HomeMy WebLinkAboutR-99-0498a
J-99-571
7/13/99
RESOLUTION NO. J " ^ 498
A RESOLUTION OF THE MIAMI CITY COMMISSION,
AUTHORIZING THE CITY MANAGER TO EXECUTE AN
AGREEMENT, IN SUBSTANTIALLY THE ATTACHED
FORM, WITH MEDAPHIS PHYSICIAN SERVICES
CORPORATION, FOR EMERGENCY MEDICAL TRANSPORT
BILLING AND COLLECTIONS FOR A TERM OF THREE
YEARS, WITH THE OPTION TO RENEW SAID
AGREEMENT FOR TWO (2) ADDITIONAL ONE-YEAR
PERIODS.
WHEREAS, pursuant to Resolution No. 99-433, adopted May 11,
1999, the City Commission accepted the terms of the negotiated
proposal by Medaphis Physician Services Corporation to provide
emergency medical service billing and collection services to the
City of Miami; and
WHEREAS, the City Commission further directed the City
Manager to present at a City Commission meeting, the negotiated
agreement with Medaphis Physician Services Corporation;
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF MIAMI, FLORIDA:
Section 1. The recitals and findings contained in the
Preamble to this Resolution are hereby adopted by reference
thereto and incorporated herein as if fully set forth in this
ATTACHMENT (5)
CYTY COVOMMON
raMING 4F
J U f_ 1 3 1999
Resolution No.
30,q - 9 )
Section.
Section 2. The City Manager is hereby authorized!' to
execute an agreement, in substantially the attached form, with
Medaphis Physician Services Corporation, to provide emergency
medical service billing and collection services to the City of
Miami for a term of three (3) years, with the option to renew
said agreement for two (2) additional one-year periods.
Section 3. This Resolution shall become effective
immediately upon its adoption and signature of the Mayor.�'
PASSED AND ADOPTED this 13th _ day of July , 1999.
JOE CAROLLO, MAYOR
In accordance with Miami Code Sec. 2-35, since the Mayor aid not indicate approval `
this legislation by signing it in the dssionatod plane moulded, saij legislation rr
becomes effective with the elapse of ten ( i o) days fir m the date of Commissicn :';.:.
ATTEST: regarding same, without the Mayor exercisin v
Vt►�aft„ �� �
WALTER J. FOEMAN, CITY CLERK11 ri, City Clerk
^
CORRECTNESS-tX
YR.O' V I15
TTORNEY
W3,573:rcl:BSS
�i The herein authorization is further subject to compliance with
all requirements that may be imposed by the City Attorney,
including but not limited to those prescribed by applicable City
Charter and Code provisions.
If the Mayor does not sign this Resolution, it shall become
effective at the end of ten calendar days from the date it was
passed and adopted. If the Mayor vetoes this Resolution, it
shall become effective immediately upon override of the veto by
the City Commission.
- 2 -
99- 498
SERVICES AGREEMENT
OR
PROFESSIONAL SERVICES AGREEMENT
This Agreement is entered into this _ day of , 199 ('but
effective as of
by and between the City of Miami, a municipal
corporation of the State of Florida ("City") and Medaphis Physician Services Corporation, a
Florida corporation ("Provider").
The Commission of the City of Miami, by Resolution No. - adopted
on , 199_, approved the selection of Provider for the provision of the EMS
Billing and Collection Services ("Services"), and authorized the City Manager to execute a
contract, under the terms and conditions set forth herein.
NOW, THEREFORE, in consideration of the mutual covenants and promises herein
contained, Provider and the City agree as follows:
TERMS:
1. RECITALS: The recitals are true and correct and are hereby incorporated into and made
a part of this Agreement.
2. TERM: The term of this Agreement shall be for -o e--e*a-YearW n hcy t $far renewal
options
, 1999 (the "Effective Date") and ending on , 2000. This
Agreement will automatically renew for an additional one (1) year terns unless either party
delivers to the other written notice of termination at least ninety (90) days prior to the
expiration of the then current term.
99- 498
6. OWNERSHIP OF DOCUMENTS: Provider understands and agrees that any
information, document, report or any other material whatsoever which is given by the City to
Provider or which is otherwise obtained or prepared by Provider pursuant to or under the terms
of this Agreement is and shall at all times remain the property of the City. Provider agrees not to
use any such information, document, report or material for any other purpose whatsoever without
the written consent of City, which may be withheld or conditioned by the City in its sole
discretion..
