001 67 12/24/90 15.00
009046600001 67 12/24/90 16.75
009046630001 57 12/24/90 350.00
009046630001 57 12/24/90 15.00
009046630001 57 12/24/90 16.75.
009046640001 50 12/24/90 350.00
009046640001 50 12/24/90 15.00
00901,6640001 50 12/24/90 16.75
009046660001 10 12/24/90 350.00
\
!
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1 I:
For The Purpose of Brevity
Pages 3 through 13
Have Been Omited
In This Sample Report
They Would Be Similar to
The Preceding Page 2
,
M!l10S0 5/1f./91 17.5'.26 MON ll,lY ACKNO\.JlEDGEMEU f OF CHARliES
D~TE 2/07/91 1/01/91 ;IIRU 2/20/91
PRACtiCE 05/,6
I,\\JL. 1-'
_:t.'f,L~"":-;' \i~::~: u': ,,~, .
AceT SERVICE
NUMOER PATIENT FC DAlE CHARGE
'10421,0001 SALI ZAR 05 2/02/91 .01
,0910430001 05 2/03/91 .01
J09104300001 05 2/03/91 .01
009104320001 PERRY 05 2/03/91 .01
009104330001 BUI 05 2/03/91 .01
009104390001 05 2/03/91 .01
009101,470001 NICKLES 05 2/QI,/91 .01
009101,500001 JONES 05 2/04/91 .01
009101,510001 05 2/04/91 .01
009104520001 05 2/05/91 .01
009104530001 05 2/05/91 .01
009104550001 MelENDEZ 05 2/05/91 .01
009101,610001 05 2/05/91 .01
009104630001 IIERNANDEZ 05 2/06/91 .01
009104650001 05 2/06/91 .01
009104670001 BROIill 05 2/06/91 .01
009104730001 05 2/07191 .01
009104760001 VARElE 05 2/07/91 .01
009104010001 MIZE 05 2/00/91 .01
009104070001 DOE I JOliN 90 2/00/91 350.00
009104070001 DOE I JOlIN 90 2/00/91 30.00
009104070001 DOE, JOliN 90 2/00/91 16.75
009104990001 KEONG 05 2/09/91 .01
009105020001 PEREZ, TOllY 05 2/10/91 .01
009105110001 NO PT 05 2/ 10/91 .01
009105150001 NO PT 05 2/11/91 .01
009105240001 NO pt 05 2/12/91 .01
009105270001 tlO PT 05 2/12/91 .01
009105300001 NO PT 05 2/13/91 .01
009105420001 NO PI 05 2/13/91 .01
009105440001 lISK, OAV 10 05 2/14/91 .01
'09105470001 NO PI 05 2/14/91 .01
,09105590001 PEREZ , AOA 05 2/15/91 .01
009105610001 NO PI 05 2/15/91 .01
009105650001 NO PI 05 2/15/91 .01
009105600001 NO PI 05 2/16/91 .01
109105750001 BRES, MAY 05 2/16/91 .01
009105010001 NO PT 05 2/17191 .01
009105020001 SAlS, TIFFANY 05 2/17191 .01
009105040001 AZADIAN, DIANE 05 2/17/91 .01
009105090001 JmlES, EILEEN 05 2/10/91 .01
~ 009106150001 NO PI 05 2/20/91 .01
TOTAL 74,330.56
10TAl TRX 666 The number of line items, and the total
volume of charges by value are summarized on
this last page of the report.
.1
1
1
i:
HB7020 5/14Nl 10.19.54 I~ 0 ~j {\I L Y lJ !: f' u $ 1 I f< l l. 1\ I'
DAlE 5/"" 2i.Ol/91 :.1\RU 20/82/91
PRACTICE
GIMRANTOR
NUMBER NAME FC DATE RECEIPTS OBT .ADJ.
