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HomeMy WebLinkAbout14- Human Resources ORIGINAL CITY OF SAN BERNARDINO — REQUEST FOR COUNCIL ACTION From: LINN LIVINGSTON Subject: RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF Dept: HUMAN RESOURCES THE CITY OF SAN BERNARDINO AUTHORIZING THE EXECUTION OF Date: June 28, 2010 AN AGREEMENT WITH LIEN ON ME, INC. TO PROVIDE BILL REVIEW SERVICES FOR THE CITY'S WORKERS' COMPENSATION PROGRAM. M/CC Meeting Date: July 6, 2010 Synopsis of Previous Council Action: Recommended Motion: Adopt Resolution. Signature Contact person: Linn Livingston Phone: 384-5161 Supporting data attached: Yes Ward: FUNDING REQUIREMENTS: Amount: $95.000 Source: (Acct. No.) 678-110-5163-0000-0057 (Acct. Description) Finance: Council Notes: Agenda Item No. 7/& /O CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION Staff Report Subject: Resolution of the Mayor and Common Council of the City of San Bernardino Authorizing the Execution of an Agreement with Lien On Me, Inc. to Provide Bill Review Services for the City's Workers' Compensation Program. Background: The Workers' Compensation Division administers the City's self-insured workers' compensation program. The Division provides workers' compensation coverage to approximately 1,700 City and Water Department employees who receive medical treatment and services in accordance with workers' compensation regulations. Mandated treatment may include medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of his/her injury. Due to the rising cost of medical treatment and care, the State of California has adopted an Official Medical Fee Schedule (OMFS), which regulates the cost of care associated with all medical treatment and ensures the reasonableness of this care so as not to impose an unnecessary hardship on employers. Bill review is one of many cost-containment programs used by the City to control workers' compensation costs. Bill review providers perform audits of medical bills to ensure compliance with the OMFS. This service not only ensures compliance by providers,but provides the City with substantial savings by identifying providers who are not in compliance with the OMFS regulations. Bill review is a specialized area in workers' compensation and requires specialized training in accordance with Article 20(commencing with Section 2592), Subchapter 3, Chapter 5,Title 10, California Code of Regulations. In April 2010,the City went out to bid for bill review services and twelve(12)vendors submitted proposals.A committee was established to review the proposals and,based on the written and oral presentations of services, the committee is recommending Lien on Me (LOM). LOM offered a competitive price and, in most areas,was more cost effective than the other bidders. LOM is experienced with public agencies and is currently providing the City of San Bernardino's bill review services. LOM brings twenty(20) years' experience providing bill reviews and ensures compliance of California regulations. As part of the contract, LOM will be responsible for auditing and reviewing pharmacy bills, inpatient and outpatient hospital bills, lien defense, and providing mandatory state reporting on behalf of the City of San Bernardino. During Fiscal Year 2009/2010,the City received medical billing totaling$4,375,032.43; by utilizing LOM as a cost-containment measure, the City saved $1,660,226.34. The Human Resources Department is requesting this agreement be approved to provide bill review services for the City of San Bernardino beginning July 6, 2010, and continued for a period of three(3)years with the option of two (2),one-(1)year extensions. Previously, it was requested that each department seek a five percent (5%) reduction from each vendor to offset the City's budget deficit. LOM has in the past and continues to agree to participate in this five percent(5%)reduction over the course of this fiscal year,which will result in a savings of approximately$5,000. LOM has also agreed to a minimal increase of two percent (2%). Financial Impact: Account Budgeted Amount: $2,581,400 Balance as of: 7/1/10 Balance after approval of this item: $2,486,400 Annual amounts are the rate of$95,000 for year one; $96,900 for year two; and $98,838 for year three. Recommendation: Adopt Resolution. t Resolution No Copy 2 RESOUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF S BERNARDINo AUTHORIZING THE EXECUTION OF AN AGREEMENT WI TH 3 LIEN ON ME, INC. TO PROVIDE BILL REVIEW SERVICES FOR THE CITY' 4 WORKERS' COMPENSATION PROGRAM. 5 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: 6 SECTION 1. The City Manager of the City of San Bernardino is hereby authorized and 7 directed to execute on behalf of said City an Agreement with Lien On Me, Inc. for the provision 8 of Workers' Compensation medical bill review services for a term of three (3) years with the 9 option of two (2), one- (1) year extensions. A copy of the Agreement is attached hereto marked 10 Exhibit"A"and incorporated herein by reference as fully as though set forth at length. tl SECTION 2. Pursuant to this determination, the Director of Finance or his/her 12 designee is hereby authorized to issue an Annual Purchase Order to Lien On Me, Inc., in an 13 ® amount not to exceed $95,000 for Year One (2010/2011); $96,900 for Year Two (2011/2012); 14 and$98,838 for Year Three(2012/2013). 15 SECTION 3. The Purchase Order shall reference this Resolution No. 2010- and 16 shall read "Lien On Me, Inc. for the provision of Workers' Compensation bill review services, 17 Purchase Order No. not to exceed $95,000 for 2010/2011; $96,900 for 2011/2012; 18 and $98,838 for 2012/2013," and shall incorporate the terms and conditions of the Services 19 Agreement. 20 SECTION 4. The authorization to execute the above-mentioned agreement is rescinded 21 if the parties to the agreement fail to execute it within sixty (60) days of the passage of this 22 Resolution. 23 24 25 P I RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING THE EXECUTION OF AN AGREEMENT WITH 2 LIEN ON ME, INC. TO PROVIDE BILL REVIEW SERVICES FOR THE CITY' WORKERS' COMPENSATION PROGRAM. 3 a I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and 5 Common Council of the City of San Bernardino at a meeting thereof, held 6 on day of 2010,by the following vote, to wit: 7 8 COUNCILMEMBERS: AYES NAPES ABSTAIN ABSENT MARQUEZ 9 DESJARDINS l0 BRINKER 11 SHORETT 12 KELLEY JOHNSON 13 pto M MCCAMACK Is Rachel G. Clark, City Clerk 16 17 The foregoing resolution is hereby approved this day of 18 , 2010. 19 20 Patrick J. Morris,Mayor City of San Bernardino 21 Approved as to form: 22 JAMES F. PENMAN, 23 City Attorney 24 25 By: 6/f EIBIT 1 SERVICES AGREEMENT 2 THIS AGREEMENT is made and entered into this ti's day of July, 2010 ('Effective 3 Date"), by and between the CITY OF SAN BERNARDINO, a charter city ("CITY"), and Lien 4 On Me, Inc. ("CONSULTANT"). 5 WITNESSETH : 6 A. WHEREAS, CITY proposes to have CONSULTANT perform the services 7 described herein below; and 8 B. WHEREAS, CONSULTANT represents that it has that degree of specialized 9 expertise contemplated within California Government Code, Section 37103, and holds all to necessary licenses to practice and perform the services herein contemplated; and 11 C. WHEREAS, CITY and CONSULTANT desire to contract for professional 12 services as described in the Scope of Services, attached hereto as Exhibit"1'; and 13 D. WHEREAS,no official or employee of CITY has a financial interest,within the Q14 provisions of California Government Code, Sections 1090-1092, in the subject matter of this 15 Agreement. 16 NOW,THEREFORE, for and in consideration of the mutual covenants and conditions 17 contained herein,the parties hereby agree as follows: 18 1.0. SERVICES PROVIDED BY CONSULTANT 19 1.1. Scope of Services. For the remuneration stipulated, CONSULTANT shall 20 provide the professional services described in the Scope of Services attached hereto as Exhibit 21 "1" and incorporated herein by this reference ("Services'). If a conflict arises between the 22 Scope of Services document and this Professional Services Agreement (hereinafter 23 "Agreement"),the terms of the Agreement shall govern. 24 1.2. Professional Practices. All Services to be provided by CONSULTANT pursuant 25 to this Agreement shall be provided by skilled personnel and in a manner consistent with the 1 1 standards of care, diligence and skill ordinarily exercised by professional consultants in similar 2 fields and circumstances in accordance with sound professional practices. CONSULTANT 3 also warrants that it is familiar with all laws that may affect its performance of this Agreement 4 and shall advise CITY of any changes in any laws that may affect CONSULTANT's 5 performance of this Agreement if the CONSULTANT has actual knowledge of such changes. 6 CONSULTANT and the CITY each represent that no CITY employee will provide any Services 7 under this Agreement. 8 1.3. Warranty. CONSULTANT warrants that it shall perform the Services required 9 by this Agreement in compliance with all applicable Federal and California employment laws 10 including, but not limited to, those laws related to minimum hours and wages; occupational 11 health and safety; fair employment and employment practices; workers' compensation insurance 12 and safety in employment; and all other Federal, State and local laws and ordinances applicable 13 to the services required under this Agreement. CONSULTANT shall indemnify and hold 14 harmless CITY from and against all claims, demands,payments, suits, actions,proceedings, and 15 judgments of every nature and description including reasonable attorneys' fees and costs, or ---- --16 recovered against-MY to the extent arising from CONSULTANT's violation of any such 17 applicable law. 18 1.4. Non-discrimination. In performing this Agreement, CONSULTANT shall not 19 engage in, nor permit its officers, employees or agents to engage in, discrimination in 20 employment of persons because of their race, religion, color, national origin, ancestry, age, 21 mental or physical disability, medical condition, marital status, sexual gender or sexual 22 orientation, except as permitted pursuant to Section 12940 of the Government Code. Violation 23 of this provision may result in the imposition of penalties referred to in Labor Code, Section 24 1735. 