7. AUDIT AND INSPECTION RIGHTS:
A. The City may, at reasonable times, and for a period of up to three (3) years
following the date of final payment by the City to Provider under this Agreement, audit , or cause
to be audited, those books and records of Provider which are related to Provider's performance
under this Agreement. Provider agrees to maintain all such books and records at its principal
place of business for a period of three (3) years after final payment is made under this
Agreement.
B. The City may, at reasonable times during the term hereof, inspect Provider's
facilities and perform such tests, as the City deems reasonably necessary, to determine whether
the goods or services required to be provided by Provider under this Agreement conform to the
terms hereof. Provider shall make available to the City all reasonable facilities and assistance to
facilitate the performance of tests or inspections by City representatives. All tests and
inspections shall be subject to, and made in accordance with, the provisions of Section 18-55.2 of
the Code of the City of Miami, Florida, as same may be amended or supplemented, from time to
time.
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3. SCOPE OF SERVICES:
A. Commencing on the Effective Date, Provider agrees to provide the Services as
specifically described, and under the special terms and conditions set forth in Attachment "A"
hereto, which by this reference is incorporated into and made a part of this Agreement.
B. Provider represents and warrants to the City that: (i) it possesses all
qualifications, licenses and expertise required for the performance of the Services: (ii) it is not
delinquent in the payment of any sums due the City, including payment of permit fees,
occupational licenses, etc., nor in the performance of any obligations to the City, (iii) all
personnel assigned to perform the Services are and shall be, at all times during the term hereof,
fully qualified and trained to perform the tasks assigned to each; and (iv) the Services will be
performed in the manner described in Attachment "A".
5. COMPENSATION:
A. The amount of compensation payable by the City to Provider shall be based on
the rates and schedules described in Attachment "B" hereto, which by this reference is
incorporated into and made a part of this Agreement.
B. Unless otherwise specifically provided in Attachment "B", payment shall be made
within L� days after receipt of Provider's invoice, which shall be accompanied
by sufficient supporting documentation and contain sufficient detail, to allow a proper audit of
expenditures, should City require one to be performed. If Provider is entitled to reimbursement
of travel expenses (i.e. Attachment "B" includes travel expenses as a specific item of
compensation], then all bills for travel expenses shall be submitted in accordance with Section
112.061, Florida Statutes.
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S. AWARD OF AGREEMENT: Provider represents and warrants to the City that it
has not employed or retained any person or company employed by the City to solicit or secure
this Agreement and that it has not offered to pay, paid, or agreed to pay any person any fee,
commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection
with, the award of this Agreement.
9. PUBLIC RECORDS: Provider understands that the public shall have access, at all
reasonable times, to all documents and information pertaining to City contracts. subject to the
provisions of Chapter 119, Florida Statutes, and agrees to allow access by the City and the public
to all documents subject to disclosure under applicable law. Provider's failure or refusal to
comply with the provisions of this section shall result in the immediate cancellation of this
Agreement by the City.
10. COMPLIANCE WITH PROGRAM REQUIREMENTS AND FEDERAL, STATE
AND LOCAL LAWS:
Provider shall comply with all requirements imposed by the Grant
for the Program, including reporting, record keeping and other requirements. Provider shall also
comply with and observe all applicable federal, state and local laws, rules, regulations, codes and
ordinances, as the may be amended from time to time.
11. INDEMNIFICATION: Provider shall indemnify, defend and hold harmless the
City and its officials, employees and agents (collectively referred to as "Indemnities") and each
of them from and against all loss, costs, penalties, fines, damages, claims, expenses (including
attorney's fees) or liabilities (collectively referred to as "Liabilities") by reason of any injury to
or death of any person or damage to or destruction or loss of any property arising out of,
resulting from, or in connection with (i) the performance or non-performance of the services
contemplated by this Agreement which is or is alleged to be directly or indirectly caused, in
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whole or in part, by any act, omission, default or negligence (whether active or passive) of
Provider or its employees, agents or subcontractors (collectively referred to as "Provider"), or
(ii) the failure of the Provider to comply with any of the paragraphs herein or the failure of the
Provider to conform to statutes, ordinances, or other regulations or requirements of any
governmental authority, federal or state, in connection with the performance of this Agreement.
