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Home My WebLink About2008-358 I. 1 RESOLUTION NO. 2008-358 2 3 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING THE EXECUTION OF AN AGREEMENT AND ISSUANCE OF AN ANNUAL PURCHASE TO ADVANCED DATA PROCESSING, INC. (ADPI) FOR FIRST RESPONDER, PARAMEDIC, AND MEMBERSHIP PROGRAM FEES. BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: 4 5 6 7 SECTION 1. Advanced Data Processing, Inc., is the best responsible bidder regarding billing 8 services for first responder, paramedic, and membership program fees, in accordance with Bid 9 Specification #F-08-21; SECTION 2. The City Manager is hereby authorized and directed to execute on behalf of City 10 11 a Vendor Services Agreement with Advanced Data Processing, Inc., a copy of which is attached. 12 hereto, marked Attachment "A" and incorporated herein by reference as fully as though set forth at 13 length; 14 SECTION 3. Said agreement will be for EMS billing collection services for the period of July 1,2008 through June 30, 2008 with two one-year renewal options Any action taken between July 1, 15 16 2008 and the date that the agreement is executed is hereby ratified. All other bids are hereby rejected. 17 SECTION 4. The Purchasing Manager is authorized to issue an annual purchase order to 18 Advanced Data Processing, Inc. The Annual Purchase Order shall incorporate by reference this 19 Resolution by number and Bid Specification #F-08-21. 20 SECTION 5. The authorization to execute the above referenced Agreement and Annual 21 Purchase Order is rescinded if the parties to the Agreement fail to execute it within sixty (60) days of 22 the passage of this Resolution. 23 III 24 III 25 III III III III 26 27 28 1 I 2008-358 1 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING THE EXECUTION OF AN AGREEMENT AND ISSUANCE OF AN ANNUAL PURCHASE TO ADVANCED DATA PROCESSING, INC. (ADPI) FOR FIRST RESPONDER, PARAMEDIC, AND MEMBERSHIP PROGRAM FEES. 2 3 4 I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and joint Common Council of the City of San Bernardino at a regular meeting thereof, held on the 5 6 15th day of September , 2008, by the following vote, to wit: 7 8 COUNCIL MEMBERS: 9 NAYS ABSTAIN ABSENT AYES 10 ESTRADA x 11 BAXTER x 12 BRINKER x 13 DERRY x 14 KELLEY x 15 JOHNSON x 16 x MCCAMMACK 17 ~~Cl~ City of San Bernardino 18 19 20 The foregoing Resolution is hereby approved this /,J?n; day ofSeptembe1; 2008. 21 22 23 24 Approved as to form: 25 JAMES F. PENMAN, City Attorney 26 27 28 2 ---J_'-----""^"^ 2008-358 VENDOR SERVICE AGREEMENT This Vendor Service Agreement is entered into this Ist day of July, 2008, between Advanced Data Processing, Inc ("ADPI") and the CITY OF SAN BERNARDINO ("CITY)". WITNESSETH: A. WHEREAS, CITY has need for billing services for first responder, paramedic, and membership program fees and, B. WHEREAS, ADPI is competent, experienced and able to perform said services: and, C. WHEREAS, ADPI has provided the most advantageous and best responsible proposal for the providing of such services; NOW THEREFORE, the parties hereto agree as follows: 1. SCOPE OF SERVICES. For the remuneration set forth in Paragraph 2, San Bernardino hereby engages the services of ADPI to furnish billing services for first responder, paramedic, and membership program fees in accordance with Proposal Package for RFP F-08-21: EMS Billing Services, submitted by ADPI, DATED July 16, 2008, a copy of which is attached hereto as Attachment "1" and by this reference made a part hereof.. 2. COMPENSATION AND EXPENSES. a. For the services delineated above, the CITY, upon presentation of an invoice, shall pay ADPI an amount in accordance with the Price Form attached hereto as Attachment "2," specifically, 25% of the net amount collected for services rendered by the City under this Agreement. b. ADPI shall provide City of San Bernardino Fire Dept with a monthly invoice in arrears and shall be provided payment within thirty (30) days therefrom. CITY retains the right to challenge all or any part of an invoice. c. No other expenditures made by ADPI shall be reimbursed by CITY. 3. TERM; TERMINATION. The term of this Agreement shall be for a period of one year with an option for two one- year extensions. The options shall be exercised by mutual written agreement of the parties executed prior to the termination of the current Agreement. This Agreement may be terminated at any time by thirty (30) days' written notice by either party. The terms of this Agreement shall remain in force unless mutually amended in writing by the parties. The duration of this Agreement may be extended on the same terms and conditions, including pricing, with the prior written consent of both parties. 1 II 2008-358 4. INDEMNITY. ADPI agrees to and shall indemnify and hold the City, its elected officials, employees, agents or representatives, free and harmless from all claims, actions, damages and liabilities of any kind and nature arising from bodily injury, including death, violations of HIPP A or right to privacy, or property damage, based or asserted upon any actual or alleged act or omission of ADPI, its employees, agents, or subcontractors, relating to or in any way connected with the accomplishment of the work or performance of services under this Agreement, unless the bodily injury or property damage was actually caused by the sole negligence of the City, its elected officials, employees, agents or representatives. As part of the foregoing indemnity, ADPI agrees to protect and defend at its own expense, including attorney's fees, the City, its elected officials, employees, agents or representatives from any and all legal actions based upon such actual or alleged acts or omissions. ADPI hereby waives any and all rights to any types of express or implied indemnity against the City, its elected officials, employees, agents or representatives, with respect to third party claims against the ADPI relating to or in any way connected with the accomplishment of the work or performance of services under this Agreement. S. INSURANCE. While not restricting or limiting the foregoing, during the term of this Agreement, ADPI shall maintain in effect policies of comprehensive public, general and automobile liability insurance, in the amount of $1,000,000.00 combined single limit, and statutory worker's compensation coverage, and shall file a Certificate of Insurance and copies of said policies with the CITY's Risk Manager prior to undertaking any work under this Agreement. CITY shall be set forth as an additional named insured in each policy of insurance provided hereunder. The Certificate of Insurance furnished to the CITY shall require the insurer to notify CITY of any change or termination in the policy. 6. NON-DISCRIMINATION. In the performance of this Agreement and in the hiring and recruitment of employees, ADPI shall not engage in, nor permit its officers, employees or agents to engage in, discrimination in employment of persons because of their race, religion, color, national origin, ancestry, age, mental or physical disability, medical condition, marital status, sexual gender or sexual orientation, or any other status protected by law. 7. INDEPENDENT CONTRACTOR. ADPI shall perform work tasks provided by this Agreement at the direction of the Fire Chief, but for all intents and purposes ADPI shall be an independent contractor and not an agent or employee of the CITY. ADPI shall secure, at its expense, and be responsible for any and all payment of Income Tax, Social Security, State Disability Insurance Compensation, Unemployment Compensation, and other payroll deductions for ADPI and its officers, agents, and employees, and all business license, if any are required, in connection with the services to be performed hereunder. 2 Ii 2008-358 8. BUSINESS REGISTRATION CERTIFICATE AND OTHER REQUIREMENTS. ADPI warrants that it possesses or shall obtain, and maintain a business registration certificate pursuant to Chapter 5 of the Municipal Code, and any other licenses, permits, qualifications, insurance and approval of whatever nature that are legally required of ADPI to practice its business or profession. 9. NOTICES. Any notices to be given pursuant to this Agreement shall be deposited with the United States Postal Service, postage prepaid and addressed as follows: Fire Chief Michael J. Conrad and EMS Coordinator Bernard Horak City of San Bernardino Fire Department 200 E. Third Street San Bernardino, CA 92410 Advanced Data Processing, Inc 6451 North Federal Highway, Suite 1002 Fort Lauderdale, FL 33308 Nothing in this paragraph shall be construed to prevent the giving of notice by personal service. TO THE CITY: TO ADPI: 10. ATTORNEYS' FEES In the event that litigation is brought by any party in connection with this Agreement, the prevailing party shall be entitled to recover from the opposing party all costs and expenses, including reasonable attorneys' fees, incurred by the prevailing party in the exercise of any of its rights or remedies hereunder or the enforcement of any of the terms, conditions or provisions hereof. The costs, salary and expenses of the City Attorney and members of his office in enforcing this Agreement on behalf of the CITY shall be considered as "attorneys' fees" for the purposes of this paragraph. 11. ASSIGNMENT. ADPI shall not voluntarily or by operation of law assign, transfer, sublet or encumber all or any part of the ADPI's interest in this Agreement without CITY's prior written consent. Any attempted assignment, transfer, subletting or encumbrance shall be void and shall constitute a breach of this Agreement and cause for the termination of this Agreement. Regardless of CITY's consent, no subletting or assignment shall release ADPI of ADPI's obligation to perform all other obligations to be performed by ADPI hereunder for the term of this Agreement. 12. VENUE. The parties hereto agree that all actions or proceedings arising in connection with this Agreement shall be tried and litigated either in the State courts located in the County of San Bernardino, State of California or the U.S. District Court for the Central District of California, Riverside Division. The aforementioned choice of venue is intended by the parties to be mandatory and not permissive in nature. 3 I: 2008-358 13. GOVERNING LAW. This Agreement shall be governed by the laws of the State of California. 14. SUCCESSORS AND ASSIGNS. This Agreement shall be binding on and inure to the benefit of the parties to this Agreement and their respective heirs, representatives, successors, and assigns. 15. HEADINGS. The subject headings of the sections of this Agreement are included for the purposes of convenience only and shall not affect the construction or the interpretation of any of its provlSlons. 16. SEVERABILITY. If any provision of this Agreement is determined by a court of competent jurisdiction to be invalid or unenforceable for any reason, such determination shall not affect the validity or enforceability of the remaining terms and provisions hereof or of the offending provision in any other circumstance, and the remaining provisions of this Agreement shall remain in full force and effect. 17. REMEDIES; WAIVER. All remedies available to either party for one or more breaches by the other party are and shall be deemed cumulative and may be exercised separately or concurrently without waiver of any other remedies. The failure of either party to act in the event of a breach of this Agreement by the other shall not be deemed a waiver of such breach or a waiver of future breaches, unless such waiver shall be in writing and signed by the party against whom enforcement is sought. 18. ENTIRE AGREEMENT; MODIFICATION. This Agreement, including Attachments "1" and "2," constitutes the entire agreement and understanding between the parties, and supersedes any prior agreements and understandings relating to the subject matter of this Agreement. To the extent there is a conflict between this Agreement and the attachments, the contents of this Agreement shall have priority. This Agreement may be modified or amended only by a written instrument executed by all parties to this Agreement. III III III III III III 4 -..I:.