00463 90 2/01/91 46.36
11803 74 2/01/91
J891957 10 2/01/91 315.00
- 00900847 67 2/01/91
0090084 7 67 2/01/91 86.59
0090 1178 41 2/01/91 381. 75
00901698 67 2/01/91
00901698 67 2/01/91 71.59
00902126 11 2/01/91 50.00
00902171 67 2/01/91 86.59
00902171 67 2/01/91
00902191 90 2/01/91 365.00
00902550 21 2/01/91 56.02
00902756 10 2/01/91 50.00
00902849 67 2/01/91
00902849 67 2/01/91 86.59
00902917 10 2/01/91 150.00
00902965 21 2/01/91 59.14
00902965 21 2/01/91 59.14
00903266 67 2/01/91 79.09
00903266 67 2/01/91
00903621 10 2/01/91 50.00
00903672 74 2/01/91 3Bl.75
00903661 74 2/01/91 374.25
00903745 21 2/01/91 292.00
0090377V 21 2/01/91 300.00
01692670 99 2/01/91
REF 9101110 PER STEVE NCO
01903044 67 2/01/91 76.71
01903044 67 2/01/91
01903331 90 2/01/91 .65
'903624 97 2/01/91 357.50
.903637 53 2/02/91
00903637 53 2/02/91 21B.OB
00903637 53 2/02/91
00903686 55 2/02/91 2(.8.54
1903686 55 2/02191
J903648 50 2/02/91 230.54
)0903846 50 2/02191
00903969 52 2/02191 219.60
00903969 52 2/02/91
00903969 64 2/02191
-00903996 53 2/02191
00903996 53 2/02191 231.61
00903996 53 2/02/91
00904000 55 2/02/91 225.46
00904000 55 2/02/91
00904006 57 2/02/91 231.61
CR_ADJ.
315.00
295.16
295.16
295.16
295.16
295.16
268.29
54.52
64.90
86.07
86.07
89.36
56.02
90.60
59.14
69.50
"i"~', .,1:'" {):
OEPOS IT REfUND
346.75
This report is delivered both weekly and monthly.
This sample is,a monthly version.' The monthly version,
simply has the "information for all weeks in the month
.,
on one report ~,_'-': This re,port balat~ces to the penny with
checks deposited, and shows any write-offs (CR.ADJ.),
~ ' .
or refunds. C.omments are inserted' to asist .in any
auditing efforts.
BALANCE
46.36-
.00
.00
.00
295.16
.00
22.50
317.66
.00
295.16
.00
.00
.00
261. 75
.00
295.16
161.75
.00
59.14-
295.16
.00
315.00
.00
.00
73.00
57.50
.00
266.29
.00
57.00
.00
302.96
64.90
.00
146.21
62.14
143.71
57.64
69.36
.00
306.96
.00
90.60
322.61
147.02
57.52
149.94
j\.Jhh..U j,I"'." It). , 1 . ~ I
DATE 5/1. 1/01/91 THRU 20/62/91 -
PRACTICE .
GUMANTOR
Nll-IBER NAME FC DATE RECEIPTS OBT .AOJ. CR .AOJ. OEPOS I T REFUND BALANCE
'"904006 57 2/02/91 90.BO 59.14
14016 57 2/02/91 90.92 60.64
.04016 57 2/02/91 237.69 151.56
00904017 55 2/02/91 231.Bl 149.94
00904017 55 2/02/91 90.BO 59.14
00904094 64 2/02/91 54.52 302.9B
00904094 52 2/02/91 89.26 .00
00904094 52 2/02/91 213.72 89.26
00904104 52 2/02/91 225.93 90.68
00904104 52 2/02/91 90.6B .00
00904104 64 2/02/91 57.64 316.61
00904106 52 2/02/91 213.72 B9.26
00904106 64 2/02/91 54.52 302.9B
00904106 52 2/02/91 89.26 .00
00904113 52 2/02/91 237.69 90.92
00904113 64 2/02/91 60.64 32B.61
00904113 52 2/02/91 90.92 .00
00904127 64 2/02/91 57.64 316.61
00904127 52 2/02/91 225.93 90.68
00904127 52 2/02/91 90.6B .00
00904129 55 2/02/91 90.BO 59.14
00904129 55 2/02/91 231.01 149.94
00691388 74 2/04191 331.75 .00
00694024 10 2/04/91 20.00 247.50
00901125 10 2/04/91 50.00 2Bl.75
00901624 11 2/04/91 31.25 31.00
00901709 20 2/04/91 56.02 3.14
00903141 41 2/04/91 374.25 .00
0090319B 90 2/04/91 200.00 165.00
00B90463 74 2/05/91 46.36 .00
0090169B 67 2/05/91 22.50 .00
.901942 50 2/05/91 233.23 148.52
901942 50 2/05/91 66.07 62.45