Provider expressly agrees to indemnify and hold harmless the Indemnities, or any of them, from
and against all liabilities which may be asserted by an employee or former employee of Provider,
or any of its subcontractors, as provided above, for which the Provider's liability to such
employee or former employee would otherwise be limited to payments under state Workers'
Compensation or similar laws.
12. DEFAULT: If Provider fails to comply with any term or condition of this Agreement,
or fails to perform any of its obligations hereunder, then Provider shall be in default. Upon the
occurrence of a default hereunder the City, in addition to all remedies available to it by law, may
immediately, upon written notice to Provider, terminate this Agreement whereupon all payments,
advances, or other compensation paid by the City to Provider while Provider was in default shall
be immediately returned to the City. Provider understands and agrees that termination of this
Agreement under this section shall not release Provider from any obligation accruing prior to the
effective date of termination. Should Provider be unable or unwilling to commence to perform
the Services within the time provided or contemplated herein, then, in addition to the foregoing,
Provider shall be liable to the City for all expenses incurred by the City in preparation and
negotiation of this Agreement, as well as all costs and expenses incurred by the City in the re -
procurement of the Services, including consequential and incidental damages.
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13. TERMINATION RIGHTS:
A. The City and the Provider shall have the right to terminate this Agreement, by
giving the other party at least (_) business days prior written notice, if either party
determines, in its sole discretion, that termination of this Agreement is in its best interest. In the
event of termination by the City it shall pay to Provider compensation for Services rendered and
expenses incurred prior to the effective date of termination. In no event shall the City be liable to
Provider for any additional compensation, other than that provided herein, or for any
consequential or incidental damages.
B. The City and the Provider shall have the right to terminate this Agreement,
without notice or liability to other party upon the occurrence of an event of default under this
Agreement, subject to the termination procedures set forth in paragraph 13C below. In the event
of Provider's default, the City shall not be obligated to pay any amounts to Provider and Provider
shall reimburse to the City all amounts received while Provider was in default under this
Agreement.
C. TERMINATION PROCEDURES
In the event this Agreement is terminated, for whatever reason, City shall choose
one of the two following options as an means of transferring its accounts receivable from
Provider to another provider of billing services:
(i) Upon the effective date of termination, Provider shall cease to enter new patient
and charge data into its computer system on behalf of City, but may, at its discretion, (a)
continue to perform the Services identified as "Reimbursement Management Services" on
Attachment "A" to this Agreement, at the then -current rates hereunder, for a period of ninety (90)
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days regarding all of City's accounts receivable relating to City's charges for clinical procedures
rendered prior to the termination date, unless this Agreement is terminated pursuant to Section
13B above and Provider or City otherwise notifies the other party in writing, (b) thereafter
discontinue processing City's existing accounts receivable, (c) deliver to City, after full payment
of all fees owed, a final list of accounts receivable, (d) provide reasonable transitional services,
and (e) have no further obligations to City. City may negotiate with Provider for additional
transitional services to be provided by Provider after the date of termination at City's additional
expense; or
(ii) On or before the effective date of termination, City shall pay Provider a one-time
fee equal to the amount listed on Attachment "B" to this Agreement (the "Termination Fee").
Upon payment of the Termination Fee, Provider shall (a) be immediately relieved of the
obligation to provide any further Services on behalf of City, (b) deliver to City, after full
payment of all fees owed, a final list of accounts receivable, (c) provide reasonable transition
services, and (d) have no further obligations to City. City may negotiate with Provider for
additional transitional services to be provided by Provider after the date of termination at City's
additional expense. The parties understand and acknowledge that the Termination Fee is
intended as a liquidated damages provision and not a penalty and is a reasonable approximation
of the unpaid start-up costs and expenses which will be incurred by Provider in the event of such
termination. The Termination Fee is in addition to any other legal or equitable remedy Provider
may have against City, if any, and in no way is intended to limit the rights and remedies Provider
may have against City arising out of any breach of this Agreement.
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0
14. INSURANCE: Provider shall, at all times during the term hereof, maintain such
insurance coverage as may be required by the City. All such insurance, including renewals, shall
be subject to the approval of the City for adequacy of protection and evidence of such coverage
shall be furnished to the City on Certificates of Insurance indicating such insurance to be in force
and effect and providing that it will not be canceled during the performance of the services under
this contract without thirty (30) calendar days prior written notice to the City. Completed
Certificates of Insurance shall be filed with the City prior to the performance of services
hereunder, provided, however, that Provider shall at any time upon request file duplicate copies
of the policies of such insurance with the City.
