AMBULANCE BILLING SERVICES CONTRACT
A PROFESSIONAL
SERVICES
CONTRACT
This contract is made and entered into on the ;:i-t11'day of lh~
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2003, by and between The Fenton Fire Protection District, a political subdivision of the state of Missouri (hereinafter known as "FENTON"), and Professional Claims Processing, Inc., a Missouri Corporation, (hereinafter known as "PCP").PREMISES: The FENTON Fire Protection District is located at 845 Gregory Lane, Fenton, Missouri 63026, and has faithfully served its district, providing Emergency Medical Services in the full tradition of the fire service, and wishes to continue its tradition of serving its district in an efficient and cost effective manner.
FENTON warrants and represents that it is a provider of ambulance services which is licensed by the Bureau of Emergency Medical Services of the State of Missouri.
FENTON can enhance its ability to responsibly serve its constituents by receiving revenue generated by the billing services provided on its behalf by PCP.
FENTON desires to enter into an exclusive professional services contract for billing services with PCP.
PCP warrants and represents that it posses the experience and expertise to provide billing services consistent with the requirements of this contract in conformity with the guidelines established by Federal and State law.
FENTON warrants and represents that its ambulances only respond to calls for ambulance service that are received through the 9-1-1 Emergency System, and, that all transports are the result of requests for emergency ambulance service, and, that all ambulance transportation is provided in ALS ambulances meeting the vehicle and crew requirements listed in 42 C.F.R. 410.41, and as required by State law and FENTON Ordinance.
PCP warrants and represents that it is qualified to provide billing services and desires to provide such services to FENTON in accordance with the terms and conditions set forth in the Fenton Fire Protection District Request For Proposal (RFP) For Ambulance Billing Service.
WITNESS THERETO:
NOW, THEREFORE, for and in consideration of the terms, conditions, and payments hereinafter provided, the parties hereto agree as follows:
I. PCP will provide to FENTON, Billing Services in accordance with the terms and conditions set forth in the Fenton Fire Protection District Request For Proposal (RFP) For Ambulance Billing Service, a copy of which is attached hereto as Exhibit 1 and incorporated herein by reference. In the event of a conflict in tenns or conditions, the provisions of the RFP shall supercede any provision set forth in this agreement. Included as a part of this service will be appropriately formatted, filed, mailed and
delivered, bills, invoices or statements to third party payers, patients, and/or other responsible parties, for all ambulance transport services rendered by FENTON. PCP will also provide all correspondence, telephone calls, or other notices commonly used in billing for ambulance services. Expressly excluded are services requiring the filing of, and/or service of, legal documents initiating and/or pursuing legal action for collection of accounts owed and due FENTON for services rendered.
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•,2. All proceeds generated by such Billing Services will be directly remitted to FENTON via a third party operated lock box. PCP will not have access to, or control of, the funds received by FENTON, nor will it negotiate any check that is generated as payment for transport under this contract.
3. FENTON will instruct its bank, or any third party which it authorizes to receive revenue generated by PCP, to promptly forward to PCP all support documentation from all payments received.
4. PCP will adhere to all collection policies and practices as established by FENTON'S Board of Directors, its administrators, and requirements of Federal and state law. PCP will refrain from using threats or intimidation as a collection technique. PCP will direct additional collection efforts to patients or individual responsible parties, including but not limited to follow up billing, letters and phone contacts. All bill collections over and above those required by law, will be at the specific
direction of FENTON. ·
5. On FENTON'S behalf, PCP will file all claims as "assignment accepted" with Medicare, Medicaid, and/or other third party insurance.
6. PCP will comply with all relevant Medicare and Medicaid regulations and guidelines regarding its collection efforts in respect to patients covered by Medicare and Medicaid.
7. Except where prohibited by a government payer, PCP will prepare and mail an initial bill or invoice for each ambulance transport that is referred by FENTON to PCP for billing under terms of this Contract. Such bills or invoices will be issued to any insurer, private third party payer, and/or to the patient.