00902112 52 2/05/91 215.03 87.95
00902112 64 2/05/91 54.52 302.9B
00902112 52 2/05/91 64.90 3.05
00902921 50 2105/91 245.06 151.69
~902921 50 2/05/91 66.07 65.62
0903016 74 2/05/91 54.52 .00
00903018 74 2/05/91 59.14 .00
00903134 50 2/05/91 233.23 14B.52
00903134 50 2/05/91 66.07 62.45
00903379 67 2/05/91 288.29 .00
~ 00903379 67 2/05/91 64.21 268.29
00903455 74 2/05/91 361. 75 .00
00903504 50 2/05/91 230.54 143.71
00903504 50 2/05/91 66.07 57.64
00903745 21 2/05/91 73.00 .00
\
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MD7020 5/14/91 18.19.54 M 0 N T II L 'j OEPOSIT RECAP , PAGE 3
OATE 5/. 2/01/91 THRU 20/82/91
PMCTlCE
GlMRAIIIOR
'DER NAME FC OATE RECEIPTS OBT.ADJ. CR.ADJ. DEPOS II REFUND BALANCE
/03779& 21 2/05/91 57.50 .00
.,,900662 50 2/05/91 86.07 68.96
01900662 50 2/05/91 249.22 155.03
01903331 74 2/05/91 57.00 .00
02883234 BARiHh, CIIRISTlNA SUDSCR I BER
79 2/05/91 337.50 .00
NSF 01 RECI PMI RECEIPIS DR.ADJ. CR.ADJ. DEPOSIT REFUND
~EEK TOIAL .00 .00 9776.17 46.36 5753.04 9776.17 346.75
00883150 10 2/06/91 15.00 64.25
00892093 30 2/06/91 330.00 .00
00893411 30 2/06/91 331.75 .00
00900427 11 2/06/91 365.00 .00
00901450 11 2/06/91 25.00 24.50
00901709 20 2/06/91 3.14 .00
00901892 86 2/06/91 .25 .00
00901974 52 2/06/91 242.37 31.02
00901974 64 2/06/91 31.02 .00
00902002 74 2/06/91 62.69 .00
SUBSCRIBER
00902071 30 2/06/91 145.91 .00
00902074 10 2/06/91 30.00 335.00
00902422 10 2/06/91 365.00 .00
00902422 79 2/06/91 365.00 365.00
00902443 50 2/06/91 203.B6 145.21
00902443 50 2/06/91 86.07 59.14
00902443 86 2/06/91 3.31 349.07
00902647 90 2/06/91 317 .40 79.35
00903061 90 2/06/91 212.00 153.00
903140 41 2/06/91 59.14 .00
.903164 74 2/06/91 3.31 59.02
00903164 21 2/06/91 59.02 .00
'903308 8', 2/06/91 .01 57.64
i0330 20 2/06/91 57.64 .00
090339 74 2/06/91 31.82 31.82
J090339 74 2/06/91 31.82 .00
0090342' 90 2/06/91 381. 75 .00
0090344 30 2/06/91 374.25 .00
009034 74 2/06/91 365.00 .00
00903633 21 2/06/91 57.64 .00
00903644 10 2/06/91 100.00 211. 75
00903873 30 2/06/91 365.00 .00
00904024 90 2/06/91 357.50 .00
00904052 30 2/06/91 372.50 .00
00904156 30 2/06/91 381.75 .00
01881398 10 2/06/91 25.00 65.00
,
i
,
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~ {:
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For the Purpose of Brevity
Pages 4 Through 38 Have Been Omited
I!
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DATE 5/~
PR^CTICr....
GUARANTOR ~
NLOlBER NIIME
InOOQS87
3161
J3956
U09Q4129
00910161
00910161
00910239
00910368
00910249
00910249
~EEK IOTAl
TOTAL PRACTICE
2/lll/91 jlllW 2U/QiiY I
FC DATE RECE IPIS DBT .ADJ.
90 5/06/91 381.75
11 5/06/91 387.50
10 5/06/91 30.00
74 5/06/91
30 5/06/91 322.50
30 5/06/91
90 5/06/91 396.75
74 5/06/91
67 5/07/91
67 5/07/91 129.78
NSF DIRECT PMI RECEIPTS DR.ADJ.
.00 .00 5844.04 55.24
CR.ADJ.
59.14
50.00
60.27
235.22
CR.ADJ.
2033 .68
\ (, ".Iff''''''l''''
." , I ;;'''
DEPOSIT REFUND
DEPOSIT REfUND
5844.04 130.00
.00
.00 147949.10
4763.21 131340.93 147949.10 2211.79
This last page of the Monthly Deposit Recap,
shows how each week is summarized, and the
entire month is summarized as we~l.
j
I,
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',_I.