~- 2008-358 VENDOR SERVICES AGREEMENT ADVANCED DATA PROCESSING, INC., and CITY OF SAN BERNARDINO FOR EMS BILLING SERVICES IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the day and date first above shown. Dated: C,/].C(.o'i! Dated: crj;r;d r CITY OF SAN BERNARDINO By: ~ / Lori Sassoon Acting City Manager ADVANCED DATA PROCESSING, INC. BY:~~ Its: Pre5j den-J. Approved as to Form: James F. Penman, City Attorney I. 2008-358 17//71c/I/l1EJlJT ''1 if . I ad . I intermedix " 6451 North Federal Highway, Suite 1002 Fort Lauderdale, FL 33308 Proposal Package For RFP F-08-21: EMS Billing Services City of San Bernardino San Bernardino, California July 16, 2008 Proposal Opening 3 p.m. Local Time I: 2008-358 EMS BILLING SERVICE CONTRACT CHECKLIST [gJ Copy of Contractor License III Bid Content and Forms. General Specification #35. Instructions to Bidder(s) I Bidders Please see Appendix A for our Certificate of Good Standing in California as well as our Delaware Articles of Incorporation to satisfy this requirement. [gJ Bidder Experience, Competency, Qualification and Profile (Vendor Document) III Bid I Bid Content Fonns Please see the body of this Proposal, pages 1-18 of the document. [gJ Non-Collusion Affidavit (City Form) Instructions to Bidder(s) I Bidders Please see Appendix B for our signed and notarized Non-Collusion Affidavit. [gJ Listing of Proposed Subcontractor (City Form) III Bid I Bid Content and Fonns Please see Appendix C for our signed Subcontractor's List. [gJ Price Form (City Form) Instructions to Bidders, III Bid Content and Fonns Please find our Price Form in a separate, sealed envelope as requested. [gJ Authorized Signatures Instructions to Bidders As specifically referenced in the body of our proposal, page 1, and marked in bold type, "all forms will be signed by Doug Shamon, our President and CEO, who is fully authorized to represent ADPI in eve/}' capacity. " [gJ Bidder Identification III Bid Content and Fonns Please find our Bidder Identification on the Cover Page of our proposal, as well as on the outside of the sealed package as requested. [gJ Addendum Received III Bid Content and Fonns Our proposal acknowledges receipt of the addendum as specifically referenced in the body of our proposal, page 1, and marked in bold type via the text: "Addendum received on July 8, 2008. " I 2008-358 IZI 90 Day Bid Validity Statement III Bid Content and Fonns As specifically referenced in the body of our proposal, page 1, and marked in bold type, "This proposal and its contents may be incorporated, in whole, into a written contract and will remain valid for a period of 90 days following the date of submittal. n IZI Authorized Signatures III Bid Content and Fonns Again, as specifically referenced in the body of our proposal, page 1, and marked in bold type, "all forms will be signed by Doug Shamon, our President and CEO, who is fully authorized to represent ADPI in evety capacity. n IZI References III Bid Content and Fonns Please see Appendix D for our References. IZI Calendar Day Acknowledgment of Delivery of Materials or Services General Specifications #9 As specifically referenced in the body of our proposal, page 2, Contract Transition, and marked in bold type, "As your current billing services provider, we anticipate no additional CSB personnel or significant transition period will be required. n IZI Proper Identification and Submittal of Bid/Bid Package, and Price Form Instructions to Bidders Please find our package identified and submitted as specified in the instructions. Bidders are reauested to submit this checklist com Dieted with all bid documents. I, 2008-358 i I adpj intennedix TABLE OF CONTENTS Table of Contents.......................................................................................................... 2 Proposal Contact Information...................................................................................... 3 Presentation .................................................................................................................. 1 Project Summary ... ....... ....... ... ................... .............. ......... ............... .................................................... ........... .......... 1 Contract Transition.... ........................ .... ...................... .............. ........ ........... .... ......................... ...... ......................... 2 Preliminary Work Plan ................................................... ..................................................................................... ...... 2 Proposed Time-Table for Deliverables During the First Year ...................................................................................2 Customization of Services for the City of San Bernardino........................................................................................ 3 Performance Methods ..... ....................................... ...... ............... ...................... ...................................................... 3 Account Services..... ...... ...... ..... .................. ..... ............. .... ..................................... .......... ............... ....................... .... 8 Customer Service....... .............. ............. ....................... ...................................................... ....... ............ .................. 10 Management Reports............................................................. ............. ................................................................... 11 Demonstrated Knowledge of and Compliance with the Following........................................................................ 12 Cost Proposal..... ....... ............ ..... ..... ........ ..................... ............... ....................................... ..................................... 13 Innovation ... ....... .................................... ................................ ....... ................... ................. ......... ................. ...... ..... 13 Additional Information . ................................ ........ ........... .......... ........... .............. ........ .......... ....... ........................... 14 2. Exceptions and Oeviations.....................................................................................15 3. Appendices ............................................................................................................. 16 4. Proposal Close........................................................................................................ 17 City of San Bernardino RFP 1"-08.21: EMS BlUing Services 2 @ADPl-lnlennedix July 16, 2008 I: 2008-358 i I adpi intennedix PROPOSAL CONTACT INFORMATION Proposal Contact: Rick Fossier Vice President of Business Development 14087 Triple Crown Drive Alpharetta, GA 30004 Phone: (770) 442-8627 Fax: (770) 442-8628 City of San Bernardino RFP F-<l8-21: EMS Billing Services 3 @ADPI-Intermedix July 16, 2008 I 2008-358 i I adpl intennedix PRESENTATION PROJECT SUMMARY Please accept this document as a formal proposal from Advanced Data Processing - a subsidiary of Intermed!x Corporation (ADPI) in response to the City of San Bernardino (CSB) RFP F-08-21: EMS Billing Services and subsequent Addendum received on July 8, 2008. This proposal and Its contents may be Incorporoted, In whole, Into 0 written contract and will remain valid for 0 period of 90 days following the dote of submittal. Further, a/l forms will be signed by Doug Shaman, our President and CEO, who Is fully authorized to represent ADPlln every capacity. Our proposal includes supplying billing and collections services for the City of San Bernardino as well as the continued administration of the City's subscription program. We appreciate the opportunity to respond to your needs and believe this proposal clearly represents our capabilities to offer you the finest EMS billing services in the country. Our key management staff has fully reviewed your RFP and will demonstrate within our proposal that AD PI remains uniquely qualified to provide the best available solution to the requirements of the City's RFP. As the City's current provider of these services, we are extremely knowledgeable in regards to the challenges of billing for first responder EMS fees as well as the opportunities that are present to enhance collection results. Specific to discussing avenues to improve reimbursement, we note the following and will expand upon each of these opportunities within our proposal 1. The current mix of commercial insurance claims submitted (11%) can be improved based upon the ability to capture face sheets from the receiving facilities, and each point of increase will mean thousands of net dollars to the City; 2. The response to question #35 in the RFP Addendum indicates that City Council is considering a proposal to allow the department to bill patients over the age of 65; 3. The City has peers in the first responder space within the State who are billing higher fees, and this too will have a positive impact on results for San Bernardino. We have been fortunate to provide these same services to the City of San Bernardino since October 2D04 and look forward to the opportunity to continue this service relationship. While there are inherent difficulties in billing for first responder services such as the lack of any payment options with both Medicare and Medi-Cal, we believe that steps can be taken to improve results for the City moving forward based on the valuable services provided by the men and women of the San Bernardino Fire Department, and ADPI remains prepared to serve the City in this role if we are afforded the opportunity. City of San Bemardino RFP F-08-21: EMS Billing Services @ADPI-Intermedix July 16. 2008 I: 2008-358 i I aclpl intennedix CONTRACT TRANSITION City Requirement: Explain haw your firm would handle the transition from the existing contract to the new contract if your firm were the successful vendor. Specificolly address how your firm would provide, in a timely manner, the contract deliverabies listed, Scope of Contract Work. A smooth continuation of billing and collection services must be provided so that the City can deliver uninterrupted and efficient customer service to its citizens. As your current billing services provider, we anticipate na additianal CSS persannel ar significant transition period will be required for the implementation of the described billing system. Our proposal to the City will include a number of revenue enhancement ideas as referenced in our Project Summary above, and all of these recommendations can be implemented as quickly as the City will allow. PRELIMINARY WORK PLAN City Requirement: Describe the phases into which the contract logically can be divided and performed. This narrative should provide an overview of the tasks far each part of the contract. List the equipment your firm would employ. State haw much lead-time, if any, your firm would need to adapt to this system once the contract is awarded. Explain what preparations would be undertaken during the lead-time. Describe the maintenance support your automated system would have. As the City's current provider, AD PI is fully prepared to continue working all accounts generated by CSB and sent to our operations staff for processing with none of the potential points of error that can occur during a transition. Over the past year, we have introduced our proprietary IMX billing system to the City, allowing for real-time web- based access to your accounts from any internet-enabled computer. Now on top of this system, we are in the process of rolling out our ad hoc Business Objects reporting tool, providing the City expanded reporting capabilities. All processing and support operations will continue to be delivered out of our Oakland, CA office under the leadership of Mr. Mori Moriuchi and his staff. PROPOSED TIME-TABLE FOR DELlVERABLES DURING THE FIRST YEAR City Requirement: Provide a praposed timetable far all contract activities addressed in the Preliminary Work Plan which must occur fram the date of contract award and throughout the first contract year. As described above. as CSB's current provider, our time-table for deliverables requires no operational or process changes on the part of the City or on the part of ADPI. Regarding the timetable for the revenue enhancement ideas suggested in our Project Summary, these issues will move at the speed which the City determines. Additionally, ADPI will continue to work on providing enhanced capabilities as part of our regular service relationship with the City, some examples of which are the ad hoc reporting tool listed directly above, the potential use of predictive dialer technology to enhance collection numbers for those patients for whom we are unabie to bill insurance, and the enhancement of collection techniques from the City's receiving facilities to optimize the amount of private insurance information being captured and billed. City of San Bernardino RFP F-08-2.1: EMS Billing Services 2 @ADPI-lnlermedix July 16, 2008 I: 2008-358 ilarJpl intennedix CUSTOMIZATION OF SERVICES FOR THE CITY OF SAN BERNARDINO City Requirement: Explain the factors your firm will consider in tailoring the billing and collection services to the needs of City employees and the City's EMS users. Nate any modifications to your standard billing and collection services that will be undertaken to ensure that this contract is customized to the special requirements of the City of San Bernardino. Billing far first responder services produces the need for system modifications based on payer requirements as well as City requirements. For example, AD PI's billing system utilizes many front-end insurance gathering techniques to find patient insurance information. However because first responder fees can not be billed to either of the two major federal insurers, our system must automatically remove insurance information when the patient is found to have either Medicare or Medi-Cal, and bill the patient directly. Additionally if the patient is found to be over the age of 65 within the current CSB rules, our system has to be modified to ensure that those claims are not sent out. It is important to note that while the two examples listed above are based upon limitations put forth within City and payer requirements, we understand how essential it is that we adhere to these factors in order to properly and efficiently processes the City's first responder claims. As your current provider, ADPI already has each of these requirements factored in to our system as it relates to the City of San Bernardino. PERFORMANCE METHODS City Requirement: Address the fallowing- Intake Procedures: Describe the procedures for importing, receiving and processing the Patient Care Report information from the Fire Department. Private Insurance Accounts: Describe the procedures for billing private insurance companies. Detail the procedures far handling rejected claims. Self Pay Accounts: Describe the procedures for billing individual users, including haw your firm would produce, print and send bills and notices. As an exhibit to this item, provide samples of correspondence, bills, notices and envelopes your firm would use. Describe the procedures for handling bills returned by the Postal Service as undeliverable, including what efforts will be taken to pursue those accounts. Insufficient Information and Uncollectible Accounts: Describe what actions your firm would take before declaring an account as having insufficient information or being uncollectible. Describe the procedures far obtaining supplemental billing information. BilLING PERFORMANCE METHODOLOGY AND TECHNICAL APPROACH Our approach to EMS billing and collections involves combing the people, processes, and technology to maximize the revenue per call for each EMS encounter. ADPI processes are engineered to focus on the uniqueness of the EMS patient encounter. We understand that EMS agencies lack the ongoing patient/provider financial relationship City of San Bemardino RFP F-08-21: EMS Billing Seivices 3 @ADPI-Intermedix July 16. 