25 1.5 Non-Exclusive Agreement. CONSULTANT acknowledges that CITY may enter 2 I into agreements with other consultants for services similar to the Services that are subject to this 2 Agreement or may have its own employees perform services similar to those services 3 contemplated by this Agreement. 4 1.6. Delegation and Assignment. This is a personal service contract, and the duties 5 set forth herein shall not be delegated or assigned to any person or entity without the prior 6 written consent of CITY, which consent shall not be unreasonably withheld or delayed. 7 CONSULTANT may engage a subcontractor(s) as permitted by law and may employ other 8 personnel to perform services contemplated by this Agreement at CONSULTANT's sole cost 9 and expense. 10 1.7 Duty of Loyalty/Conflict of Interest. The CONSULTANT understands and 11 agrees that as the CITY's consultant, CONSULTANT shall maintain a fiduciary duty and a duty 12 of loyalty to the CITY in performing CONSULTANT's obligations under this Agreement. 13 CONSULTANT, in performing its obligations under this Agreement, is governed by I14 California's conflict of interest laws, Government Code Section 87100 et seq., and Title 2, 15 California Code of Regulations, Section 18700 et seq. I - -- 1-6 1$ -CITY-Business Certificate. CONSULTANT shall obtain and maintain during 17 the term of this Agreement, a valid CITY Business Registration Certificate pursuant to Title 5 18 of the City of San Bernardino Municipal Code and any and all other licenses, permits, 19 qualifications, insurance and approvals of whatever nature that are legally required of 20 CONSULTANT to practice its profession, skill or business. 21 2.0. COMPENSATION AND BILLING 22 2.1. Compensation. Except as provided herein, CONSULTANT compensation shall 23 be at the rate of$95,000 for year one; $96,900 for year two; and$98,838 for year three. 24 2.2. Additional Services. CONSULTANT shall not receive compensation for any 25 services provided outside the scope of services specified in Exhibit"1"unless the CITY,prior 3 1 to CONSULTANT performing the additional services, approves such additional services in 2 writing. It is specifically understood that oral requests and/or approvals of such additional 3 services or additional compensation shall be barred and are unenforceable. 4 2.3. Method of Billine. CONSULTANT shall submit invoices to CITY for approval. 5 Said invoice shall be based on the total of all CONSULTANT's services which have been 6 performed in accordance with the terms of this Agreement during the period covered by such 7 invoice. CITY shall pay CONSULTANT's invoice within thirty (30) days from the date CITY S receives said invoice. The invoice shall describe in detail the services performed and the 9 associated time for completion. Any additional services approved and performed pursuant to 10 this Agreement shall be designated as "Additional Services" and shall identify the number of the 11 authorized change order, where applicable, on all invoices. 12 2.4. Records and Audits. Records of CONSULTANT's Services directly relating to 13 this Agreement shall be maintained in accordance with generally recognized accounting • 14 principles and shall be made available to CITY for inspection and/or audit at mutually 15 convenient times for a period of seven (7) years from the Effective Date. Any such inspection - 16 shall be conducted at the CITY's expense,during normal-busihess hours and upon reasonable 17 prior written notice to CONSULTANT. Such audit shall also be subject to the execution of a 18 confidentiality agreement regarding inadvertent access to confidential information not related to 19 the CITY. 20 3.0. TERM AND NOTIFICATION. 21 3.1. Term. This Agreement shall commence on the Effective Date and continue three 22 (3) years, with the option of two (2), one- (1) year extensions, unless the Agreement is 23 previously terminated as provided for herein. 24 3.2 Termination. CITY or CONSULTANT may terminate the Services provided 25 under Section 1.1 of this Agreement upon thirty(30) days written notice to the other party. In 4 I the event of termination, CONSULTANT shall be paid the reasonable value of Services w"- 2 rendered to the date of termination. 3 3.3 Documents. In the event of an early termination of this Agreement, all 4 documents prepared by CONSULTANT in its performance of this Agreement including, but not 5 limited to, workers' compensation medical bills, shall be delivered to the CITY within ten (10) 6 days of delivery of termination notice to CONSULTANT, at no cost to CITY. Any use of 7 uncompleted documents without specific written authorization from CONSULTANT shall be at 8 CITY's sole risk and without liability or legal expense to CONSULTANT. 9 4.0. INSURANCE to 4.1. Scope and Limits of Insurance. CONSULTANT shall obtain and maintain 11 during the term of this Agreement all of the following insurance coverages: 12 (a) Commercial general liability, including premises-operations, 13 products/completed operations, broad form property damage, blanket Q14 contractual liability, independent contractors, personal injury with a 15 policy limit of One Million Dollars ($1,000,000.00), combined single I& limits,per occurrence and aggregate_- -- - 17 (b) Automobile liability for owned vehicles, hired, and non-owned vehicles, 18 with a policy limit of One Million Dollars ($1,000,000.00), combined 19 single limits, per occurrence and aggregate. 20 (c) Workers' compensation insurance as required by the State of California. 21 4.2. Endorsements. The commercial general liability insurance policy shall contain 22 or be endorsed, using general policy endorsements,to contain the following provisions: 23 (a) Additional insureds: "The City of San Bernardino and its elected and 24 appointed boards, officers, and employees are additional insureds with 25 I 5 I respect to their vicarious liability arising out of CONSULTANT's 2 performance of the Services hereunder." 3 (b) Other insurance: "Any other insurance maintained by the City of San 4 Bernardino shall be excess and not contributing with the insurance 5 provided by this policy with respect to claims arising solely and directly 6 from CONSULTANT's provision of the Services." 7 4.3. Certificates of Insurance. CONSULTANT shall provide to CITY certificates of 8 insurance showing the insurance coverages and required endorsements described above,prior to 9 performing any services under this Agreement. 10 4.4. Non-limiting. Nothing in this Section shall be construed as limiting in any way, 11 the indemnification provision contained in this Agreement, or the extent to which 12 CONSULTANT may be held responsible for payments of damages to persons or property. 13 4.5 Notice of Cancellation: CONSULTANT shall provide the CITY thirty(30) days Q14 prior written notice of cancellation of or a material change in any of the required coverages. 15 5.0. GENERAL PROVISIONS —- 16 - 5.1. Entire Agreement: This Agreement, together with Exhibit "1" attached hereto 17 constitutes the entire Agreement between the parties with respect to any matter referenced 18 herein and supersedes any and all other prior writings and oral negotiations. This Agreement 19 may be modified only in writing, and signed by the parties in interest at the time of such 20 modification. The terms of this Agreement shall prevail over any inconsistent provision in any 21 other contract document appurtenant hereto, including the exhibit to this Agreement. 22 5.2. Notices. Any notices, documents, correspondence or other communications 23 concerning this Agreement or the work hereunder may be provided by personal delivery, 24 deemed served or delivered: a) at the time of delivery if such communication is sent by personal 25 delivery, b) at the time of transmission if such communication is sent by facsimile; and c)48 6 1 hours after deposit in the U.S. Mail as reflected by the official U.S. postmark if such 2 communication is sent through regular United States mail. 3 CONSULTANT: CITY: 4 Tess Foley, Linn Livingston, President of Client Services Human Resources Director 5 Lien On Me,Inc. City of San Bernardino P.O. Box 91630 300 North "D" Street 6 Pasadena, CA 91109 San Bernardino, CA 92418 7 Telephone: (626) 921-1120 Telephone: (909) 384-5161 Fax: (626) 921-1132 Fax: (909) 384-5397 8 5.3. Attomevs' Fees: hi the event that litigation is brought by any party in connection 9 with this Agreement, the prevailing party shall be entitled to recover from the opposing party all to costs and expenses, including reasonable attorneys' fees, incurred by the prevailing party in the 11 exercise of any of its rights or remedies hereunder or the enforcement of any of the terms, 12 conditions, or provisions hereof. The costs, salary and expenses of the City Attorney and 13 ® members of his office in enforcing this contract on behalf of the CITY shall be considered as 14 attorneys' fees" for the purposes of this Agreement. 15 5.4. Govemine Law. This Agreement shall be governed by and construed under the ---- --- 16-. laws of the State of California without giving effect to that body of laws pertaining to conflict of 17 laws. hi the event of any legal action to enforce or interpret this Agreement, the parties hereto 18 agree that the sole and exclusive venue shall be a court of competent jurisdiction located in San 19 Bernardino County, California. 