If, in the judgment of the City, prevailing conditions warrant the provision by Provider of
additional liability insurance coverage or coverage which is different in kind, the City reserves
the right to require the provision by Provider of an amount of coverage different from the
amounts or kind previously required and shall afford written notice of such change in
requirements thirty (30) days prior to the date on which the requirements shall take effect.
Should the Provider fail or refuse to satisfy the requirement of changed coverage within thirty
(30) days following the City's written notice, this Contract shall be considered terminated on the
date that the required change in policy coverage would otherwise take effect.
15. CONFLICT OF INTEREST:
A. Provider is aware of the conflict of interest laws of the City of Miami (Miami City
Code Chapter 2, Article V), Dade County, Florida (Dade County Code, Section 2-11.1 et. seq.)
and of the State of Florida as set forth in the Florida. Statutes, and agrees that it will fully comply
in all respects with the terms of said laws and any future amendments thereto.
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D. Provider covenants that no person or entity under its employ, presently exercising
any functions or responsibilities in connection with this Agreement, has any personal financial
interests, direct or indirect, with the City. Provider further covenants that, in the performance of
this Agreement, no person or entity having such conflicting interest shall be utilized in respect to
services provided hereunder. Any such conflict of interest(s) on the part of Provider, its
employees or associated persons, or entities must be disclosed in writing to the City.
16. NONDISCRIMINATION: Provider represents and warrants to the City that Provider
does not and will not engage in discriminatory practices and that there shall be no discrimination
in connection with Provider's performance under this Agreement on account of race, color, sex,
religion, age, handicap, marital status or national origin. Provider further covenants that no
otherwise qualified individual shall, solely by reason of his/her race, color, sex, religion, age,
handicap, marital status or national origin, be excluded from participation in, be denied services,
or be subject to discrimination under any provision of this Agreement.
17. MINORITY AND WOMEN BUSINESS AFFAIRS AND PROCUREMENT
PROGRAM: The City has established a Minority and Women Business Affairs and
Procurement Program (the "M/WBE Program") designed to increase the volume of City
procurement and contracts with Blacks, Hispanic and Women -owned business. The M/WBE
Program is found in Ordinance No. 10062, a copy of which has been delivered to, and receipt of
which is hereby acknowledged by, Provider. Provider understands and agrees that the City shall
have the right to terminate and cancel this Agreement, without notice or penalty to the City, and
to eliminate Provider from consideration and participation in future City contracts if Provider, in
the preparation and/or submission of the Proposal, submitted false of misleading information as
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to its status as Black., Hispanic and/or Women owned business and/or the quality and/or type of
minority or women oxvned business participation.
18. ASSIGNMENT: This Agreement shall not be assigned by Provider, in whole or in
part, without the prior written consent of the City's, which may be withheld or conditioned, in
the City's sole discretion.
19. NOTICES: All notices or other communications required under this Agreement shall
be in writing and shall be given by hand -delivery or by registered or certified U.S. Mail, return
receipt requested, addressed to the other party at the address indicated herein or to such other
address as a party may designate by notice given as herein provided. Notice shall be deemed
given on the day on which personally delivered; or, if by mail, on the fifth day after being posted
or the date of actual receipt, whichever is earlier.
TO PROVIDER: TO THE CITY:
20. MISCELLANEOUS PROVISIONS:
A. This Agreement shall be construed and enforced according to the laws of the State
of Florida.
B. Title and paragraph headings are for convenient reference and are not a part of this
Agreement.
C. No waiver or breach of any provision of this Agreement shall constitute a waiver
of any subsequent breach of the same or any other provision hereof, and no waiver shall be
effective unless made in writing.
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D. Should any provision. paragraph, sentence. word or phrase contained in this
Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise
unenforceable under the laws of the State of Florida or the City of Miami, such provision,
paragraph, sentence, word or phrase shall be deemed modified to the extent necessary in order to
conform with such laws, or if not modifiable, then same shall be deemed severable, and in either
event, the remaining terms and provisions of this Agreement shall remain unmodified and in full
force and effect or limitation of its use.
E. This Agreement constitutes the sole and entire agreement between the parties
hereto. No modification or amendment hereto shall be valid unless in writing and executed by
property authorized representatives of the parties hereto.
21. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties
hereto, their heirs, executors, legal representatives, successors, or assigns.
22. INDEPENDENT CONTRACTOR:
Provider has been procured and is being
engaged to provide services to the City as an independent contractor, and not as an agent or
employee of the City. Accordingly, Provider shall not attain, nor be entitled to, any rights or
benefits under the Civil Service or Pension Ordinances of the City, nor any rights generally
afforded classified or unclassified employees. Provider further understands that Florida
Workers' Compensation benefits available to employees of the City are not available to Provider,
and agrees to provide workers' compensation insurance for any employee or agent of Provider
rendering services to the City under this Agreement.
23. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the
availability of funds and continued authorization for program activities and the Agreement is
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subject to amendment or termination due to lack of funds, reduction of funds and/or change in
regulations, upon thirty (30) days notice..
24. ENTIRE AGREEMENT: This instrument and its attachments constitute the sole and
only agreement of the parties relating to the subject matter hereof and correctly set forth the
rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises,
negotiations, or representations not expressly set forth in this Agreement are of no force or effect.
25. COUNTERPARTS: This Agreement may be executed in two or more counterparts,
each of which shall constitute an original but all of which, when taken together, shall constitute
one and the same agreement.
26. APPROVAL BY THE OVERSIGHT BOARD: The State of Florida has appointed an
Emergency Financial Oversight Board (the "Oversight Board") which is empowered to review
and approve all pending City of Miami contracts. As a result, contracts shall not be binding on
the City until such time as they have been approved by the Oversight Board. Execution of this
Agreement by the City Manager shall constitute evidence of its approval by the Oversight
Board.
27. SPECIAL INSURANCE AND INDEMNIFICATION RIDER: Please initial if
applicable: YES: ❑
NO: ❑
IN WITNESS WHEREOF, the parties hereto have caused this instrument to be
executed by their respective officials thereunto duly authorized, this the day and year above
written.
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tJ9— 4((��JQQV
ATTEST:
Walter Foeman, City Clerk
ATTEST:
Print Name:
Title: Corporate Secretary
"City„
CITY OF MIAMI, a municipal
corporation
By:_
Donald H. Warshaw, City Manager
"Provider"
a corporation
By: — —
Print Name:
Title: President.
APPROVED AS TO FORM AND APPROVED AS TO INSURANCE
CORRECTNESS: REQUIREMENTS:
ALEJANDRO VILARELLO
City Attorney
MARIO SOLDEVILLA
Assistant Director
Risk Management Division
CoMTMS-Medaphis.doc 13 99 98 _ (]
ATTACHMENT "A"
SCOPE OF SERVICES
REIMBURSEMENT MANAGEMENT SERVICES
• Billings and Collections
• Fee Schedule Analysis/Development
• Carrier Participation Decisions
• Monthly Reporting
• Payor Relations
• Electronic Claims Filing with Carriers
• Insurance Filing for Patients
• SNF Contracting
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ATTACHMENT "A"
SCOPE OF SERVICES
REIMBURSEMENT MANAGEMENT SERVICES
A. OPERATIONS
• Information Capture and Data Collection at Patient Care Site by Hard Copy, Tape or
Bisynchronous Communications with Routine Audits to Hospital Records (When
Applicable)
• Data Preparation Prior to Billing
• Patient Billing
• Insurance Processing (All Carriers) Via Tape, Hard Copy, or Bisynchronous , with Filing
Directly to Carriers, Automatic Filing of Secondary Insurance, Automatic Reject Billing and
Automatic Balance Billing
• Account Receivable Management with Full Managerial Reporting System
• Patient Inquiries and Correspondence
• Cash Receipts and Bank Deposit
• Delinquency Follow-up
• Mail Processing
• Coordination with Hospitals to Minimize Lost Charges and Non -billable Services
• Maintenance of Third -party Profiles
• Maintenance of Current Fees, Codes and Description Files
• Daily, Weekly, Monthly Reports
• Production and Statistical Reporting
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ATTACHMENT "A"
SCOPE OF SERVICES
(EMS)
REIMBURSEMENT MANAGEMENT SERVICES
I. City Responsibilities
Provide Provider within Minimum Information. City shall use its best efforts to:
(a) Work with Provider to develop efficient process which minimize disruption of City's
business;
(b) On a timely basis and in a mutually acceptable format, provide the information
necessary for Provider to perform the Services in an efficient manner. Such
information should include:
(1) Patient's name, sex, date of birth, status (single, married. other)
(2) Responsible party's name, address, telephone number, employer
(3) Insured's name (if different from patient), sex date of birth, address,
relationship to patient, insureds employer (if group policy), insureds
employer's address
(4) Name of insurance company, address, policy certificate number, group policy
number
(5) Copy of emergency registration log or daily log from record if information is
required.