2008 I, 2008-358 i lac)pl intennedix that is common in other healthcare entities, such as physician and hospital care, as there is no admission or patient registration department. Additionally, the individuals who are providing care are also responsible for gathering billing information from severely ill or injured patients frequently resulting in gaps and errors in patient information. Recognizing these constraints, we have constructed processes that optimize the use of critical internal and external resources on the front end while performing billing for residents and non-residents of the City. Our billing and collection services can be segmented into distinct processes from PCR Creation to Reporting, with each step of the process guided by Compliance and Account Management teams as depicted in the illustration below. Each step in the process contains specific objectives that contribute to the maximization of revenue per patient encounter through an engineered series of edits, feedback mechanisms, and controls that enable us to operate effectively and efficiently and delineate the inherent segregation of duties. Every patient bill is "touched" during each phase of our process and always with the underlying goal of achieving maximum reimbursement. THE FRONT END PROCESS: PCR CREATION AND PCR TRANSFORMATION Objectives: 1. To capture every call and bill within 24 hours of receipt. 2. To ensure proper coding/pricing: resulting in the maximum allowable reimbursement for all services provided by your staff. 3. To ensure absolute compliance with all federal, state and local regulations. 4. To create "clean claims," resulting in fee recovery in the fastest possible manner. 5. To place insurance carriers as the primary guarantor and patients as the secondary City of San Bemardino RFp.F-08-21: EMS Billing Services 4 @ADPI-Intermedix July 16, 2008 I 2008-358 j I aeJpl intennedix Throughout the PCR creation and transformation process, a number of systems and tools are utilized as described below and depicted in our PCR Process Flow below. IIWNG DATA -lnsur_ -Pt~phlcs _c._ -"'''' -Codlnl I,,^,MS "",om r-....I PCR Information Flow Incident information will be documented using patient care reports (PCR) per the City's current process. PCRs will be transmitted to ADPI via our secured website as has already been established with your data collection software, Healthware Solutions_ PCR data will be immediately imported into CodeQ, ADPI's proprietary front-end coding software. We will continue to work with the City to schedule the consistent delivery of patient run reports, as is already in practice between our two organizations. PCR Transformation Our quality edits identify and correct inconsistencies in information that would result in a delay or rejection of the insurance claim. Our proprietary front-end edit application, CodeQ-Sweep, analyzes numerous data quality and integrity elements from demographic anomalies like incomplete addresses, non-conforming social security numbers and missing date-of-birth information. Patient encounter information is analyzed through a series of automated filters and system edits that produce the required codification, although this is not at issue with the San City of San Bernardino RFp.F-08-21: EMS Billing Services 5 @ADPl-lntermedix July 16, 2008 I, 2008-358 i I aclpi intennedix Bernardino claims. As a rule, we provide our certified coding staff with objective criteria for establishing appropriate code levels when necessary. Only coders with intensive training and appropriate certification are allowed to code encounters. CodeQ-Sweep also provides workflow controls that result in faster "clean" claim generation, therefore resulting in fewer denials. Because CSB claims are all billed at the flat $200 rate, much ofthe normal coding functionality we provide to our transporting clients becomes unnecessary, adding to the efficiency with which ADPI can move CSB claims from receipt to billed claims. Code Q As new accounts are loaded into the system, the run report is reviewed and cleared for billing. The coder is also able to read the narrative from the patient care report. Electronic Eligibility Eligibility inquiries occur during the PCR Transformation phase when patient records are passed through ADPI's eligibility algorithm. Our eligibility system uses industry standard ANSI electronic eligibility requests to identify patient insurance coverage from a number of sources, including data obtained from hospitals within the City through our hospital liaison program. All patient encounters are run through this eligibility process to obtain all additional valid patient information. Extensive edits and Account Specialists are in place to ensure that the data used is current and applicable to the current call. If insurance information has not been identified at the scene, the patient account is run through a series of electronic eligibility transactions to retrieve appropriate information. Following are the most frequently used resources: _ Medicare electronic eligibility (if found for a CSB patient, information is removed and billed as a self-pay if no commercial secondary insurance is found) - Hospital interfaces - Insurance eligibility via clearinghouse - Cascading electronic private insurance eligibility - Skip tracing Often times we are not only missing insurance information but patient demographics are incomplete. Before sending a patient bill, ADPI performs the following steps: - Skip tracing via Accurint to find missing patient demographics. - Deliverable address reviews utilizing Mellissa Data. Any information obtained is matched to the patient account in our system before it moves on to the billing process phase. City of San Bernardino RFP F-OB-21: EMS Billing Services 6 @ADPI-Intermedix July 16, 2008 -__ 1:- 2008-358 i laclpj intermedix THE BILLING PROCESS Objectives: 1. To file a clean claim within 24 hours of completion. 2. To file electronically to as many third party payers as possible. 3. To bill patients on a timely basis. Billing the Payer Commercial insurance claims are processed through our claims clearinghouse, within 24 hours of completion or printed and mailed if electronic delivery is not available. Copies of PCRs or explanation of benefits statements are attached to claims when applicable. Once accounts are updated and if the patient is deemed to be the guarantor, they will be sent an invoice/statement. Invoices contain, in addition to accurate charges for services, a request for patient insurance information and instructions on how to provide such information. Insurance information can be provided by patients via mail (with enclosed courtesy return-payment envelope), through a dedicated phone line or on our secure patient website, www.emsclaims.net. We can also include customized letterhead, messages, and inserts such as surveys, questionnaires, comment cards, and notices for your subscription program to be included in your statement mailings (optional). Mailings request forward address corrections to reduce undeliverable mail and cycle time. Accaunt Screen From the main account screen, both our clients and our employees can view all reievant patient demographics, charges, transactions, and incident information. Each transaction can be hyperlinked to PDF images of scanned documents. Employees and client users having financial role access can also print patient statements on-demand (in case a patient walks into our offices or your finance office, for example). ADPI employees are also able to edit demographic information using the Web-Edit button. Billing Cycle - Statements Within ADPI's normal processing environment, best practices have called for re-billing performed four times at regular intervals (cycle billing) with review of accounts determining if collection action is required. Between statement one and statement two, if a response has not been received by the patient, our auto-dialing phone system will generate a phone call to the patient in order to obtain insurance information or to set-up payment arrangements. This is new functionality that we have introduced, and we believe it will pay substantial dividends with San Bernardino accounts. We prefer to maintain accounts for a year because we often receive delayed payments up until the 1 year mark. Of course we will continue to meet the requirements of the City's cycle unless CSB agrees that a different billing cycle can produce better results as put forth by ADPI at any point. City of San Bemardino RFP 1'-08-21: EMS Billing Services 7 @ADPl-lntermeclix July 16, 2008 ____1-'-------__ 2008-358 i latlpl intennedix Audits will be performed in many cases before submission of the claim. For example, some claims are audited before submission to the carrier and proprietary medical necessity codes will be assigned to each claim. Web-Edit ADPI employees are able to edit patient demographic and insurance information. For instance, an employee can tag a Power of Attorney document with a barcode so that it can be scanned into our system. All of this functionality is already available to the City of San Bernardino and can be demonstrated to anyone in the City who would like to further understand the functionality ADPI offers as part of our core service offering. ACCOUNT SERVICES City Requirement: Describe all controls that would be established to insure on accurate accounting of fee payments or any other forms of payment, i.e. credit cords and/or Internet. Note the location where payments would be moiled and/or delivered in person. Detail the procedure for accepting and processing payments both by mail and in person. In this section, describe all bookkeeping procedures to be used. Also describe all other records your firm must keep, such as files, books and documents. As an exhibit to this item, provide a sample of the monthly invoice to be sent to the San Bernardino City Fire Department for services rendered. ADPI ACCOUNT SERVICES AND PAYER RESPONSE MANAGEMENT Objectives: 1. To post payments and balance within 24 hours of receipt. 2. To provide appropriate account level payment detail within 48 hours of receipt. 3. To provide effective customer service to patients who contact our office. 4. To provide timely and effective response to payer's denial or request for additional information. Payment Handling Currently, all payments are sent to ADPI for deposit into San Bernardino's bank account. Ideally, all payments would be sent to a San Bernardino lock box. All payments in both environments are processed in a secure fashion and ADPI is provided with posting information and patient correspondence on a daily basis. Upon receipt of payment documentation (typically 24 hours after deposit date), payments are posted to the appropriate account and reconciled to the bank deposit. Payment Review Each payment received from a third party is reviewed to ensure accurate reimbursement. If a "short pay" exists, the account is noted for our exception processing which results in an appeal to the third party carrier for payment. If patterns develop, we work directly with the appropriate representatives of the carrier to resolve them. We have been successful in resolving a significant amount of "short paysll for our clients. City of San Bemardino RFP F.08.21: EMS Billing Services 8 @ADPI.lntermedix July 16, 2008 I, 2008-358 i laclpl intennedix Correspondence All patient and insurance correspondence is reviewed and accounts are updated with information within 24 hours of receipt. Trend analyses are done to constantly refine the filing process and to identify specific third party correspondence issues. Denial Management and Reporting Our denial management program manages submission of clean claims to avoid denials and in the event of a denial, aggressively pursues payment. The system electronically posts payments and denials for payers who send electronic remittance. Depending on denial type, we initiate a series of actions related to the denial reason. For example, if a claim is denied due to policy number, we contact the patient to obtain the correct insurance information. Our reports track denials by type. These reports can be part of a regular monthly report package or run as ad hoc reports. The accurate mining of this denial data is the most critical element of our denial management process. Once the top denial reasons are targeted, we dedicate resources to diagnose consistent causes with the goal of preventing on-going denials. Overpayments/Refunds Our system automatically flags credit balance accounts, generating a special report that lists all accounts to be researched. Refund requests are presented to the client in report format with supporting documentation (e.g. copies of all remittance documentation and account payments), an explanation of recipient, amount of refund. and where to mail the refund check. We complete all documentation that must accompany the refund request. We retain copies of all receivable-related correspondence indexed by deposit batch date. We also provide the information in Excel format for simple check processing. Once submitted by ADPI to the City of San Bernardino, it then becomes the department's responsibility to process and issue a refund check to the appropriate payer. Specialty Cases In the case of patient hardship, we will arrange for a payment plan of no less than ten dollars per month or another amount designated by the City. The account is marked as a payment plan and is withheld from collections as long as payments are being made. We do recommend credit card payments in lieu of payment plans. All "special" cases or write-off policies will be