CHARGES FOR SERVICES RENDERED - INVOICES AND PAYMENT 8. For Billing Services rendered under this contract, PCP will be compensated by FENTON in
accordance with Subdivision B of §3060. l 0 of the Medicare Carriers Manual, FENTON will pay PCP an Eight Percent (8%) fee of the funds collected by PCP on FENTON' S behalf under the terms of this contract. invoices and Payment for Billing Services will be as follows:
8.1. PCP will submit a statement to FENTON for Billing Services at the end of each month. These statements will detail revenue generated by PCP on behalf of FENTON.
8.2. FENTON will remit to PCP the full amount due within thirty (30) days of the statement date. If FENTON should dispute any portion of the amount due PCP, FENTON will remit to PCP all undisputed amounts within thirty (30) days of the statement date.
8.3. Disputed amounts referenced in 8.2 above will be resolved between FENTON and PCP within forty-five (45) days of the statement date and outstanding amounts will be remitted by FENTON to PCP on the next month's statement.
MISCELLANEOUS TERMS AND CONDITIONS
9. PCP will assist FENTON in providing on-site seminars and training to FENTON personnel with regards to the implementation of this contract and in the proper data collection and documentation of
all run sheets and reports used for billing, including appropriate completion of ARFs and the sixteen (16) critical billing elements identified on in Exhibit 2.
l 0. FENTON will designate an employee as Billing Liaison Officer, said officer will work with PCP to ensure that billing information requirements are properly communicated to all FENTON personnel.
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11. PCP represents and warrants that it will, throughout the duration of this contract: maintain its expertise in the provision of billing services on behalf of FENTON; perform all diagnosis and procedure coding as may be required for such medical claims and to make necessary inquires of various health care providers as may be required for such coding; cross reference patient files by various methods, i.e., last name, social security number, address (either pickup or residence) and date of service; prepare and deliver monthly and annual reports for the use by FENTON detailing quantity of runs and types of runs; prepare and deliver monthly and annual reports for use by FENTON detailing collection activities to include aging of accounts, accounts receivable summary, deposit recap, open account history, summary of transactions, acknowledgement of charges, closed accounts summary, aged accounts receivable by financial class and sources of revenue; any other reports requested by FENTON will be furnished; provide reports that demonstrate clear audit trails, detailed payment, adjustment and account balance experience by account and in accordance with generally accepted accounting
standards and practices; handle third party payer submission and inquires regarding insurance claims;
show claim submission dates, follow-up payments of account, source of payment and full itemization of charges; provide toll free long-distance calls associated with claim submissions and billing for FENTON; provide toll-free number and address on all correspondence to patients and insurance carriers; prepare and mail all invoices for ambulance services rendered within three (3) working days ofreceipt of billing information from FENTON; invoices will be aged and generate special messages approved by FENTON; post payments within 72 hours of receipt, noting source of payment to beco~e
part of the permanent file; all receivable will be sent to FENTON; work directly with representatives
of FENTON to make available any additional reports, reasonably requested for accounting or
management purposes; and provide all statements, claims forms and paper associated with billing for FENTON.
12. PCP represents and warrants that it is a member of a nationally based Medicare Consulting Group which is headed by PCP'S Medicare Consultant. PCP offers to FENTON the expert legal services of
its Medicare Consultant on issues that pertain to interpretation and compliance with Medicare law.
13. PCP represents and covenants that at all times during the term of this contract: (i) PCP and its
employees and agents will comply and perform all services in accordance with all applicable federal, state and local laws, regulations and ordinances and prevailing professional standards or protocols at the time such services are rendered; (ii) all approvals, licenses and certificates required for PCP and its employees and agents by applicable federal, state and local laws and regulations will have been procured and will be mair:itained.
14. FENTON represents and covenants that at all times during the term of this contract: (i) FENTON and its employees and agents will comply and perform all services in accordance with all applicable
federal, state and local Jaws, regulations and ordinances and prevailing professional standards or protocols at the time such services are rendered; (ii) all approvals, licenses and certificates required for FENTON and its employees and agents by applicable federal, state and local laws and regulations will have been procured and will be maintained.