(6) EMS Supplemental Report (if used)
(7) Copy of release of information and insurance assignment of benefits, upon
request by Provider
(8) HMO/PPO authorization number approval (if applicable)
(9) Copy of paid at time of service receipt (if applicable)
(10) Date of service, chief complaint, medical history and exam, treatment,
diagnosis and physician notes.
(c) Furnish a complete daily batch of those Department Records for which Provider is to
provide the Services, consecutively numbered and logged. If medical records are
missing, they will be identified on a "straggler report" and City will be asked to locate
the missing records.
(d) Furnish and/or cause to be transmitted and mail (courier at Provider' expense) to
Provider no less than every other business day and within three business days of
service, a copy of the medical record for each patient for whom Provider provides the
Services.
(e) Other run sheet information if necessary.
(f) Work with Provider to establish electronic transmission of patient's demographic and
financial information.
(g) Provide access to one or more members of City's staff to answer questions regarding
claims.
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(h) Notify Provider of patients who qualifv for free or reduced charges services due to
financial hardship.
(i) Provide names and summary information of new personnel for initiation of payor
credentialing by Provider.
0) Send copies of worker's compensation notification of compensable injury forms.
(k) Provide Provider with City's fee schedule for entry onto Provider' system prior to the
start date of this Agreement. Provider will continue to update such fee schedule upon
written notification to Provider of any change to such fee schedule by City.
U. Provider Sei- vices:
• Electronically enter demographic information and coding information onto the Provider
Computer System.
• Handle all accounts in accordance with standard accounting principles and all applicable
laws.
• Provide fee schedule consultation.
• Bill managed care accounts in accordance with the terms of City's executed contracts. If no
contract exist, bill such account in accordance with the rules of the state in which care was
provided or, if no state rules apply, in accordance with Provider's normal business
procedures.
• Account for charts considered not billable (left without being seen, left against medical
advice, patient seen by a private physician and any non billable procedures such as a patient
recheck, etc.) These charts will become part of the reporting package, however, Provider's
fee will not apply to these voided charts.
• Receive copies of the patient's charts, check for completeness, maintain a daily log of charts
received.
• Have complete management responsibility for the billing office personnel including training
and personnel evaluation and provide documentation feedback for all new staff during first 3
months of employment.
• Accurately code each patient chart, on the basis of the information provided by City.
including ICD-9 and CPT coding, and enter demographic information and coding
information onto the Provider Computer System.
• Electronic filing with Medicare, Medicaid and Blue Shield, and other third -party payors,
where applicable.
• Electronic filing of all major insurance carriers through NEIC (National Electronics
Insurance Corporation) or other claims clearinghouse, where applicable.
• Electronic remittance from Medicare and all other carriers, where applicable.
• Mail Patient Statements/Notices/third-party pre -collection letters.
• Provide a toll -free "800" phone number to answer phone inquires concerning patient account
information.
• Respond to inquires received by mail from patients and/or third -party payors.
• Receive all payment and reimbursement notices from City's bank lock box and post
payments to the appropriate patient account.
• Manage patient refunds.
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• Post all contract discounts and adjustments which are required by law or authorized by the
City.
• Provide on -site training at City (schedule and frequency to be mutually agreed upon).
Training shall include sections on billing requirements. medical necessity for transports, and
other documentation issues required for proper billing in normal business practices.
• Provide fee schedule evaluation and development.
• Provide managed care contract review via a written synopsis.
• Provide third -party payor credentialing for all necessary provide numbers.
• Provide customized statements in group's name.
• File primary, secondary and tertiary insurance for patient and resubmit rejections and no
action accounts.
• Back-up data off system every night and store back-up tapes off -site.
• Provide weekly and monthly report, including generally accounts receivable management
and efficiency reports and statistical and trending reports. Provider will provide clinical and
special reports requested City on an as -needed basis. City agrees to pay an additional charge
if extraordinary programming efforts are required to run a specific report not offered in
Provider' normal course of business.