specifically cited by the City and must be approved by authorized individuals. These cases will be marked in our system and handled according to your specific requirements. ERA Browser We receive ERA (electronic remittance advice) from many payers. City of San Bernardino RFP F..OB-21: EMS Billing Services 9 @ADPI-Intermedix July 16, 200B I: 2008-358 i I Eelp] intennedix ERA Log Our system can "auto-post" responses from the received ERA's. Sometimes an employee may wish to drill-down into the ERA elements to figure out exactly what the system did when it posted the transactions. Our system is able to tell our employees in plain English what happened. and it also notes where corrections were able to be made on the account (such as name spelling corrections, etc.) automatically. Manual Posting For payers that send printed EOBs instead of ERAs, we have a web-based posting system that is used by our employees. All data is checked before committing the transactions to our database. An audit trail is always kept with the UserlD that posted the transactions to ensure the best QA processes. Daily Check Pasting ADPI performs checks and balances at numerous levels to ensure all the money posted balances at the end of each day. Our Regional Directors use internal reports to verify the total amount of money posted each day at each of AD PI's regional offices around the country. CUSTOMER SERVICE City Requirement: Describe the procedures and controls that your firm will use to respond to, and to resolve inquiries, complaints and requests for account information from users, insurance companies, lawyers and others. Describe where this function would be performed and by whom. Explain how your firm would keep the Son Bernardino City Fire Deportment informed of the number and types of complaints received. Describe the timeliness and methods for responding to the Son Bernardino City Fire Deportment requests. Describe service to those customers of the City with particular emphasis on the following: . Ability to provide live telephone support via local and long-distance toll-free Numbers . Days and hours that telephone support is available . Availability of a bilingual (English/Spanish) speaking staff . Policies and procedures on handling investigation of errors and discrepancies . Patient information updates, and disclosure of policies regarding potential discounts, refunds, payments, etc. . Timeliness of pasting of payments, distribution of statements and refunds, and . Patient notification as to account change of status or resolution of issues. PATIENT AND CLIENT CUSTOMER SERVICE ADPI is committed to providing the highest level of service to our accounts at both the client and patient levels. To this end we have implemented systems that provide dedicated toll free access, multi-lingual CSRs for foreign language patients and active customer service hours from 8:30 a.m. to S:OO p.m. daily PST, excluding holidays. In addition to these hours, we often make outbound calls that extend into early evenings and Saturday mornings when necessary. Our goal for all patient calls is to significantly reduce patient wait time by consistently achieving City of San Bemardino RFP F-08-21: EMS Billing Services 10 @ADPI-Intennedix July 16, 2008 I 2008-358 i I aclpl intennedix no more than 10 seconds call waiting and monitoring all calls for accuracy, courtesy, and type of phone call. Further. we offer patients the option to provide insurance information to us through our website, eliminating the need to mail in information or make a phone call. All activity is documented in the system's patient notes section with standard note codes used in all possible instances. It is of utmost importance to our Customer Service Team to maintain a professional and courteous demeanor and do everything possible to assist your patients with getting their issues resolved. Our customer service personnel are instructed on how to gently handle each patient or payer call as a representative of the City. With a "soft collect" approach, easy payment arrangements and a translator service, we make it easy for your patients and payers. Just as it is our goal to ensure that patients receive excellent customer service, we are aiso invested in the satisfaction of the City throughout the process. Therefore we provide you with access to a dedicated Regional Director who knows the day to day operations of your account at all times, and who is charged with the primary goal of making sure that all of your needs are being met and that we are successfully increasing your revenue. Any operational, process, or report changes on the City's behalf would be communicated to Mori Moriuchi, your Regional Director, who will ensure that changes are made accordingly. Our team is dedicated to responding to your inquiries within one business day of initial contact. Finally, ADPI hosts a yearly client meeting to inform all clients of industry updates, bring in keynote speakers for industry perspective, and to gather our clients and operations teams for feedback sessions. We also bi-annually publish a client newsletter that provides informative industry articles and company-specific updates. ADPI is an avid supporter of the industry and targets our sponsorships and leadership opportunities to organizations that benefit the EMS/Fire-Rescue industry. MANAGEMENT REPORTS City Requirement: Describe all information your firm would include on monthly management reports, and how it would be derived. Describe the quality controls you would use to ensure accuracy of reporting. Include discussion of preformatted standardized forms; flexible reporting capabilities (including ability for City to create new reports and/or modify existing standardized reports) and report modification and data retrieval. AD PI is pleased to provide our clients with the tools to be constantly informed about their financial status and operations through our powerful reporting solution utilizing Business Objects. These tools provide real time access to all information entered into the ADPI system by the City of San Bernardino and are OIIailable 24 hours a day 7 days a week via the internet and our secure servers. Every PCR, patient account, call statistic, demographic resource, financial information, etc., is continuously available via any internet capable computer. All information is encrypted for security, and is maintained and backed-up in multiple, geographically separated locations, utilizing our mirrored, multiple-redundant system. Accounts collected, individual patient accounts, medic statistics, call statistics, and financial statistics are all available in a dynamic, real-time format. As soon as information is entered via a medic's patient care report or by our staff processing account activities, that information is available to authorized users. Within nanoseconds from the time the run report is sent to ADPI and entered in our system, the City of San Bemardino RFP F-08-21: EMS Billing SelVices 11 @ADPI-Intennedix July 16, 2008 I: 2008-358 iladp] intennedix account is generated and the statistics concerning that call have been added to the various reports throughout the system. In addition to management reports, you will also hove secure on-line access to ALL dinicol documentation sent to ADPI related to your potient calls, from the EKG strips and basic run report to any additional supporting data scanned and indexed for each individual encounter. We provide an assortment of standard reports that are grouped into three general categories: financial reports, patient records. and medic/department statistics and are available through our website. Sample reports are included in Appendix E following the proposal. Should the City require a specific report not included in our suite of available reports, a simple email or telephone request to our in-house programming staff will initiate the addition of that report typically within 24-48 hours. If the custom report is one that you will need to run on a consistent basis. we will simply add it to your "Reports" menu that you can access from the system at any time. DEMONSTRATED KNOWLEDGE OF AND COMPLIANCE WITH THE FOLLOWING City Requirement: Demonstrated knawledge of and campliance with: Health Insurance Partability and Accauntability Act (HIPAA), Health Care Financing Administratian (HCFA) Regulatians, reparts shawing clear audit trails in accordance with Generally Accepted Accaunting Practices. ADPI seeks to supply the most productive, efficient and compliant emergency services billing and collection services in the industry for all of our clients. We comply with all state, federal and local rules and regulations, with close attention to and abiding by regulations specific to our industry. We have put forth an extensive and aggressive compliance program. Our adherence to current Federal HIPM guidelines relating to privacy and security implementation further emphasizes our commitment to compliance on behalf of our clients. We set standards and employ audit checks on these standards to ensure we produce clean claims that get paid. All auditing is done in compliance with generally accepted GM practices. ADPI has had an active compliance program in place since 1999 when the DIG first presented the voluntary Compliance Program Guidance for Third-Party Medical Billing Companies. We certify that the ADPI compliance plan is compliant with the intent and activities included in the U.S. DIG Compliance Program Guidance for Third Party Medical Billing Companies established December 18, 1998. This plan is enforced from our President down to the coders, encompassing every individual within ADPI. All ADPI systems comply with HIPAA requirements of Security, Privacy, and transmission of data. Further, we have included a detailed description of our System Architecture and Security as Appendix F that speaks to encryption of electronic data sent to ADPI from your field units or participating hospital and demonstrates our commitment to providing the highest level of security within the framework of ADPI's systems and technology. City of San Bemardino RFP P-08-21: EMS Billing Services 12 @ADPI-Intermedix July 16, 200B n I, 2008-358 i I adpl intennedix COST PROPOSAL City Requirement: The vendor sholl submit a proposal based on a percentage of collection. The cost proposal must contain data to support the proposed charges. The proposed charges must be stated for each of the following accounts: . Private Insurance . Self Pay Accounts . Paramedic Membership Program Fees/Renewal . Miscellaneous Other Costs Vendor sholl identify and provide the costs for any additional charges that may become billable to the City, which haves not been identitied above. Any increase or extra cost for billing services during the term at this contract will require on agreement tram both parties. Once the agreement has been reached, a new contract with the amendments will require final approval from the Mayor and Common Council. Vendor shall provide the City with a monthly invoice in arrears for compensation. The City will provide payment to vendor within thirty (30) days of receipt of billing from vendor. The City will retain the right to challenge all or any part at on invoice. Vendor understands that if there is a substantial drop in collections, The City is requiring a formal communication of the decline, the potential reason for the decline, and recommendations to correct the problem. As required in the City's RFP format, ADPI has completed the pricing forms as supplied and submitted under separate cover. INNOVATION Describe innovative methods tor increasing revenue collection that reflects advances in technology or collection strategies that the vendor can provide. Vendor shall outline such strategies or technologies and provide examples of how their use improved revenue for specific agencies. As described in our Project Summary, we believe a number of imminent opportunities exist to improve the billing results we generate for CSB. Specifically, we note the following: . The current mix of commercial insurance for claims we are submitting on behalf of CSB totals only 11% of all claims. While the demographics of San Bernardino are certainly not the same as those in Corona, CA, where ADPI also provides first responder billing, we believe that a good portion of the 37% of commercial insurance billed in Corona is the direct result of receiving face sheets from the hospitals to which patients are ultimately transported. We believe that with some additional focus by the staff of ADPI and CSB to collect hospital face sheets, the City will see your insurance percentage rise commensurate with our experience. Furthermore, where average payment per account on commercial insurance claims exceeds $150 per account and results in a net collection percentage greater than 75%, those claims that remain in the private pay group continue to suffer from the payer characteristics of this group, seeing collections per account of less than $25 in both San Bernardino and Corona. City of San Bemardino RFP F-OB-21: EMS Billing Services 13 @ADPI-Intermedix July 16, 2008 I.c 2008-358 il aclpl intennedix . The current average charge in San Bernardino is only $200, whereas in Corona the average charge is $350 for the same first responder services. We submit that if CSB would raise its fees to a similar level, this too would have a dramatically positive impact on your revenue. Specifically, ADPl's financial model predicts that such a fee increase could produce as much as an additional 40%+ in revenue to the City. . The City has a policy of not charging individuals over the age of 65. While we understand the nature of this policy, we also believe that given the intent to optimize revenue from these valuable services that the City's Fire Department provides, this policy is stifling collections that could be coming in to the City. While the City's over-65 population skews Iowan a national level, they still represent a large subset of the claims produced by the City. Thus, ADPI recommends that the City consider the financial advantages of expioring this additional revenue stream from those patients over 65 with the ability to pay. ADDITIONAL INFORMATION Information not specifically requested in the foregoing sections but which is considered essential to the proposal may be presented in this section. Some suggestions of additional Information include, but are not limited to, copies of relevant media reprints and promotional brochures of your firm. For your review, we have included copies of our two most recent industry newsletters, The EMS Informant. as well as the past two editions of our Compliance Newsletter, demonstrating the level of detail at which we view the entire EM5 billing industry, in Appendix G. We would be pleased to provide additional copies along with other Issues should the City wish to review ADPl's approach in greater detail. ADPI is currently processing claims for more than 30 clients in the State of California, and we have a very strong desire to continue to serve the City of San Bernardino. To demonstrate this, we have put forth a fee proposal that is significantly more aggressive than our current rate; additionally, we have included some flexibility in approach, contingent upon the City's willingness to effect changes in your current transport fees and data collection efforts. We are making major commitments in the California marketplace and will continue to bring technology capacity and operational focus to bear on the results we produce. Given these goals and our aggressive fee rate offer to the City, we aim to demonstrate the level of seriousness with which we are responding to your RFP and how this will continue to reflect on the performance we deliver as your service provider. City of San Bernardino RFP P-08-21: EMS Billing Services 14 @ADPl-lntermedix July 16. 