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"
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B~lANCE
141.75-
310.00'
297.50
.00
.00
322.50
.00
.00
16.75
251.97
;: "I
,
',PAGE
M 0 N T II ~ y 0 E'P 0 SiT R E CAP
2/01/91 THRU 20/02/91
FltlAL TOTALS
M07020 5114/91 10:19.54
OAIE 5114/91
PRACTICE.
GUARANTOR
~" I"lBER
~870
,0020
01900397
00901017
00903369
00903359
00903067
00903258
00902124
00901n4
SUMMARY STATISTICS
-EIPTS
CHECKS
. ...,REel PAYMENTS
-fUND
147949.10
.00
+ .00
. 2211.79
...MMISSIONABLE AAT 145737.31
14573.73
COMMISSION EARNED
RfCEIPTS
NSF CHECKS
REFUllD
147949.10
.00
. 2211.79
CCl-IMISSION EARNED . 14573.73
TOTAL DUE 131163.58
-------------
-------------
REFUND CHECKS
REFUNO AMOUNT
346.7S
322.50
380.00
214.50
59.14
57.65
389.25
292.00
20.00
130.00
TYPE
PATIENT
INSURANCE
INSURANCE
PATIENT
PATIENT
PATIE,n
PATIENT
H1SURANCE
PAT lENT
MANUAL ISSUE
This report is delivered weekly and monthly.
Refunds are listed, and exact commisions are equated.
Note that when ~efunds or NSF checks are deducted,
we do not earn iny fees on these funds.
\,"
" I-
You pay ABC onLy' for funds that we cause to come in.
.':"
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<;' ... ... C
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PR~CTICE . 2/01/9; TIIRU 2/28/91
CURRENT PERIOD YE~R TO O~TE
'c OESCR IPTI ONS NO. TRX ~MOUNT PERCENT NO. TRX ~MOUNT PERCENT
CREOIT ADJUSTMENTS
20 BLUE CROSS UIl" INFO I 3.T4 T 3.14
21 BLUE SIIIElD \J1T1I INFO 2 130.50 .7 4 197.81 .2
30 liMO 2 234.73 1.3 2 234.73 .3
50 MEDICARE ASSIGNED 9 782.79 4.5 21 1,830.51 2.6
52 MEOI/MEOI 19 1,850.60 10.6 32 2,947.42 4.2
53 MEDICARE INS. ONLY ASSIGNED 16 ',172.74 6.7 27 1,985.56 2.8
54 R/R MEDICARE .- ASSIGNED ." 1 84.95 .5 4 290.87 .4
55 MEDICARE \.lITH PVl ASSIGNED 11 974.43 5.6 28 2,373.54 3.4
57 MEDICARE \.IITII PVT INS. ONLY 8 720.62 4.2 19 1,678.28 2.4
64 MEOICAL AOJ ONLY 22 1,174.70 6.7 34 1,676.52 2.7
67 MEOICAL UITII POE 10 2,932.76 16.8 18 5,278.38 7.6
74 INSURANCE ONLY 21 3,894.67 22.4 42 8,329.60 12.0
79 COLLECTION ACCOUNT 5 1,671.75 9.6 108 38,220.75 55.3
83 PATIENT DECEASED 2 118.30 .6 4 534.96 .7
84 UNDER PAYMENT 3 8.59 7 9.12
86 8AO DEBT 6 878.45 5.0 17 2,548.90 3.6
88 TRANSFER CREOIl 2 739.25 4.2 2 739.25 1.0
TOTAL 140 17 ,372.97 100.0 370 69,079.3/, 100.0
DEB Il AOJUSTMENTS
50 MEOICARE ASSIGNED 1 219.39 . 4.9
53 MEOICARE INS. ONLY ASSIGNED 1 57.64 1.3
74 INSURANCE ONLY 5 1,233.43 32.8 5 1,233.43 27.6
79 COLLECTION ACCOUNT 2 730.00 19.5 3 1,037.50 23.2
88 TRANSFER CREOIl 2 739.25 19.7 2 739.25 16.5
90 GROUP INS. 2 702.50 18.7 3 760.02 17. I
99 Ref UNO I 346.75 9.2 3 419.75 9.3
TOTAL 12 3,751.93 100.0 18 4.466.98 100.0
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MB1100 5114191 19..31.2BA G E 0 A C' C 0 U N'.T S R.E eEl VABLE BY F I H A H C I A L ,li\l"l;
DATE 31_ C LAS S
PRACTICE
I,
FC DESCRIPTION TOT AL ALL REC CURRENT OVER 30 DAYS OVER 60 DAYS OVER 90 DAYS
DOLLARS DOLLARS 7. DOLLARS X DOLLARS 7. DOLLARS 7.