20 5.5. Assignment: CONSULTANT shall not voluntarily or by operation of law 21 assign, transfer, sublet or encumber all or any part of CONSULTANT's interest in this 22 Agreement to an unrelated third party without CITY s prior written consent,which consent shall 23 not be unreasonably withheld or delayed. Any attempted assignment,transfer, subletting or 24 encumbrance shall be void and shall constitute a breach of this Agreement and cause for 25 termination of this Agreement. Regardless of CITY's consent, no subletting or assignment shall 7 1 release CONSULTANT of CONSULTANT's obligation to perform all other obligations to be 2 performed by CONSULTANT hereunder for the term of this Agreement. 3 5.6. Indemnification and Hold Harmless. CONSULTANT shall protect,defend, 4 indemnify and hold harmless CITY and its elected and appointed officials, boards, 5 commissions, officers and employees from any and all claims, losses, demands, suits, 6 administrative actions, penalties, liabilities and expenses, including reasonable attorneys' fees, 7 damage to property or injuries to or death of any person or persons or damages of any nature 8 including, but not limited to, all civil claims or workers' compensation claims to the extent 9 directly arising from or in CONSULTANT's negligent or wrongful acts or omissions in 10 connection with the performance under this Agreement. 11 5.7. Independent Contractor. CONSULTANT, at all times while performing under 12 this Agreement, is and shall be acting as an independent contractor and not as an agent or 13 employee of CITY. CONSULTANT shall secure, at its expense, and be responsible for any and O14 all payment of wages, benefits and taxes including, but not limited to, Income Tax, Social 15 Security, State Disability Insurance Compensation, Unemployment Compensation, and other — 16 payroll-deductions for CONSULTANT and its officers, agents, and employees, and all business 17 licenses,if any are required, in connection with the Services to be performed hereunder. Neither 18 CONSULTANT nor its officers, agents and employees shall be entitled to receive any benefits 19 which employees of CITY are entitled to receive and shall not be entitled to Workers' 20 Compensation insurance, unemployment compensation, medical insurance, life insurance, paid 21 vacations, paid holidays, pension, profit sharing or Social Security on account of 22 CONSULTANT and its officers', agents' and employees' work for the CITY. This Agreement 23 does not create the relationship of agent, servant, employee partnership or joint venture between 24 the CITY and CONSULTANT. 25 5.8. Conflict of Interest Disclosure: CONSULTANT or its employees may be subject 8 1 to the provisions of the California Political Reform Act of 1974 (the "Act"), which (1) requires 2 such persons to disclose financial interests that may be materially affected by the work 3 performed under this Agreement, and (2)prohibits such persons from making or participating in 4 making decisions that will have a foreseeable financial affect on such interest. 5 CONSULTANT shall conform to all requirements of the Act. Failure to do so 6 constitutes a material breach and is grounds for termination of the Agreement by CITY. 7 5.9. Responsibility for Errors. CONSULTANT shall be responsible for its work and 6 results under this Agreement. CONSULTANT,when requested, shall furnish clarification 9 and/or explanation as may be required by the CITY's representative, regarding any services 10 rendered under this Agreement at no additional cost to CITY. In the event that an error or ti omission attributable to CONSULTANT occurs, then CONSULTANT shall, at no cost to 12 CITY, provide all other CONSULTANT professional services necessary to rectify and correct 13 the matter to the sole satisfaction of CITY and to participate in any meetings required with • 14 regard to the correction. CONSULTANT will assume the information supplied by the CITY, (or 15 on its behalf by third parties) is accurate and complete. CONSULTANT's responsibilities (and "16 associated compensation)do not include independent verification of required information. 17 Problems with information quality and/or delays in providing such information may result in a 18 delay in the performance of the Services or an increase in fees. 19 5.10. Prohibited Employment. CONSULTANT shall not employ any current 20 employee of CITY to perform the work under this Agreement while this Agreement is in effect. 21 . 5.11. Costs. Each party shall bear its own costs and fees incurred in the preparation 22 and negotiation of this Agreement and in the performance of its obligations hereunder except as 23 expressly provided herein. 24 5.12. No Third Party Beneficiary Rights. This Agreement is entered into for the sole I25 benefit of CITY and CONSULTANT and no other parties are intended to be direct or incidental V 9 I beneficiaries of this Agreement and no third party shall have any right in, under or to this 2 Agreement. 3 5.13. Headings Paragraphs and subparagraph headings contained in this Agreement 4 are included solely for convenience and are not intended to modify, explain or to be a full or 5 accurate description of the content thereof and shall not in any way affect the meaning or 6 interpretation of this Agreement. 7 5.14. Amendments. Only a writing executed by all of the parties hereto or their S respective successors and assigns may amend this Agreement. 9 5.15. Waiver. The delay or failure of either party at any time to require performance 10 or compliance by the other of any of its obligations or agreements shall in no way be deemed a 11 waiver of those rights to require such performance or compliance. No waiver of any provision 12 of this Agreement shall be effective unless in writing and signed by a duly authorized 13 representative of the party against whom enforcement of a waiver is sought. The waiver of any © 14 right or remedy with respect to any occurrence or event shall not be deemed a waiver of any 15 right or remedy with respect to any other occurrence or event, nor shall any waiver constitute a 1-6. . continuing waiver. 17 5.16. Severability. If any provision of this Agreement is determined by a court of 18 competent jurisdiction to be invalid or unenforceable for any reason, such determination shall 19 not affect the validity or enforceability of the remaining terms and provisions hereof or of the 20 offending provision in any other circumstance, and the remaining provisions of this Agreement 21 shall remain in full force and effect. 22 5.17. Counterparts: This Agreement may be executed in one or more counterparts, 23 each of which shall be deemed an original. All counterparts shall be construed together and 24 shall constitute one agreement. 25 5.18. Coroorate Authority. The persons executing this Agreement on behalf of the I 10 I parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said 2 parties and that by doing so, the parties hereto are formally bound to the provisions of this 3 Agreement. 4 5 6 7 9 10 IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the day 11 and date first above shown. 12 ATTEST: CITY OF SAN BERNARDINO 13 Municipal Corporation and Charter City 14 15 Rachel Clark, City Clerk Charles McNeely, City Manager — — 16 — CONSULTANT: 17 By: 18 Approved as to form: 19 JAMES F. PENMAN 20 City Attomey 21 By: 22 23 HR/Agenda It=:L0M:Agre==t.L0M2010 24 25 II 1 SERVICES AGREEMENT 2 THIS AGREEMENT is made and entered into this 6h day of July, 2010 ("Effective 3 Date"), by and between the CITY OF SAN BERNARDINO, a charter city ("CITY"), and Lien 4 On Me, Inc. ("CONSULTANT'). 5 WITNESSETH : 6 A. WHEREAS, CITY proposes to have CONSULTANT perform the services 7 described herein below; and 8 B. WHEREAS, CONSULTANT represents that it has that degree of specialized t 9 expertise contemplated within California Government Code, Section 37103, and holds all 10 necessary licenses to practice and perform the services herein contemplated; and 11 C. WHEREAS, CITY and CONSULTANT desire to contract for professional 12 services as described in the Scope of Services, attached hereto as Exhibit "I"; and 13 D. WHEREAS, no official or employee of CITY has a financial interest,within the Q14 provisions of California Government Code, Sections 1090-1092, in the subject matter of this 15 Agreement. 16 NOW, THEREFORE, for and in consideration of the mutual covenants and conditions 17 contained herein, the parties hereby agree as follows: 11 1.0. SERVICES PROVIDED BY CONSULTANT 19 1.1. Scope of Services. For the remuneration stipulated, CONSULTANT shall 20 provide the professional services described in the Scope of Services attached hereto as Exhibit 21 "1" and incorporated herein by this reference ("Services"). If a conflict arises between the 22 Scope of Services document and this Professional Services Agreement (hereinafter 23 "Agreement"), the terms of the Agreement shall govern. 24 1.2. Professional Practices. All Services to be provided by CONSULTANT pursuant 25 to this Agreement shall be provided by skilled personnel and in a manner consistent with the 1 I standards of care, diligence and skill ordinarily exercised by professional consultants in similar 2 fields and circumstances in accordance with sound professional practices. CONSULTANT 3 also warrants that it is familiar with all laws that may affect its performance of this Agreement 4 and shall advise CITY of any changes in any laws that may affect CONSULTANT's 5 performance of this Agreement if the CONSULTANT has actual knowledge of such changes. 6 CONSULTANT and the CITY each represent that no CITY employee will provide any Services 7 under this Agreement. 