15. PCP agrees to indemnify, defend and hold harmless FENTON, its Board of Directors, Chief Officers and every employee from any liability or financial Joss including, without limitation, attorneys fees and costs, arising in any manner whatsoever from any intentional, reckless, negligent, or otherwise wrongful acts, errors or omissions of PCP or any person employed by bidder, including agents and independent contractors, in the performance of the ambulance billing service for FENTON. However, PCP will not be held responsible for any incorrect billing based on erroneous or incomplete
information provided by FENTON.
16. PCP shall fully comply with HIPAA and agrees to execute a Business Associate Agreement provided by FENTON.
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17. In the event FENTON receives any payment(s) that was made in error by an insurance, or private payer, and a refund of that payment is legally required, FENTON is responsible for such refund(s) in
full. PCP is then responsible to refund to FENTON any payment made by FENTON to PCP for billing services.
18. FENTON'S role as the primary 9-1-1 provider of emergency medical services within FENTON'S
district or when rendering mutual aid will not be affected by this Contract.
19. The initial term of this contract is from
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, 2003 and ends December 31, 2003.19.1. Thereafter this contract will automatically renew on an annual basis, unless canceled by
either party hereto, by written notice to the other, at least sixty (60) days prior to the end of the term. Otherwise, each such renewal tenn will be consistent with the calendar year.
19.2. Either party reserves the right to terminate this contract at any time, for cause, with a sixty
(60) day notice. Such termination will be by written notice.
20. For purposes of this Contract, FENTON and PCP are independent contractors, and this contract will not constitute the formation of a partnership, joint venture, employment, or master-servant
relationship. The parties further agree that PCP and/or FENTON, and any employees of PCP and/or FENTON will not be entitled to any benefits of an employee of the other.
21. FENTON and PCP agree that they will have knowledge of various business practices, strategies and methods of the other party, to which they would not otherwise be aware except by this contract. Such knowledge will be held in strict confidence, and the parties agree not to disclose to anyone, except duly authorized administrative personnel of either party, any such knowledge.
22. FENTON and PCP agree not to issue unfavorable remarks, spoken or written, about the practices,
personnel, or methods of the other to anyone other than to duly authorized administrative personnel of either party, and to further uphold the good name and reputation of the other. The parties agree to
work together in a professional and mutually supportive manner in all practices.
23. The parties hereto will neither assign nor transfer their respective rights or obligations under this
contract except with the express prior written authorization of the other party.
24. This Contract will be governed and interpreted in accordance with the laws of the State of Missouri. 25. This Contract may be amended only by a subsequent written agreement between duly authorized
representatives of FENTON and PCP.
26. The failure of FENTON or PCP to object to or take affirmative action with respect to any conduct of
the other that is in violation of the provisions herein will not be considered as a waiver of that violation
or any prior or future violations of the provisions of this Contract.
27. This contract will be binding on the parties and their heirs, successors and permitted assigns.
28. Any notice or other communication required or contemplated under the provisions of the contract will be in writing and delivered in person, evidenced by a signed receipt, or mailed by certified mail, return receipt requested, postage prepaid, to the persons and addresses set forth below the parties' signature or to such other persons or addresses as FENTON or PCP may provide by notice to the other. The date of the notice will be the date of mailing if the notice is mailed by certified mail. Respective
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Fenton Fire Protection District 845 Gregory Lane
Fenton, Missouri 63026
Professional Claims Processing, Inc. 911 Holly Hills Drive
P.O. Box 2888
St. Louis, Missouri 63111-0088
29. The signers of this contract warrant and represent that they are acting officially and properly on behalf
of their respective institutions and have been duly authorized, directed and empowered to execute this
contract by their properly elected Board of Directors.
30. Each and every provision contained and set forth in the "Additional Items" section on page 7 of the
RFP attached hereto as Exhibit I are incorporated herein in their entirety as though completely setout
herein and are made a part of this agreement.
IN WITNESS WHEREOF, the parties have executed this contract at St. Louis, Missouri, as of the day and year first above written.
PROFESSIONAL CLAIMS PROCESSING
FENTON FIRE PROTECTION DISTRICT
Address:
911 Holly Hills Drive
P.O. Box 2888 St. Louis. Missouri 63111-0088