FliP CAll .02- .02-
u; ORY RUN 842.66- 44. lS- 1.2 58.56- .1- 739.35- .4-
06 MEOI CARE 207. 990.10 226.94- 6.2 92.99 .2 165.12- .B- 1,289.17 .6
10 CASII 59,950.27 141.lS- 3.9 5,616.25 9.6 2,985.25 14.2 51,490.52 25.8
11 PATIENT PAYMENT 2,454.98 310.00- 8.5 446.00- .8- 1,053.52- 5.0- 4,264.50 2.1
12 PATIENT REC. INS. CIIK. 1,258.34 1,258.34 .6
20 BLUE CROSS \.11111 INFO 2,395.36 314.24 .5 381. lS 1.8 1,699.37 .9
21 BLUE SIIIElO ~ITlI INFO 1,120.25 374.25 .6 3Bl.lS 1.8 364.25 .2
26 RETURN HAIL 1.664.05 1,664.05' .8
30 liMO 10,778.33 2,345.00 4.0 1,096.lS 5.2 7,336.58 3.7
31 IIEALTII NET 374.25 374.25 .2
37 MAXI CARE 1,678.50 1,678.50 .8
40 INDUSTRIAL 1,873.B2 331.lS- 9.1 9.25- 365.00 1.7 1,849.82 .9
41 J(J\ISER 13,458.25 130.00 3.6- 2,231.00 3.8 981. lS 4.7 10,115.50 5.1
47 UIIP/~AT1'S IIEALTII FOUNDATION 396.75 396.75 .7
50 MEDICARE ASSlGNED 14,122.43 72.77 2.0- 2,971.99 5.1 835.30 4.0 10,242.37 5.1
52 MEOI/MEOI 8.926.55 .07- 4,434.36 7.6 4,492.26 2.3
53 MEDICARE INS. ONLY ASSIGNED 4,757.26 .01- 1,124.29 1.9 5.88- 3,63B.86 1.8
54 R/R MEOICARE -. ASSIGNED -- t.7 .49 47.49
55 MEDICARE ~1l11 PVT ASSIGNED 5,206.23 151.59- 4.2 1,784.9B 3.0 44B.76 2.1 3,124.08 1.6
57 MEDICARE \.11TH PVT INS. ONLY 7,841.62 366.83- 10.1 3,450.83 5.9 432.11 2. I 4,325.51 2.2
59 PVT ~ITH MEDICARE AS 2ND 1,523.50 1.158.50 2.0 365.00 .2
66 MEDICAL ~/O POE 10,476.50 3,433. lS 5.8 7,042.lS 3.5
67 MEOICAl ~ITlI POE 24,639.B3 821.92- 22.6 5,333.25 9.1 309.88- 1.5- 20,438.38 10.3
74 INSURANCE OlllY 18,681.87 315.00- 8.6 6,739.00 11.5 2,683.7S . 12.8 9,574.12 4.8
75 PROF. COURTESY OISCOUNT 603.50- 603.50- 2.9-
78 INS. ONLY-PERSONAL FREINO 15,274.99 .50 3,732.00 6.4 715.00 3.4 10,827.49 5.4
79 COllECTION ACCOUNT 3,145.01 448.50- 12.3 1,408.00- 2.4- .25- 5,001.76 2.5
90 GROUP INS. 62,440.21 686.00- 18.8 15,086.65 25.7 11,466.77 54.6 36,572.79 18.3
01 INSURANCE X 2 1,010.16 381.lS 1.8 628.41 .3
lEGAL ~I TIlOUT LIEN 357.50 357.50 .2
TOTALS 2lS,398.22 3,641.84- 100.0 58,698.27 100.0 21,017.52 100.0 199,324.27 100.0
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UN!! 72 TRIPS
UN!! 73 TRIf'S
OTIIER UN!! TRIPS
TOTAL TRIPS
---------------------------------------------------------------------------------------------------------------------------------
80 00
, , COtIMUN!TV HOSP 11 Al 32 61 93
~ tlEDICAl CENTER 31 4 36
T tlEtlOR IAl HOSP IT Al 2 4 6
j., HOSP I I
. VAllEY MED. CENTER 21 24 3 48
... MEDICAL CENTER 2 2 4
TOTAL 89 95 92 276
'I VENTS 001) I TI1RU (J..\75
ENV OF REFOR f
'Lj
_ _ FIRE DEFARTMENT .