6 1.3. Warranty. CONSULTANT warrants that it shall perform the Services required 9 by this Agreement in compliance with all applicable Federal and California employment laws 10 including, but not limited to, those laws related to minimum hours and wages; occupational 11 health and safety; fair employment and employment practices; workers' compensation insurance 12 and safety in employment; and all other Federal, State and local laws and ordinances applicable 13 to the services required under this Agreement. CONSULTANT shall indemnify and hold 14 harmless CITY from and against all claims, demands, payments, suits, actions,proceedings, and 15 judgments of every nature and description including reasonable attorneys' fees and costs, or 16 recovered against CITY to the extent arising from CONSULTANT's violation of any such 17 applicable law. 18 1.4. Non-discrimination. In performing this Agreement, CONSULTANT shall not 19 engage in, nor permit its officers, employees or agents to engage in, discrimination in 20 employment of persons because of their race, religion, color, national origin, ancestry, age, 21 mental or physical disability, medical condition, marital status, sexual gender or sexual 22 orientation, except as permitted pursuant to Section 12940 of the Government Code. Violation 23 of this provision may result in the imposition of penalties referred to in Labor Code, Section 24 1735. 25 1.5 Non-Exclusive Agreement. CONSULTANT acknowledges that CITY may enter 2 1 into agreements with other consultants for services similar to the Services that are subject to this 2 Agreement or may have its own employees perform services similar to those services 3 contemplated by this Agreement. 4 1.6. Delegation and Assignment. This is a personal service contract, and the duties 5 set forth herein shall not be delegated or assigned to any person or entity without the prior 6 written consent of CITY, which consent shall not be unreasonably withheld or delayed. 7 CONSULTANT may engage a subcontractor(s) as permitted by law and may employ other 6 personnel to perform services contemplated by this Agreement at CONSULTANT's sole cost 9 and expense. 10 1.7 Duty of Loyalty/Conflict of Interest. The CONSULTANT understands and 11 agrees that as the CITY's consultant, CONSULTANT shall maintain a fiduciary duty and a duty 12 of loyalty to the CITY in performing CONSULTANT's obligations under this Agreement. 13 CONSULTANT, in performing its obligations under this Agreement, is governed by Q14 California's conflict of interest laws, Government Code Section 87100 et seq., and Title 2, 15 California Code of Regulations, Section 18700 et seq. 16 1.8 CITY Business Certificate. CONSULTANT shall obtain and maintain during 17 the term of this Agreement, a valid CITY Business Registration Certificate pursuant to Title 5 18 of the City of San Bernardino Municipal Code and any and all other licenses, permits, 19 qualifications, insurance and approvals of whatever nature that are legally required of 20 CONSULTANT to practice its profession, skill or business. 21 2.0. COMPENSATION AND BILLING 22 2.1. Compensation. Except as provided herein, CONSULTANT compensation shall 23 be at the rate of$95,000 for year one; $96,900 for year two; and $98,838 for year three. 24 2.2. Additional Services. CONSULTANT shall not receive compensation for any 25 services provided outside the scope of services specified in Exhibit "1"unless the CITY,prior 3 I to CONSULTANT performing the additional services, approves such additional services in 2 writing. It is specifically understood that oral requests and/or approvals of such additional 3 services or additional compensation shall be barred and are unenforceable. 4 2.3. Method of Billing. CONSULTANT shall submit invoices to CITY for approval. 5 Said invoice shall be based on the total of all CONSULTANT's services which have been 6 performed in accordance with the terms of this Agreement during the period covered by such 7 invoice. CITY shall pay CONSULTANT's invoice within thirty (30) days from the date CITY 8 receives said invoice. The invoice shall describe in detail the services performed and the 9 associated time for completion. Any additional services approved and performed pursuant to 10 this Agreement shall be designated as "Additional Services" and shall identify the number of the 11 authorized change order,where applicable, on all invoices. 12 2.4. Records and Audits. Records of CONSULTANT's Services directly relating to 13 this Agreement shall be maintained in accordance with generally recognized accounting Q14 principles and shall be made available to CITY for inspection and/or audit at mutually 15 convenient times for a period of seven (7) years from the Effective Date. Any such inspection 16 shall be conducted at the CITY's expense, during normal business hours and upon reasonable 17 prior written notice to CONSULTANT. Such audit shall also be subject to the execution of a 18 confidentiality agreement regarding inadvertent access to confidential information not related to 19 the CITY. 20 3.0. TERM AND NOTIFICATION. 21 3.1. Term. This Agreement shall commence on the Effective Date and continue three 22 (3) years, with the option of two (2), one- (1) year extensions, unless the Agreement i 23 previously terminated as provided for herein. 24 3.2 Terminatio n. CITY or CONSULTANT may terminate the Services provided 25 ( under Section 1.1 of this Agreement upon thirty(30) days written notice to the other party. In 4 I the event of termination, CONSULTANT shall be paid the reasonable value of Services v 2 rendered to the date of termination. 3 3.3 Documents. In the event of an early termination of this Agreement, all 4 documents prepared by CONSULTANT in its performance of this Agreement including,but not 5 limited to, workers' compensation medical bills, shall be delivered to the CITY within ten (10) 6 days of delivery of termination notice to CONSULTANT, at no cost to CITY. Any use of 7 uncompleted documents without specific written authorization from CONSULTANT shall be at 8 CITY's sole risk and without liability or legal expense to CONSULTANT. 9 4.0. INSURANCE 10 4.1. Scope and Limits of Insurance. CONSULTANT shall obtain and maintain 11 during the term of this Agreement all of the following insurance coverages: 12 (a) Commercial general liability, including premises-operations, 13 products/completed operations, broad form property damage, blanket O14 contractual liability, independent contractors, personal injury with a 15 policy limit of One Million Dollars ($1,000,000.00), combined single 16 limits,per occurrence and aggregate. 17 (b) Automobile liability for owned vehicles, hired, and non-owned vehicles, 18 with a policy limit of One Million Dollars ($1,000,000.00), combined 19 single limits,per occurrence and aggregate. 20 (c) Workers' compensation insurance as required by the State of California. 21 4.2. Endorsements. The commercial general liability insurance policy shall contain 22 or be endorsed, using general policy endorsements,to contain the following provisions: 23 (a) Additional insureds: "The City of San Bernardino and its elected and 24 appointed boards, officers, and employees are additional insureds with 25 5 1 respect to their vicarious liability arising out of CONSULTANT's w 2 performance of the Services hereunder." 3 (b) Other insurance: "Any other insurance maintained by the City of San 4 Bernardino shall be excess and not contributing with the insurance 5 provided by this policy with respect to claims arising solely and directly 6 from CONSULTANT's provision of the Services." 7 4.3. Certificates of Insurance. CONSULTANT shall provide to CITY certificates of 8 insurance showing the insurance coverages and required endorsements described above,prior to 9 performing any services under this Agreement. 10 4.4. Non-limiting. Nothing in this Section shall be construed as limiting in any way, 11 the indemnification provision contained in this Agreement, or the extent to which 12 CONSULTANT may be held responsible for payments of damages to persons or property. 13 4.5 Notice of Cancellation: CONSULTANT shall provide the CITY thirty (30) days • 14 prior written notice of cancellation of or a material change in any of the required coverages. 15 5.0. GENERAL PROVISIONS 16 5.1. Entire Agreement: This Agreement, together with Exhibit "1" attached hereto 17 constitutes the entire Agreement between the parties with respect to any matter referenced 18 herein and supersedes any and all other prior writings and oral negotiations. This Agreement 19 may be modified only in writing, and signed by the parties in interest at the time of such 20 modification. The terms of this Agreement shall prevail over any inconsistent provision in any 21 other contract document appurtenant hereto, including the exhibit to this Agreement. 22 5.2. Notices. Any notices, documents, correspondence or other communications 23 concerning this Agreement or the work hereunder may be provided by personal delivery, 24 deemed served or delivered: a) at the time of delivery if such communication is sent by personal 25 delivery; b) at the time of transmission if such communication is sent by facsimile; and c)48 6 I hours after deposit in the U.S. Mail as reflected by the official U.S. postmark if such 2 communication is sent through regular United States mail. 3 CONSULTANT: CITY: 4 Tess Foley, Linn Livingston, President of Client Services Human Resources Director 5 Lien On Me,Inc. City of San Bernardino P.O. Box 91630 300 North "D" Street 6 Pasadena, CA 91109 San Bernardino, CA 92418 7 Telephone: (626) 921-1120 Telephone: (909)384-5161 Fax: (626) 921-1132 Fax: (909) 384-5397 8 5.3. Attomevs'Fees: In the event that litigation is brought by any party in connection 9 with this Agreement, the prevailing party shall be entitled to recover from the opposing party all 10 costs and expenses, including reasonable attorneys' fees, incurred by the prevailing party in the ll exercise of any of its rights or remedies hereunder or the enforcement of any of the terms, 12 conditions, or provisions hereof. The costs, salary and expenses of the City Attorney and 13 ® members of his office in enforcing this contract on behalf of the CITY shall be considered as 14 "attorneys' fees" for the purposes of this Agreement. 15 5.4. Governing Law. This Agreement shall be governed by and construed under the 16 laws of the State of California without giving effect to that body of laws pertaining to conflict of 17 laws. In the event of any legal action to enforce or interpret this Agreement, the parties hereto 18 agree that the sole and exclusive venue shall be a court of competent jurisdiction located in San 19 Bernardino County, California. 