2008 I 2008-358 i ladpJ intermedix 2. EXCEPTIONS AND DEVIATIONS ADPI takes no exceptions to the CS8 requirements as listed in this RFP. City of San Bernardino RFP F'08-21: EMS Billing Services 15 @ADPI-Intermedix July 16, 2008 2008-358 i I adpj intennedix 3. APPENDICES Appendix A - Contractor Licensing: Certificate of Good Standing-cA; Delaware Articles of Incorporation Appendix B - Non-Collusion Affidavit Appendix C - Subcontractor's List Appendix D - References Appendix E - Sample Reports Appendix F - System Architecture and Security Appendix G - January 2008 EMS Informant, July 2008 EMS Informant; May 2008 Compliance Newsletter, June 2008 Compliance Newsletter Appendix H - Sample Correspondence: Sample Patient Invoice; Sample ADPllnvoice to the City City of San Bemardino RFP 1"-08-21: EMS Billing Services 16 @ADPI-Intermedix July 16. 2008 I, 2008-358 i laap] intennedix , 4. PROPOSAL ClOSE ADPI would like to thank you for the opportunity to present our proposal to continue provision of EMS First Responder Billing for the City of San Bernardino. As indicated in our response, we believe that ADPI offers the City a solution that is unparalleled in terms of the level of expertise and commitment we will continue to bring as your EMS billing service provider, and all at what we believe you will find to be a highly competitive fee rate. We offer proven recommendations to enhance your results. There are no "switching" costs or risks by continuing our business relationship, and our company is committed to this relationship with the City and to improving results for the services provided. As indicated, we believe that historical results can be improved dramatically given some meaningful attention to some field-related and administrative changes on the side of CSB and additional elements of improvement that ADPI is committed to making on our end as your service provider. If you should have any further questions concerning the contents of this proposal or any other issues we can help clarify, please do not hesitate to contact Rick Fossier, ADPI's Vice President of Business Development, at 770-442- 8627. Again, thank you and we look forward to the opportunity to grow our relationship with the City of San Bernardino. City of San Bernardino RFP F-0B-21: EMS Billing Services 17 @ADPHnterrnedix July 16, 2008 I 2008-358 State of California Secretary of State CERTIFICATE OF STATUS FOREIGN CORPORATION I, BRUCE McPHERSON, Secretary of State of the State of California, hereby certify: That on the 20th day of May, 2004, ADVANCED DATA PROCESSING, INC., a corporation organized and existing under the laws of Delaware, complied with the requirements of California law in effect on that date for the purpose of qualifying to transact intrastate business in this State; and That the above corporation is entitled to transact intrastate business in the State of California as of the date of this certificate. however, subject to any licensing requirements otherwise imposed by the laws of this State; and That no information is available in this office on the financial condition, business activity or practices of this corporation. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of August 17, 2006. BRUCE McPHERSON Secretary of State ch NP-25 (REV 0J/31/l15) . OSP 05 H201 ..., 'Delixware PAGE 1 ,. , '11ie :first State I, HARRIET SMITH WINDSOR, SECRETARY OF STATE OF THE STATE OF "ADVANCED DATA PROCESSING, INC." IS Y INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE AND IS GOOD STANDING AND HAS A LEGAL CORPORATE EXISTENCE SO FAR AS OFFICE SHOW, AS OF THE SECOND DAY OF BER, A.D. 2002. CERTIFY THAT THE SAID "ADVANCED DATA SSING, INC." WAS INCORPORATED ON THE EIGHTEENTH DAY OF ER, A.D. 2002. AND I 00 HEREBY FURTHER CERTIFY THAT THE FRANCHISE TAXES NOT BEEN ASSESSED TO DATE. .J.t~ J,,_.'iA..-91-~ Harriet Smith Windsor, Seer,...., 01 S..., 8300 AUl.aENTICATION: 2016068 DATE: 10-02-02 I 2008-358 NON - COLLUSION AFFIDAVIT TO: THE COMMON COUNCIL, CITY OF SAN BERNARDINO In accordance with Title 23, United States Code, Section 112, the undersigned hereby states under penalty of perjury: That he/she has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken action in restraint of free competitive bidding in connection with RFP F-QS.21. Business Name Advanced Data Processing, Inc. Business Address 6451 N. Federal Highway, Suite 1002, Ft. Lauderdale, FL 33308 Signature of bidder X 0 k.... Fort Lauderdale, FL Place of Residence Subscribed and sworn before me this I L\ 1 h day of ~, 20 Df) . Notary Public in and for the County of J>r OW (l r cI , State of CaliferRia, f I Dn d. Cl Mycommissionexpires De(em~_J I J.oo6 ,20.DfL.Vp?rJonCt/l~ k.nCJih . .1<1__ ...., NIl . ..... ..... . "C:' ....1IIc1. (' .. 100 7111M .....,..-.... I, 2008-358 SUBCONTRACTOR'S LIST RFP F-08-21 EMS Billing As required by Califomia State Law, the General Contractor bidding will hereinafter state the subcontractor who will be the subcontractor on the job for each particular trade or subdivision of the work in an amount in excess of one-half of one percent of the General Contractor's total bid and will state the firm name and principal location of the mill, shop, or office of each. If a General Contractor fails to specify a subcontractor, or if he specifies more than one subcontractor for the same portion of work to be performed under the contract in excess of one-half of one percent, he agrees that he is fully qualified to perform that portion himself and that he shall perform that portion himself. DIVISION OF NAME OF FIRM OR LOCATION WORK OR CONTRACTOR CITY TRADE NONE s~r REJECTION OF BIDS The undersigned agrees that the City of San Bemardino reserves the right to reject any or all bids, and reserves the right to waive informalities in a bid or bids not affected by law, if to do seems to best serve the public interest. . I 2008-358 APPENDIX D We have chosen the specific references listed below either due to geographic proximity, size of account or simply those agency leaders who know our company very well and will give the City assurance and confidence that we will provide the same level of service and attention to all of our customers, regardless of account volume. We encourage you to call our references and should the City want to speak to any of our 235+ clients specifically, we would be pleased to provide any account contacts requested. EMS Agency Contact/11tle Description of Services Address Phone/emall (if applicable) Chief First Responder BiUing 815 West Sixth Street Phone: 951-736-2460 City of Corona Mike Porter Corona, CA 91720 Mike.Dorter(lilcLcorona.ca.us Debra Pryor, EM5 billing/collections 2100 Martin Luther King Jr Way Phone: 510-981-5500 Berkeley Fire Fire Chief or 5,700 annual transports Department Rod Foster, Client since April 2002 2nd Floor dorvor(ii)ci. berkelev .ca.us Captain Regional Director: Mari Moriuchi 8erkeley, CA 94704 rfostertfi)ci.berkelev.ca.us EMS billing/collections Albany Fire Marc McGinn, 1,500 annual transports 1000 San Pablo Avenue Phone: 510-528-5773 Department Fire Chief Client since April 2003 Aibany, CA 94706 mmceinn(a)albanvca.orlz Regional Director: Mari Moriuchi EMS billing/collections San Francisco Julia Dawson, 60,000 annual transports 698 Second 5t Phone: (415) 558-3445 Fire Department CFO Client since San Francisco, CA 94107 iulia.dawson(Q)sff!:ov.orf!: Regional Director: Mori Moriuchi Wayne EMS billing/collections Littleton Fire Zygowicz 3,500 annual transports 2255 West Berry Avenue Phone: 303 795 3864 Department Division Chief Client since Littleton, CO 80165 wzvli!owiczlIDlittletonli!ov.orli! Regional VP Pamela Olkowski EM5 billing/collections Englewood Fire Stephen Green 2,200 annual transports 3615 50uth Elati 5t Phone: (303) 762-2476 Department EM5 Chief Client since Engiewood, CO 80110 sli!reenlIDenli!lewood2ov.orli! Regional VP Pamela Olkowski Denver Health EM5 billing/collections and Human Peg Burnette 48,000 annual transports 666 Bannock Street Phone: 303 436 6076 Services CFO Client since Denver, CO 80204 oburnettelIDdhha.orlz Regional VP Pamela Olkowski I 2008-358 APPENDIX E SAMPLE REPORTS Standard reports are grouped into three general categories: financial reports, patient records, and medic/department statistics. We have included the following examples of some of our typical reports. Financial Reports There are several standard financial reports available to authorized personnel as designated by the client. These reports are available for every month the client has been with ADPI-IMX (and using this data collection system). Gross Revenues, Assignment! Adjustment, and Financial Class Reports 0001.....CoNKI.dGr Dl'Pn .0, . ~ Collected Dollars Per Month 211,0"' lB.O" I :~:::I' 160,_ 150'-1 14Utllj 150.OMl nO,_1 ; 1I0,ol.i o IO'.OO'~ "'0001 11,010 It,oo, il.OOO ~ ::::::j ~ ::::j ~.~ .......lOK JlII_2eM -~iIH-_lOOll s.o-~~:~';::'_ J_tot] MOnlll !_Ttllal_st_n2_stllllonl; stllllon4~Sllllonl...-S'llIloII3 stllIonS_MoWautl 450,000 425,80' 400,000 375,00' 35MOO 325,000 301,000 275,000 j2SUoaj ~ 21UOGj 200.9001 175,OOG 150'0001. 125,000 '10.'00 75,000i SUDol 25.000 ,I eJ Dollars CoM.CUd Graoh 0 l'l"PTJPPP1! Gr_h 0 CustClm Rooorts Colleded Dollars Per Month Mar_iON "'_20M J~'.2004 5tp_2004 _.2004 lVl-lOOS r.tv_20n "'1'/'_2005 lel-lUS 5t'_2ooS NO\I_ZOn JaIl_lOOi MOrllh 1:- 2008-358 The graphs shown above on the Financial Statistics page are the same reports but for two separate clients, reflecting the level of customization that will be available to you. The basic information in both reports reflect the actual dollars collected per month, with an average collected per month also depicted via the level line across the graph. In the top example, that client also wished to track the revenue based upon individual stations, so their individual levels of revenue are depicted as well. This is shown since inception of the agreement between the provider and ADPI-IMX. In the second example, also utilizing an unidentified but actual client, you can see where the amount collected each month has varied from just under $250,000 in March 2004, to slightly more than $300,000 in January 2006 and is reflected by the blue line. The level red line reflects the average of all the amounts collected over the entire contract; in this case showing slightly more than $300,000 monthly. Accounts Collected Report (Receipts by Payer Type and Carrier) Fi",,"cl~1 Acx:ount Volunteer Fire Dept. Biling cycle 01-01-2007 to 01-31-2001 Fee peidl!MS Paidlntennedix .- .354119.51 $.732.31 [Jan] {Fob] [Mar} [Apr] [Mayl [Jun] Dull [Au!!] [Sep] {Oct] [No,,] [Dec} ...........".--..,,-.--."'.."-...--------."-~-.----~=~~!~~_.~.s_~::~_.------,...":~~~::::=:':.:=--~.,. 2005-09-29 zoos.:.oJ.;oS' ZOO6-U-OS zoo6-b3.lCf _....21 zoos,.Q4-O{ ZOOs-oe.2t 201J6;.06-14 2006-01-14 2006-og.i. 2006-03-31 2-OOS~iO'20 2006-11-25 ZOO6.,Q90.2,:' 2006.10.21 2lJ06.09-o,. 2006-05-12- 2OG6-07~lS 2006"*"23 too6-~ 20D6-11H8 50.00 0.00 1510.30 0.00 1549.22 0.00 1.60 0.00 25.0D 0.00 20.00 0.00 947.50 0.00 535.92 0.00 490.97 0.00 MAl 0.00 20.00 0.00 25.00 0;00 719.25 0,00 441.00 0.00 22.66 0.00 39.ZZ 0.00 4.34 0.00 ZI.38 0.00 39.88 0.00 175.00 0.00 234.60 0.00 patieftt Payment MlmoMI.tterman'Healltare Memon.! Herman HlaIthea... Human. choice c.. Patient Payment PeDentPayment: OmeplSuildlllf'S Slue Cross 81 abJe. Shietdof TIC 8111III Cross 81 Blue Shi-'d of TIC patient Payment Patient Payment patieftt Paym8nt TIC Children's H..... Plan CHIP crime Vic:timI' Compensation Amerigroap A~p A_ .......... Amerigroup ll'C-P1ogI"estivo Insurance PetientPayment ---- 2007-01-02 6 2007,01.02- &, 2007-01-02 2007-m.402 6. 