RUN STATlSflCS
1/01/90 THOU 1/30/90
DATE 11/12/90 PAGE 2
TItlE 13.30.38
.;EYNA
': OF film
UNIT 72
UNIT 73
Of HER UNITS
10TAl ALL UNITS
;tJIlL film
TRIF'S MINIJTES MILES Tfms MINUTES MILES
89 331:2 2119 95 4013 2117
TRIPS MINUTES MilES
13 156 8
TRIF'S Mlt~TES MILES
197 7531 424
II" 9 RUN
HI u [(UN
79 1141
79 Jl4I
: III ALL TYf1:S
89 :n62
209
95 4013
2117
92 1297
8
276 8672
m
:lDENfS (iOOI 1IIIil1 0375
END OF REFORT
There is no
!
to the
I
\
cha'rge
,.-J'
,...!
for this report
This report is in addition
standard ABC month end reports
The names of the
medical... ienters
beerr blacked
':
and the client name have
out
.
.
I .1
lit.IHH
hUH Jilll 1:::1111...::>
'ilOI/~O THRU 1/.;.0/90
.
_ I Hie 1.S,SV..A:J
. ~ .
2;e-s T I: '1NAT ION
UNIT 72 TRIPS
WIlT 73 TRlF'S
OTHER UNIT TRiPS
TOTAL TRIPS
88
88
93
~~
6
1
48
4
'1.76
COMMUNiTY HOSPITAl '0 61
.J.
MEDICAL CENTER 31 4
T NEMOR iAl HOSP IT Al 2 4
1- HOSP I
VAllEY MED. CENTER 21 24 .)
. HEDiCIlL CENTER , 2
<
TOTAL 89 95 92
cIDENTS 0001 THRU 0375
END OF REPORT.
',15
.-. 'I riEYUA
_ FIRE DEPARTMENT.
RUN STATiSTICS
1/01/90 THRU 1/30/90
95 4013
DATE 11I12/90 PAGE
TIME 13.30.38
OTHER UNITS TOTAL All UNiTS
-------------------------------------
TRiPS MltlUTES MiLES TRiPS MINUTES MILES
13 156 8 197 7531 424
79 1141 79 1141
92; 1297 8 276 8672 m
. n Pt::1JI' RUN
UNIT 72 UNIT 73
'" o~lAl h1JN
D f>.Y RUN
f'\ OllJAl AiD RUN
C. A If:EllED RUN
TRiPS MINUTES MiLES TRIPS MINUTES NILES
69 3302 209 95 4013 207
- -rOfAl All TYf1:S
89 3362
209
207
#tC(;1 DENTS 0001 THRIl 0.375
END OF REPORT
There is no
.
i
to the
I
\
charge
.v"
..:::
for this report
This report is in addition
standard ABC month end reports
The names. of the, medical,._~enters and the client name have
been' blacked out
-....-.....
'.. :
.
.
..
CLIENT REFERENCE LIST
We felt that it might be of assistance to you to have a partial listing of our clients to use as
references in your independent verification of our abilities and our character. With this in
mind we have prepared the following list.
It is important to note, however, that any firm can prepare a list of their "best" clients, but that
would not be a representative sample or even a realistic picture of that firm. We have prepared
our list as a cross section of our entire client base - not just the best-case scenarios.
As our clients will tell you, it is not whether we have made mistakes, it is the manner in which
we have handled our mistakes, and that we have in each case, learned from them. At ABC we
continue to strive for perfection. Looking forward to our continuing discussion.
Client Reference List
o October 7th, 1991
l.othar E.R Cramer M.D., Inc.
Contact: Donna. Cramer o.
(213) 698-2196
.Am.lr H. Sha.h.a.ndeh M.D., Inc.
(714) 838-1647
Eastgate Medical Center
Contacts: Boott A. .Furman
AnnMa.rle Wlnkle
(714) 897-1071
City of South Pasadena. Pa.rA.m~ics
Contact: Barbara. James
(818) 441-7839
K1ng Drew Medical Foundatlon, Inc.
Conta.ot: De.nJ.el Wootsn, M.D.
(213) 603-4683
Ta.rza.na. Anesthesia Group, Inc.
Contact: Daniel Lavigna M.D.,
(818) 718-7130
ShBldon Rubinstein D.P.M.
Conta.ot: Mary Rubinstein
(714) 682-3764
City of AIhambra. p8J'AmAitics
Conta.ot: Julie Norris
(818) 670-6017
10) We have provided the name of the contact person, where applicable. If no name is sho~n,
please ask for the physician listed.
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