• Adapt to all government and third -party payor policy changes.
• Provide monthly management reporting to include:
■ monthly/yearly financial comparative trends by payclass and procedure
® Revenue by vehicle
e charge and payment analysis total and by payclass
e location productivity profile and summary
■ aging payment report
• Provide current knowledge of governmental regulations, third -party payor activities,
completion, economic changes and other outside influences affecting City.
• Follow up on delinquent insurance accounts
• Provide annual charge review and analysis/projections
• Provide annual impact analysis of Medicare reduction and/or participation evaluation and
recommendation.
• Maintain computer system with system generated operational reports.
Assist in providing Skilled Nursing Facility contracting according to Medicare regulations.
CoMTMS-Medaphis.doc 18
ATTACHED "B"
SERVICES FEES
A. For Services performed on a Contingency Fee Basis:
Beginning as of the Effective Date, City agrees to pay Provider the Monthly Fee, billable on the
first day of each month, as set forth below:
(i) an amount equal to , percent (___%) of the Net Collections made by or through Provider
on City's account receivable (other than the Prior A/R) for the previous month; or
Client acknowledges and agrees that Medaphis (i) is not responsible for, and has had no
involvement or participation in, the gathering, preparation or development of the back-up
documentation which substantiates or evidences the Prior A/R from or detecting or correcting
prior errors with regard to the Prior A/R. All information received from prior vendors to the City
of Miami., with aging greater than 120 days shall be deemed collection accounts and treated as
such.
Net Collection means the total sum of all moneys collected by or through Provider for all clinical
service rendered by City, less amounts refunded or credited to a patient or third party payor as a
result of overpayments, erroneous payments or bad checks. When unpaid billing are referred to a
collection agency or law firm, the amount of Net Collection will include the net amount received
by City through the efforts of the collection agency after deducting the collection agency fee.
Provider shall be responsible for selecting a collection agency (Medical Account Systems) and
shall negotiate all operating standards with Medical Account Systems. All fees for collection
agency activity shall be the responsibility of the City of Miami.
Prior A/R Gross Collections means the total sum of all monies collected by or through Provider
for all clinical services rendered by City for the Prior A/R.
FOR CITY FROM ANY STATE HAVING THIS MEDICAID RESTRICTION (applicable at
this time: Florida): Notwithstanding any term or condition of the Agreement to the contrary,
Provider' fee for the provision of Services with respect to those of City's behalf, will be equal to
$ 9.00 per patient encounter, regardless of the amount of the charges associated with any such
encounter and the amount of reimbursement, if any, to City for the Medicaid program with
respect to such changes.
B. Minimum Net Revenue Guarantee:
Using a lagging period of six (6) months from the date to be used for calculations, and on a
quarterly basis from the starting date of the contract, the minimum acceptable collection rate shall
CoM:EMS-Medaphis.doc 19
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be 48% of the total gross collections. The amount may be expressed in dollars, and is calculated
as the converted dollar amount of the gross collected percentage, at the time of calculation.
Provider shall not be required to meet the standards as set forth above if an event beyond
Provider's control occurs. If Medaphis recognizes an event that may affect the Aggregate Net
Collection Percentage, the Average A/R Days, or Outstanding Receivable Target, Provider shall
immediately notify the City of Miami in writing, including an explanation as to the causes of the
event, and the expected impact to the City, including resolution recommendations. In this event.
the City of Miami and Provider shall negotiate revised performance standards.
In the event that Medaphis does not meet the minimum net revenue percentage for the period in
question, (not due to the events in the previous paragraph), the charges for services rendered will
decrease to five (5%) percent. The amount charged by Provider shall remain at that fixed rate
until the next calculation period, when, if performance standards are achieved, the fees for
services rendered shall return to the original quoted amount of 6.35% of Net Collected.
In the event that Provider achieves collection rates greater than forty-eight (48%) of the Gross
Collected, the following fees shall apply:
51 - 55% 6.85% (an additional .5%)
> 56% 7.35% (an additional .5%)
1. For Pre -collection Services: In addition to the Monthly Fee, City will remit to Provider
charges of $ 1.00 per letter for Pre -collection Letters sent on City's behalf during the previous
month. A "Pre -collection Letter" is a correspondence to a debtor prepared under a contract with
a collection agency or law firm, which threatens further collection efforts by a collection agency
or law firm.
