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Home My WebLink About21-Fire Department CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION From: Larry R. Pitzer, Fire Chief Subject: Resolution 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. Date: September 14, 2004 OR~G\NAL MC/C Meeting Date: October 4,2004 Dept: Fire Synopsis of Previous Council Action: RECOMMENDATION: Adopt resolution. Contact Person: Larrv R. Pitzer Phone: (909) 384-5286 Supporting data attached: Staff Report, Resolution, Agreement Ward: City Wide FUNDING REQUIREMENTS: Amount: $60,550 Source: (Acc!. No) 001-201-5505 (Acc!. Description) Other Professional Services Finance: Council Notes: Agenda Item -#J! /O(lrjoy '\Z.t:8J J:l-zoA- ~~ STAFF REPORT SUBJECT Resolution authorizing the City of San Bernardino Fire Department to enter into a billing service agreement with Advanced Data Processing, Inc. (ADPI) for first responder, paramedic, and membership program fees. BACKGROUND Fire/Emergency Medical Service (EMS) is a comprehensive service for pre-hospital emergency care and transportation of the sick and injured to increase survival rate, decrease permanent injury and alleviate suffering by ensuring that our staff provides basic life support (BLS) and advance life support (ALS) to victims on scene. The billing process is initiated when EMS personnel collect patient information on an EMS run sheet due to a service call (9-1-1). The forms are collected and brought to administration for accuracy and completeness. They are then forwarded to the bill-processing vendor for EMS user fee billing collections. Fire Department personnel provide BLS and ALS services at medical aid calls. BLS and ALS calls are charged $250 per call and billed to the person receiving the help. Also, the city provides the opportunity for city residents to enroll in the paramedic membership program. The membership program is designed to assist our city residents with affordable EMS. The Fire Department does not bill enrollees in the membership program for service calls. One membership is sold per household; consequently, all family members living within the household are covered by the membership. The membership is renewed annually and the billing-processing vendor notifies the individuals when renewal is due. The city has two annual membership fees $24.00 and $12.00 (low-income members). A Request for Quote (RFQ) #F 05-008 was issued to solicit formal bids for EMS billing services on April 29, 2004. Notices inviting bids from qualified vendors for EMS billing services were distributed to the San Bernardino Area Chamber of Commerce, the City's Web Site, and advertised in The Sun Newspaper. Bid packages were requested by seventeen (17) vendors and seven (7) bid responses were received. Our current provider, Stat Physicians' Services, was the only local vendor that responded to RFQ #F 05-008. However, effective September I, 2004, they are closing their business and have elected to withdraw their bid for consideration. Stat Physicians' Services has extended their service for the City until October I, 2004. An evaluation committee (Fire and Finance staff) was developed to review the bid responses and it was determined that an addendum needed to be issued. The addendum requested vendors to provide confirmation of understanding that the city only provides first responder services (not transport services); the city is not eligible for Medicare or Medical reimbursement; vendor will maintain and bill for the paramedic program; and the vendor has the capability to interface with Healthware Software program. Fire and Finance staff evaluated the proposals submitted and rated them on a scale of 0-100. Compliance with technical specifications, price, and experience were considered. Allied Information and Services Corp. received the highest over-all evaluation for EMS billing services. ADPI is able to meet the required technical specifications and has experienced staff (attachment "B"). On August 31, 2004, the City was notified in writing that Allied Information and Services Corp. sold their business to ADPI (attachment C). ADPI headquarters are located in Miami, Florida and have expanded their business to the West Coast. They will keep the Oakland office operational for their West Coast clients and will provide uninterrupted service. On September 3, 2004, AD PI submitted a letter confirming the acceptance of the terms and conditions for bid proposal #F 05-008 that Allied Information and Services Corp. submitted (attachment D). ADPI fully accepts and agrees to the proposal put forth and accepted by the City and is prepared to perform all services stated. Pursuant to the City's bidding process, it