20 5.5. Assignment: CONSULTANT shall not voluntarily or by operation of law 21 assign, transfer, sublet or encumber all or any part of CONSULTANT's interest in this 22 Agreement to an unrelated third party without CITY's prior written consent, which consent shall 23 not be unreasonably withheld or delayed. Any attempted assignment,transfer, subletting or 24 encumbrance shall be void and shall constitute a breach of this Agreement and cause for 25 termination of this Agreement. Regardless of Crl Y's consent,no subletting or assignment shall 7 1 release CONSULTANT of CONSULTANT's obligation to perform all other obligations to be 2 performed by CONSULTANT hereunder for the term of this Agreement. i 3 5.6. Indemnification and Hold Harmless. CONSULTANT shall protect, defend, 4 indemnify and hold harmless CITY and its elected and appointed officials, boards, 5 commissions, officers and employees from any and all claims, losses, demands, suits, 6 administrative actions, penalties, liabilities and expenses, including reasonable attorneys' fees, 7 damage to property or injuries to or death of any person or persons or damages of any nature 8 including, but not limited to, all civil claims or workers' compensation claims to the extent 9 directly arising from or in CONSULTANT's negligent or wrongful acts or omissions in 10 connection with the performance under this Agreement. 11 5.7. Independent Contractor. CONSULTANT, at all times while performing under 12 this Agreement, is and shall be acting as an independent contractor and not as an agent or 13 employee of CITY. CONSULTANT shall secure, at its expense, and be responsible for any and Q14 all payment of wages, benefits and taxes including, but not limited to, Income Tax, Social 15 Security, State Disability Insurance Compensation, Unemployment Compensation, and other 16 payroll deductions for CONSULTANT and its officers, agents, and employees, and all business 17 licenses, if any are required, in connection with the Services to be performed hereunder. Neither 18 CONSULTANT nor its officers, agents and employees shall be entitled to receive any benefits 19 which employees of CITY are entitled to receive and shall not be entitled to Workers' 20 Compensation insurance, unemployment compensation, medical insurance, life insurance, paid 21 vacations, paid holidays, pension, profit sharing or Social Security on account of 22 CONSULTANT and its officers', agents' and employees' work for the CITY. This Agreement 23 does not create the relationship of agent, servant, employee partnership or joint venture between 24 the CITY and CONSULTANT. 25 5.8. Conflict of Interest Disclosure: CONSULTANT or its employees may be subject 8 1 to the provisions of the California Political Reform Act of 1974 (the "Act"), which (1) requires 2 such persons to disclose financial interests that may be materially affected by the work 3 performed under this Agreement, and(2)prohibits such persons from making or participating in 4 making decisions that will have a foreseeable financial affect on such interest. 5 CONSULTANT shall conform to all requirements of the Act. Failure to do so 6 constitutes a material breach and is grounds for termination of the Agreement by CITY. 7 5.9. Responsibility for Errors. CONSULTANT shall be responsible for its work and s results under this Agreement. CONSULTANT, when requested, shall finnish clarification 9 and/or explanation as may be required by the CITY's representative, regarding any services to rendered under this Agreement at no additional cost to CITY. In the event that an error or 11 omission attributable to CONSULTANT occurs, then CONSULTANT shall, at no cost to 12 CITY, provide all other CONSULTANT professional services necessary to rectify and correct 13 the matter to the sole satisfaction of CITY and to participate in any meetings required with O14 regard to the correction. CONSULTANT will assume the in formation supplied by the CITY, (or 15 on its behalf by third parties) is accurate and complete. CONSULTANT's responsibilities (and 16 associated compensation) do not include independent verification of required information. 17 Problems with information quality and/or delays in providing such information may result in a 18 delay in the performance of the Services or an increase in fees. 19 5.10. Prohibited Employment. CONSULTANT shall not employ any current 20 employee of CITY to perform the work under this Agreement while this Agreement is in effect. 21 5.11. Costs. Each party shall bear its own costs and fees incurred in the preparation 22 and negotiation of this Agreement and in the performance of its obligations hereunder except as 23 expressly provided herein. 24 5.12. No Third Party Beneficiary Rights. This Agreement is entered into for the sole 25 benefit of CITY and CONSULTANT and no other parties are intended to be direct or incidental 9 1 beneficiaries of this Agreement and no third party shall have any right in, under or to this ® 2 Agreement. 3 5.13. Headings Paragraphs and subparagraph headings contained in this Agreement 4 are included solely for convenience and are not intended to modify, explain or to be a full or 5 accurate description of the content thereof and shall not in any way affect the meaning or 6 interpretation of this Agreement. 7 5.14. Amendments. Only a writing executed by all of the parties hereto or their 8 respective successors and assigns may amend this Agreement. 9 5.15. Waiver. The delay or failure of either party at any time to require performance 10 or compliance by the other of any of its obligations or agreements shall in no way be deemed a 11 waiver of those rights to require such performance or compliance. No waiver of any provision 12 of this Agreement shall be effective unless in writing and signed by a duly authorized 13 representative of the party against whom enforcement of a waiver is sought. The waiver of any O14 right or remedy with respect to any occurrence or event shall not be deemed a waiver of any 15 right or remedy with respect to any other occurrence or event, nor shall any waiver constitute a 16 continuing waiver. 17 5.16. Severability. If any provision of this Agreement is determined by a court of 18 competent jurisdiction to be invalid or unenforceable for any reason, such determination shall 19 not affect the validity or enforceability of the remaining terms and provisions hereof or of the 20 offending provision in any other circumstance, and the remaining provisions of this Agreement 21 shall remain in full force and effect. 22 5.17. Counterparts: This Agreement may be executed in one or more counterparts, 23 each of which shall be deemed an original. All counterparts shall be construed together and 24 shall constitute one agreement. 25 5.18. Corporate Authority. The persons executing this Agreement on behalf of the 10 1 parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said 2 parties and that by doing so, the parties hereto are formally bound to the provisions of this 3 Agreement. 4 6 7 8 9 10 IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the day 11 and date first above shown. 12 ATTEST: CITY OF SAN BERNARDINO 13 Municipal Corporation and Charter City Q 14 15 Rachel Clark, City Clerk Charles McNeely, City Manager 16 CONSULTANT: 17 By: 18 Approved as to form: 19 JAMES F. PENMAN 20 City Attorney 21 By?mdall�:LOM:Agreemmt.LOM.2010 22 23 HR/ 24 25 11 III. PROPOSAL SPECIFICATIONS EXMBIT 1 SERVICES TO BE PROVIDED Following is a description of the required services for the Workers' Compensation Bill Review Services. The following minimum services will be required of the vendor awarded the bill review agreement: SERVICES TO BE PROVIDED • Provide state of the art bill review services for the City of San Bernardino; • Review all bills in a timely matter for compliance with applicable fee schedules and reduce accordingly, including those that fall outside of a fee schedule or PPO network; • Identify and reduce all duplicate billings; • Deny charges for all items not required for injury described; • Identify all unauthorized charges to insure billing does not exceed parameters of injured workers' treatment plan; • Provide an Explanation of Review ( EOR) for each bill reviewed • Maintain contracts with effective PPO organizations ( including pharmacies),that include providers in the City of San Bernardino area; • Provide reports on a weekly, monthly and annual basis outlining bill review activity savings and cost. Provide ad hoc reports as necessary; • Handle all provider inquires regarding bill reductions; • Provide Hospital Bill Audits and Reports. © Lien On Me, Inc. is currently providing bill review services for City of San Bernardino. At this time we are providing all that is required in this RFP F-10-20 for Workers' Compensation Bill Review. Lien On Me, Inc. in this proposal will agree to continue to perform bill review services under the Scope of Work, Proposal Specification RFP F-10-20 Workers' Compensation requirements. PROPOSAL CONTENT An overview of your companies' experience in providing bill review services for Cities and other municipal clients; Lien On Me, Inc. prides itself with providing bill review services to many of the cities here it Southern California. We currently provide bill review services to City of San Bernardino, City of Long Beach, City of Glendale, City of Burbank, City of Santa Ana, City of Newport Beach, City of Costa Mesa, City of Monterey Park, City of Ventura, and City of Simi Valley. We also provide bill review services for school districts, public transportation an private clients. We thoroughly understand the needs of our cities and how important it is to contain the public's costs. Whenever we have a dispute with a provider, or are in a middle of negotiations, we remind them that this is the City's money and we need to keep in mind what's the best interest of the public. That provider in most cases can be a resident of that City and understands and appreciates our cost containment methods. As a California based organization, we are qualified to deal with the ever changing dynamics of the California marketplace and in particular any issues that may impact the City of San Bernardino. Lien On Me, Inc. provides and will continue to provide a broad spectrum of medical bill review services to the City of San Bernardino. Our services are as follows: • Fee schedule review and reductions • Usual and customary review, reduction and negotiation • PPO/MPN re-pricing • Guaranteed turn-around time • Provider inquiry response and resolution • Fee reduction defense services • Integration with utilization review services • Integration with Pharmacy Benefit Management services • Integration with existing customized ancillary programs • Hospital Inpatient review, reduction and negotiation as applicable • Outpatient surgical review, reduction and negotiation as applicable • EDI interface • Courier Service • Examiner Toolbox (web-based portal) • Minimum of 3 professional references; Ms. Carolyn Richard Client since 1998 for Bill Review Workers' Compensation Administrator City of Santa Ana Q 20 Civic Center Plaza, 4'h Floor Santa Ana, CA 92702 (714) 647-6912 Mr. Michael Alio Client since 2009 for Bill Review Risk Manager and Lien Defense City of Long Beach 333 W. Ocean Blvd., 10th Floor Long Beach, CA 90802 (562) 570-6754 Mr. Thomas M. Malooly Client since 2005 for Bill Review Risk Manager and Lien Defense 613 East Broadway, Room 100 Glendale, CA 91206 (818) 548-2151 Mr. Jonathan Chang Client since 2005 for Bill Review WC Administrator and Lien Defense City of Burbank 301 East Olive Avenue, Suite 320 Burbank, CA 91510 (818) 238-5012 Mr. At Gorski Client since 2005 for Bill Review Risk Manager and Lien Defense Orange County Transportation Authority Orange, CA 92863 (714) 560-5817 • Bill review and cost savings PPO philosophy; Lien On Me, Inc. takes pride in all the services we provide. We started a Bill Review department in 1994 when we recognized some of the same abuse in bill review as we saw on the lien side. Our philosophy became "if we appropriately review a bill and the provider is paid correctly, the result will be less disputes" A welcome return in an already adversarial system. We implemented workflows to assure bills are reviewed timely, we follow the correct Sate mandated fee schedules, utilize current Preferred Provider Organizations (PPOs) and negotiate aggressively. Our efforts also reduced the calls to the claims departments as well as the number of liens filed. Lien On Me, Inc. continuously monitors your savings derived from both bill review and provided by our PPO partners. This ensures our clients receive the best possible outcomes. We thoroughly understand the needs of our clients and the importance of containing their medical costs. When we have to address provider disputes or negotiate, we do so with our clients' best interests. Your dollar is our dollar. Over the years Lien On Me, Inc. has accumulated and set up a proprietary data system that also helped in our efforts to aggressively negotiate bills. We have established relationships with leading PPO Networks across the U.S. and offer our clients access to a variety of PPO networks based on geographic coverage and patient requirements. Lien On Me, Inc.'s automated system identifies all PPO discounts as the provider's bill is processed. This helps to gain additional savings by enforcing the terms of the applicable contracts, usually with discounts below fee schedule. Proper application of PPO contracts combined with the superior performance of the Lien On Me, Inc. review consistently results in the highest savings to our clients. A thorough analysis of your bill history will allow us to recommend network partners than can produce surprising results. Lien On Me, Inc. builds this step ® into our service implementation plan to insure success with your bill review process. • Medical bill review software utilized and the software provider; Lien On Me, Inc. owns its own Bill Review Service company. We do currently lease our backend review engine software that is a fully automated nationwide web based. The system provides cutting edge technology that allows us to generate accurate reviews with maximum savings. The system fully integrates with claim management and managed care systems. Integration allows users to access bill review history and make notes or comments if appropriate. Our software also includes the National Drug Code (NDC) database through Medi-Span, which identifies the wholesale cost of drugs. This standard of reduction has been found reasonable at the WCAB and is universally accepted by pharmacy providers. Our medical bill review software is updated weekly with fee schedule changes. Our clients are not charged for system upgrades or enhancements required by changes in the California fee schedule. Data can be sorted in nearly any desired format. The ability to sort data quickly allows us to generate reports for client management needs. The system also allows us to exchange production claim, vendor, and payment information via EDI with the California Workers' Compensation Information System (WCIS). Lien On Me, Inc. has also developed its own proprietary bill review management reporting system, whIchwecaII "DDAS". The DDAS system incorporates the customer's data from the bill review engine. It offers our customers web-based access to their Explanations of Reviews (EORs), as well as allowing them to drill down on any key billing factors from Social Security Numbers, ICD9 Codes, CPT codes, specific medial providers, claims, etc. While initially viewed as a web page, the data may be converted to an Excel worksheet and exported to the customer's workstation for detailed analysis as needed. The DDAS system allows our customers to be able to directly access key economic data to analyze the details of a claim, a medical practice, or emerging economic and/or medical trends. Medical cost containment and medical bill review)sn't just about the newest p technology. The key factor to a manager is how well that technology translates data into knowledge so that it can be used to enhance your decision-making abilities. That's where Lien On Me, Inc. differs from all others, when we use our leased and proprietary software in conjunction with a management team that is dedicated to helping our customer maximize all their management resources. Sample of DDAS On-Line Screen Shot is available upon request Bill review work flow from receipt of bill through Explanation of Review (EOR) and recommended payment; • Bills received in mailroom, date stamped and forward to MBR Manager • MBR Manager examines each bill and distributes accordingly. • Bills are re-priced and audited to Fee Schedule. • Bills without Fee Schedule reductions are to be forwarded to Sr. MBR Auditor for negotiation. • First Quality Assurance conducted on each bill audited/re-priced on-line. • External PPO applied to each bill and Quality Assurance Conducted for any missed PPO reduction. • EORs are printed and matched with hardcopy bills. • Second Quality Assurance conducted. • Bills with allowance of$10,000.00 or more and//or 30% savings to MBR Manager for Third Quality Assurance. Q • Post EORs to permanent history. o Forward Payment File via EDI to client/administrator or issuance of payment to Providers. • Send hardcopy Bills and EORs via post office to Client. Bill Review Workflow is available upon request • Experience and training of bill review staff; Bill Review Professionals: Continuous recruiting, hiring and training of experienced medical bill review professionals are conducted by our Human Resource professionals. Bill review professionals are recruited for positions based on State of California Code of Regulations for bill review certification. We have held to these types of standards long before these regulations were promulgated. These regulations ensure bill review companies are no longer able to utilize clerical staff to perform the tasks of medical bill audits as has been common practice in the past. Our practice of utilizing experienced and technical reviewers has allowed us to exceed the standards set forth by the California Code of Regulations. We believe on-going training and education is vital to our success and, therefore, the following experience has always been required of potential new hires: p^ Lien On Me, Inc. Managers: Associates degree, national certification or equivalent in business required. Minimum five (5) years experience in medical bill review. Have thorough knowledge and understanding of state fee schedules and labor codes. Demonstrate excellent customer service and communication skills. Have demonstrated past experience in management or supervision. Possesses good computer and analytical skills. Lien On Me, Inc. Hearing Representatives: Associates degree preferred. Minimum five (5) years experience in workers' compensation. Claims and/or Hearing experience at the WCAB. Excellent customer service and communication skills. Knowledge of the OMFS, American Medical Association Q and American Academy of Orthopedic Surgeons guidelines for professional fees, and the National Correct Coding Initiative edits from Medicare for outpatient surgical fees. Lien On Me, Inc. Expert Witness: Coding certification or business equivalent required. Minimum five (5) years experience in workers' compensation. Thorough knowledge of the OMFS. Comprehension of the American Medical Association and the American Academy of Orthopedic Surgeons guidelines for professional bills, and the National Correct Coding Initiative edits from Medicare for outpatient surgical fees. Lien On Me, Inc. Auditors: High School diploma required. Designation as required by California Code of Regulations, Coding certification or business equivalent required. Five (5) years experience in medical bill review. Have consistently met 99.5% accuracy as a LOM Reviewer. Thoroughly understand state fee schedules. Lien On Me, Inc. Reviewers: High School diploma required. Coding certification, designation or business equivalent required. Excellent data entry skills. Three years (3) experience in bill review. Thoroughly understand state fee schedules. Our professionals are required to complete continuing education classes that are conducted live, online and internally, to maintain and upgrade their skills related to coding, new legislation and fee schedule changes. Our medical bill reviewers are certified biennially with the Insurance Commissioner of the State of California pursuant to California Insurance Code Section 11761 and California Code of Regulations, Title 10, Section 2592.04 and 259.07. Copy of Certification of Medical Bill Reviewers and Resumes of current bill reviewers on the City of San Bernardino account are available upon request. • Average and corporate standard turn around time for bills; Lien On Me, Inc. turnaround time is (5) business days from receipt of the medical bill. Rush reviews can also be done on the same day before 3:00 p.m. referred via facsimile, at no additional charge. We are currently averaging 2 business day turnaround. We take great pride in consistently delivering service as promised. The average turnaround time of our bills has consistently been under 5 business day(s). In 2009 our averages were: • 1St quarter, average turnaround time—3.0 days • 2 n quarter, average turnaround time — 2.9 days • 3rd quarter, average turnaround time — 2.1 days • 4th quarter, average turnaround time— 2.2 days • Fee options and how fees are calculated; $6.00 per bill: Each bill we review that isn't a hospital, negotiations, usual and customary or pharmacy bill will cost the City $6.00 per bill. ® $4.00 per bill for full pays and pharmacy bills: Every bill that comes in our bill review department that states full pay which is the amount that the provider is asking for in full then it would cost the City $4.00 per bill. For every pharmacy bill we will charge the City $4.00 per bill. 5% of savings for inpatientloutpatient hospital bills means we charge the City 5% of the bill review savings. Savings is the difference between the provider charge and the recommended allowance. 23%for PPO Savings (except Blue Cross which is 26% of savings) means that we charge 23% of savings that the PPO discount allows. For example if the bill charge was $1,000 and fee schedule reduced it to $500 and the PPO network discount reduced it an additional $100 than we charge the City 23% of the additional $100 savings. For the blue Cross PPO it would be 26% of savings of the additional $100 savings. 20%for PPA (Negotiations and Usual & Customary) means any bill that falls out of the OMFS (CA Fee Schedule) can be subject to Usual & Customary review or negotiations. When this occurs we than charge 20% of the savings we capture which is the difference between the provider charge and the recommended allowance. $0.40 per bill for WCIS State Reporting means we charge every bill that we report to the State of California $0.40 in addition to the review charge above. For example if it was a regular provider bill then we would charge $6 for the review and an additional $0.40 for the QState reporting which would total $6.40 per bill. • Average level of savings for bill review; Lien On Me, Inc. gross savings for all our clients was 60% in 2009. Lien On Me, Inc. always strives to do better. • In the absence of a fee schedule, how are rate reductions negotiated; If a bill doesn't fall under the OMFS and no PPO discounts are available, Lien On Me, Inc. is able to provide the City of San Bernardino an aggressive negotiation. When a provider's charges are not bound by fee schedule, Lien On Me, Inc. follows the guidelines established in the en banc decisions of Kunz and Tapia. We first utilize a proprietary database to determine U&C for the provider's charges. The amount is then compared to other providers within the same geographic area, PPO providers, Medicare, etc. An average is determined and Lien On Me, Inc. finalizes the U&C review. We have found that the courts follow this well proven approach. Lien On Me, Inc. can also negotiate any bills that fall outside OMFS or any Network savings. This process will involve a direct negotiation with the provider to gain their agreement on a reduced payment. The above U&C review will first be completed. Once the U&C review is done then the Lien On Me, Inc. bill review expert proceeds with negotiating with the provider. Our senior level bill review analysts complete a thorough and technical review which has helped Lien On Me, Inc. get the best possible savings for all our clients. All such successful negotiations will include a sign agreement with the provider stating the terms of the payment and that is results in a full and final payment. • Computer systems and the ability to interface with City of San Bernardino and utilization review vendor computer systems. Also, the ability to generate reports documenting bill review activity, cost savings for the City; Lien On Me, Inc. is currently the bill review vendor for the City of San Bernardino. We are already interfaced with the City and receiving utilization review vendor's information. We can integrate with your current utilization review vendor's computer system if the City is interested. Lien On Me, Inc. is also generating reports documenting bill review activity and cost savings for the City on a monthly basis. The current reports we are providing are: INVOICE MANAGEMENT REPORT: The Invoice Management Report is a monthly, quarterly or annual report that contains a summary of the number of bills reviewed by type (Inpatient/ Outpatient, Pharmacy Med-legal). The report includes additional payment, full pay and negotiation recommendations. The summary also breaks down billed charges (fee schedule/usual & customary savings, duplicates, PPO savings and recommended allowances). All fees related to fee schedule, usual and customary, negotiations and PPO/MPN reductions are included. Total fees as they relate to gross and net savings are outlined. SAVINGS SUMMARY REPORT: The Savings Summary Report describes the number of lines reviewed per bill and includes PPO/MPN penetration and savings. The total charges reviewed and savings generated from all reviews is summarized. ASAVING SUMMARY BY PROVIDER: The Saving Summary by Provider is typically generated monthly on specific providers. It provides demographic information on the claimant as well as specific information related to each charge. Typical information found in this report is the injured worker name, dates of service, date reviewed, claim number, provider name, billed charges, reductions and allowances. BILL REVIEW MANAGEMENT REPORT: The Bill Review Management Report provides a summary of the total number of bills reviewed, provider charges, gross savings, provider recommended allowances and the percentage of gross savings as it relates to fees. SUMMARY: In addition to those reports provided routinely on a monthly basis, Lien On Me, Inc. can provide management reports at any time for any interval requested. This can be done either on a "by request" basis or on any predetermined schedule to meet your requirements. If requested, we also provide our clients our on-line "DDAS" system that allows you to view your data on-line and export it into Microsoft Excel worksheets for individualized analysis. - Our system is capable of creating ad hoc reports by date range as well as numerous other selection criteria. Many of our clients have specific requirements, which we have formatted into spreadsheets for customized reporting. We can work with the City to provide an ad hoc report as needed. Sample Management Reports and Ad Hoc Reports are available upon request. • PPO networks offered and the average below fee schedule reductions; Lien On Me, Inc. maintains relationships with PPOs through a combination of lease access and direct contracts. The number of PPOs available to our clients is increased on a continual basis, and we consistently evaluate which ones are the best for each individual client. We recognize our clients need for specialized networks to achieve their individual cost containment goals. A variety of PPOs have been integrated into the system. Many are small regional and serve a special purpose for the particular client accessing the network. Our ability to customized and integrate various PPOs upon request is a significant advantage to our clients. First Health/Focus NCC Blue Cross PPO Next Healthsmart(Inter Ian Claris Pointe Prime Health TN Healthcare Tree Rivers AZ Foundation Integrated Health Plan Corvel Provider directories are available upon request. Lien On Me, Inc. currently averages an additional 4.8% savings from our PPO networks after fee schedule is applied. ® PPO fee options and how fees are calculated; 23% for PPO Savings (except Blue Cross which is 26% of savings): The fees are calculated 23% of savings that the PPO discount allows. For example if the bill charge was $1,000 and fee schedule reduced it to $500 and the PPO network discount reduced it an additional $100 then we charge the City of San Bernardino 23% of the additional $100 savings. For the Blue Cross PPO it would be 26% of savings. • Pharmacy PPO services and average savings; Lien On Me, Inc. is getting an average of 15% of savings from the Pharmacy PPOs we apply. Lien On Me, Inc. does recommend the City of San Bernardino a pharmacy benefit program to increase your pharmacy savings. Lien On Me, Inc. uses Express Scripts for the pharmacy benefit program. Express Scripts corporate philosophy is rooted in the belief that managing their partners' medical costs is of the critical importance. Express Scripts accomplishes this by taking an active role in both identifying and resolving drug therapy issues and helping their clients reduce overall healthcare costs by improving the quality of patient care, enhancing therapeutic outcomes, and reducing inappropriate pharmaceutical expenditures. This philosophy combined with more than 20 years experience has helped Express Scripts become a leading national provider of workers' compensation services to nearly three quarters of a million patients annually. Express Scripts Pharmacy Benefit Management program is unparalleled in the industry today. Express Scripts ensures negotiated discounts and special pricing is passed on to customers regardless of the proximity of the network provider. Express Scripts is committed to providing the highest quality products and service. Detailed below are key features that distinguish Express Scripts from the competition: P P Express Scripts's Proprietary Auto Authorization Process: Express Scripts's proprietary auto authorization process replaces the traditional, manual process of adjudicating pharmacy claims that require prior authorization. A key advantage of Express Scripts's proprietary auto-authorization process is that the pharmacy does not need to contact Express Scripts for authorization, Express Scripts will automatically send the pharmacy an electronic message instructing them that Express Scripts is in the process of determining if the medication is authorized. The goal is to assist in managing the authorization process without losing control of the fill at the pharmacy level to a third party biller. In-house Clinical Pharmacist Expertise: Express Scripts's program was developed by their in-house Department of Clinical Services team, staffed by PharmDs and licensed Pharmacists. Years of experience allow their team to effectively manage their pharmacy program and provide the following components found in no other PBM in our industry: Injury Specific Formulary: Using NCCI or ICD-9 codes, Express Scripts is able to offer a customized formulary specific to individual injury classifications, matching the medications to the actual injury. • PDRx—An individualized, retrospective Pharmacist Drug Review(PDRx) delivers a formal written report, focusing on specific drug therapy problems to be resolved and desired outcomes to be achieved. • Consult Rx— Express Scripts in-house pharmacy Help Desk! Staffed by their © licensed clinical pharmacist, Express Scripts provides you easy access for consultation for your claims staff and claimants. Focused Penetration Efforts: Express Scripts believes that a program that is able to increase network pharmacy utilization is more valuable than a program that simply reduces pharmacy reimbursement for medications. For this reason, Express Scripts has implemented several proactive processes to ensure your penetration into the network is maximized: • Express Scripts provides fully customized identification material to aid in the proper channeling of claims at the point of sale. • By leveraging IVR technology, Express Scripts assists in claimant communication in order to better relay program benefits. Express Scripts allows claimants have the ability to identify their network pharmacy of choice. Express Scripts then proactively communicates directly with the pharmacy to provide billing information, ensuring the billing of prescriptions through the Express Scripts network. • Express Scripts's open communication with network partners assist in the channeling of out-of-network bills to assist in full penetration efforts. Web Based Reporting: Express Scripts's comprehensive on-line reporting and productivity tool allows claim managers, supervisors and adjusters immediate access to customized reporting formats that track financial savings, utilization management, clinical management, patient activity, as well as monitor authorizations and view claimant history. Express Scripts has the capability to report on trends, company wide, as well as for a specific patient. Client management and adjusters can utilize this data to make educated and appropriate decisions for their claimants. Third Party Billing 1 Doctor Dispensing: Express Scripts has developed the most comprehensive and effective process for handling out of network bills in the industry. This process minimizes paper, maximizes clinical cost savings and elevates network penetration. This is accomplished through a distinct but synergistic product offering of Third Party Biller Connectivity. In addition, Express Scripts is establishing a program to capture prescriptions dispensed by physicians. One Stop Shop and Dedicated Service: A single phone call to our 800 number streamlines the order process for the adjuster/nurse case manager and provides our client with vendor management and guaranteed savings. Referrals can also be processed on the web at www.express-scripts.com Express Scripts contacts the claimant and provider to verify claimant demographics and appointment at least 24- hours prior to all service. Our proactive approach increases accuracy and promptness reducing discrepancies. Express Scripts provides status reports, fax or email confirmation for all service orders. Express Scripts's hours of operation are Monday thru Friday, 8:00 a.m. to 10:00 p.m. EST, after hours and weekend emergencies are accommodated by several on-call Express Scripts associates, including a clinical pharmacist. Our on-call associates are specially trained to handle emergency situations. Additionally, Express Scripts will assign a local and home office representative to their clients. Provider Relations Department: Express Scripts provides complete network management ensuring contracted discounts, provider credentialing, licensure, proper limits of liability and coverage for all vendor partners. Express Scripts uses a proprietary program, PointRight, to grade and evaluate all vendors on an ongoing basis. Express Scripts's proven Cost Containment programs produce client savings of 20- 25% over state fee schedule. As the provider to the largest Worker's Compensation carrier in the United States, Express Scripts has successfully delivered real dollar savings, while maximizing penetration and controlling utilization. Express Scripts truly provides a better choice! © Any distinguishing or unique qualifications that your company possesses or any other information that documents your ability to provide quality bill review services; What distinguishes Lien On Me, Inc. from all other bill review companies are our Lien Defense program, the claims background of our management staff, and our exemplary customer service. The Lien Defense program was the purpose for the creation of Lien On Me, Inc. Ms. Harlin and Mr. Lents (Director of Lien Defense) came from the workers' compensation claims arena giving them an intimate knowledge of what clients' needs were regarding lien negotiation and litigation. By being able to coordinate Lien On Me, Inc. Medical Bill Review with Lien Defense, the bill review expert witnesses are well prepared for any hearings that may arise. Not only are they prepared for bill review issues but are also instructed in legal arguments. The Director of Lien Defense will also assist defense counsel with coding questions and strategies to better prepare for lien litigation. Our President, Tess Foley, has a long history of Workers' Compensation claims handling and management. She understands and anticipates our clients' needs. Her versatile skills, along with those of our multifaceted management staff, bring a much valued service to all of our clients. Thus, we are able to provide a product that is helpful in integrating your entire Workers' Compensation program. Our exemplary customer service separates our Medical Bill Review from all competitors. The executive management team recognizes satisfied customers are essential to business success and the most important relationship we have is with our customers. Because we are large enough to service national clients yet small enough to customize our programs, we can tailor ourselves to the specific needs of each individual client. • It is our commitment to deliver quality cost containment services achieving maximum savings at a competitive cost to our customer. • It is our commitment to meet and exceed your service expectations. We recognize that our contribution to the claims process is critical to your on-going success in this ® dynamic and changing marketplace. • It is our commitment to be responsive when issues occur and reliable when it comes to the rapid resolution of service issues. • It is our commitment to create a program for the City of San Bernardino that is effective, efficient and easy. Lien On Me, Inc. also has the capability of imaging/scanning documents in a format if the City of San Bernardino requests. We have been on a paperless program since 2004 and are very familiar with the requirements of the Electronic Data Interface process. Lien On Me, Inc. has many different types of imaging processes and can work with the City for the most efficient workflow. The workflow that most of our existing clients use is included for your review. • An Overview of your company's experience in providing bill review services for cities and other clients Lien On Me, Inc. has addressed this questions in the t t bullet point of the proposal answer • Minimum of three professional references Lien On Me, Inc. has addressed this questions in the 2ntl bullet point of the proposal answer ® • Experience and training of bill review staff, including how continued education requirements are met Lien On Me, Inc. had addressed this question in the 6"'bullet point of the proposal answer • WCIS Reporting Procedures and Fees. After completion of medical bill reviews and audits of all clients' provider bills, Lien On Me, Inc. will generate a Medical Bill Review (MBR) Data File and forward to client via Electronic Data Interface (EDI) for issuance of payments to providers per our Explanation of Review(EOR) allowance. Client will then generate a Payment Data/Information File and will send it via EDI to Lien On Me, Inc. to import into our MBR software/system. A workers' Compensation Information System (WCIS) Data File is then generated and is exported into the WCIS Database. Lien On Me, Inc.'s fee for filling MBR Data File for State Reporting to the WCIS is 0.40 cents per bill.