2. Termination Fee - Contingency Fee Language: In the event of termination of this
Agreement, for any reason, and City chooses the option set forth in _ as the
procedure for transferring its accounts receivable to another entity pursuant to such termination,
the termination fee shall be equal to one-half of the monthly fee percentage provided for on
Schedule 2 to this Agreement multiplied by the average number of accounts processed per month
for the six (6) months immediately preceding the effective date of such termination, multiplied
by three (3) months.
CAI: Eh1S-Medaphis.doc 20 9 9 r 498
SCHEDULES
PRACTICE ASSUMPTIONS
The following assumptions are based on information City has provided to Provider. Based
on these assumptions, Provider has determined the collectability of City's accounts receivable
and has derived the schedule of Monthly Fees set forth in Schedule 2 of the foregoing
Agreement.
1. Average gross charges per month:
2. Unbillable and contractual allowances:
3. Bad debt:
4. Payor mix:
Self Pay
Medicare
Medicaid
Commercial
PPO
Managed Care/HMO
Packaged Billing
Appeals
Others, Misc.
Total
5. Average net collections per month:
6. Average number of procedures per month:
7. Average number of encounters per month:
CoA1:GA15-Medaphis.doc 21
TO
CITY OF MIAMI, FLORIDA
INTER -OFFICE MEMORANDUM 16
DATE:
Honorable Mayor and Members JUN 28 i999
of the City Commission SUBJECT:
Medaphis Contract
FROM: REFERENCES:
/ona d H. Warshaw ENCLOSURES:
CijX Manager
FILE:
RECOMMENDATION:
It is respectfully recommended that the City Commission authorize the City Manager to
executed an agreement, in substantially attached form, for Emergency Medical Transport
Billing and Collections with Medpahis, Inc.
BACKGROUND:
In October 1998, the City Commission directed the administration to entered into
competitive negotiations with the three vendors who had submitted proposals in response
to RFP 96-97-110 for EMS Billing/Collections. The City Manager appointed a
negotiating team that included the various parties from departments involved with the
contract and a private sector representative:
Marva L. Wiley Special Assistant to the City Manager
Frank Rollason Deputy Fire Chief
Maurice L. Kemp Assistant Fire Chief
J. Scott Simpson Assistant Finance Director
Pete Chircut Treasurer
James Osteen Information Technology
Frank Fernandez AVP, Materials Management - Baptist Health Systems
After determining the relevant criteria, the Team convened the proposers at an
orientation meeting in December. The Team requested that each proposer submit a
proposal that highlighted the items contained in the orientation letter, which reflected
those relevant issues and directed the proposers to address same in their proposals. The
Team received those proposals on January 21, 1999. Each Team member reviewed the
proposals before the Team commenced negotiations on March 22, 1999. The Team was
unable to complete negotiations on that date as each proposer was left with questions that
required additional research. In addition to the other outstanding questions, the Team
formally requested that each proposer submit a sample/demo of its software on or before
April 12, 1999, for the review of the paramedics (the end users). Two proposers
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complied with that request while the third proposer indicated its intention to withdraw
from the process on April 14, 1999. Negotiations continued on .April 19, 1999, with the
remaining two proposers.
Ultimately, the Team unanimously selected Medaphis as the firm of choice with the
following terms:
Collection Rate 6.35%
Penalty Rate 5% 1
Incentive Rate 6.85% 2
Super Incentive Rate 7.35%3
The prior contract which had been shared between Advanced Data Processing, Inc. and
Medaphis, Inc. provided for a collection rate of 7% with no incentives or penalties.
Additionally, the prior contract did not provide for a guaranteed collection rate. The
average collection rates for both firms has been 48-52%. At the meeting of May 11,
1999, the City Commission authorized the City Manager to negotiate an agreement with
said firm, in a form acceptable to the City Attorney, and further directed the City
Manager to present the negotiated agreement to the City Commission for its ratification
and approval.
DHW/MLW
' For any given month in which the vendor fails to meet its guaranteed 48% collection
rate. To be determined retroactively at a 6 month lag.
2 For any month in which the endor generates a collection rate between 51% and 55%.
To be determined retroactive) at a 6 month lag.
' For any month in which the vendor generates a collection rate in excess of 56%. To be
determined retroactively at a 6 month lag.
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