2007-lJ1.02 6 21)07-01.02 6 2007-01-02 6 2007-01-112..6 2007-01-02 6 2007-01-02 2007-01-02 6 2OG7~01,02 2007-01-02 6 2007_01_112 2007-01-02 6 2007001-02 2007-01-02 ZOQ7-01..:02 2007-01-02 2007001-02- 6 Z007-o1-02 6 This is an example of the Accounts Collected report available to the designated personnel of each individual client. The agency determines who in their department will have access to this information. In this example, the posted date reflects the actual date that the payment was made on the account. Scan 10 is the number assigned by ADPI- IMX to the document related to that account, such as an EOB and/or a check for payment. Account # is the system assigned patient account number for that particular patient. Paid EMS is the actual payment amount received by ADPI-IMX for processing. Paid IMX is a custom column for those accounts in which a payment was made directly to another designated receiver for any reason. The fee is the calculated amount due to ADPI-IMX for servicing that account, based upon the percentage rate established in the service agreement. The insurance name is the name of the primary insurance responsible for that payment. Items listed in the Scan 10, Account #, and Patient Name columns are hyperlinks. Clicking on any of these items takes you to additional information about the account. The database can be sorted by simply clicking on the column header for that particular column. 1 2008-358 Accounts Aging Reports Accounts Aging Report New Braunfels Fire Oept (2096~1 .2005-12-31) NnMF 1174918[05-4071. ... [10-02:20051 [133534[05-4389-01110-27:2005\ .. [14.dic"", 11410491000... .10.00 .. 1141049 12005:10-11 [Open m I:ance 1204615 FFi204615 [2005-11-10 lOpeD This is an example of our typical accounts aging report. This type of information is only available to those persons designated by the Client as requiring this level of access. Accounts Receivable Status Report Accourts Detail EMS (20061 NAME 11II_____ ~dOo... 11545.00 155892 198608 [000 [CLOSED Ic- 1222904 !39769 1183135 1000 iCLOSED IMecicare [915~OO ~[397.69 15n31 10_00 [CLOSED ~...e ~!OOO [000 1000 [CLOSED IUeknown 10.00 :0.00 10.00 [0.00 [CLOSED I:::.::, [155300 '155300 1000 1000 [CLOSED INo-!----,~-! I I ~iII1Ce 10.00 _ ia.ao [a_aD \0.00 ICLOSED l~dicare :900.00 '211.62 1688.38 10.00 l~oSED IMcdOo... !930.00 !58057 [52657 1-17714 [CLOSED ~, 1208575 [000 1000 1208575 [OPEN IMedicare [80200 ;199.18 1602-82 io,oo iCLOSED iMedicare 1870.00 i37G.tS !499.82 io.oo iCLOSED --~ I: 2008-358 Patient Payment per Transport and Patient Payment per Encounter o Dollars Collected Graph ~ PPPT!PPPE Graph 0 Custom Reports Patient Payments Per Transport" Encounter 625 - 600 S75 5" 525 500 t::475 o ~450 c ~ 425 l- ~ 400 ~ =a: 375 o 250 350 m 300 275 225 Jll.n.2004 Mar-20M MiIlY-2004 jul_2004 Sl!:p.2004 Nov-20D4 Jan-ZOOS Mar_ZOOS May_lOOS jul.2005 Sep-2005 Nov_20M Momn I'" '/Transport ... S /Encounter - AVO SfT - Avg S lEI The above graph is also part of the Financial Statistics section of the web access reports. It reflects the Patient Payments per Transport (PPPT shown in red) and the Patient Payments per Encounter (PPPE shown in blue.) The graphs reflect the variances for each month the agreement between the provider and ADPI-IMX has been in effect, depending upon the circumstances of the actual amounts received. In this example, the PPPT for this agency is averaging approximately $500.00 per transport. This type of information is extremely valuable for budget planning, as it is easily seen that at $500.00 per transport average collected, an agency that transports 3800 patients annually could expect to collect $1,900,000.00. The downward trend near the end of the graph is normal, as it reflects those accounts that have been billed, but may not have been collected at the time the graph was prepared. Since this information is dynamic real-time information, this chart could change slightly throughout the day as payments are posted to the individual patient accounts by ADPHMX. I Patient Reports 2008-358 In addition to the actual run reports for all patients and any supplemental documents that are associated with each report, other patient reports can be accessed from the secure website. 72-Hour Patient Manager 72 Hour Patient Manager ..................................... ......."........". [Show All] [Refresh Data] [Jon] [Fob] [Mar] [Apr] [Moy] Dun] [Jul] [AuO] [Sop] rOot] [Nov] [ooc] J~,U~UEH~II~ImJgJ.I~I!!l,m.I~1.I!:l!~H~H9lJ!1Jg!I!'1.I~.!21J~1[Y1J~.!.l~IM,J~! 15 items found ........ _.~-;;~~._.~.~~~d~;.,.~.~~~,..~.~~~-..D~dd~~~...[~fpri~~...'Ej"~dd~~d~~ ~ Call Type I!I Dispatch Time 0 Disposition I!I Incident. 0 QI 0 Charges Fem.. Female Male Female Female Female Female Male Male Female Male Female Male Male Female 27 ~5 43 39 ~ 80 51 17 . ~7 47 80 52 11 2~ 1980-02-19 1941-12-0.5 1963-05-18 1968-03;:.26 2000-03.27 1927:.03.01 1955.12-02 1989-12-17 1999-02-28 1940:'02~22 1960-02-08 192~'11-23 1954.12-16 1995~-19 1980-06-19 Pnority2 Priority 1 Medical Oiabetic Other Cardiac Headache stn>ko MVA MVA MVA Medical Unknown Diabetic Choking Animal Bite Unconscious Priority-2 Priority 1 Priority 1 Priority 2 u:-:.-:::---:-::...-~~_~_~~~"~~~ri~~::ii::~~.~:1 .I :~_:~2Y'-' 2007.03.27 10:28 2001-03~27' 14:55 2001-03.2715:52 2007~03.27 18:53 2007-03.2721:37 2007-03-28 14:39 2007-03.2818:35 2007~03~28 18:50 2007-03-2818:50 2007.03~28 21:09 2007-03-2909:42 2007-03.2912:31 2007.03-2913:34 2007-03.2918:26 2007-03-2923:38 200709 20079-9 200709 200-709 200709 200709 200709 200709 200709 200709 200709 200709 200709 200709 200709 This report displays all patient encounters within the last 72 hours. It can be sorted by using the checkboxes at the top of the report. A similar report listing all patients since contract inception is also available, sorted by year and month. As with other reports, clicking any of the column headers will sort the individual report by that column. For example, clicking on the Call Type column header will sort the report alphabetically based on that column, resulting in the Animal Bite call being first, with the resulting reports in alphabetical order based on the type. I 2008-358 Medic and Department Statistic Reports The following sample reports show the type of medic and department statistics are available to designated personnel. Call Volume and Call Location Reports CAI r.S BY TIME OF DAY ____________I.IOT ]i31i819122132T291i216~~liOfOf166 I 85% I 78% 156010 I 29%J 24% 1 39% ~\ 6~ I 26% I 32%1 550/0 I ()% J 37% I2f015["2'7[40I22'l5 I 2 191i1141 9 .~ 113%j 0% 1310/.1 36%130% 129% ,230/0 i .20% ~144%122%181%!30% fOl~fOl15 32 1101 1 0 I 8 14r4~179 l~lml~~I~IIM1-__1~1~.11~I~l~l~_ I-Olll2ro!"28-~I13 13121312[OTTT64 I 0% ! 4% I 12% i 13o/~ t.21% - _1~__114~o i 20% I 7%1 8% ] ()O(o__1 9% 1 J4%.- Tlme 10600-1159 11200-1759 I 11800-2359 10000-0559 pPage C.A,LL LOCATIONS BY MONTH ____________ITor. 1.1 ~I;. I ~/. I ~/. I O~. I O~. I ~/. I.. O~ I O~'[ ~/.l ~/. 11~ I O~ I. ro-l~r---o~i1ro!O!Oro'-----oror-o~ i~:l%jml~!}~!~_I~I~i~I~I~I~j~1 I 0 I 0 l1!Oro!OrojOrol211TO["T ~_~ll%_I~I,~!~i~l~l~l~I~!~I~ o rorol1l1!OI-----O~i-----orol1ro!4 i~_I~I~il%il%:~!~il~!mj~I~I~I~ 10-1 0 l"""""OjOro!OjOl1rororo'-----l 2 -I 3 im m ~_i~l~imlm!l%i~I_~lm!~ ~ i 0 I 0 I1r3:-T4--i1i1i1[Oro~jOl1:\ i 0%.1 ~o .1 1% I 2% I. 5% l .!% I t~ I 1~Q I 0%1 0%. I 0%. I 0% i_l~_ ~I' 41 116[29ii7rsl21l25il3j34"~~1 37 1311326 ,4~..~~131%i~12~1~.l3~i~i4~l~3~!3~13~ 1 0 I 0 rororojOlO'[-----orororoiOro I 0% I. 0% i 0% I 0% i 0% 1 O%! 0%0%1 0% i O~Q I ()O~Q i ~ _L~_ 1 11 I 6 ~rloTlof13rsi7~~f13[14-I133 Il~lml.!~lt~!!~ll~!~I.~I~,!l~lt~i~,.~ rorolOllllrororo!OlO!Orol2 1~1.~I~Jl%lt%l~l~I~I~I.~I~lmi~ ~117 ~118 :4123 ;4124 !4125 I !4126 ; ~4127 i :4127' I 14128 , :4129 I 2008-358 DISPATCHED CAB. TYPES PER MONTH CallTyp~ ____________I.TOT. 11~1 8 i6T617~~1 7 tiOr5T~T-:~[11r-B6 ! oo/~ _ 2o/Il [ 1% I }~ J 2% I 2%__ YVo .!20/oJ l~o I l%_J~o j 30(~ i 2% I 1 ro~[l 12T~i~~1 1 I 2 ror112~1 0 ~ !. Q4(o ..! _~ ()% I 0% [0% I ~o ;, ()~ inOO(o_J 9'10_ I 0%__ 1,00/6 OO.lo! 0% iQlO~~1 2 i~I~i1i1ro-l2lOlO[1O l~l_~__l_~____~I_~I_~!~l~!_~lml~_I~_l__~__ ~131~i1Oi8!16i9i8I7~II7I6i'91 L~1o 10% OO~o J 20/0 \_2% l ~~__ 1.2"(0 __! 2% ,11% I 0% __ __ 2~J l~ .! _20/0 1:1i1~1 1 ~r1i~I~!1lOl3i3T2f16 i 00/0 : 0010 i,O% I 0% ! 0'% i 0% i 0% L 0%.1 0% I 0% I 0%_ l()OIo i 00/0 !3i1]1~i1I2I2I2!1ill5i1f24 !~!~i~ll%l~i_~I~_i~l~l~_ll%l~l~ I 0 ' 1 ilr-o-lOi~~lOillOlO,-1 2 ~I 7 ,00/0 100/010% 10% 10% 10% t-()% : o~oJO% [0% l_~ ,00100% I 0 I 0 ro-I 0 10101 0 IOIO[ 0 12i113 ~___~IO%I~I_~I~_J_~_!m_I_~__~I_~I~l~ 111011131O~[ 1 1010'-;-1 1 ili113112 10%1001010% ;0%10%_ 0% !.O%_iO!'~__O%lE%_IQ1Yo_IO% 1,0010_ ~132-1 32 126T29T21133!23iJO~1 26 l20i24[ 325 t~_I~,~I~I.mlml.~i~I~_ ~I~_I_~.__~. r--i-13-IOIOI~r-1IOr-1'----1 1 ro;-I 0 1---01~i1O l ~_ l C!(~_ 1_ 00/0 l~~ ,0% I 0% J_O%! 0% __ O~ 0% 0%. 00/0 J O~o '-1 2 lO!3il1012~1 0 1011r21012~ _~I~i~_:~I~I~ ~1~_I~_I~_lml~I~_ ~11i4121~1~1~11!1131O!1i11 1~1~I~i~.~~i~I~lmlml~_I~!~ !3l6l9l6l8i1Oj7:~i1I!~I5~[78 Imll%i~!l%lml~!l%I~I~l~l_l%i~ll% ro-ro-~[ 0 IOro-l1j---OlOlOiO~ro-i1 iO%.~~i?% ~~~iO% ~iO% 10% ~!OOA :0'% I IAbdPain I. iAller Rx I '"" IAnimal Bile !Assault I [AutoP'd [Bac_k Pain [Bums 1 lea Poison ICPR [cor. , ICbddbril iCholciDg 1 I ]DOS , I :DW>sO< iDrowning I I. 2008-358 Medic Statistlcs,lncluding Individual Medic Encounter and Refusal Counts MEDIC MANAGEMENT REPORT EMS 2006 ~easics DoNIs IiIcounts D"rcents DOrulJ$ ..- ,.. U1 . " .7 17 " '00 .. . 17 .7 19 ,. 133 " . 15 ., 17 22 .. .. . 19 51 .. " '08 ,OS . " .. 17 .. ..7 ... 7 19 .. .. " 1 . 17 ., 5 .. 27 7 . 18 .. .. .. 13' ., . 17 .. 17 .. ... " 11 19 .. 19 " ,.. 92 . .. .. .. .. - ... " . " " .. 19 .. 7 10 .. 53 " 19 7 . 17 .. .. .. Response Time Reports bspclDSe TllHs !IlIIIIiIiI - -- Tr~...d trNtment .... 04"":00 ...... 07.0191 2001-02-04 , 04:43:00 Tr~lIftendlraaln'lolnt .127 14:30:00 ""'17 07-0194 2007-02-05 . 14:26:00 TrHtm<<It,tr_port 4127 15:20:00 ...... 07.196 2007-02-05 7 15:13:00 ........ 5Ul 911'" 09:51:00 .... T,..trnent, no~ .... 09:52:00 411693 07-191 2007-02.06 , 09:50:00 5400 91"" 11:42:00 ..., NDtn<<ment.,natransport .", 17:":00 <Il1Sll07 07-201 2007+02-06 , 17:41:00 5111 911'" 11:36;00 ..., No trHItment,. no fAMport .... 1I:38:OQ 418817 07-202: 2007-02-06 , 18:35:00 .... 911'" M:4!5:00 ..., Trlnsport..-ldtnltlMllt 4127 06:41:00 419573 07-204 2007-02'07 5 06:43:00 443. 911'" lJlI:49:oo .... TrantpOrt<<ldtretttnent '''7 08:49:00 ...189 07.207 2007-02-01 0 08149=00 .... 911 can 12:31:00 ..., Tranlll'Ol'tlftdlnlRnlnt .,,, 12:32:00 ...- 07-UO 2007.02-01 , 12::30:00 .... 911Q' 14:55100 .... Trenspgrt end tnNtment .'" 14:58:00 ...... 01.212: 2007-1)%-07 , 14:'55:00 .... 911 cell 13:06:00 _e-30 TrHtment, no trensport "10 13:07:00 422119 07-0211 2OO1.0N17 , 13:05:00 .780 911C1l1 lZ:36:00 M~12 TrNtrMnt, trinlport 'U' 12:39100 ...... 07-213 aoDl-0Z-08 , 12:34:(10 ....... 81S "".. 13:45:00 M-82 Trensportandtreltment .,,, 13:48:00 4%2614 07.215 Zool-0Z-0ll . 13:44:00 - "".. 21:14:00 .... TrantpOrt end tn*Mrlt 4210 21:21:00 ....22 07-0211 2007-02-88 , 21:13:00 4741 911'" 14:15:00 .... Tr_portand tremnent 4209 14:11:00 423160 01-%20 2007-02-09 . 14:13:00 110 911'" 19:22:00 .... TrMsportn treCnent 41Z1 19:25:00 4ZS291 07-Z22 2001-02-09 . 19:%1:00 51'" 'lice. 11:43:00 .... flll!NIAllUnfoundedMoPl ."', ."'... D7-ZZ:S 2001-02:-10 U:4t,OQ .... 911clll1 11:45:110 .... NolrMtmeftt..no~part 4210 11:46:00 .""'" lt1-221 2001_02_10 , 11:":00 _ ~_~~!,~_:_jJ-E~-~( t ii,pelF I. Drug Usage Report - .... A'....1 .... .... .... .... .... .... .... ..., .... Intubation Report y N Y Y Y N N Y N Y Y 2008-358 ""'" "'-- lntuINttI.. Report 1 1 . 1 1 1 Z 1 1 Z 1 200700198 01953 01953 2007011955 200702104 200702649 200702649 200703848 200706872 200706872 200708007 ~~P.~;.t;;_~~-~_~i[~~E~.C T1i_.p.'~~' 2006.12.10 2006-12~1S 2006-12-16 2006~12.17 2006-12-17 2006.12;,22 2006-12-23 200f012-23 2006-12.23 zooe-lrZS 2006.12.29 -"SO _Aspirin -"- ~pirin JfTG SPTiIY -- _Aspirin ....... _NTG Spr4Y JITG Spray -"'" 363930 376323 376323 376147 380362 391015 392015 414167 567719 567719 615825 2007-01-02 2D01~Ol-18 2007-01-18 2007-01-18 2007-01-Z0 2007-01-25 2007-01-25 Z007-02-05 2007-03-03 2007-03-03 ZOQ7-03-13 - 1 1 1 1 Z 1 1 1 . Z 1 2008-358 APPENDIX F SYSTEM ARCHITECTURE AND SECURITY Computer Facilities/Disaster Recovery We have included specific information below concerning the technology employed by ADPI-IMX in our operations. Our proprietary Intermedix billing platform (IMX) has been exclusively designed by our company to provide our customers with the most effective and actionable information and approach in the ambulance billing industry. The personnel who have developed our platform continue to manage and expand our capabilities, and as such, we are not reliant on any third-party vendor to make changes or adaptations to our system based upon client requests. ADPI-IMX's billing platform is highly-advanced, providing excellent management tools and extreme security. Our servers are hosted in highly secure high-tech data centers in Austin, Texas and Houston, Texas. Physical access to the building is secured by guards. Physical access to the server room is secured via biometric security requiring a handprint (Austin) or a fingerprint (Houston). We use Secure Socket layer (SSl) encryption on all communications to and from our web servers outside our domain and point-to-point 128 bit encrypted Virtual Private Network (lPsec) communication between our operations centers and the data centers. Our systems architecture includes full redundancy and real-time replication to five servers in three locations. All web services include load-balancing technologies to ensure maximum system response time. Our systems architecture is depicted below: System A~chitecture "e t'N"=~"- ~ JK Apache Tomcat Con nector ~ :rf~~~~ ;:",,::!~~., , Triptix Web Service Key IlntermedixApplication I IThirdParty Application I t'?!IHtei-mBffiX'1Daj3.:~i\:'1 ~ M SOL ...91,..... :~U1'h -, :;:':.0;;:#;,:).':" Accurint Web SelVice .. lexisNexis. I ,-~._~ --- 2008-358 Every production server is protected by firewall rules (using Unux "iptables" or OpenBSD "pf.") Rules block essentially all incoming traffic and blocked packets are logged. Only allowed SSL entry points can access the servers. Our Columbus billing office is protected by the AT&T Network-Based Firewall. In addition to real-time database replication committed to five servers within milliseconds, we write to L TO-2 tape backups daily and store offsite. Houston Facility Austin Facility AT&T 3Mb Data Connection Columbus Campus We monitor the system using advanced monitoring technologies. The system emails our software support team anytime an exception occurs on the development or production servers. We instantly know if anything goes wrong. We proactively monitor our system including system bandwidth at key egress/ingress points with system logs which are viewed nightly as shown below: . Ho~ll."Ir..I.... 9-.":lt'*"'..