is recommended that ADPI be awarded the agreement under addendum RFQ #F 05-008 for EMS billing services. ADPI has agreed to the commission rate of 7% to bill first responder and paramedic fees. Fire staff recommends that this resolution authorizing the execution of a three-year agreement with ADPI to provide EMS billing be adopted (attachment "A"). FINANCIAL IMP ACT The projected revenue from emergency medical service user fees for FY 04-05 is $850,000. $15,000 in revenue from the membership program is also anticipated in FY 04-05, for a combined total revenue of $865,000. Compensation to AD PI is a percentage not to exceed seven percent (7%) of amounts collected on behalf of the Fire Department under the billing program. Therefore, it is estimated that ADPI will be paid approximately $60,550 annually. Funding for this agreement was included in the FY 04-05 Fire Department budget, account 001-201-5505. If revenues exceed projections, the agreement costs will increase accordingly. However, the increased revenue will offset the increased agreement cost. RECOMMENDA nON Adopt Resolution. 2 . RESOLUTION NO. 2004-33(C 0) ~V 2 3 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. 4 5 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 8 Corp., is the best responsible bidder regarding billing services for first responder, paramedic, and 9 membership program fees, in accordance with Bid Specification #F 05-008; 10 SECTION 2. The Mayor or her designee is hereby authorized and directed to execute on II behalf of City a Services Agreement with Advanced Data Processing, Inc., a copy of which is 12 attached hereto, marked Attachment "A" and incorporated herein by reference as fully as though set 13 14 forth at length; SECTION 3. Said agreement will be for collection services for the period of October 1,2004 IS through June 30, 2005 with two one-year renewal options; contingent upon funds being available and 16 allocated in the budget; 17 SECTION 4. The Purchasing Manager is authorized to issue an annual purchase order to 18 19 20 Advanced Data Processing, Inc. The annual purchase order is for one year with the option of two one- year extensions. All other bids are hereby rejected; 21 SECTION S. 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. 27 1111 28 III 1 III 2 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. 3 4 I HEREBY CERTIFY that the foregoing resolution was duly adopted by the Mayor and 5 Common Council of the City of San Bernardino at a joint regular meeting thereof, 6 October , 2004 by the following vote, to wit: day of held on the 18th 7 8 COUNCILMEMBERS AYES NAYS ABSTAIN ABSENT ESTRADA X LONGVILLE X MCGINNIS X DERRY X -~ KELLEY X JOHNSON X MCCAMMACK X 9 10 II 12 13 14 15 16 17 -) .; U ',.' h '(CH' !teL, ~./) . l {cViP Rachel G. Clark, City Clerk, '!:W V)(1 ILL L1fl".J}1{ dt ,:V.A_' h (i1{.~, CJ . 'L 'I - /'17>1' ayof October ,004_ ( , . 18 19 20 The foregoing resolution is hereby approved this -- 21 22 23 24 Approved as to Form and legal content: 25 JAMES F. PENMAN, City Attorney 26 27 28 By: (1~ l.f~ {I 2 . All lED INfORUATICNISERVIC[S r C R P Attachment "e" August Jl, 2004 Ciry of San BemardiDo 300 North "0" Street San BcmanIino, CA 92418 Dear Nonna; Allied IDfonnarioo &: Services Corp. (AIS) bas a ricb 20.year history scrvi.n& EMS clients. We have expaadcd In an opcralioa of 46 employees, Im'in8 38 CllI\1IIIUIIiti ill four stata. With your bell', AlS bas prospered through the addition of new lIllCOUIIIll and the expansion of our busiucss. 1 baw n:ccmly decided In retire from EMS billing. I am pleased to announce that we baY\: ~ a transadioa with AcMDced DaD Processing, IDe., the counlIy's IelIding EMS biI1ing company, to take 0\II:f your EMS biIIiDg OIl our behalf. ADPI wiD use !be lIIIIIIC facilities, allIIpI1fer systaIlS and people you ~ IlOIIIC In 1nI8t to baDdIc your EMS billing needs. 1 will remain involved to address any continuity issues and to provide managerial support. ADPI bas been in business tV< (M;I' 20 }'QJ3 lIIId specializn iD a complclc EMS biIIiag and coUectioo syst<:ms solution fOr municipalities that provide l:IIll:IamcY and llOII-llellCY ambulaDce services, just like you. ADP. is !be IargRl .qJ~ III [~ia1ty EMS billing company in the United Stales, serving Dearly 50 fire.n:sCllc O!:B"n;.Jlrions with a CQI1Ibined population of over 10 million residedts. Wc haw aIrcady compktccl a smooth operatiooal transition with IIIIintmrupted scrvioe to all our cIieIIls. Dm P8SIIIl'O, V_ Ptaidcnt with twelve }'QJ3 cxperiaICC at ADPI, wiD be takin& over my responsibilities. TCI'CIIl:C 1.0, Dan Kehoe, Cecelia La, and Vinccnl Hoang wiD cxmtinue in their ACCOUIIl ~ft ,,~_ and Projcc:t Maaa8cmcnt roles. If pmDiUed lIIlcIer our contJaA:t with you, we have assigned the contract to ADPI. Where assignment requires your COIISeIIt, we have DOl )'I'l assigned !be ClIIIInIct and &nt ask you In amsideI' COIl!Cl1ling In an assignmeDt. If you arc unablc to conseut to an assignmeDt. you wiD conIime In be smed by AlS UIIder an In'llII8C111C11t we have made with ADPI. Our team is very excited about the new support and m1ouroes we gain from this arrangement with ADPl. J haY\: also cncIosecI a Ielu:r ofilllroduction &un Don Passaro for your review. If you haw any questions or coar.ems fc:cl free In contact Don Passaro or me at (5 10) 769-9648. 11IIIIlks again for your support. ~~' ~ I\~ I ~~~~~,S~~ EMS RII.IIN~. CmlNT ON t~. August 31, 2004 City of San Bernanlino 300 North "D" SlRel San Bernardino, CA 92418 Dear Norma: Our Western RegjOll team - Dan Kehoe, Terence 1.0, Vmcem Hoang, and Cooolia 1.0, and the rest of the 0aIdand staff staod ready and 08lF to ccntinuc to serve your .-Is for excellence in EMS billing. In addition to the ~ you have come to rely OIl in Oaklalld, we have: a team of 100 located in Miami to fuItber support OUT 0ak1and operatioD and provide addi:tiona1 expertise to help OUT clients in the areas of compliance, teclmology, inSUI1lllCe eligibility, and eleclmllic patient care reporting manaa~ sy9lcms We have already completed a smooth operational trallSition from A1S to ADPI. We an putting action plans in place to help improve our ability to SClW you. Some of the areas we 1.ook to improve include compliance" insurance e1igib!lity, and electronic data inten:bangc. I will he IlOIllaCtina you in the coming weeks to personally introduce myself and to share our vision with you. If you have any questions or caoa:ms fecI frI:e to contact me at (S 10) 769-9648. Thanks again for your support. ~ S. ~ Don Passaro Vice Pn:sideot I"~, I ~!J.~~~,S~~. Attachment liD" EM$ HllllNr., COlJN't ON tie;. September 3, 2004 Ms. Marsha Zeller, Purchasing Manager City of San Bemardin.o 300 North "0" Street 4th Floor San Bernardino, CA 92418 Dear Ms. Zeller, Per the directions Ms. Norma Camarena provided to our West Coast Account Manager, Dan Kehoe, I am forwarding the requested documentation and confinnation of acceptance from Advanced Data Processing, Inc. (ADPI) in reference to Allied [nfonnation & Services Corporation bid proposal #F..Q5-008. We certainly understand the rationale for the questions being posed and will do everything necessaJY to make clear our complete commitment to all that Dan and the rest of the management team there in our West Coast offices have put forth to the City of San Bernardino. As it relates to the proposal that was originally put forth to the City of San Bernardino by Allied Information & Services Corporation, ADPI takes no elCceptionS to the proposal. That statement includes all components of the proposal, including the TenDs and Conditions listed, the quoted price and a\1 other stated deliverables and services. Should the City of San Bernardino have any questions or need for further clarification on this matter, you should not hesitate to call me to discuss. But again, !b.e proposal as it has beeD put forth and accepted by the City is fu\1y acceptable to ADPI and we are prepared to perfonn all services as stated therein. Regarding your request for references, I offer the following list for the City's review. [would encourage you to contact our references regarding our perfonnance and committnent to the highest standards of excellence: IStart >>a14 Alma.. C1i0llC AddrnolC_act Phone toPreomt T..._rt. Palm Beach John WilSOII, EMS CapWlI Coonly ~o S Miliw:y Trail #101 July 1998 25.000 W Palm Beach, FL 33415 ~61-61~800 David Kainrad. EMS DilllCtOr LccCOlIlIIy davek@1<ep.com January 38,000 147~2 Six Mi\e Cyptess Pkwy 2000 Ft. Mw:rs. FL 33912 239-335-1614 Cily of Mike KroetF, EMS Chief Cincinll3D Mile.kroeger@cincilmati-oh.gov April 2004 29,000 430 CealnIl Avellue Cinc;n..,m OH 4~202 513.352-6225 520 NW 165" 51""", 51e. 201. Mia"'; FL 33169 . 800.216.1149' fox: 305.945.6692 . em.c1.lms.com ,......'-*'- U-JI U.,J I~, I ~~~~~,S~!? f...\1S 8IU.ING. (Dl.""'l ON l~. Brevard Ann Fosburr, Finanal Mer County !ADn.fosbun@wuntypt.brevard.f1.lll Aprill99ll 35,600 1040 S Florida A~. RockIed2e. FL 32955 321-663-2056 Polk COUDty Beverly ChmanJt, EMS Manager Bcvcr1yChc:naull@po1k~ty.nel FeIlroal)' 46,000 BanllW Air, Bldg 2SO. Suite 12 2001 BanllW, FL 33831 863-519-7401 lacbmville Chief MDIdand, EMS Chief -Iand@cojnct September 37.000 515 N1uJia S_ 2001 1acksonville, FL 32202 904~30-7873 Naslrville David ScwcU, Asst. Chief David.5tWeU@nashYille.JlfY AquSt 45,000 SO Hermitage AWllue 2004 Nashville, TennCSlltt 37201 615-862-5459 Beyond these listed references and to address your request fur background infonnation on Advanced Data Processing, Inc., we are headquartered in Miami, Florida and have a sales office located outside of Atlanta, Georgia. We serve a grand total of 85 clients across 9 states and collect in excess of $170 Million annually. Most notably, we derive 100"10 of our company revenues from EMS Revenue Management and have been doing so fur more than 20 years. I trust that this letter will provide you with the information to assure you that the proposal AIS originally put forth to the City of San Benwdino wiD be fully supported by an organization that is absolutely committed to maintaining our position ofleadership and integrity within the EMS Billing business. Thank you fur the opportunity to introduce the background of our company to you, and we look forward to bringing our total expertise and delivering the highest level of results, exactly as was described in the proposal from Dan Kehoe. Respeaful1y Submitted, -~ ;::nAU-I Rick Fossier Vice President, Sales S20 NW 16S" Slreet S.e. 201, Miami Fl 33169 . 800.226.1149' lax: 30S.94S.6692 . em,da;",..""", Attachment "A" I "DRAFT" 2 SERVICES AGREEMENT 3 THIS AGREEMENT is entered into this 1st day of September 2004, Allied Information and Services Corp. ("CONTRACTOR") and the CITY OF SAN BERNARDINO ("CITY)". 4 5 WHEREAS, CITY has need for billing services for first responder and paramedic fees; 6 WHEREAS, CONTRACTOR is competent, experienced and able to perform said services; and, 7 8 WHEREAS, CONTRACTOR has provided the most advantageous and best responsible proposal for such services; 9 NOW THEREFORE, the parties hereto agree as follows: 10 1. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 CONTRACTOR shall furnish billing services as indicated below: A. Initial invoices will be mailed out within 3 days of receipt of paramedic run tickets. The following billing schedule will be followed: Initial Invoice Second Notice Past Due Notice Collection Final Demand Immediately 30 days 45 days 60 days 75 days B. 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. C. 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. D. CONTRACTOR will submit to the CITY documentation of each time they work a delinquent 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 the CITY prefers (up to 75 days). E. Over 90 day cash accounts 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. 1 1 2 3 4 5 6 7 8 , 9 ~ 10 2. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 F. 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. G. 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. H. CONTRACTOR will collect and log into departmental receipt all funds collected as a result of services provided by the CITY within two days of receipt. They will be logged by the CONTRACTOR and delivered to the CITY by maiVcourier. A check will be issued to the CITY monthly with a detailed report showing all payments, refunds, and adjustments. Over the term of this Agreement, CONTRACTOR shall be paid for such services an amount equal to 7% of bill collections. 3. CONTRACTOR shall be responsible for all costs incurred in billing EMS servIces and paramedic membership fees, for the exception, of the compensation rate of 7% for billing first responder and paramedic fees. 4. The CITY projects that the CONTRACTOR will collect $850,000 for EMS user fees and $15,000 for paramedic membership fees, if, CONTRACTOR unable to collect projected fees shall provide to the CITY's designee a detailed explanation and graphs showing the loss of collections. 5. CONTRACTOR shall be compliance with all regulations and procedures of the Health Insurance Portability and Accountability Act, known as "HIPPA", that requires privacy of patients' medical records and information is protected. 6. CONTRACTOR shall be capable to receive and send data usmg Healthware Solutions software. 7. 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. 2 ~ 1 I 8. CONTRACTOR shall provide Fire Department with a monthly invoice in arrears and shall be 2 provided payment within thirty (30) days therefrom. CITY retains the right to challenge all or 3 any part of an invoice. 4 9. The term of this Agreement shall be for a period of three (3) years from the date first shown 5 above, with two (2) one (I) year renewal options. 6 10. In the event the CITY exercises the right to terminate the agreement for dissatisfaction, the 7 CITY will give the vendor three (3) days written notice of such termination. 8 9 II. The CITY and the CONTRACTOR each reserve the right to cancel, for any reason, all or 10 portion of the services covered by this agreement. Each party must give a thirty (3) written 11 notice to the other. 12 12. CONTRACTOR shall indemnify, defend and hold CITY, its officers, employees and agents 13 harmless from any claim, demand, liability, suit, judgment or expense (including, without 14 limitation, reasonable costs of defense) arising out of or related to CONTRACTOR's 15 performance of this agreement, except that such duty to indemnify, defend and hold harmless 16 shall not apply where injury to person or property is caused by CITY's willful misconduct or 17 sole negligence. The costs, salary and expenses of the City Attorney and members of his office 18 in enforcing this Agreement on behalf of the City shall be considered as "attorney's fees" for 19 the purposes of this paragraph. 20 21 13. While not restricting or limiting the foregoing, during the term of this Agreement, 22 CONTRACTOR shall maintain in effect policies of comprehensive public, general, and 23 automobile liability insurance, in the amount of $1,000,000 combined single limit, and 24 statutory worker's compensation coverage, and shall file copies of said policies with the 25 CITY's Risk Manager prior to undertaking any work under this Agreement. The policies shall 26 name the CITY as an additional insured and shall provide for ten (10) day notification to the 27 CITY if said policies are terminated or materially altered. 28 3 5 6 7 8 ~ 9 :~ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 I 14. CONTRACTOR shall perform work tasks as directed by the Fire Chief or designee, but for all 2 intents and purposes, CONTRACTOR shall be an independent contractor and not an agent or 3 employee of the CITY. 4 15. In the performance of this Agreement and in the 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. 16. Any notice to be given pursuant to this Agreement shall be deposited with the United States Postal Service, postage prepaid and addressed as follows: TO THE CITY: Larry Pitzer, Fire Chief City of San Bernardino Fire Department 200 East Third Street San Bernardino CA 92410 TO THE CONTRACTOR Allied Information and Services Corp. 7750 Pardee Lane Suite 200 Oakland CA 94621 (510) 769-9648 4 1 2 Nothing in this paragraph shall be construed to prevent the giving of notice by personal service. 3 IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the day 4 and date first above shown. 5 6 Date: 7 8 9 10 11 12 13 Date: 14 15 ATTEST: 16 17 Rachel Clark, City Clerk 18 Approved as to form 19 and legal content: , 20 James F. Penman City Attorney 21 22 By: 23 24 25 26 27 28 by: Allied Information and Services Corp. Business Name Authorized Signature Name: Patrick Ho Title: President/CEO CITY OF SAN BERNARDINO by: Judith Valles Mayor City of San Bernardino 5 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, with principal offices located at 300 North "0" Street, San Bernardino, California 92418, hereinafter referred to as the "CITY", and Advanced Data Processing, Inc., 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 -# d-I ~- /oj(C/ot( Page 1019 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 30f9 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 of9 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 Addilionallnsured). 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 5 019 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 & 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 of9 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 of9 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, ifthe 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 of9 Exhibit A Business Associate Addendum Advanced Data Processing, Inc. 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 _' 2004, ("the Agreement") by adding the following additional language to the Agreement. 1. 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 j. 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 ofthis Addendum will extend to such PHI. Exhibit A Page 1012 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 of2 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: 1. Provide biiling 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 wiil maintain current membership roster for the Paramedic Membership Program. The CONTRACTOR wiil 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 andlor 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. II. 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 confidentiai 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 num bers. 3. Provide accurate coding of medical claims. 2. Maintain responsibility for obtaining missing or incomplete insurance information. 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 Second Notice Telephone Contact First Letter Contact Second Letter Contract/ Second Telephone Contact Third Letter Contact Delinquent Audit/Phone Audit Final Demand Notice Refer to City Policy Exhibit B 2 days 30 days 45 days 60 days 90 days 120 days 135 days 150 days 180 days Page 2 of 5 Insurance Accounts Cycle: Initial Invoice 2 days 30 days 30 days (every) First Follow Up Continued Follow Ups Special Accounts Cycle: Installment Follow Up Lien/Bankruptcy Follow Up Special Program Follow UP Returned Mail Cycle: Skip Search Request Hospital Assistance 30 days 60 days (every) 60 days (every 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 prog ress). 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 FR 70138; (December 18, 1998). Exhibit B Page 4 of 5 CITY's 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 OFFICE OF THE CITY CLERK RACHEL G. CLARK, C.M.C. - CITY CLERK 300 North "D" Street. San Bernardino. CA 92418.0001 909.384.5002. Fax: 909.384.5158 www.ci.san-bernardino.ca.us ,t,' October 20, 2004 Doug Shamon, President Advanced Data Processing, Inc. 7750 Pardee Lane Oakland, CA 94621 Dear Mr. Shamon, At the Mayor and Common Council meeting of October 18, 2004, the City of San Bernardino adopted Resolution 2004-333 - Resolution 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. Enclosed are two (2) original agreements. Please sign in the appropriate location and return one original agreement to the City Clerk's Office, Attn: Michelle Taylor, P.O. Box 1318, San Bernardino, CA 92402, as soon as possible. Retain one agreement for your files. Please be advised that the resolution and agreements will be null and void if not executed within 60 days, or by December 17, 2004. If you have any questions, please do not hesitate to contact me at (909)384-5002. Sincerely, .1 : I/i {< ( ( , Michelle Taylor Senior Secretary " (,';: "-. Enclosure CITY m' SAN BERNARDINO ADOPTED SHARED VALUES: Integrity. Accountability. Respect for Human Dignity. Honesty To: From: Date: Re: Copy: CITY OF SAN BERNARDINO INTER-OFFICE MEMORANDUM i~::: I'~ r . Rachel Clark, City Clerk '04 !inll !\!,' 18 P:3 :35 Robert L. Simmons, Sr. Assistant City Attorney November 18, 2004 Services Agreement for paramedic billing services Norma Camarena, Fire Department Enclosed is the original signed agreement with APDI West, Inc. When the agreement was drafted by the contractor, it was done just after a merger between two companies. This is the first agreeement written by the west coast entity. As a result, the contractor inserted the name incorrectly in the agreement. I told the contractor to insert the correct name in the agreement, sign it and return it to me for review. APDI West, Inc. is the correct name for the company originally identified in the agreement as Advanced Data Processing, Inc. Please call me if you have any questions. ~~~ Robert 1. Simmons CITY OF SAN BERNARDINO Interoffice Memorandum CITY CLERK'S OFFICE Records and Information Management (RIM) Program DATE: November 23, 2004 TO: Larry Pitzer, Fire Chief FROM: Michelle Taylor, Senior Secretary RE: Resolution 2004-333 - ADPI West, Inc. CC: Veronica Martinez, Senior Secretary Attached is a fully executed copy of the billing services agreement with ADPI West for first responder, paramedic, and membership program fees. The original agreement is on file in the City Clerk's Office. If you have any questions, please call me at ext. 3206. ** FOR OFFICE USE ONLY - NOT A PUBLIC DOCUMENT ** RESOLUTION AGENDA ITEM TRACKING FORM Meeting Date (Date Adopted): 1(:)- 1'1;- olt Item # ~, Resolution # Vote: Ayes i-~ S-'') Nays Q Abstain B Change to motion to amend original documents 0 Companion Resolutions -ZcxYt - :5 3-:, Absent -1 NullNoid After: l-o days / rz..-CrO''t Resolution # On Attachments: 0 Note on Resolution of attachment stored separately: 0 PUBLISH 0 POST 0 RECORD W/COUNTY 0 By: Date Sent to Mayor: \ 0' I cl--G'1 Date of Mayor's Signature: 10 - lei C q Reso. Log Updated: to" Seal Impressed: ~- Date of Clerk/CDC Signature: ICJ \ cl-c</ Date Memo/Letter Sent for Signature: I;t Reminder Letter Sent: \ 0 20 -c 1 Date Returned: -1J- I /(0'1 Not Returned: 0 2nd Reminder Letter Sent: Request for Council Action & Staff Report Attached: Updated Prior Resolutions (Other Than Below): Updated CITY Personnel Folders (6413, 6429, 6433,10584,10585,12634): Updated CDC Personnel Folders (5557): Updated Traffic Folders (3985, 8234, 655, 92-389): YesL No Yes No/' Yes NoL- Yes NOf- Yes No Copies Distributed to: Animal Control 0 City Administrator 0 City Attorney e:( Code Compliance 0 Development Services 0 Others: EDA o o r:( ff o Information Services 0 Parks & Recreation 0 Police Department 0 Public Services 0 Water Department 0 if Facilities Finance Fire Department Human Resources Notes: Ready to File: _ Date: Revised 12/18/03