__IS... <:;;-_: - 1..8- . (J!; 6l1~ _-....,'..~..._ !::: II::l: :i:.: :1): ;:,tillJ;:;..'; :j i "::: :,.-..i~q __j"t,1 ,hilt -lJlr" -,'" ",,'-'hifi;:H}U >> n u << U ~ .. ~ .. 2 .. a >> u u u U !~:i~_ _ u u u U ~ . . .. 2 .. = a u u " U !~:~~- >> u u u u ~ . 5 4 2 .. n _ u u << u ! ~~t::+f:il.Jd~ a u u << u ~ . .. ~ 2 .. n a u U << u JIit~",;~~;..~U:;;:L:Jdl .-." J; _.O~ ,--.." 1-:::: .:.!O..IU J::;::~ R-.O~ - -";'"'''j-''''' -, -j..,..,...;..., u..l...;... ,". '.'. '_'T"""" , I'":::: - -H -f". :,'j:..'--';''I"-'''''': (!l'- i >> u u << u ~ . . . 2 . R >> U U << U !:::I:.:.i;::..';t':I:;':.l:~ i s:~ :lj~iillii~iiji:iii'iit-;11iiliJiiiii~:iI!1 \ilii"ii,ii;;ii.ii i~i;1111iijii~jiliil~ I >> U U " U U . ~ . 1 . = >> U H U U 1_.' _.' ...,.,.0 1_.0 ;t 0.0 .....~ ; j;' ". . "t ::~!.~ -roo! tot ., !'1~-:r ',n,.-;T,njr .'1 . . . U ~ U u ~ U 1::1:'.' .., ... ... 1. U .. 0 ~ I ., k_ 2008-358 Client Access Each identified website user will be supplied with a login name and password. The login information is only supplied to those employees designated and agreed upon by the department. These employees will gain access to real-time patient information, documentation, and client specific billing information. From our system you are able to monitor all aspects of your billing operations, including but not limited to: EMTjparamedic documentation, call statistics, transport statistics, and many other reports. The reports that Waukesha will look at are the same reports that ADPI-IMX has access to. These reports will be used to monitor your account and to set benchmarks for future revenue goals and enhancements. Disaster Recovery ADPI-IMX developed and owns our proprietary billing software. Our in-house programming staff allows us the flexibility to work with client's needs and eliminates the concern that a software vendor will stop operating and leave the City with no solution. We are your total solution partner, which gives you the confidence that things will happen quickly and according to your needs. Our server infrastructure is built with redundancy and fault tolerance as one of the primary design goals. To ensure uninterrupted availability and disaster recovery, ADPI-IMX utilizes a multiple server, mirrored, redundant, geographically separated system of servers. Multiple power feeds and network feeds are provided by both facilities. In addition, diesel generators are at each site to provide backup power if the utility companies are unable to provide resources. Our environment has proven to be a stable environment with more than adequate back-up capabilities. Every server has redundant power supplies, each fed with separate power distribution mains. As well, every server has at least two network interfaces, each connected to different network switches. Digitai images are continuously backed up between facilities using the rsync utility. Databases are continuously backed up between cities using the database's native data replication feature. These backups and securities will serve as ADPI-IMX's disaster recovery plan in the case of an emergency. Web sessions are replicated between servers in the web cluster. If one web server were to fail, the end-user would not even realize the session had moved to a different node in the cluster. All servers use RAID. Our standard server RAID configuration involves using two RAID arrays in each server. The first array is a two-disk RAID-l mirror for the OS partition. The second is a four disk RAID-5 array containing the important data files. We pay Dell for premium support for our production servers, and if any replacement parts are necessary, the parts are shipped and received at our co-location facilities within four hours. Physical access to our hardware at the co-location facilities is restricted to authorized personnel only. Even further, both facilities also require biometric identity scans in order to gain physical access to the server. Remote access to servers is restricted to authorized IT system personnel only. All remote access is protected and encrypted using SSH (Secure Shell). Only certain IP addresses are permitted remote access. All internet-facing servers are protected by firewalls. Inbound and outbound port access is very restricted (for example, non-secure ports such as tel net and standard FTP not permitted). The firewalls also provide logging and auditing services. Employee access to external websites is restricted to a certain list of approved sites all related directly to required job functions. Mail servers use spam detection software ("spam assassin") and virus detecting software ("ClamAV") to protect employees email. I: 2008-358 failover capacity is possible due to the various redundancies in the system architecture as previously discussed. Backups are continuous, also as previously described. Additionally, the following steps are in place to insure data integrity; . Nightly backups of all data . Real-time replication of billing and patient related data . Regular oversight on all aspects of the backup plan . Backups stored in locations that ensure protection in case of emergencies . RAID protection which accounts for hardware failure of servers that store data . Billing representatives login info meets HIPAA requirements for complexity . firewall protection . Internal network access is limited to authorized VPN users that are trained to not share logins with anyone . Internal access to the building is secured via a card swiping access system . All access in to and out of the ADPI-IMX offices are logged electronically . These access logs are monitored I, 2008-358 The Compliance Adviser National Provider Identifier A new term to add to our abbreviation knowledge base is NPI, or National Provider Identifier. The NPI is a unique identification number for all covered health care providers, including ambulance services. This number is used on all insurance claim submissions including Medicare and Medicaid. The NPI replaces separate individual numbers assigned by each insurance carrier for service providers. Required use of NPls became effective last month as part of HIPAA's Administrative Simplification Standard. By having a unique number for eech health care provider, information can be more easily shared between providers and health plans for billing and payment purposes. Management Spotlight: Janice Metzger C.P.A., Vice President Houston Regional Office " I adpi intermedix June 2008 Inside this 1_ NII_ 1 -- ,-- .-~..I7f"IJ' 1 S.._lltl'~M 17M eompu.w:. HGtIImI _r_ 2 DIM:",..,.. of PHI 3 EM6 Allbftrllllhln6 3 a..-n'"" 4 c..-... -- Oversees billing operations for 110 clients in Texas, Oklahoma, Georgia; includes initial billing, follow-up, client visits and calls, and resolving payor issues 10+ years ambulance billing experience (Part A-hospitals, Part B, and now a billing company) Participated In state ambulance associations to facilitate improved policiesJ procedures. This included working on teams with Medicare, Medicaid, state, and local legislators for increased funding, rule interpretations, enacting new laws, rules, policies, and adoption of condition codes . Spoken at state and national ambulance conferences 2 II 2008-358 ....2 TlHtc-p1__ The Compliance Hotline 1-877 -277 -2329 . Many questions have come up this month regarding our Compliance Hotline. As mentioned In previous Compliance Advisers, a thlrd.party company hired by ADPllntermedlx supplies this service. Once the callis answered, some preliminary pieces of Information are discussed. Callers are asked If they wish to give their name or remain anonymous. At the end of the call, anonymous callers are given a reference number which they are to use when fOllowlng-up. The company contacts our Compliance Department and the Issue Is then addressed with the specific office, Managers, etc. No caller-specific information Is given to the Compliance Department. The responsible parties are given 2-3 weeks to report back to Compliance. At that time, callers may call the hotllne back for an update on their Inqulryllssue. If they wish, they may call an additional time and discuss things even further. Callers are never retallatad against for making calls to the hotllne. We rely on this service to give us vital Information on h_ _ are doing and areas which could benefit from c:tIange.. If employees are not comfortable going through the tredltlonal chain of command (Supervisors and Managers) they are encouraged to call this line. It is available 24 hours a day, 7 days a week, 365 days a year. Occasionally, situations arise wh... employees are not sure If their concem warrants a call to the Compliance Hotline. If this happens, they are more than wel. come to call or emall someone within their own Management teem or the Compliance Department for advice. The only way we can continually grow as a company Is by employees taking an active role In the way we operate as a whole. ". ;;.;;'~I';;:: \ ;.. '.....'-'~._- . ----.:/ ~ Ongoing Training . Jillyan Thompaon traveled to our Houston office to perform the annual Compliance and HIPAA training. This was the first of our 2008 annual office visits. She and Joe McCloskey will be In Ohio and Miami during July for the training as well, with Denver and Oakland to follow. . Vice President Janice Metzger also gave a presentation for Information specific to Texas Medicare and Medicaid. The staff had good questions and came away with a better under. standing of Compliance and HIPAA rules and regulations. . Joe McCloskey also had Initial Compliance training with Okeechobee County, a new client In upstate Florida this month. I, -- 2008-358 -- ~3 Disclosures of PHI . HIPAA greatly limits the disclosures EMS personnel can make. . Anyone dealing with Customer Service phone calls should keep In mind that _ must have specific patient releases on fila from attomays. If an attorney sands a signed patlant relaasa of Information (Iettar of representation) for a specific date of service, we can only send them Information for that date. If they call back requastlng infonnatlon for additional dates of servlca, thay must send addltl_1 signed I_rs pertaining to those dates. A single signed lettar encompassing multiple dates Is acceptable, but all requested dates must be clearly noted. . We must have a patlant's permission before speaking to others about their account. If a spouse, daughter, son, aunt, neighbor, ate. calls to discuss someone else's account, the patient must have glvan their consent beforehand. We cannot disclose any Information without tha patient's pannlsslon. If a patiant is deceased and the callar says thay hava powar of attorney, ask them to mall or fax proof of POA. After such proof Is recalved, we may discuss that account. . We are allowed to recalve Information from someone othar than tha patlant, but the person supplying that Information must ba noted In tha account In case something turns out to be Incorrect and we n_ to know how we got it. . If Managers or staff members have questions about this, you are encouragad to contact the Compliance Department for furthar clarification. Common EMS Abbreviations . Back by popular demand; . Dx. Diagnosis . PE. Physical Exam manyemploy_s have said . Fx: Fracture . Peripheral. toward the surface these abbreviations have . h/o. History of . PMH. Past Medical History been very helpful as PO. Per Oral (medication) references In everyday job . Hx. History . functions. . 1M: Intramuscular . POA: Powsr of Attorney . 10. Intrao.........s (through bona) . Posterior: towardlfrom the back . ALS. Advanced ute SUpport . IV: Intravenous . PRo Per Rectum . A & O. Alert & Oriented . LOC: Loss of Consciousness . RMA: Refused Medica. Assistance x1:time . MCD. Medicaid . ROM: Range of Motion x2. place . MCR: Medicare . Rx: T....tm.nt or PNscriptlon x3:person . MYA: Motor Vehicle Accident . SOB. Shortness Of Breath x4: altu.tlon . NIA: Not Applicable . STAT. Immediately . Anterion towanllfrom the front . NPI: Nat'l ProvIcIer ldentlller . TKO. To K_ Open . BLS. Basic Life Support . NIV. Nausea & Vomiting . TNT: Treabnent No Transport . clc. Chief Complaint . NKA: No Known Allergies . VB. Vltel Signs . clo. Complains of . OTC. Over The Counter . WC. Wheelchair --~~'--~~ 2008-358 ADPI Intermedix Corporate Office: 6451 N Federal Hwy Suite 1002 Fort Lauderdale, Fl. 33308 See you soon! Questions, Comments, Concerns . As always, we _Icome any and all questions, comments and concems regarding The Compliance Adviser. . Send questions through management or directly to Jlllyan Thompson ClI ithomDson2Cemsclaims.com. . Thanks once again to all those _0 contributed Ideas and information to this edition of The Compliance Adviser, especially Janice Metzger In Houston and Kimberly Clark In the Columbus office. View our web video at: www.imDactmovie .com/adD "Do the right thing. " .c- ____1-'---____________ 2008-358 The Compliance Adviser Intermedix Corporation . Doug Shamon, President and Chief Executive Officer, recently sent a letter to all employees announcing two major develop- ments within our company. . The first was about our corporate name change from MCI to Intermedix Corporation. Intermedix Corporation is comprised of EPBS Intenneclix, ADPllntermedix and Revenue Rescue Intermedix (the fire billing portion of our company). . The second was about Ken Cooke joining our team as the new Chief Operating Officer. Ken most recently worked at Price Waterhouse Coopers as their US and Global Chief Information Officer as well as the managing partner for Enterprise Solutions Center. As such, he oversaw all internal support functions and managed more than 1,800 employees. We all welcome Ken and look forward to having him as a member of our Senior Management Team going forward. The Compliance Hotline 1-877 -277 -2329 As a ...mlnd.... tile Compliance Hotline I. available 24 hou.. a day. 7 days a week. Calle.. may ehoo.e to .emaln anonymous and anonymous calle.. will lie a..lgned an Individual code numlle. for follow-up purpo.... The hotllne Is a valuable tool for our ever-growlng company and employee. .hould u.e It If they do not feel comfortable going directly to thel. own Management team. Intermedix Corporation May 2008 5th Edition Inside this 1_: ~..- 1 ChMIge c__ 1 HIPAA """"".tIon 2 ---.. 2 DlsclOIJU",. of I'HI 3 IIMIIt:M T..IfII._'~ 3 -- 4 c......,., etHIC""" - ~, ~;! }~ 11' :IL~ ::,~, .~ . I. :e1T.!tli! I I. D;~~ ,~~ . ;1 ~ !Lc... .{ ,i~ ,;,. ~ 2008-358 .... 11Ie - .. . - What Does HIPAA Do? . It give. patients mo.. control over their health Information. It .ets boundaries on the use and ..Iea.e of health record.. It e.tabll.hes appropriate .afeguard. which health ca.. providers mu.t achieve to protect PHI privacy. It hold. violators accountable with Impo.able civil and criminal penal tie. if they violate privacy rule.. . . . . It .trlke. a balance when public ...pon.lbility .upport. disclosu... to protect public health. It enable. patients to find out how their information may be used and about certain dlsclo.ure. of their PHI that have been made. It limits ..lease of Information to the minimum rea.onably needed for the purpo.e of dl.clo.u... It give. patients the right to examine and obtain a copy of their health ..cord. and request corrections. . . . . It empowers Individuals to control certain u.es and di.closure. of their health Information. Other HIP AA Information Q: Who must comply with HIPAA privacy .tandard.? A: As required by Cong...., HIPAA covers Health plans, Health ca.. clearinghouses, Health ca.. providers who conduct certain financial and admlni.trative transaction. electronically. Q: Why I. HIPAA needed? A: Prior to HIPAA, PHI could be dl.trlbut.d for ....on. which had nothing to do with a pati.nt's treatment. HIPAA establi.he. Federal safeguards to protect the confidentiality of medical information. Health ca.. providers have always tried to protect PHI. However, In today'. world, keeping paper record. In locked filing cabinets doesn't cut It. With Information held and .ent electronically, HIPAA provides clear standards for the protection of PHI. Ongoing Training . The Compliance Department will begin the annual Compliance and HIPAA training in June. We will be traveling to each of our Regional oftIc:es to add.... our own Compliance program, the n.... for employees to ..main Informed about what we do, and n_ and ongoing HIPAA Information. I, 2008-358 -- "-3 Disclosures of PHI . HIPAA greatly limits the disclosures EMS ......on...1 can mak.. . Th.... are six alloweble law enforcement disclosures: 1. Required by law 2. Id.ntmcatlon and location purposes 3. CrIm. victims 4. DtIC....nts (coroners and fu...ral directors for nOJloCrIm_at... daatbs) 5. CrIm. on pramlses 6. R.portlng crlm. In emergencies . W. are required to comply with an official lIUb_a from an agency with subpoena power. Some .xamples of official lIUbpoenas are the Offlca of Inspector General, a state Investlgatlv. agency or a state medical board. We are only to disclose the request... Infonnetlon and should maintain a .......rd of IL W. should also notify pati.nts becaus. they can object to It if they so desire. . W. must respond to a request for Information from a patl_ or their lagal representative. A I.tter from an attorney mUllt Ira"" a signed authorization from the patl.nt advising the release Is pannlsslble. If a patient Is requesting this Information on thalr own, thair req......t _ not need to be notarized. H_, if It Is an attorney's request, it must be notarized. . g. If someone has health care POA for an Individual, can th.y obtain acc.ss to that Individual's medical record? . A: Yes, an Individual with a health care POA will have the right to access the m"'lcal records of the Individual relat... to that re_ntatlon. . g: Does HIPAA all_ parents the right to ... their children's medical records? . A: Yas, unl.ss the stata or local laws prohibit It, unless the minor obtained care at the direction of a court or a p.rson appoint'" by the court, or unl.ss the parent agrees the minor and health care _vlder have a confid.ntlal relationship. Common EMS Abbreviations: How many do you know? . ALS. Advanced Life Support . HK: History . PO. Per Oral (medication) . A & 0: Alert & Oriented . 1M: Intramuscular . POA: Power of Attorney x1:tlme . 10. Intraosseous (through bone) . Posterlon towenllfrom the back x2: place . IV: Intravenous . PR: Per Rectum x3:person . LOC: Lo.. of Consclousn... . RMA. R_ Medical AssIstance x4: situation . MVA: Motor Vehicle Accident . ROM. Range of Motion . Anterior: towenl/from the front NIA: Not Applicable Ra. Treabnent or Prescription . . . BLS, Basic Life Support NN: Nau... & Vomiting SOB, Shortness Of Breath . . . clc. Chief Complaint NKA: No Known A1le..les STAT'immedlately . . . c/o. Complains of OTC. OVer The Counter TKO, To K_ Open . . . Dx: Diagnosis PE: Physical Exam TNT. Treatment No Tran_rt . . . Fx: Fracture Peripheral: -.n1 the surface VS. Vital Signs . . . hlo. History ef PMH: p_t .11I111_....., we. Wheelchair . . __--1_'-___ 2008-358 Intermedix Corporation Corporate Office: 6451 N Federal Hwy Suite 1002 Fort Lauderdale, Fl. 33308 See you soon! Questions, Comments, Concerns . As always, _ welcome any and all questions, comments and concems regarding lbe Compliance Adviser. . Send questions through managament or directly to Jillyan lbompson @ IthomDson2@emsclalms.com. . lbanks once again to ail those _0 contributed ideas and infOrmation to this edition of lbe Compliance Adviser. View our web video at: www.imDactmovie .com/adD "Do the right thing. " San Bernardino Fire Dpartment PO Box 510 Alameda, CA 94501 1.1111I1111..1111 1'29258833 Return Service Requested June 26, 2008 2008-358 San Bernardino Fire Toll Free MaiD 800 339 1159 Emergency Medical Services Bill Date or Service: 05-12-2008 IJ.I""I,I"U,I,I"ItI",I,I...II,I,I...I"I",II"III1.IJ.I San Bernardino File Opartment provided you emergency medical services on the above mentioned service date. At this time, we . m.IJJi8l .... . -. . .n.1f~""".iRBH_~"",,-prosram;.~fordl... ~~. services, please complete and sign the reverse side of this biD and return in the enclosed envelope. If you do not have insurance, please calI 800 339 1159 to set lip a payment plan. The amount due is your responsibility. "I \II \11 '-101 \( (O( '-I 05-12-2008 Emergency Medical Services 200.00 AMOUNT DUE DUE DATE $200.00 07-26-2008 -"-- --0--.' -""0"".0.0"-.- "'----..- .....-------0'-- ----- --- ------ Detach and Return --------- -- -------- ,.,-' --- - -- ------------ -..---:.:::. ::'.'.::'.:... ... ~r.rNlDDIi~r'dm~EE:EEtljTIj'.[jTIjthe fon~ ExpiffiitiUJife ED tIT] X SiptmuudlOlizillg _acconIiog 10....... or)Wr-.liosucr........... Pi.... DOte !bat ifpayiDg by credit card your sta_ will list TnIermedix, Inc. as !be mercbmL D8te I ACCOUNT# 01782520 '.....111.. Amount Due Payment Amount Due Date $ 200.00 $ 07-26-2008 San Bernardino Fire Dpartrnent PO Box 510 Alameda, CA 94501-9610 1.I"d..I.I.I,"I1I1I,"It1I1,II,....I.....II.llILutLdl Please make checks payable to: San Beraadino FIre Dept Wbeoyou p"y by dIock you _us 10_ yoor_dcdlOlli<ally. FODdt may bowilbdn:wn _yoo<_assooa ..Ihe.....day...._ yourpaymall..lf..._ )IOlIrdlock_yyou will DOl_)Wrdledi: --your_iIIiitutiaII;_.Ihe_wiII_OIIyoor -- 1MllIltIo1.3000329P 1936000324178102055 S-CRE DO NOT SEND CASH I ~ In order to process your claim, please provill;l~,J ~e information below and mail the form to So BemanllBo Fire Dpartmellt, PO Bel[ Slo. Alameda, CA 94501 or fax it to our toll-free number 1-518-632-5580 Do you have insur.mce? YesLl No D (If you do not have insurance, complete onlv the Patient IDCOI'IIUldotI section.) MI D rn~rn~rrrn [IIji~iityi~Erro Telephooe Number (Include Area Code) ITD - ITD - ITIIJ Patienfs Sex M 0 F 0 1 autborize any bolder of medical or otber inJbrmatim about me to releue to the SociaJ Security Admiaistntia:t. or iIs iDarnediaries or carrieri a ~otbor goveromeat_cr ..........Clllria"n"pOllSible filr pa)'lDOlll ~mtilnnaIioa_1iJr Ibis..wed Mdcuecr_oIaim. I"""," a copy oftbis _ to be us<d in pIa<e ofllle ooBiDal and _ pa)'lDOlll of medical insluaocc. _ to tIle..m.c provid<r. Medicare ID (Include letters and numben) Railroad 0 Policy Holder's First Name MI D Patient~ Relationship to Insured Self 0 Spouse 0 Other 0 Primary 0 ~O If services were related to an accidCllt or injury, please provide any additional insurance information Cor the responsible party, such as homeowners, automobile, workers' compensation, or liability. Insurance Company Name Patienfs Relation&bip to Inomed SeIC 0 Spouse 0 Other 0 Insurance Contact Phone Number ITIJ - ITD - ITTIJ For otIce use only - P_Acc:ounI Number 01182520 1111111111111111 I intermedix 6451 N. Federal Highway Suite 1002 Fort Lauderdale, FL 33308 United States www.emselaims.com San Bernardino Fire Dept. 200 East Third Street San Bernardino CA 92410 United States 2008-358 <~~ ~~.) ~t ,!, Charges per Accounts Adjustments Patient Credit Card Payments May 2008 May 2008 Credit Card Fees Credit card collections Thank you for your business. Invoice ~Ai~:ii~::. " ~~M~"':t.....;J!,,,,:-,'_-<;,, Net 30 II 2008-358 /)TT/lclfUEAJT '2 'I PRICE FORM Enclose in a separate envelope for evaluation. Failure to complete this entire price fonn may result in an incomplete bid. REQUEST FOR PROPOSALS: RFP F-08-21 DESCRIPTION OF RFP: EMS Billing Services COMPANY NAME/ADDRESS: Advanced Data Processing, Inc. 6451 N. Federal Highway, Suite 1002 Ft. Lauderdale, FL 33308 NAMEfTELEPHONE NO. OF AUTHORIZED REPRESENTATIVE Doug Shamon, President and CEO 954-308-8705 ANNUAL PURCHASE ORDER Effective on or about July 2, 2008 through June 30, 2009, plus three single year options, for City's partial requirements, on an as-needed basis, with no guaranteed usage for EMS Billing Services. Ootion year one, if exercised, shall be effective July 2,2009 through June 30, 2010. Ootion year two, if exercised, shall be effective July 2, 2010 through June 30, 2011. Ootion year three, if exercised, shall be effective July 2, 2011 through June 30, 2012. Actual option year pricing shall be negotiated with the successful Bidder(s) prior to exercising of any given option year. Option years shall become effective only upon issuance by the City of a duly authorized Purchase Order. Please provide detailed Firm Fixed Price cost information in the spaces provided below, and any other incidental or additional costs required to complete the Technical Specification requirements. II 2008-358 PRICE FORM (continued) The below cost proposal must contain data to support the proposed charQes. 1. Vendor purposes to be compensated for such services an amount equal to: 25% of net collections or an altemate Percent (%) of bill collections, (please state percentage.) flat rate per incident of $12.00- 2. State the purposed charges for each of the following accounts: a. Private Insurance -$:-25% of net collections or $12.00 per incident" b. Self Pay Accounts _$. ?fi% of "At ~oIlAMion~ or $;1? 00 per incident** c. Paramedic Membership Program Fees/Renewal -$" 25% of membership fee collections or ! 1 ,JOa cllII IUcllly d. Miscellaneous Other Costs -$ not aoolicable 3. Vendor shall identify and provide the costs for any additional charges that may become billable to the City, which have not been identified above. ~ no additional charges ~ ~ ~ "In keeping with the request of San Bernardino our pricing proposal is expressed as a percentage of collections. We have provided an altemative flat fee per incident pricing option for the County to consider. ADPI-IMX agrees to negotiate our percentage of collections fee on an annual basis in the future based upon changes made by the County relative to the fees being charged by the County to your patients and based upon data COllection activities on the part of the County which could increase the amount of insurance found on your patient accounts. if the County were to select the flat fee aliernative provided, this price would be subject to increase annually based upon the medical portion of the Consumer Price Index. (Attach additional sheets if necessary, including supporting data for purposed charges.) 2008-358 PRICE FORM (conUnued) Are there any other additional or incidental costs that will be require meet the requirements of the Technical Specifications? Yes I No answered "Yes", please provide detail of said additional costs:_ ur firm in order to . circle one). If you Please indicate any elements of the Technical Specifications that cannot be met by your firm. _ ADPI HAS NO EXCEPTIONS Have you included in your bid all informational items and forms as reqUested@ No (circle one). If you answered "No", please explain: This offer shall remain firm for 90 days from RFP close date. Terms and conditions as set forth in this RFP apply to this bid. NOT APPLICABLE Cash discount allowable % days; unless otherwise stated, payment terms are: Net thirty (30) days. In signing this bid, Bidder warrants that all certifications and documents requested herein are attached ..nd properly completed and signed. From time to time, the City may issue one or more addenda to this RFP. Below, please indicate all Addenda to this RFP received by your firm, and the date said Addenda waslwere received. Verification of Addenda Received Addenda No: Addenda No: JULY 7, 2008 Received on: Received on: .. , , / ""I "i tJ ~ I; Addenda No: AUTHORIZED SIGNATURE: 2008-358 - Received on: ~~ PRINT SIGNER'S NAME AND TITLE: Doug Shamon DATE SIGNED: COMPANY NAME & ADDRESS: ,. PHONE: 954 - 3 08- 8 705 EMAIL: dshamon@intermedix.com ~- "~ President and CEO July 14, 2008 Advanced Data Processing, Inc. 6451 N. Federal Highway, Suite 1002 Ft. Lauderdale, FL 33308 FAX: 305-521-0778 IF SUBMITTING A "NO BID", PLEASE STATE REASON(S) BELOW: