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HomeMy WebLinkAboutBid ResponseMISKESSON Emergency Medical Transport Billing and Collection Services — RFP 547382 Prepared For: wwwwwww e Nene 3. • .1". • 16 6. 6. • 0 6 • • • 6 • 6. MMMMMMMMMMMMMMMMM M. 6 6 111 6 * MMMMMMMMMMMMMMM City of Miami May 18, 2016 Prepared by: PST Services, Inc., a McKesson company Headquarters: 5995 Windward Parkway Alpharetta, Georgia 30005 Local Office: 7955 NW 12th Street, Suite 100 Doral, Florida 33126 www.mckesson.co s BUSINESS CARE CONNECTIVITY Contact for RFP and Contracting: Mauricio Chavez, Specialty VP — EMS 305-970-2780 (cell) 305-229-4322 (fax) Mauricio.Chavez@McKesson.corn Federal Tax ID: 58-1953146 MCKESSON Ms. Pearl Bethel City of Miami 3500 Pan American Drive Miami, Florida 33133 May 18, 2016 Dear Ms. Bethel and members of the Evaluation Committee: PST Services, Inc., a McKesson company (McKesson), is pleased to submit our proposal in response to your Emergency Medical Transport Billing and Collection Services Request for Proposal. The City of Miami is a valued client with whom we have experienced a very collaborative relationship. We are proud of what we have helped your organization accomplish over the past 20 years and we look forward to continuing the momentum of this successful program. We have over 25 years of EMS billing and medical billing experience. We specialize in EMS billing and medical revenue management. Our organization possesses both the trained personnel and expertise required to continue providing outstanding EMS billing and claims management for the City of Miami. You can continue to expect the highest level of service and excellent billing results from McKesson. McKesson began billing for the City of Miami in the 1990s. I personally have been working with the City of Miami since Day 1, first as a programmer, then as a client manager, and on to Director of Operations and Specialty Vice President of EMS. When I began working with the City on EMS billing, Carlos Jimenez was the chief and the City transported a fraction of the patients that are transported today. At that time, the City decided to use two vendors for billing to determine who would do a better job. In 1999, the City released an RFP for a vendor to perform the billing for all EMS accounts. McKesson won easily, driven by the fact that our collections were higher, our service was better, and our expertise in helping with audits, particularly Medicaid audits, was superior. In 2005, the City decided to piggyback off of an existing McKesson contract so that we could continue to provide outstanding service to the City without interruption. Fast forward to 2016, several chiefs later, and many more transports a year. McKesson continues to provide outstanding service to the City of Miami. No other vendor knows the City of Miami as we do. We have close to 200 EMS clients and the City of Miami stands unique in terms of demographics. It is a mix of tourists, impoverished areas, and affluent areas not found anywhere else in the United States. McKesson also performs the billing for the Jackson Memorial Hospital emergency room physicians. This means that we have valuable patient demographic information already in our system. No other vendor will have access to that type of information. Staying with McKesson will mean no loss of revenue due to a transition. The real secret to our success are the employees that work with the City. The employees that started with you in the 1990s STILL work on the City of Miami account, myself included. We have grown with McKesson Business Performance Services 7955 NW 12th Street, Suite 100 Doral, Florida 33126 www.mckesson.com/bps/ems MSKESSON s s a s s a# i s H L R i a a k R R R R 0 p a R s R p s's s s s 0. p R R a 11 R s R R R a s R s a R A R R s a R s 0 R 110 s; s e R a s 0 a 0 a A s e a a p s 0 0 R0 p with the City. No one else can offer that type of stability. We are proud of the excellent and consistent service we have provided the City throughout all these years. All requests for reports and general questions are answered almost immediately. We have provided documentation and patient care report writing training at the request of the City. We can meet in person at the discretion of the City since our office is only 15 minutes away from the Fire Administrative Headquarters. We have even taken the time to speak to your union in order to explain the EMS billing process since they have a revenue sharing agreement with the City. We welcome the opportunity to provide you with additional information in an oral interview with our experienced team.. Please contact me if you need further information or to schedule a time for oral presentations: 305-97o-278o or Mauricio.Chavez.(McKesson.cozn. I look forward to hearing from you. We describe our solution in detail in the following pages. On behalf of McKesson, Z am very excited about the opportunity to continue our successful relationship with the City of Miami. Sincerely, Mauricio Chavez Specialty Vice President, EMS Billing McKesson McKesson Business Performance Services 7955 NW izth Street, Suite 100 Doral, Florida 33126 www.inekesson.corn/bps/exns Confidential Information The following content in this proposal is confidential and shall not be shared with anyone not involved in the evaluation of this proposal. • Client descriptions (pages 8 — 11) Page 1 PROPOSALNAME CLIENTNAME DUEDATE MWKES ON Table of Contents EXECUTIVE SUMMARY 5 PROPOSER'S EXPERIENCE PAST PERFORMANCE 7 Billing and Accounts Receivable Management Services 7 KEY PERSONNEL PERFORMING SERVICES 14 PROPOSED APPROACH TO PROVIDING THE SERVICES 19 Appeal processing 24 Co-insurance / supplemental insurance processing 25 Private pay account processing and follow-up 26 Establishment of payment plans 26 Response to Scope of Services 31 3. Transition 31 4. Services to be Provided 31 5. Billing Services 35 6. Personal Injury Protection (PIP) Claims Review 42 7. Service Fees 44 8. Receipt of Funds 44 9. Service Review 45 10. Data Format 46 11. Demographic Information 47 I 12. Mileage Calculation 47 13. Claim Submission 48 14. Reporting Requirements 48 15. Monthly Reports 49 16. Other Services or Provisions 54 RESPONSE TO MINIMUM QUALIFICATIONS 58 LIST OF APPENDICES 59 Page 4 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M KE SON Executive Summary We are pleased to offer this response to the City of Miami's Request for Proposals 547382 for Emergency Medical Transport Billing and Collection Services. Medical billing can be problematic due to the difficulty of capturing demographic information in the field. Compliance issues present another hurdle, particularly when dealing with Medicare and Medicaid populations and complex HIPAA regulations. By continuing to contract with us, you will experience the same exceptional financial performance you are accustomed to, and a compliance program that is unparalleled in the industry. We will meet with you on a monthly basis or as needed since we are just minutes away, to review reports that detail gross and net charges, collections, and accounts receivable. We will continue to conduct on -site training sessions to help your paramedics learn proper documentation methods for optimal billing and compliance. The following elements allow us to deliver a billing program that will continue to exceed your financial and compliance expectations: Advanced Technology and Reporting Capabilities Unlike most other billing vendors, we own virtually every significant software system, tool, and process involved in revenue cycle management. Owning all pieces of the billing process end -to - end allows us to eliminate paperwork, accelerate processing, and reduce costs through automated processing. We provide easily accessible standard reports. We also have the capability to customize and create reports to address your unique needs. Demonstrated Commitment to Compliance We have an annual $7 million compliance budget We have made a formal commitment to be compliant in all aspects of our business. With an annual compliance budget of over $7 million, we designed our compliance agenda based on the Department of Health and Human Services Office of Inspector General (OIG) Compliance Program Guidance for Third -Party Medical Billing Companies. Integrated into everything we do, our compliance efforts are designed to establish a culture that promotes prevention, detection, and resolution of conduct that conforms to federal and state law, and federal, state, and private payer healthcare program requirements, as well as our ethical and business policies. Our investment in compliance means you can stay ahead of complex, ever -changing regulatory requirements and enjoy the peace of mind that comes with knowing we have implemented safeguards and controls that are consistent with or surpass those recommended by federal regulatory agencies. Page 5 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 I SKESSON The City of Miami has been a direct beneficiary of our robust compliance program. We have undergone several Medicaid audits together, that are issued regularly by The State of Florida. In each and every audit since the mid 1.99o's we have been able to pull each and every single Patient Care Report and explain to Medicaid why we billed it and why it should be covered by the Medicaid program. We have had successful outcomes in every Medicaid audit because we understand The Florida Medicaid program more than any other vendor. Our compliance department and our operational execution of our internal rules and procedures are the driving force behind our success. No other vendor puts the investment that we do into compliance and insuring proper execution of compliance programs. Just having words on paper does not create success, proper execution does. Significant Experience Integrating with ePCR Systems Our billing McKesson has a strong history of integration with EMS record �m ��,� managements systems platforms; we currently integrate with a multitude systof EMS software companies throughout the United States including with eery major SafetyPAD. With this integration, we acquire patient treatment and ePCR platforrn demographic information electronically. Nearly i00% of our EMS transport billing clients upload patient treatment and demographic information electronically from EMS-RMS platforms to McKesson. We have developed a unique billing audit process with SafetyPAD where we take the unique record number from the billing extract (the case number) and import it into our billing system. We run Crystal reports from both the SafetyPAD system and the McKesson front-end system to insure that every single run has made it into our database. We then compare all billable runs to those that were actually billed to ensure that all runs have made it through our billing process. Electronic Integration with Transport Hospitals We have a strong history of successfully integrating with many transport hospitals in order to acquire patient health insurance information. Electronic integration is the ultimatesolution to acquire the cleanest and most accurate patient health insurance information possible. We currently integrate with all of your transport hospitals that allow it. We have the experience, expertise, and passion to assist you in continuing your EMS billing program. Thank you for allowing us the opportunity to respond to your RFP and continue our successful relationship. �t. Mauricio Chavez Specialty Vice President, EMS Billing McKesson Page. 6 :i mergency Medical Transport Billing & Collection Services City of Miami May:18, 2016 !MUUS ON Proposer's Experience Past Performance a) Describe the Proposer's organizational history and structure; years Proposer and/or firm has been in business providing a similar service (s). The history of McKesson dates back to the beginnings of organized healthcare in the United States. Founded in 1833 by John McKesson and Charles Olcott in New York City, the company was initially focused on the importation and wholesaling of therapeutic drugs and chemicals. In fact, our company created the first national drug distribution system. Over the course of more than 180 years, we have grown by providing pharmaceutical and medical -surgical supply management across the spectrum of care; healthcare information technology for hospitals, physicians, homecare and payers; hospital and retail pharmacy automation; and services for manufacturers and payers designed to improve outcomes for patients. Today, McKesson ranks 11th on the FORTUNE 500 with $190 billion in annual revenue and over 76,000 employees. Our unique position in the industry allows us to apply the most advanced clinical knowledge, process expertise and technology to the challenges of today and tomorrow. McKesson is made up of many businesses, all serving the health care industry. Our businesses fall into one of two primary categories: Distribution Solutions and Technology Solutions. #1 pharmaceutical distributor in U.S. and Canada #1 generics distributor #1 in medical -surgical distribution to alternate care sites Leader in clinical, revenue -cycle and resource -management solutions Leading RelayHealth claims -processing and connectivity business #1 in medical -management software and services to payers Billing and Accounts Receivable Management Services Since 1974, McKesson has had the most comprehensive array of services available to help hospitals and physicians adapt to the post -reform environment (there was of course no EMS billing in 1974) . With proven experience in managing change, developing flexible technological approaches and employing our diverse practice management expertise, we possess the deep resources healthcare organizations need to thrive. As a leader in revenue cycle management across the healthcare continuum, we have the depth of experience your organization needs to improve collections and capture hard -to -collect payer Page 7 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 McKESSON accounts serviced by the other vendor. In 1999, the City chose McKesson as the sole billing vendor. The City has undergone several Medicaid audits since then (the state of Florida typically conducts audits every five years) . In each case, we have been able to whittle down the amount owed to negligible figures. This success is no accident. We have a strong compliance department with written policies that dictate how we bill different governmental payers. Florida Medicaid in particular has specific rules and regulations that we must follow — and we are experts at navigating the rules. We have undergone many successful Medicaid audits for our clients, and we hope to continue to do so for The City of Miami. In a climate of ever -changing governmental rules and regulations, including the Patient Protection and Affordable Care Act (PPACA) , revenue for the City of Miami has increased year over year. We provide the City of Miami with outstanding service. We answer all questions almost immediately. There is always someone available to answer question — whether by email, office phone, or mobile phones. We have even answered questions after hours. No other vendor will provide this level of service. Our office is only 15 minutes away from your headquarters. The City is welcome to visit our Doral office anytime. We are also available to meet in person at the City's discretion, as we have many times. We have provided patient care report documentation training several times throughout the years and through all shifts. In addition, we give constant feedback on documentation that we feel will improve the quality of the documentation. We are always available to provide training in order to improve report writing and increase revenues for the City. We have seamlessly developed several ePCR interfaces through the years as the City has changed ePCR vendors. The City currently uses SafetyPAD and we were very involved in the design and implementation of the interface. McKesson has processes in place in order to verify that every run entered into the SafetyPAD system makes it into our billing system and is billed by McKesson. We enhanced the interface over a year ago in order to automatically calculate patient loaded miles for the City of Miami based on the scene address and the hospital where the patient was transported. In the past, the City used an "as the crow flies" measurement that was automatically passed to McKesson. This method had the potential for shortchanging the City by several miles for each transport. The new McKesson method has accurately increased the miles per transport and has increased revenue. We are always looking for ways to improve our program and increase revenue while remaining compliant with all existing rules and regulations. Another proof of our commitment to improvement is our recent innovation to capture patient signatures electronically. Medicare REQUIRES a patient signature for every run BEFORE the run can be billed to Medicare. The best time to collect a patient signature is at the time of transport. There are times when the City does not or cannot obtain a patient signature and McKesson must gather a signature from the patient before filing a claim. Most patients were not returning the signature forms that were mailed out. McKesson decided to add an e-signature Page 12 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MCKEON feature to our online patient portal, www.peryourhealth.com. Your patients have been using the portal for many years, and have witnessed improvements to the portal. Now when we are missing a patient signature, we direct a patient to our portal where they can provide an e- signature so that we may bill Medicare. The patient can also update their address, insurance, guarantor information, and save or print out a patient statement through the same portal. We will happily demo the portal for the City of Miami so that you can see what your patients sees. No other vendor has such a robust patient portal. Since the City of Miami shares revenue with union members, we have even met with your union to explain the EMS billing process. We have always gone beyond to exceed the City's expectations. This same dedication is also seen in the way we treat your patients. Throughout the years, patient complaints are almost zero. We hope to continue to provide the City with the revenue and service it has experienced since the 1990s. d) Provide information concerning any prior or pending litigation, either civil or criminal, involving a governmental agency or which may affect the performance of the services to be rendered herein, in which the Proposer, any of its employees is or has been involved within the last five years. To the best of our knowledge, the EMS billing division of McKesson does not have any pending litigation involving a governmental agency or that could affect the performance of the services provided to the City. However, as a publicly traded company, we are required to state that any material litigation related to McKesson Corporation is included in our SEC filings available at www.mckesson.com under the Investors link. Page 13 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 McKESSON Key Personnel Performing Services 1. Provide an organization chart showing the Project Manager and all key personnel, including their titles, to be assigned to this project. All key personnel include all partners, managers, seniors and other professional staff that will perform work and/or services in this project. Pat Leonard President, McKesson Business Performance Services Jimmy Stuart VP, HAP & EMS Billing Svcs Julie Tetzloff VP, EMS Billing Ops Mauricio Chavez Specialty Vice President — EMS Mary Martin Director, Operations L Mevis Echeverria Data Entry Maria Torres Data Entry Olga Garcia Payment Posting Iris De La Torre Governmental Specialist Irene Stukl Accounts Receivable Management Specialist 2. Describe the experience, qualifications and other vital information, including number of years of relevant experience on previous similar projects, of the Project Manager and all key personnel, who will be assigned to this project. Our experienced team of professionals has the education and training necessary to implement and manage a successful ambulance billing program for you. In addition to these lead employees (biographies below) , we will also assign your account to a billing team to ensure we have an adequate number of specialists and resources to serve you. We are proud of the strength of our team and encourage your selection staff to read the following biographies. Page 14 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M KESSON Patrick (Pat) Leonard, MBA, President, McKesson Business Performance Services Mr. Leonard is responsible for all operations related to academic/multi-specialty enterprise, office -based, anesthesiology, emergency medicine, pathology, independent laboratory, outreach laboratory, and radiology business. Prior to our acquisition of Per -Se Technologies in 2007, he served as president of Per - Se Technologies' physician solutions from 2006-2007 and senior vice president for specialty operations from 2004-2006. Mr. Leonard joined Per -Se in 1994 and held leadership positions with the service group and account management team. Before that, he was a consultant for Rockwell International and spent four years in public accounting with Deloitte & Touche. Mr. Leonard earned his Bachelor in Accounting from George Mason University and his Master in Business Administration (MBA) from University of Pittsburgh. Christopher Robertson, MHA, Vice President Mr. Robertson is Vice President, Operations for McKesson's billing services. He has been an employee of McKesson since May 1999. Starting his McKesson career as an account manager, he advanced to regional vice president, and, in 2004, was named vice president for the west division of McKesson radiology operations. Mr. Robertson holds a Bachelor of Science in Biology and a Master of Health Administration from the University of Missouri. Jimmy Stuart, Vice President, Hospital Affiliated Physicians and Emergency Medical Services Operations Mr. Stuart has responsibility for hospital affiliated physicians operations including emergency medicine, emergency medical services, and anesthesia revenue cycle management services. In his previous position, he was responsible for the radiology operations in the eastern United States. He joined the company in 1995, has served in various radiology operational roles for the past 15 years, and was previously responsible for the southeast operations. Mr. Stuart earned his Bachelor of Business Administration degree from Texas Tech University and Master of Business Administration degree from the University of West Florida. John R. Outlaw, CHC, CHBME, Compliance Officer Mr. Outlaw is the compliance officer for our hospital affiliated physicians and EMS billing division and has 30 years of experience in healthcare claims administration, third party medical billing and government contracting. Prior to joining McKesson, he was vice president for regulatory affairs and chief compliance officer for PSA, LLC, a division of MED3000, where he served as the chief company contact with regulatory agencies, industry advocacy groups and other key policymakers and industry stakeholders, and provided strategic input in PSA's business development and revenue cycle management activities. He also spent 19 years with Palmetto Government Benefits Administrators (PGBA), where he was Director of TRICARE Operations. He holds certification in Healthcare Compliance (CHC) by the Healthcare Compliance Certification Board and is a Certified Healthcare Billing Management Executive (CHBME) with the Healthcare Billing & Management Association (HBMA), where he is also a member of the Board of Directors and is past chair of the HBMA's ethics and compliance committee, Patrick DeAngelo, Vice President and Chief Information Officer Joining McKesson in 2005, Mr. DeAngelo is currently responsible for information security, infrastructure, development, implementation, optimization and maintenance of all information technology systems. He has over 15 years of healthcare financial operations management and technical experience for the two largest companies in the business, Siemens and McKesson, He was a major contributor in developing the technical and operational BPO infrastructure for Siemens Medical Solutions, Zavata, and McKesson. Page 15 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M KESSON Theresa M. Gray, Director of Information Technology Ms. Gray is responsible for leading our solutions development team in its commitment to the development of software for success in exceeding industry requirements. Under her leadership, we have rewritten specialty -based software advancing our offerings to clients. In her previous role, she developed the implementations team in her prior role that is focused on the successful long-term partnerships with our new office -based, hospital -based, and academic clients. Beginning her career at McKesson in 1988 as a programmer/analyst specializing in claims and remittance, Ms. Gray has a Bachelor of Science Degree of Computer Science/Business. Broad functional strengths include operational and account management with technical development skills. Herroles within the organization include director of IT and implementations; vice president of clearinghouse operations; director of IT for three legacy billing platforms; programming manager; MDIV programmer/analyst; and regional consulting analyst. Rob Loyd, Director of Implementations Mr. Loyd is responsible for leading our implementations team in its commitment to the development of successful long-term partnerships with our new office -based, hospital -based, and academic clients. I-Ie and his team provide accountability in all implementation tasks using well -planned and documented transition services that deliver predictable and consistent results. Beginning his career at McKesson in 1994 as an operations manager, Rob has had the opportunity to work in various arenas of revenue cycle management including front-end and back -end processes, as well as high-level interface development/management skills. His roles with the organization include operations manager, system support manager, process improvement analyst, business analyst, project manager; and interface development manager. Julie Tetzloff, Vice President, Emergency Medical Services Ms. Tetzloff is responsible for operations and account management in the Emergency Medical. Services billing division of McKesson Business Performance Services. She has been with the company since 1996 and has served in various roles during her tenure. She has experience with operations, account management, Six Sigma process improvement methodology, new client implementations, and acquisition integration. Ms. Tetzloff earned her Bachelor of Arts degree from Miami University and a Master of Public Health degree from Tulane University. Mauricio Chavez, Specialty Vice President — EMS Mr. Chavez is responsible for all EMS billing operations in our Miami EMS Billing Center of Excellence. He is responsible for overall client satisfaction. Mr. Chavez meets with clients on an as needed basis to tackle issues, answer questions, review financials, provide training, and other responsibilities that arise in the day-to-day business operations. Mr. Chavez joined McKesson in 1989. Through the years, he has served in many roles with in the company, from computer operations, programming, report writing, client management, and director of operations. He has been directly involved with the City of Miami since day one, and continues to be the main contact and project manager for the City of Miami. Mary Martin, Director of Operations Ms. Martin is responsible for overseeing the day-to-day operations of data entry, payment posting, coding, customer service, and AR management departments. Her experience and attention to detail is what sets her apart from others. She has worked with all EMS agencies that are processed from the McKesson EMS Center of Excellence in Miami, Florida. McKesson recognizes her over 40 years of service with the company. Mary has worked with the City of Miami since day one and continues to manage the day-to-day activities of the City's account. Page 16 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MKESSON Joe Lineberry, CPC, CHC, RMS Compliance Officer Mr. Lineberry leads our business compliance team and has business compliance responsibility for the coding quality assurance program, including coding regulatory support, quarterly auditing of coders and documenting and reporting quarterly coding audit results to our business unit leadership team, McKesson Technology Services (MTS) corporate compliance team, and the MTS leadership team. His payer and billing company experience provides unique insight to help clients resolve coding, billing, and compliance challenges. Mr. Lineberry's areas of expertise include denial management, Medicare billing regulations, coding, and compliance plan development and physician documentation analysis for compliance. He and his team conduct client and coder in-service training and provide updates to clients via the ReveNews, a McKesson client publication. Since joining McKesson in 1997, Mr. Lineberry has also served as a regulatory affairs specialist in the corporate billing compliance department. He was previously a claims manager for CIGNA Healthcare in Atlanta, Georgia. Mr. Lineberry holds certification in Health Care Compliance (CHC) through the Health Care Compliance Association, has been credentialed as a Certified Professional Coder (CPC) by the American Academy of Professional Coders since 1997, and has served as an instructor of the CPC curriculum at Herzing College in Atlanta, Georgia. 3. Provide resumes, ifavailable with job descriptions and other detailed qualification information on the Project Manager and all key personnel who will be assigned to this project. In addition to Mauricio Chavez, Specialty Vice President — EMS, and Mary Martin, Director of Operations, (resumes provided in the Appendix section of our proposal) the following individuals will be dedicated to your account. Mevis Echeverria — Data Entry — Mevis has been working with McKesson in a data entry capacity for over 25 years. In that time, she has worked with many EMS accounts, including the City of Miami, She has worked with City of Miami since day 1. She has extensive knowledge of what data is needed for the billing process. Maria Torres — Data Entry — Maria has been working for McKesson for over 15 years in the data entry department. She currently performs data entry for many of our EMS clients, including the City of Miami She has worked with the City of Miami since day one. Olga Garcia — Payment Posting — Olga has been working for McKesson for over 35 years. She has extensive experience with the posting of monies to accounts, balancing to lockboxes, and processing refunds for clients. She has been performing and managing the payment posting duties for the City of Miami since day one. Iris De La Torre — Governmental Specialist — Iris has been working with McKesson for over 25 years. She has extensive experience in working with Governmental payers to get your claims paid. She oversees all of the Medicare and Medicaid denials, submits claims for review, tracks trends, and provides feedback to upper management. Iris has the appropriate training so that she can stay on top of all changes to Governmental payer's rules and regulations. She currently oversees all the of Governmental payer denials for all of the EMS transport billing clients for McKesson. She has been working the governmental claims for the City of Miami since day one and has assisted in all Florida Medicaid audits that have occurred throughout the years. Page 17 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MKESSON Irene Stuki— Accounts Receivable Management Specialist - Irene has been working with McKesson for 25 years. Her expertise is in working accounts receivables to maximize revenues for our clients. She has been working on EMS transport billing accounts since she began with McKesson in 1990. She has been working with the City of Miami since day one and continues to provide follow-up and customer service to the City of Miami patients. We hope you have noticed something. Our employees stay with us a long time, many times throughout their entire career. Our employees stay with us for the same reason our clients stay with us, we treat them well. NO OTHER VENDOR can offer the level of stability that McKesson offers. Make no mistake about it, a stable workforce matters. Heavy turnover causes chaos in an operational environment. That chaos directly affects client service and revenue. We have had the same employees working on your account since the first day we started performing your billing. It would take a new vendor 15 years to catch up to our level of expertise on the uniqueness of the City of Miami. As required in your RFP, we will advise the City of any changes to the project manager and key personnel identified in this proposal. Page 18 Emergency Medical Transport Billing & Collection Services City of 1Vliaml May 18, 2016 MSKE SQN Proposed Approach to Providing the Services 1. Describe Proposer's approach to project organization and management, including the responsibilities of Proposer's management and staff personnel that will perform work in this project. The same billing team that worked with the City of Miami in the 1990s will continue to manage the City of Miami account. Supervisors manage teams of billing specialists. The billing specialists manage all aspects of their client accounts including call charge/bill, health insurance acquisition, posting, and accounts receivable follow-up. We divide billing work by function. As they do today — the City of Miami can contact any member of our team to ask questions or obtain information on patient accounts. We have ALWAYS responded to all City of Miami requests in an expeditious manner, and we will continue to do so. 2. Provide Proposer's operational plan that clearly indicates how the Proposer plans to provide the services requested in this Solicitation. The Proposer's operational plan must detail how the Proposer intends to fully satisfy the requirements outlined in this RFP, and proposed actions that will be taken to ensure maximum recovery of each account that has been assigned. (See Section 3.0) The operational plan should: Our billing and collection cycle solution focuses on improving our clients' billing process, resulting in lower costs, increased collections, and more effective accounts receivable management. We achieve this by implementing our Lean Six Sigma best practice process management including specific billing protocols, pre -claims submission editing follow-up, along with payer -specific claims follow-up guidelines, patient/guarantor billing and follow-up, client and staff education, and the overall application of our management methodologies which have proven very effective in other comparable companies. Our process in handing an account, from start to finish, entails the steps illustrated in the diagram on the following page: Page 19 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MKESSON P all e nt treatment/demo info captured by EMS personnel in EMS ePCR Hospital acquires accurate health insurance information; Sends totdcKessbn electronically Claim created, edited& submittedto insurance comp -any Patient care report files coded with most appropriate HCPCSandICD code McKesson updates health insurance information to ePCR. Payment processed by insurance company Paymbntsentto .r client lockbox Payment info forwardedto McKesson for posting Balance due sent to individual or written -off per established policy Figure 1 - McKesson's Best Practice Process Management using the McKesson EMS Billing System. Your revenue cycle processes and collections will improve through our accurate data collection, specific billing protocols, application of pre -claims submission editing, payer -specific claims submission and follow-up, patient/guarantor billing and follow-up, client and staff education, and our management methodologies. EMS Revenue Cycle Process Overview 1. Demographics Interfaced — Our system interfaces with the Hospital Information System (HIS) to import Patient Demographic information. 2. Charges Interfaced — Patient care records interface into the system. 3. Transports Coded — Certified coders code and enter transports into EMS Coder. They use web -based Requests for Additional Information (RAI) to clarify missing or incomplete information. 4. Claims Editing — The system automatically edits claims. Our employees follow-up on rejections. 5. Claims Submission — Claims are generated and sent electronically to our clearinghouse (Relay Health) for transmission to over 1,800 payers, including commercial and government (Medicare, Medicaid, TRICARE, etc.) . Claims can also be printed and mailed. 6. Patient Statements Generation— We print and mail patient statements for self -pay and patient responsibility billing using the latest in United States Postal Service (USPS) -approved software to ensure we have the most accurate addresses. Page 20 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKE$SON 7. Remittance Receipt — The system automatically receives Electronic Remittance Advices (ERAs) from the payers posts them by line item, Employees key and post paper remittance advices by line item. 8. Payment Posting — The system processes and posts payments sent to your lockbox (Electronic Funds Transfer, Cash Deposits, Checks, etc.) by line item. 9. Payment Verification — Payments are compared to expected reimbursement. Employees identify, follow-up on, and resolve under -payments and over -payments. 10. Payer Monitoring and Follow -Up reports are generated and denials are tracked and resolved. 11. Accounts Receivable Follow -Up — Our specialistsperform account follow-up with payers and patients to ensure timely payment, including automated outstanding balance reminder calls by our Tele Connect system. 12. Patient Services — For inquiries or to make payments, patients (or guarantors) can contact our customer service center during normal business hours to speak with a customer service specialist. All statements contain the toll -free number and instructions to access our patient portal. 1) Indicate how the Proposer will address client relations while maximizing collections. As the City of Miami already knows, we are committed to excellence in customer service. We understand our customer service department is an extension of your organization and we train our staff to be courteous and helpful when responding to EMS patient phone calls. Customer service representatives are available via a toll free number Monday through Friday (excluding holidays) from 8:00 a.m. to 5:00 p.m. Eastern to answer any incoming customer service inquiries. Our goal is to satisfy all caller issues quickly and courteously. However, callers who feel the customer service representative is not helpful or is responding inappropriately will have the option to speak with the team supervisor to resolve the issue. For self -pay accounts, we base our follow-up philosophy on our mutually developed strategy. We send three self -pay statements and make at least one phone call over a 90-day timeframe. Teaming with you, we have established a matrix by statement balance and period that describes the self -pay collections process from first statement to collections. As part of our program, we have established: • Accounts receivable policies and procedures • Pre -collections policies and procedures • Payment plan policies and procedures • Small balance write-off policies and procedures Page 21 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON We make every attempt, including establishing payment plans according to your policies, to keep accounts from being sent for collection agency activity. At any time a payment is made within the statement cycle, we restart the process and continue to make every effort to collect the outstanding balances. We have always and will always treat all of your patients with respect. It is why we have had very few patient complaints in the last 20 years. We do this while still pursuing revenue as aggressively as possible, particularly from governmental and commercial payers. The proof that we are also extracting as much as possible from your self -pay population is in the amounts collected by Penn Credit, your collection agency. Penn Credit only collects about one to two percent of what McKesson send to collections. This is not because Penn is doing a bad job; it is because McKesson is doing an outstanding job of finding patient insurance information and pursing all self -pay accounts before they are sent to collections. 2) Provide examples of the type and series of collection notices that are proposed and indicate chronological stages of their use in the individual collection process. We have provided samples of our patient correspondence in the Appendix section of our proposal. Once the initial claim is sent to primary and secondary providers, we send out subsequent bills on a 30-, 60-, and sometimes 90-day billing cycle following the date of the initial bill. 3) State the length of time a collection activity is maintained by Proposer before the particular account is downgraded or considered uncollectible. At the end of the billing cycle, any remaining balance is designated for write-off and is either written off in total or forwarded to a collection agency as dictated by the City. We currently keep accounts for six to eight months from the time the account has a self -pay balance before sending the account to collections. We work with patients to setup payment plans whenever possible to avoid sending an account to collections. The patient receives a combination of statements and letter, plus a TeleConnect call, depending on the financial class and billing cycle the patient is in. The proof of our success with this process is in the amount collected by your collection agency, Penn Credit. Penn Credit is collecting only between one and two percent of the amounts sent over by McKesson. This means that McKesson is collecting on almost every account that can be collected. There are always patients that will not respond until their account is sent to collection and their credit report is affected, which is certainly a collection agency function. 4) Describe Proposer's collection procedures. As your current billing services provider, we have already established mutually acceptable billing policies and account follow-up procedures. Focused on these parameters, account follow- up specialists monitor your interests. Page 22 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MKESSON Insurance McKesson staff will monitor all billing data submitted for reimbursement to alert us of any potential delay in payment. Special system alerts automatically identify claims that are reaching unacceptable aging limits based on the current claim responsibility. Our account follow-up staff addresses claims early in the aging process to ensure optimal cash collections. They follow a strict protocol of corrective action as outstanding balances reach critical aging points. We select our account follow-up personnel because they possess a special skill set that ensures dedication to the task and persuasive communication. We prepare and train our personnel to work with both insurance companies and patients to collect the outstanding A/R effectively. Reporting on production is critical. We generate daily reports to monitor productivity and cash flow metrics. We set target performance measures for each McKesson account and we use reporting tools track activity to reach these goals. Setting goals and monitoring performance becomes an integral part of our operations. Medicare We process Medicare claims, as we do all third party payers, through a daily series of front-end edits on the McKesson system designed to stop any incomplete claim. We can correct and submit a clean claim for billing by identifying claims issues at this early stage. A claim submitted through the McKesson Exchange will be subjected to additional edits and payer specific requirements. Claims caught at this stage will be denied internally and reported on a claim rejection report for repair. Medicare will receive claims processed successfully through the Exchange and will issue payment or denials. We receive response from Medicare electronically where payment terminates the process and denial prompts investigation. McKesson will investigate the reason for denial and take steps to resolve any discrepancy of opinion. We will pursue payment via the Medicare appeals and fair hearing process to obtain proper payment. We track all action taken to resolve claim denial issues closely. Medicare Denial Specialists work them to completion. Medicaid As stated in the Medicare section above, the process for all third party payers is similar. Where pathways are slightly different and filing timelines are different, we direct our processing pathways at ensuring accurate billing and collections in a timely manner. We check all private patients for Medicaid eligibility as well as confirm status of all Medicaid patients against the Medicaid database. Page 23 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MKESSON We also thoroughly review all Medicaid claims to ensure that they meet all Medicaid medical necessity guidelines. If a Medicaid claim does not meet the guidelines, we do not bill it. We process Medicaid claims and receive payments electronically where available. Setting the McKesson system up to recognize proper payment and adjustment is necessary for all third party payers that provide this information. We monitor governmental payers for expected payment cycles. Where reports indicate that claims have fallen outside these expected measures, we have trained our staff to investigate and identify immediately any issue that may result in slow payment or unwarranted denials. The Medicaid claim cycle completes once McKesson confirms that the charges were paid appropriately and the balance is adjusted to zero. We will not bill Medicaid patients directly for any portion of the charge. Timeframe: Daily, as alerted by system and reports. Self -Pay For self -pay accounts, we base our follow-up philosophy on a mutually developed strategy after assessment of your department's accounts receivables rather than basing it on level of difficulty to collect or a pre -determined calculation. Typically, we send three self -pay statements and make at least one phone call over a 90-day timeframe. We will use your small balance criteria to send statements and letters on small balance accounts. Teaming with you, we will mutually establish a matrix by statement balance and period that describes the self -pay collections process from first statement to collections. As part of the implementation process, you will work with us to establish: • Accounts receivable policies and procedures • Pre -collections policies and procedures • Payment plan policies and procedures • Small balance write-off policies and procedures We make every attempt, including establishing payment plans according to your policies, to keep accounts from being sent for collection agency activity. At any time a payment is made within the statement cycle, we restart the process and continue to make every effort to collect the outstanding balances. Timeframe: Daily, as alerted by -system -and -reports. Appeal processing McKesson specializes in denial management and revenue optimization. As such, we must re -file any insurance denial and manage the outcome. All of our clients benefit from our denial monitoring and re -filing services. Page 24 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MKESSON McKesson knows what payer requirements are, what format they want their claims forms in, what edits they use, how modifiers should be used, and what is going to be denied. We will identify opportunities to optimize reimbursement, such as correct coding edits. McKesson Strengths: • McKesson has the Gold Standard Compliance Program. We keep up with all regulatory changes in the industry. • McKesson uses the Fraud and Abuse Management Systems (FAMS) that the Center for Medicare and Medicaid Services uses to audit the provider community. • McKesson has created a catalog of behavior patterns that identify when a claim falls within normal parameters. Additionally McKesson will: • Perform a thorough analysis to identify the top reasons for denials. • Establish standardized reject and denial codes for tracking purposes. • Introduce send back forms to be used before the claim goes out. If a coder is uncertain of a diagnosis or documentation determines a claim is not a payable diagnosis or the diagnosis cannot be coded, this can significantly reduce the number of denials before the claim goes to the payer. • Develop a reporting system to track denials and measure progress (including user- friendly reports with drill -down capabilities for detailed analysis) . • Use the hard data to drive your corrective actions. Prioritize denial problems based on revenue impact. • Provide well -trained, experienced personnel to work back -end denial reports, do the research, obtain additional information, and re -file the claim • Use denial data to implement corrective actions on the front end. This turns a denied claim into a payable claim prior to submission and speeds up cash. Timeframe: Daily, as alerted by system and reports. Co-insurance / supplemental insurance processing Where patients have co-insurance/supplemental insurance, our system will produce a claim after receiving payment from the primary payer. We process these secondary claims through the _McKesson Exchange and PrintandMail Serviceslasercenter, where they will beproducedon -- payer specific claim forms. Timeframe: Daily, within 24 hours of primary payment. Page 25 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON Private pay account processing and follow-up Where we have issued all third party payments and adjustments and claim balances become the patient's responsibility, a patient will automatically become eligible to receive a statement for the balance. Eligible patients will receive City -formatted billing statements directly from the McKesson Statement print and Laser Center. Here all statements are printed, folded, stuffed in envelopes, and prepared for mailing with automation. Each statement communicates every transaction to the patient on a line item basis. We provide a toll -free telephone number for patients to discuss any questions regarding the billing process with a McKesson Account Representative. As an alternative to calling the toll -free number, patients can also access information regarding their account via our patient portal called PerYourHealth.com. This allows patients to view statements, update demographic and insurance information, as well as get answers to balance related questions 24/7. Timeframe: Daily, within 24 hours of primary payment. Establishment of payment plans The McKesson EMS Billing system can establish patient payment plans easily. We will provide this service as deemed necessary by the City. You can also establish minimum amounts. Timeframe: As necessary. For self -pay accounts, we base our follow-up philosophy on a mutually developed strategy after assessment of your department's accounts receivables rather than basing it on level of difficulty to collect or a pre -determined calculation. Typically, we send three self -pay statements and make at least one phone call over a 90-day timeframe. We will use your small balance criteria to send statements and letters on small balance accounts. Teaming with you, we will mutually establish a matrix by statement balance and period that describes the self -pay collections process from first statement to collections. As part of the implementation process, you willwork with us to establish: — Accounts receivable policies and procedures — Pre -collections policies and procedures — Payment plan policies and procedures — Small balance write-off policies and procedures We make every attempt, including establishing payment plans according to your policies, to keep accounts from being sent for collection agency activity. At any time a payment is made Page 26 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MESON within the statement cycle, we restart the process and continue to make every effort to collect the outstanding balances. 5) Describe the Proposer's capabilities to accommodate electronic transfer of accounts, computer disk and/or hard copy paper files. We are able to accommodate any method of data transfer, electronic or hardcopy, and do so for the City today. We currently have a robust interface with your current ePCR system SafetyPAD. We have modified that interface as required each time the City has changed ePCR vendors (about three times through the years). We have a dedicated team of McKesson programmers that work only on interfaces, and are able to modify the data interfaces quickly. We also have several methods of sharing confidential data with the City, from secure email to SFT sites. We have even developed an internal tool named Slingshot that is capable of handling files over 10mbs which regular email cannot handle. We currently use our SFTP solution to share data files with the City of Miami. 6) Describe the methods the Proposer accepts for payment (i.e., credit card, check, etc.). We accept all methods of payment from your patients including credit card, check, and PayPal. Patients can access our online portal or call the toll -free number to make a payment on their account. 7) Describe Proposer's ability to fulfill the reporting requirements, as described in the Scope of Services, Section 3.0 (14). As your current billing services provider, we already provide the City with the reports described in the Scope of Services, Section. 3.0 (14) . We will continue to provide these reports to the City. The City can request additional reports at any time for no additional cost. 8) Provide samples of the proposed billing forms/invoices described in the Billing Services, Section 3.0 (5) (g) and (h). We have provided samples of the billing forms/invoices in the Appendix section of our proposal. 9) Describe Proposers systematic plan for determining over payments and assuring refunds are provided to patients or third party providers within three months of overpayment/credit status. Refunds Fromtimeto time, -overpayments -occur onpatientaccounts due to many reasons including the insurance company and the patient both paid the bill; the patient paid the bill twice; the insurance company paid the bill twice, etc. When we discover an overpayment, one of our employees not involved with the previous transaction(s) will validate the refund. We will perform all procedures in accordance with internal policy, client contracts, and governmental regulations. We will maintain documentation of any action taken. Page 27 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON In the case of a patient overpayment or upon receiving direction from the related third party, a refund check request shall be prepared and forwarded to the client (or McKesson personnel as appropriate), who then prepares and sends the refund check. Only validated refunds may generate a refund check request. The City states that refunds must be handled within three months. McKesson actually handles all refunds within 60 days. That policy was written by our compliance department and is executed by our operational staff to ensure compliance with all governmental regulations. 10) Include a narrative that details the complaint procedures, including the resolution process that will be followed in the event a complaint is received from a client or their representative. As an important part of our business, we are committed to excellent customer service. We understand our customer service department is an extension of your organization and we train our staff to be courteous and helpful when responding to EMS patient phone calls. Our goal is to satisfy all caller issues quickly and courteously. However, callers who feel the customer service representative is not helpful or is responding inappropriately will have the option to speak with the team supervisor to resolve the issue. In this case, the team supervisor enters a brief recap of the call on the patient notes screen of the customer service software at the end of the call. The supervisor then debriefs the customer service representative and provides any coaching required. Should instances of caller complaints continue regarding the same customer service representative, we will re-train him or her. Further incidents could result in employee termination. Complaints regarding the customer service department will be forwarded to an assigned contact within your organization. Additionally, all of our executive staff employees can be accessed virtually 24/7 by any of your key administrative personnel to respond to any issues or inquiries. As the City of Miami is aware, we have received a minimal number of patient complaints in the last 20 years. Whenever there has been a patient that is not satisfied, we have quickly relayed that information to City personnel. Every instance has been resolved. We hope to continue to give your patients and City excellent customer service for years to come. Page 28 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M KESSON 11) Identify if Proposer has taken any exception to the terms of this Solicitation. If so, indicate what alternative is being offered and the cost implications of the exception (s). These are clarifications rather than exceptions. RFP Section RFP Language McKesson Assumption Certification, p. 3 Does the Proposer acknowledge that the Attached Professional Services Agreement is an example of the standard Agreement used in conjunction with the Services related to this solicitation and shall not be amended? PST Services, Inc. has made certain assumptions regarding the Professional Services Agreement, which are noted in its response to this RFP. In addition, PST may need to add terms and conditions to the Agreement that are specific to the EMS billing services PST shall provide. Terms and Conditions, 1. General Conditions, 1.22 Conflict of Interest, p. 10 Bidders/Proposers, by responding to this Formal Solicitation, certify that to the best of their knowledge or belief, no elected/appointed official or employee of the City of Miami is financially interested, directly or indirectly, in the purchase of goods/services specified in this Formal Solicitation. Any such interests on the part of the Bidder/Proposer or its employees must be disclosed in writing to the City. Further, you must disclose the name of any City employee who owns, directly or indirectly, an Interest of five percent (5%) or more of the total assets of capital stock in your firm. Because PST Services, Inc. is a wholly owned subsidiary of McKesson Corporation, a publically traded company, it is not possible to verify if any City of Miami employee owns stock in McKesson Corporation. Revised Sample Contract, 5. Ownership of Documents, pp. 4 -5 Contractor understands and agrees that any information, document, report or any other material whatsoever which is given by the City to Contractor, its employees, or any subcontractor, or which is otherwise obtained or prepared by Contractor solely and exclusively for the City pursuant to or under the terms of this Agreement, is and shall at all times remain the property of the City. Contractor agrees not to use any such information, document, report or material for any other purpose whatsoever without the written consent of the City Manager, which may be withheld or conditioned by the City Manager in his/her sole discretion. Contractor is permitted to make and to maintain duplicate copies of the files, records, documents, etc. if Contractor determines copies of such records are necessary subsequent to the termination of this Agreement; however, in no way shall the confidentiality as permitted by applicable laws be breached. The City shall maintain and retain ownership of any and all documents which result upon the completion of the work and Services under this Agreement as per the terms of this Section 5. PST Services, Inc. assumes that the City owns its own data, but PST Services, Inc. retains ownership of its own intellectual property, as well as any forms and processes It creates. Page 29 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M KESSON 2.11 Insurance Requirements The Successful Proposer shall furnish to City of Miami, c/o Procurement Department, 444 SW 2nd Avenue, 6th Floor, Miami, Florida 33130, Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets the requirements as outlined below; (1) Worker's Compensation A. Limits of Liability - Statutory - State of Florida (2) Commercial General Liability (Primary and Non - Contributory): A. Limits of Liability Bodily Injury and Property Damage Liability - Each Occurrence: $1,000,000 General Aggregate Limit: $2,000,000 Personal and Adv. Injury. Products and Completed Operations and Fire Damage: $1,000,000. B. Endorsements Required: City of Miami included as an Additional insured. Employees included as insured. Contractual Liability. (3) Business Automobile Liability A. Limits of Liability Bodily injury and property damage liability combined single limits. Any Auto, including hired, borrowed or owned, or non -owned autos used in connection with the work - $1,000,000 B. Endorsements Required: City of Miami included as an Additional Insured PST Services, Inc. is a subsidiary of McKesson Corporation, a Fortune 11 company, and maintains appropriate levels of insurance. As such, upon award of the contract, PST Services, Inc. will work the City to negotiate specific language regarding insurance as well as provide evidence of appropriate coverage. We have maintained appropriate converge since the beginning of our business relationship with the City in 1999. Page 30 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MESON Response to Scope of Services 3. Transition The Successful Proposer shall have sixty (60) days from award of the contract to transition the services from the incumbent vendor to the Selected Proposer's system. The Department will coordinate the Successful Proposer's activities with the incumbent vendor to ensure an orderly transition. Moreover, a seamless data conversion must occur with incumbent vendor. During the "transitional period" the Successful Proposer shall maintain "current existing performance levels" with regard to billing and collections. A 2% or less margin of deviation will be considered acceptable. As your current billing vendor, McKesson is the only company that can state with 100% confidence that we will be able to continue providing services on day one of a new contract with the City. By staying with McKesson, the City will not experience any interruption in cash flow or customer service. The Successful Proposer will not receive compensation during this transitional period and shall be limited to the fees provided in the Price Schedule. The Successful Proposer, in carrying out the above, will be expected to cooperate with the Department and other City agencies in determining the training, forms, requirements, necessary files and other materials and services required to initiate and maintain these operations. This does not apply to McKesson as there will not be a transition period. 4. Services to be Provided Successful Proposer shall: a) Have the ability to accept data from the Department or its electronic Patient Care Reporting system (ePCR) provider and accurately process billings; We currently accept data from the Department and its ePCR system to accurately process billings. We receive a daily billing file and reconcile the billing system to files received to ensure that we bill all accounts. We would like to enhance the audit trail of accounts received to accounts billed comparing the "Case Number" in the SafetyPAD system to the Case Number imported into the McKesson billing system. We can interface with any ePCR system the City were to choose in -the -future.. -We have -rewritten -the interface three -times for --the City. b) Retrieve all data from incumbent billing provider and download into Successful Proposer's database; As the incumbent billing provider, we will not need to establish any data transfers with other vendors. Page 31 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 IKESSON c) Have the ability to access and resume service on previously billed accounts; and We will continue billing patient accounts as we currently do today on day one of the new contract with the City. There will be no downtime or transition activities. d) Have the ability to produce required reports including but not limited to financial and management reports. We currently produce all reports requested by the City of Miami, including financial and management reports. We can create any new reports for the City as requested at no additional charge. If the data is in our system, we can report on it. In addition to the above, the Successful Proposer shall: a) Clearly demonstrate the ability to delineate and operate a fail-safe Data Recovery Project Plan and System should a disaster or unanticipated down time occur; To avoid malfunction -related data loss, we back up all systems nightly and store 60 days of backups in an on -site fireproof vault. We send weekly backups to offsite secure storage for additional protection. In the event of a business interruption/ disaster, there are sufficient redundancies built into the configuration to ensure that adequate resources are available to continue processing your organization's business. Having our system servers housed in a secure data center affords us the capability to become a mobile office and/or to shift work to another of our 50 offices throughout the country. We have data lines and communications across all power grids in the United States. Our employees can access the system via the McKesson network configuration, Internet access using VPN, and telephone / modem connections. Should a disaster occur in your city or the Center of Excellence managing your accounts, we can make your data available to other power grids for processing at one of our other locations. Should a disaster occur at our North Druid Hills, Georgia Data Center, we have contracted with IBM's VSR silver service (virtualized server recovery- a cloud recovery solution) and IBM Enterprise Recovery for hot site services for servers not qualified under VSR. This DR program is a hybrid solution. We back up our systems to IBM's Sterling Forest, New York location daily. Special 800 numbers are published and provided to our staff for them to call, Recorded. messages include important contact numbers so that we can aid in the process of relocation of essential operations staff to one of our other Center of Excellence offices that is out of harm's way. Through regular testing of our system failure and disaster plans, we have implemented the -necessary policies- procedures, and resources to either restore data from backup or switch production to another McKesson Center of Excellence within one day. During one of the many hurricanes to hit Miami a few years ago, the McKesson building lost power for over two weeks. We were able to access our billing system, including our IP phones from a large conference center that still exists within the office complex where our building is Page 32 Emergency Medical Transport Billing & Collection Services City of'Miami May 18, 2016 I KESSON located. We were able to continue to process accounts and even receive patient phone calls with minimal interruption to operations and no interruption to cash flow. b) Provide a thorough description of the technology that will be utilized (Le., hardware, software, database, security and network infrastructure). Unlike most other billing vendors, we own virtually every significant software system, tool, and process involved in revenue cycle management. Owning all pieces of the billing process end -to - end allows us to eliminate paperwork, accelerate processing, and reduce costs through automated processing. Those end -to -end billing processes include: • Our EMS Coding front-end process marries electronic patient care records to hospital patient demographic/insurance records and allows our staff to code your transport and prepare it for billing to the appropriate insurance carrier. • A benefit to the City of Miami is the quality reporting on crewmembers and signature capture through our EMS Coding reporting system. EMS Coding provides an unmatched tool for managing hospital electronic interfaces maintained for you, allowing us to identify poor performing interfaces for process improvement purposes. EMS Coding also provides an eloquent tool to manage and inventory PCRs records queued up for billing purposes, allowing us to monitor the number of PCRs waiting to be processed. • A team of 29 professionals, including nine full-time programmers, provides customization to our proprietary billing platform, MDIV to meet your program requirements. Using our own billing software system allows us to respond rapidly to changes in the market for our expanding client base. • Relay Health, our internal electronic clearinghouse, used by many billing vendors to manage their electronic transactions. Our system manages over 1.9 billion financial transactions annually, valued at over $1.1 trillion, Many billing vendors actually use McKesson's clearinghouse solution to manage their electronic transactions. Relay Health also provides an online insurance verification tool, providing the ability to confirm insurance coverage before filing a claim. • Our own patient payment portal, PerYourHealth, allows your patients to update their demographic/insurance information, make payments online, download patient statements, and even provide an e-signature for those cases where a proper signature was not captured at the time of transport. • Our data warehouse facilitates data flow. Each day, every client's billing and accounts receivable activity information feeds into the data warehouse for storage. We also use this data to generate reports. Page 33 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON c) Demonstrate and describe its plan for achieving compliance with the Transaction and Code Set, Security and Privacy regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPPA); and McKesson is in full compliance with all HIPAA rules and regulations. We send ICD-10 Diagnosis codes to all payers, including Medicare and we file everything electronically to Medicare (no paper) . Our ability to submit successfully to all payers is proof of our compliance with HIPAA TCS. In addition, we use an outside vendor to validate our Local Medicare Review Policies (LMRP) and Correct Coding Initiatives (CCI) edits. McKesson has developed specific HIPAA-compliant policies and procedures for Privacy and Security compliance as listed below, Our compliance with PCI and HIPAA regulations is audited at least quarterly. General Policies • HIPAA Privacy Structure • Privacy Questions, Complaints and Incidents • Minimum Necessary • Computer Information Security • Employee HIPAA Privacy Training • Electronic Transmission of PHI - Email • Electronic Transmission of PHI — Fax • PHI Outside of McKesson RMS Controlled Facilities • Media Management • Physical Access • Personally Identifiable Information (PII) & Protected Health Information (PHI) Work In Process Storage • Working Remotely • Business Associates • Disclosures and Accounting of Disclosures • External Communication of HIPAA Policies • De -Identified Protected Health Information (PHI) • Marketing of Protected Health Information (PHI) • Protecting Credit and Debit Card Information Page 34 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M KES ON Interacting With Patients • Handling a Patient's Request for Confidential Communications • Handling a Patient's Request for Restrictions to Protect Their Healthcare Information • Communicating With Patient's Representatives • Patient's Right to Copies of Confidential Health Information d) Demonstrate established relationships with insurance providers to ensure a timely collection of relevant insurance information. As your current billing vendor, and as a vendor with a strong presence in Florida, we have established relationships with insurance providers and collect relevant insurance information in a timely manner. Our strong presence in Florida is not just in EMS billing, we also bill for other specialties throughout the state such as radiology, pathology, emergency room physicians and anesthesiologist. This large billing volume has allowed us to create special relationships with Florida payers that no other vendor can match. In addition, we have electronic data interface with your largest transport hospitals, which provides us with another reliable method of receiving patient insurance and demographic information. We also subscribe to all available governmental and third party data bases to search for missing patient demographic and insurance information. Our McKesson owned claims clearinghouse, Relay Health, is also used to check insurance coverage. 5. Billing Services The Successful Proposer shall employ, maintain and assign an adequate number of competent and qualified professionals, as deemed necessary by the Department to meet the performance requirements. The Successful Proposer shall take the necessary steps in terms of billing patients, following -up with patients via mail, phone, or other available communications means, to maintain the same, or higher collection levels as the incumbent vendor during calendar year 2014/2015. The Selected Proposer shall transfer any uncollectible accounts to the Department at the request of the Department. We are currently able to meet performance requirements in handling your accounts and maximizing your revenue. Our experienced staff, which no other vendor will be able to duplicate, is the reason for our consistently great service and collection achievements. We always strive to outdo ourselves and are constantly looking for ways to improve the process for the City of Miami. As of this writing, our cash collections are up over $1.8 million compared to last fiscal. year. Page 35 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKE SON Pursuant to the Scope of Services, the Successful Proposer shall perform all services and/or work necessary to complete the following tasks and/or provide the following items: a) Electronic Receipts of Billing Information from Department: The Successful Proposer shall have the capability to receive all billing information from the Department and/or its ePCR provider in a standard electronic format. We currently receive all billing information from the Department and its ePCR provider, SafetyPAD, electronically. We can enhance or write new interfaces as required by the City at no additional charge. b) Electronic Claims Submission: The Successful Proposer shall provide the capability to transmit/submit claims electronically to Medicare, Medicaid, and commercial insurance carriers. We use Relay Health, our McKesson -owned, internal electronic clearinghouse, for transmission to over 1,800 payers, including governmental (Medicare, Medicaid, TRICARE, etc.) and commercial, to manage their electronic transactions. Our system manages over 1.9 billion financial transactions annually, valued at over $1.1 trillion. Relay Health also provides an online insurance verification tool, providing the ability to confirm insurance coverage before filing a claim. All of these tools are currently used by McKesson to process the City of Miami claims. No other billing vendor owns a clearinghouse or has control over the entire process as McKesson does. c) Patient Information: The Successful Proposer shall take action to obtain any necessary information which. may not be in the initial account file. The Successful Proposer shall enter into a business associate agreement with area hospitals to obtain patient information in accordance with Health Insurance Portability & Accountability Act (HIPPA). We understand the challenges the City of Miami faces in collecting patient demographic and insurance information in the field. This is why we use several methods to obtain any necessary information not contained in the initial account file including, electronic interfaces with your transport hospitals, manual lookups at transport hospitals, request for information letters to patients, skip tracing services, etc. We do not stop until we are certain that a patient simply does not have insurance coverage, and even then we insure that all of the patient demographic information is complete, The City of Miami is a unique mix of tourists, impoverished areas, and theelderly,_ which. is unique to any other agency in the United States. McKesson is the only vendor that can truly understand the intricacies in dealing with the challenges faced in processing claims for the City of Miami and in finding much needed and hard to get patient demographic and insurance information. Any other vendor would take years to learn what it takes to work with the City of Miami, years that will mean loss of revenue to the City, which can never be recovered. Page 36 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M"KESSON We have existing business associate agreements with area hospitals and obtain patient information from them in a HIPAA-compliant manner today. d) Insurance Reviews: The Successful Proposer shall perform all necessary insurance follow-ups to assure maximum collection on claims. McKesson and the City have established acceptable billing policies and account follow-up procedures. Focused on these parameters, account follow-up specialists monitor your interests. Insurance McKesson staff monitor all billing data submitted for reimbursement to alert us of any potential delay in payment. Special system alerts automatically identify claims that are reaching unacceptable aging limits based on the current claim responsibility. Our account follow-up staff addresses claims early in the aging process to ensure optimal cash collections. They follow a strict protocol of corrective action as outstanding balances reach critical aging points. We select our account follow-up personnel because they possess a special skill set that ensures dedication to the task and persuasive communication. We prepare and train our personnel to work with both insurance companies and patients to collect the outstanding A/R effectively. Reporting on production is critical. We generate daily reports to monitor productivity and cash flow metrics. We set target performance measures for each McKesson account and we use reporting tools track activity to reach these goals. Setting goals and monitoring performance becomes an integral part of our operations. Medicare We process Medicare claims, as we do all third party payers, through a daily series of front-end edits on the McKesson system designed to stop any incomplete claim. We can correct and submit a clean claim for billing by identifying claims issues at this early stage. A claim submitted through the McKesson Exchange will be subjected to additional edits and payer specific requirements. Claims caught at this stage will be denied internally and reported on a claim rejection report for repair. Medicare will receive claims processed successfully through the Exchange and will issue payment or denials. We receive response from Medicare electronically where payment terminates the process and denial prompts investigation. McKesson will investigate the reason for denial and take steps to resolve any discrepancy of opinion. We will pursue payment via the Medicare appeals and fair hearing process to obtain proper payment. We track all action taken to resolve claim denial issues closely. Medicare Denial Specialists work them to completion. Page 37 Emergency Medical Transport Pilling & Collection Services City of Miami May 18, 2016 MSKESSON Medicaid As stated in the Medicare section above, the process for all third party payers is similar. Where pathways are slightly different and filing timelines are different, we direct our processing pathways at ensuring accurate billing and collections in a timely manner. We check all private patients for Medicaid eligibility as well as confirm status of all Medicaid patients against the Medicaid database. We also thoroughly review all Medicaid claims to ensure that they meet all Medicaid medical necessity guidelines. If a Medicaid claim does not meet the guidelines, we do not bill it. We process Medicaid claims and receive payments electronically where available. Setting the McKesson system up to recognize proper payment and adjustment is necessary for all third party payers that provide this information. We monitor governmental payers for expected payment cycles. Where reports indicate that claims have fallen outside these expected measures, we have trained our staff to investigate and identify immediately any issue that may result in slow payment or unwarranted denials. The Medicaid claim cycle completes once McKesson confirms that the charges were paid appropriately and the balance is adjusted to zero. We will not bill Medicaid patients directly for any portion of the charge. Timeframe: Daily, as alerted by system and reports. Self -Pay For self -pay accounts, we base our follow-up philosophy on a mutually developed strategy. We currently send a combination of three statements and letters along with a TeleConnect call, depending on the financial class and billing cycle of the patient. We will continue to use your small balance criteria to send statements and letters on small balance accounts. Teaming with you, we established a matrix by statement balance and period that describes the self -pay collections process from first statement to collections. We have worked with you to establish: • Accounts receivable policies and procedures • Pre -collections policies and procedures • Payment plan policies and procedures • Small balance write-off policies and procedures We make every attempt, including establishing payment plans according to your policies, to keep accounts from being sent for collection agency activity. At any time a payment is made within the statement cycle, we restart the process and continue to make every effort to collect the outstanding balances. Page 38 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M KESSON Timeframe: Daily, as alerted by system and reports. e) Medicare/Medicaid: The Successful Proposer shall comply with all Medicare, Medicaid, and HIPAA rules and regulations. The Successful Proposer shall enter into a business associate agreement with the Department. This shall include keeping abreast of all Medicare, Medicaid, insurance, and other health care issues which may impact payments to the Department for emergency transports. The Successful Proposer shall review each Patient Care Report (PCR) narrative to make a level of service determination based on Medicaid guidelines, prior to releasing claims to Medicaid. We have and always will comply with all Medicare, Medicaid, and HIPAA rules and regulations when handling City accounts. We have an existing business associate agreement with the Department and will execute another one for this new contract to ensure we maintain compliance at all times. Our compliance department maintains current knowledge of all applicable laws and regulations affecting medical billing. We regularly distribute ReveNews, a McKesson -published newsletter dedicated to divulging information related to regulatory affairs. In addition, your staff will continue to be in regular contact with our team to discuss any changes to billing requirements. We will provide on -going training to you as necessary. As stated earlier in our response, we understand the unique challenges faced by the City in processing Florida Medicaid claims and the risks associated with improperly filing claims to governmental payers. Other local municipalities that do not use McKesson have had issues with both Medicaid and Medicare claims. Our compliance department mitigates those risks by having strong policies regarding how Medicare and Florida Medicaid claims are files. The important part of any policy is in its execution. This is where the experience of McKesson employees comes in. No other company can boast the years of experience our staff has. We process governmental claims with strong and strict adherence to our compliance polices. When audits do happen, you know that McKesson will be taking the lead in handling the audit for the City, just as we have done many times before. We do not throw it on your lap and make it the City's problem to resolve. This is all part of excellence in customer service, and frankly, it's the right thing to do. As personnel that have been with the City for years can attest, these are not just words. McKesson has taken the lead in all Florida Medicaid audits that have occurred throughout the years. More importantly, we have had successful outcomes to all of those audits. The City has not been part of any Medicare audits. f) Crossover Eligibility: The Successful Proposer is responsible for identifying and securing payments due to crossover eligibility, co-insurance, deductibles, etc. Where patients have co-insurance or supplemental insurance, our system will produce a claim after receiving payment from the primary payer. We process these secondary claims through the Page 39 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON McKesson Exchange and Print and Mail Services laser center, where they will be produced on payer specific claim forms. Deductibles and other situations are easily handled by the McKesson billing system and are billed appropriately depending on the situation. g) Timely Billings: The Successful Proposer shall be expected to bill emergency transport patients and/or file patient insurance within 30 days upon receiving transport information from the Department. In the event the information is unattainable, the Department expects a CLAIM to be Bled as soon as the information required is obtained, and in all cases an invoice be sent to patients with valid addresses. A sample of the billings/invoice shall be included in the proposal. We will continue to bill emergency transport patients and/or file patient insurance claims within 30 days, often sooner. We will file all claims as soon as we have obtained the required information. We have provided sample invoices in the Appendix section of our proposal. h) Follow-up Billings and Procedures: The Successful Proposer shall have a detailed plan and procedure for claim follow-up to assure maximum collection. Please refer to our response to the section titled Proposed Approach to Providing the Services, specifically the description beginning on page 37. The Successful Proposer shall be expected to re -bill emergency transport patients and/or patients' insurance claims on unpaid balances. This invoice shall reflect detail account activity, including but not limited to, the Department patient account number, original billing amount, detail payment information, and account balance. A sample of the rebill/invoice shall be included in the proposal. Our billing and collection cycle solution provides the City with lower costs, increased collections, and more effective accounts receivable management. We achieve this by using our Lean Six Sigma best practice process management including specific billing protocols, pre -claims submission editing follow-up, along with payer -specific claims follow-up guidelines, patient/guarantor billing and follow-up, client and staff education, and the overall application of our management methodologies which have proven very effective in other comparable companies. - We have detailed plans and procedures in place for the Cityof Miami, which we have tweaked and followed throughout the years to ensure maximum collections. Our statements contain all the required information and can be modified further to meet any future needs of the City. We have provided samples of our patient invoices in the Appendix section of our proposal. Page 40 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON i) Current Database: The Successful Proposer shall be able to merge current open accounts from the Department or its ePCR provider and current provider billing system. In addition, the Successful Proposer shall grant access to authorized Department employees to the Successful Proposer's billing database, including the ability to search for patient information by one or more of the following fields: patient name, date of service, Successful Proposer patient account number, or Department patient account number. Department employees will also be granted access to print patient account statements, similar to those requested by and mailed to the patient by the Successful Proposer. As the current billing vendor, no transitional activities need to take place, and there will be no revenue loss for the City. There will also be no "learning curve" as there would be with another vendor, which could also lead to unrecoverable revenue loss to the City. The City of Miami can have access to our billing system at any time. Our portal has the ability to allow the City personnel to print or download patient statements and meets all of the other requirements listed. j) Refunds: The Successful Proposer shall establish a systematic plan for determining overpayments and assuring refunds to patients or third party payers are processed within three (3) months from the date when the account goes into overpayment/credit balance status. A copy of this plan shall be included in the proposal. Refunds From time to time, overpayments occur on patient accounts due to many reasons including the insurance company and the patient both paid the bill; the patient paid the bill twice; the insurance company paid the bill twice, etc. When we discover an overpayment, one of our employees not involved with the previous transaction(s) will validate the refund. We will perform all procedures in accordance with internal policy, client contracts, and governmental regulations. We will maintain documentation of any action taken. In the case of a patient, overpayment or upon receiving direction from the related third party, a refund check request shall be prepared and forwarded to the City (or McKesson personnel as appropriate) , who then prepares and sends the refund check. Only validated refunds may generate a refund check request. Page 41 Emergency Medical Transport Uilling & Collection Services City of Miami May 18, 2016 MESON k) Patient Account Numbering System: All patient account numbers must be cross-referenced with the Department incident number. The Department incident number is in a calendar year -number format and will be sent to the Successful Proposer as a two -digit year, a five digit incident number. For example, an incident number for three patients on one call, will be forwarded to the Successful Proposer as Department patient account number 14- 00001 representing patient one, account 14- 00002 representing patient two, and account number 14-00003 representing patient three. Regardless of the patient account numbering system used by the Successful Proposer, the Successful Proposer shall provide the Department patient account number on all billings and patient correspondence including, but not limited to, the patient account statement and all monthly reports. Additionally, the Successful Proposer shall provide the Department access to the Successful Proposer's database with the ability to search for patient information by one or more of the following fields: patient name, date of service, Successful Proposer patient account number, or Department patient account number. All patient account numbers currently cross-reference with Department incident numbers. The patient account number will continue to appear on all billings and patient correspondence, including patient account statements and monthly reports. As mentioned previously, the Department's authorized individuals have inquiry access to the billing solution and can search for patient information using any field contained within the system. 1) Probate Claims: The Successful Proposer shall be responsible for filing probate claims, when applicable, on behalf of the Department. All requests for Satisfaction of Claims shall be forwarded to the Department for approval and signature. We will continue to file probate claims on behalf of the Department as necessary and forward all requests for satisfaction of claims to the Department for approval and signature. 6. Personal Injury Protection (PIP) Claims Review Successful Proposer shall: a) Diligently and expeditiously process PIP insurance claims with the PIP insurer. We will continue to process PIP insurance claims with the PIP insurer diligently and expeditiously. Page 42 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON b) Coordinate its services relating to auto -related emergency transport accounts with those of the attorney retained by the Department to provide legal services relating to PIP insurance claims (PIP Attorney), in order to enable and ensure maximized collection efforts for auto -related emergency transport accounts. Successful Proposer and PIP Attorney shall work cooperatively to coordinate their efforts and do so in accordance with any applicable laws, including but not limited to the Fair Debt Collection Practices Act and HIPAA. Coordination of services and timeframes between Successful Proposer and the PIP Attorney will be coordinated through the Department staff. To maximize collection efforts, we will continue to coordinate services relating to auto -related emergency transport accounts with those of the attorney retained by the Department. All. interactions will comply with applicable laws, including FDCPA and HIPAA. c) Diligently and expeditiously research PIP information for auto -related accounts without PIP information; after which accounts that are still missing necessary PIP information shall be promptly referred to PIP Attorney for additional research of PIP information. We will continue to research all necessary information for auto -related accounts without PIP information diligently and expeditiously. We will promptly refer accounts that are still missing necessary PIP information to the PIP attorney for additional research. d) Provide all auto -related account information to PIP Attorney on a regular basis to enable PIP Attorney to review accounts and take legal action, if warranted, to maximize PIP payments. We will provide all auto -related account information to the PIP Attorney on a regular basis as requested by the City. e) Provide department with a summary report showing PIP account number, account status, billed amount, collected amount, adjusted amount, date referred to PIP Attorney (if any) and outcome. We will provide the Department with a summary report showing PIP account number, account status, billed amount, collected amount, adjusted amount, date referred to PIP Attorney, and outcome as requested by the City. f) Track and report to Department on a monthly basis payments received on accounts referred to PIP Attorney for action. - We will track and report to the Department payments received on accounts referred to the PIP attorney for action on a monthly basis. Page 43 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MESON g) Provide historical billing & collection information on auto -related accounts to allow PIP Attorney historical review to maximize collections within statutory limits. We will provide historical billing and collection information on auto -related accounts to allow the PIP attorney historical review to maximize collections within statutory limits. 7. Service Fees The Selected Proposer shall perform EMS billing and collection services on behalf of the Department. All monies collected by the Selected Proposer shall be deposited in the designated lockbox. At the end of each calendar month Selected Proposer shall send an invoice to the Department with collection details of all Department transports entered in the Selected Proposer's billing system from the preceding month. Payments to the Selected Proposer will be made by the Department after satisfactory reconciliation of the invoices. The invoice shall be based on the proposed Appendix B, Fee Schedule (See Section 2.20, Service Fees). The Successful Proposer shall be entitled to fees on all collections for billings during Contract term, up to six (6) months after expiration or termination of Contract. The Department will be entitled to a refund of fees due to refunds on collections for billings during Contract term, up to one (1) year after expiration or termination of Contract. We will comply with this provision. 8. Receipt of Funds a) Lock Box: The Successful Proposer shall be required to establish a "lock box" for all receipts under this Contract. This lock box shall be established with a financial institution under Contract with the Department. All customer and third party receipts are to be mailed to the designated lock box for accounting of deposits. The Successful Proposer shall make arrangement to have copies of all deposits and backup forwarded to them from the financial institution. We will continue to use the existing Wells Fargo lockbox for all receipts under the new contract. All customer and third party receipts are mailed to the lockbox - McKesson never handles the Department's receipts. We have an established process with your bank to receive all necessary copies of documentation related patient payments. b) Receipt Posting: The .routine function of posting charges, receipts, account balances, etc. are never to exceed seven (7) working days from receipt of same. Copies of all deposits and back-up information shall be provided to the Department within seven (7) working days of deposit. Our payment -posting specialists handle the posting of payments. As a standard practice, they perforrn line item payment posting on a daily basis for allpayer and patient payments, as well as Page 44 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKE SON deductibles, allowances, and denials. When posting payments, receipt date and deposit date are posted by line item to the date of service. We post zero payments with an explanatory note for tracking purposes. Balancing to the charge transaction level is required. We will continue to provide the Department with copies of all deposits and back-up information within seven working days of the deposit. The same personnel have been handling the payment posting functions for the City of Miami since the 1990s. c) Credit Cards: The Successful Proposer shall be required to establish a method to accept and record credit cards from patients electronically. With McKesson's innovative transported patient web portal, PerYourHealth.com, your customers can securely access their balances, print out their statement or save it as a PDF file, update demographic and insurance information, and make payments via credit or debit card or PayPal online. Using this portal, your customers may view information about incurred charges and received payments, as well as obtain answers to many medical billing questions. Note: Department financial institution will be identified by the Department to the Successful Proposer upon Contract execution. We will continue to use the City's Wells Fargo lockbox for all deposits. 9. Service Review The Successful Proposer shall meet with a representative or representatives of the Department at a location of the Department's choosing at least Bi-:Monthly. Topics to be discussed will include differences in the expected versus actual collection rate, deficiencies in clinical and demographic documentation, ALS/BLS patient treatment, and other topics of concern to the Successful Proposer or Department. At the service review meetings the Successful Proposer will be expected to have specific suggestions for improving any deficiencies identified in either parties' documentation or processes. We will continue to meet with Department representatives bi-monthly and as needed to discuss any concerns and review performance. We always have the ability to meet onsite since our office is only 15 minutes away from Fire Administration Headquarters. We also welcome the City to visit our Doral operations center. Page 45 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M KESS©{ 10. Data Fortnat All reports shall be provided in hard -copy form as well as CD form in a file format usable by the Department. These formats are as follows: 1. Excel 2. Text We will continue to provide all reports in hardcopy as well as on CD in either Excel or text format as preferred by the Department. All patient contacts are documented using the Department's electronic ePCR system. During a patient encounter a member of the Department documents relevant clinical and demographic information in an electronic format that is stored in a Structured Query Language (SQL) database on a server owned by the Department. The Department will provide all information relevant to billing via an electronic billing extract produced at least once every 24 hours. This data will be provided in the form of one Extensible Markup Language (xml) file per billable patient encounter. Successful Proposers will be required to demonstrate the ability to accept data in this format with little or no modification. We currently accept xml formatted files from the Department with no modification necessary. The Department is interested in maximizing the existing and planned reporting capabilities of the current ePCR vendor. To further this goal, Successful Proposers will be required to demonstrate the ability to periodically produce a demographic extract containing information related to a given patient encounter. This information is expected to include at least the amount billed for the encounter, the amount collected for the encounter, primary and secondary payers, patient's SSN (if not collected on scene), health insurance information (carrier name, policy and group number, etc.). We currently provide reports that meet the needs of the Department. Because of the flexibility of our billing system, we are able to provide the Department with enhanced reporting if desired. We can provide reports on any data field contained within our billing solution. Page 46 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON 11. Demographic Information The Department will not always be able to obtain or provide complete demographic or insurance information to the Successful Proposer due to the emergency nature of the incidents responded to by the Department. Successful Proposer will be required to demonstrate relationships with health insurance providers and entities whose primary business is the collection, storage, and dissemination of this type of information. Successful Proposer will be required to have the ability to electronically access these databases and directly download required information. Successful Proposer will further be required to obtain electronic access to patient records at the hospitals. Ofparticular interest to the Department is a billing company's ability to obtain billing information when provided with a patient's complete driver license number. This capability is to be used to obtain demographic and insurance information that is not obtainable through other means. We are currently able to acquire patient health insurance and demographic information on the Department's behalf when we receive patient care reports with missing information and we will continue to do so. We are the only vendor that understands the unique challenges faced by the City of Miami. No other vendor can match our strong presence in Florida, in particular South Florida. We understand the Florida payers and understand how to find much needed and hard to get patient demographic and insurance info for the City of Miami. The proof of our success is not just our strong collections, but also the weak collections from your collection agency, Penn Credit. Penn only collects 2% of what McKesson refers to the collection agency. This is no accident, It is the result of the hard and expert work by the McKesson staff. 12. Mileage Calculation The Successful Proposer shall have a system that will automaticailygeocode all incident locations reported in the Department billing extract. This system must be able to calculate the mileage from an incident scene to the patient's destination hospital. We currently have this capability and will continue to leverage it for the City. Approximately one year ago, we enhanced our interface in order to calculate patient loaded miles automatically for the City of Miami based on the scene address and the hospital where the patient was transported. The City used to calculate miles using an "as the crow flies" measurement. The new McKesson method has increased the accuracy of the miles per transport calculation and has resulted in increased revenue for the City. We are always looking for ways to improve our program and increase revenue while remaining compliant with allexistingrules and regulations. Page 47 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MESON 13. Claim Submission The Successful Proposer shall process all claims as expeditiously as possible. Successful Proposer shall agree to a specific processing schedule. Any file that identifies automobile insurance as the primary or secondary insurance provider will be submitted to the responsible party on the first business day that the file is in the billing companies' possession. All other files shall be submitted to the responsible party within 48 hours of receipt. Successful Proposer will be required to show the capacity to adhere to this schedule. Activity Timeframe Receipt of ePCR and related information from City Immediately upon upload, complete within 48 hours. Verification of ePCR and related information Immediately upon upload, complete within 48 hours. Validation of patient's insurance status Immediately upon upload, complete within 48 hours. HCPCS and ICD-9 (10) coding procedures Upon receiving narrative report, complete within 24 hours. Data entry Daily Claims processing Daily, within 24 hours of completed claim Invoice / statement generation Daily, within 24 hours of becoming patient responsibility. Claims submission Daily, within 24 hours of complete billing information Payment posting Daily, within 24 hours of payment notification Account follow-up Daily, as alerted by system and reports Appeal processing Daily, as alerted by system and reports Co-insurance / supplemental insurance processing Daily, within 24 hours of primary payment Private pay account processing and follow-up Daily, within 24 hours of primary payment Establishment of payment plans As necessary 14. Reporting Requirements The Successful Proposer shall maintain a computerized database of all accounts and shall provide the Department with reports to show management and financial information. The Successful Proposer at a minimum will provide all reports provided to the Department by the incumbent. The Department will provide samples of all current reports to the Successful Proposer. The format of reports required under this contract will be determined by the. Department._ In- addition _.to the reports described below, the Successful Proposer shall provide any custom reports at the request of the Department in a mutually agreeable timeframe at no cost. As the incumbent billing provider, we will continue to provide the reports we already deliver to the Department. Page 48 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M KESSON In addition, McKesson Practice Focus, our business intelligence and reporting tool, enables the Department to access medical billing and accounts receivable management information on- demand using a Web browser and any Internet -enabled device. SAP Business Objects, a very well respected and powerful reporting and analysis tool used by many Fortune 500 companies for internal reporting, power this tool. From high-level dashboards to drill -down and linked reports that provide the detail to make changes, McKesson Practice Focus helps get the answers needed to improve the your performance. McKesson Practice Focus includes: • Easily accessible standard reports • The ability to customize and create reports that address your unique needs The access is secure, restricted and HIPAA compliant. With an easy -to -use interface, professional administrators or anyone you employ (with the proper access privileges) will be able to drill into vital information and perform detailed analyses. You can view stored reports or create new ones. Users can also export reports to Microsoft® Excel® or save them as an Adobe® PDF. Custom dashboards, predefined alerts, dynamic charts, and flexible reports enable you to monitor key performance indicators and identify trends unique to you. This transparency will affect positive change and foster growth for the City. We have provided sample reports in the Appendix section of our proposal. 15. Monthly Reports On a monthly basis, the Successful Proposer shall submit to the Department, at a minimum, the following: 1) Report of Transports Billed and Payments Received: This report will compare all billings to all the incidents in the billing extracts sent to the Successful Proposer. The report shall identify date of transport, fire incident number, patient number, patient name, complete patient address, incident date, the invoiced date, number of transports billed, procedures billed, dollars billed, the number of transports not billed, and the dollar value of accounts not billed. A grand total of billed and not billed for the month of transport must also be computed. Additionally, the report must summarize the monthly billing activity as follows: Number ofALS billings with amount billed, including details for mileage, oxygen and all other billable services. Number of BLS billings with amount billed, number of mileage and amount billed, including details for mileage, and all other billable services. Page 49 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 McKESSON The report will also include other transport categories, such as number of billings and amount billed. This report must summarize the number of billings and amounts by type of transport, and item billed, such as number of miles billed, dollar value of miles billed, number of oxygen billings and all other billable services. 2) Report of Collections: This report shall verify and reconcile lock box batch deposit activity with collection posting activity. The report shall identify the patient number, fire department alarm number, patient name, patient complete address, payment amount, type, batch #, batch total, and grand total of all monthly payments. 3) Collection Statistics Report: This report shall provide statistical information about billing and collections over time; show gross billings by date of incident (transport) month and the related collections to date. Gross billings should not be reduced for returned mail, bad debts, or authorized write-offs. The report shall differentiate for billing type, such as ALS and BLS, including all fees associated with the transport. The report shall include the total billed in the transport month, and in any subsequent months. Collection information by month shall also be provided. A grand total for each column shall be provided. 4) Payment Report: This report shall show the accounts receivable in lockbox batch deposit order during the month and must include, as a minimum: incident number, patient number, patient name, patient's complete address, payment amount and type, batch total on each lockbox batch number, and grand total of all monthly payments. 5) Collection Summary: This report shall list monthly payments in item (5) above by original transport month, incident month and amount collected in the month. 6) Report on Transports Deemed Not Medically Necessary: This report will detail all incidents that the Successful Proposer or any 3rd party payer deem not medically necessary. Included in this report will be the incident number, officer in charge, reported level of service, reason for the finding of non -medical necessity. 7) Report of Medical Supplies Used: This report will estimate the amount of medical supplies used based on the treatments that Department report writer's document. The Department will assist the Successful Proposer in the creation of this report by providing the rules and assumptions the Successful Proposer will need to create an acceptable report. 8) Insurance Activity Report: This report will show the portion of actual collections and the accounts receivable, detailed by self, Medicaid, Medicare, Automobile Insurance, and private insurance, by type of transport (ALS and BLS). A combined grand total for each column will be provided. Page 50 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON 9) Total Billings by Incident Month: This report will list cumulative number of gross billings for each incident (transport) month by type of transport (ALS and BLS). A combined grand total for each column will be provided. 10) Accounts Receivable (A/R): This report will show the amount owed by all transported patients at the end of the month and will include: gross billing since inception, payments since inception, Department approved adjustments and write- offs since inception, Medicaid and Medicare adjustments, and ending balance of accounts receivable, by type of transport (ALS and BLS). A combined grand total for each column will be provided. 11) Adjustments and Write-offs: This report will provide details of amounts in write- off columns of item (8) above for the current month and show: patient number, patient name, gross billing amount, payments made, adjustment or write-off amount approved, and revised amount due, by type of transport (ALS and BLS). A combined grand total for each column will be provided. 12) Credit Balance Report: This report will list all accounts having a credit balance at the end of the month. This report would show: patient number, patient's name, incident date, amount billed, amount paid by payer, and credit balance amount. 13) Refund Listing: This report will list accounts requiring a refund due to overpayment and mustshow: patient number, patient name, patient address, incident date, amount originally billed, total amount paid on account detailed by date, amount and related lockbox batch number, refund amount, and payer due refund. 14) Number of Days between Incident Date and Billing Date Thirty (30) days: This report will list all incidents billed during the month, and the number of days between the incident date and the first billing date. The report would show: patient number, patient's name, incident date, first billing date, and number of days between incident and billing date sorted by rescue unit number. Also shows subtotals for each unit and average number of days between incident and billing. Report may also include date report received. 15) Collection Summary Inception to Date by Month: This report will list total charges by transport month without write-offs or reductions, total payments to date, gross collection rate, amount paid to billing vendor based upon collections by billing month, "arid gross effective collection rate, 16) Report of Transports by Rescue Unit and Officer in Charge: This report will track bills by type, by unit, by officer in charge as well as collections by type of insurance. Page 51 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 !MESON N 17) Report Comparing Dispatch Type to Patient Treatment: This report will compare the dispatch type determined by the Clausen Medical Priority Dispatch system to the level of service paid for by the responsible party. Included in this report will be the incident number, officer in charge, and other information pertinent to justifying the use of an ALS apparatus. In addition to the above monthly reports, the Successful Proposer shall provide the following reports: 1) Schedule of Transport Charges & Collections: This report shall include a summary of the following: Number of Transports, Gross Charges, Adjustments, Net Charges, Receipts, Balance Due, Percentages showing Gross Collections, Net Collections and percent of Paying Patients -All classified by Transport Month/Year. 2) Collection Schedule: This report shall include Deposit Date, Number of Items, what Collected for Today/each day, what was collected Month -to -Date, Collected Fiscal Year -to -Date, and Collected Cumulative, 3) Monthly Billing & Collection Summary: This report shall include Transport Month/Year, Total Gross Billing, Less Gross Adjustments, Collections this Month, Collections to date; Collected Gross Amount over 50%. Note: This report shall be provided as backup to the Finance Department for payment of invoice and should provide calculation ofmonthly fee for third -party billing company. 4) Collection by Financial Class: This report shall provide a summary for each Transport Month/Year broken down by Account Type (Self -pay, Medicaid, Medicare, Private Insurance) Report shall include: Billed Amount, Amount Collected, Percent Collected, Number of Accounts, Number of Not Billable Collections, Gross Unbillable Collections, Total Accounts, and the Gross Amount Billed. 5) Ambulance Billing Adjustments -Write -Offs -Reversals: his report shall include the Patient Account Number, Patient Name, Incident Date, Adjustment Amount, Adjustment or Reversal, and Type of Adjustment. 6) A/R by Payor Class: This report shall include the Patient Account Number, Patient Name, Incident Date, File Date, Payor Class, Amount Billed, Adjustment Amounts, Amount Paid, and Amount Due. This report shall also include summary totals by Fiscal Year and Payor Class. Page 52 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 M KESSON 7) Report by Incident Date (In Numerical Order by Date): This report shall include the Patient Account Number, Patient Name, Street Address, Department/State, Incident Date, Total Charges (amount billed), Adjustment Amount, Amount Paid, and Amount Due. 8) A/R Aged Trial Balance: This report shall include Final Totals as well as the Number of Accounts Aged for the following categories: Current, Over thirty (30) days, over sixty (60) days, Over One Hundred Twenty (120) days, Over One Hundred Fifty 150 days and the Balance. 9) Ambulance Payment Report: This report shall include the Patient Account Number, Patient Name, Street Address, City/State, Incident Date, Check Number, Check Amount, and Payment Type. Note: This report shall provide summary (as well as detail) of total amount collected for the month with a total number of accounts and the amount collected broken down by classification of payment. 10) Report ofA/R: This report shall provide Dollar Amount as well as the Number of Gross Billings Less what was removed from A/R for the month, Less Payments, Less Adjustments/Write-Offs, Less Reversals to give the Balance ofA/R. 11) Insurance Receivable Report: This report shall include Transport Month/Year and Balances, Number of Accounts broken down by Insurance Type. Last page provides totals by category. 12) Ambulance Unit Report by Incident Month: This report shall Include Number of Calls, Gross Billing, Amount Received and Percent of Gross broken down by Transport Month/Year and Unit Numbers. 13) Ambulance New Billing Report: This report shall include Patient Account Number, Patient Name, Incident Date, Base Amount, Mileage Amount, Total Billed, Call Classification (ALS/BLS, etc.) for all new billings. 14) Deposit Report: This report shall include deposit Batch Number, Account Number, Patient Account Number, Patient Address, Date of Service, Payment Date, Check Number, Check Amount, payment Type, and Payer Name. The Successful Proposer shall provide this report at least biweekly for the current month's deposits. Page 53 Emergency Medical Transport Billing & Collection Services City of Miarni May 18, 2016 MKESSON 15) Audit Report of Accounts Changed -This report shall include the Patient Account Number, Patient Name, Date of Service, Reason for Change, Amount Changed From, Amount Changed To, Net Amount of Change and Date of Change. The purpose of this report is to identify changes made to existing patient account charges. 16) General Account Activity -This report shall include the General Account Number, Payor Name, Check Number, Check Amount, and Deposit Date. The purpose of this report is to provide a detail listing of payments posted to a general account pending transfer to specific patient account(s) or refunded to the payor. Note: At the discretion of the Department, some of the above reports may only need to be produced quarterly. 17) Ad Hoc Reports -While the Successful Proposer shall provide monthly reports specified above on a routine basis, the Successful Proposer may be required to generate and provide ad hoc reports as needed by the Department. This may include additional monthly reports not listed above. These reports would be limited to information available in the Successful Proposer's database. 18) Annotated Log Reports: The Successful Proposer shall maintain an annotated log by patient account for any and all contacts with the patients/customer. This shall include any insurance, billing, or collection activity. This information shall be provided when requested by the Department. We provide all required monthly reports to the City. 16. Other Services or Provisions 1) Patient Calls: The Successful Proposer shall provide a minimum of two (2) toll free local, and/or toll free long distance numbers by which patients/customers may contact them anywhere in the Continental United States. These numbers shall be published on all correspondence and letterheads generated by the Successful Proposer. We currently provide your patients with a toll free local number and a toll free long distance number and will continue to do so. We publish the phone numbers of all correspondence sent to patients. Page 54 Emergency Medical Transport billing & Collection Services City of Miami May 18, 2016 ! KESSON 2) Patient/Customer Communications: All written or verbal communications between the Successful Proposer and the patient/customer (patient or legal guardian) will be conducted in a professional and courteous manner and all complaints shall be investigated. All patient/customer contact whether written, verbal or otherwise shall be posted to the annotated logs. All written patient/customer communications shall include the Department patient account number. As the City of Miami can already attest to, we will always conduct all written or verbal communications with the patients in a professional and courteous manner and all complaints will be documented and investigated. McKesson's Standards of Conduct Program guides our business and employee actions to achieve an unequaled level of performance and quality for our customers. One of the cornerstones of our employee program includes Quality Systems and Services. McKesson provides systems and services of high quality that address the needs and wants of our customers. We have a genuine desire to satisfy our customers with dedication, efforts and results second to none. McKesson has well documented policies and procedures regarding customer service, We can share these policies on a detailed and confidential basis once the City is a McKesson client. The following guidelines are an excerpt from our program book relating to Quality Systems and Services: • We employ people with the necessary experience, education and expertise to address the needs and wants of our customers We strive to anticipate our customers' needs so we can exceed their expectations. • We demonstrate sensitivity and responsiveness to others by listening attentively and patiently to comments, ideas and concerns to achieve genuine customer satisfaction. • We workas an effective team and promote and encourage effective teamwork. • We represent McKesson throughour individual daily actions in a manner that reflects positively on our company. • We provide appropriate training to achieve and maintain quality in the delivery of services to our customers. McKesson recognizes that your patients and guarantors may be unfamiliar with medical billing and insurance procedures. Handling their inquiries requires considerable time, patience, and medical billing and insurance knowledge. Available during normal business hours, our customer service specialists are specially selected personnel who have received extensive training, possess excellent communication skills, and will interact with your patients as if they were your own staff. While on the phone, they have instant, on-line access to related documentation so that most issues are resolved during the initial call. Page 55 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON Our toll -free phone number is printed on each statement. All issues called in are logged by type for tracking and reporting. We investigate all complaints. McKesson's customer service specialists: • Answer patient account inquiries within normal business hours • Follow approved self -pay policies and procedures • Update patient demographic and insurance information when received from patients • Initiate re -billing to appropriate responsible parties • Provide regular feedback to your organization regarding patient issues The proof of our success in executing our customer service policies is evident in the minimal amount of patient issues we have had since we began providing billing services for the City 26 years ago. No other vendor has such an outstanding record of customer service success. 3) Quarterly Meeting: The Successful Proposer shall meet quarterly with designated Department personnel at a Department designated site for in-service training of Department Administrative personnel and to address contractual, managerial, and/or administrative issues pertinent to the Contract. We will continue to meet quarterly, or as needed, with designated Department personnel to provide in-service training and to address contractual, managerial, and/or administrative issues pertinent to the contract. We are always willing to meet in person with the City since our Doral billing office is only 15 minutes away from Fire Admin Headquarters. We also welcome City personnel to visit our billing office. 4) Education: The Successful Proposer is required to provide in-service training to the Department Administrative personnel on all Medicare, Medicaid, and HIPAA rules and regulations. This in-service training shall be provided during the quarterly meetings specified above. This shall include providing Department staff with all informational updates that are deemed pertinent to emergency transport billing. McKesson will continue to provide documentation training for patient care reports that will detail Medicare, Medicaid, and all applicable regulations. The training discusses in detail Medical necessity rules for both emergency and non -emergency transports and supporting documentation needed for both emergency and nonemergency transports. Trainers will distribute all visual aids, including handouts. We will conduct training sessions as needed to meet the needs of the City. Trainers can use real City examples during the training, and we can schedule multiple -training -sessions on different days/times to ensure that all shifts- areableto attend the training. McKesson is always available to answer questions that may arise after the training or at any time. McKesson will provide constant documentation feedback to appropriate personnel. We know that a department as large as the City of Miami has constant turnover, which is why we have always agreed to hold multiple training sessions. Documentation is critical Page 56 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MESON to the success of the billing operation. This is a team effort between the City and McKesson and we will do everything in our power to ensure the success of this long and fruitful partnership. 5) Request for Information: All requests to the Department for EMS records are to be in writing and shall include the Department patient account number. Verbal requests will be denied. All requests for EMS records will be in writing and will include the Department patient account number. We will not make any verbal requests for records from the Department. Any request for records will always be sent via secure email or other secure channels to ensure the confidentiality of the information. 6) Statement/Account Balance Requests: The Department shall forward all requests for Statement or Patient Account Balance to the' Successful Proposer electronically for processing. We will continue to process all requests for statement or patient account balance forwarded from the Department. Page 57 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON Response to Minimum Qualifications The Successful Proposer shall: a) Provide a full-time Project Manager and/or team member(s), assigned to the City's contract for EMS transportation billing and collection services. Mauricio Chavez, Specialty Vice President of EMS Billing and Mary Martin, Director of EMS Billing Operations, are currently the main project managers assigned to your account and they will continue in this function. As always, the City can contact any member of the team to address any questions or concerns. b) Have a record of performance of no less than five (5) consecutive years, operating under the same name, and providing EMS transportation billing and collection services for a governmental entity, quasi -governmental entity, or not -for -profit entity of similar size. We have been providing EMS billing services for over 25 years and have been the City's billing vendor since the 1990s. c) Possess adequate resources and personnel available for committing to a contract for the provision of the EMS transportation billing and collection services. As a Fortune 11 company, McKesson has the resources (financial, personnel,- technological, etc.) to continue performing outstanding EMS transportation billing and collection services for the City of Miami. We have always assigned adequate resources and personnel to ensure the success of this project, and we will continue to do so. d) Have never filed for bankruptcy, be in sound financial condition, have no record of pending lawsuits or criminal activities, and shall not have conflicts of interest which may be of embarrassment to the City. McKesson has never filed for bankruptcy and currently ranks 11th on the Fortune 500 with over $190 billion in annual revenue. Page 58 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 McKESSON List of Appendices Indian River Case Study Lee County Press Release Employee Resumes Patient Correspondence Sample Reports McKesson Standard Contract Page 59 Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 McKESSON Case Study • nce Organization Indian River County Fire Rescue Indian River. County, Fla, - 240 employees 11 ambulances 12,000 billable transports annually Solution Spotlight McKesson Revenue Management Solutions Critical Issues naccurate coding and ocumentation - Insufficient compliance Lack of actionable management reports Results A 30% increase in cash collections Gross collections improved to 66%, 32% above the national. average of 50% Stronger compliance - Detailed management reports McKESSON Empowering Healthcare Indian River County Fire Rescue Optimizes Billing with New Partner, Experiences Cash Avalanche Coding problems, documentation errors, insufficient reporting capabilities and more stringent compliance rules all converged to abrade the bottom Tine of Indian River County Fire Rescue. Because the agency was not performing well financially, needed capital expenditures had to be delayed. Indian River zeroed in on the problem: The incumbent billing services provider's capabilities had not kept pace with the organization's needs and revenue was being lost. After an extensive search for a new partner, Indian River chose McKesson. McKesson revamped the agency's billing processes, giving Indian River the power to significantly boost collections, strengthen compliance and purchase two new ambulances. Challenges For Indian River and other emergency medical services (EMS) providers, medical billing can be problematic due to the difficulty of capturing demographic information in the field and the absence of control over patient populations. Compliance issues present another hurdle, particularly when dealing with Medicare and Medicaid populations and complex Health Insurance Portability and Accountability Act (HIPAA) regulations. Before contracting with McKesson, Indian River's medical billing and compliance services were handled by a local firm. "It was a small organization with Limited resources and employees," explains Brian Burkeen, EMS chief. "We felt we had outgrown its capabilities. We were not satisfied that it could continue meeting our compliance needs." Answers An Indian River County review committee established criteria for selecting a new medical billing company, and an RFP was issued. Detailed reporting capabilities were a key factor in selecting the new vendor. "We wanted to be able to document the billing process, determine who was paying us and who wasn't, and determine collection trends," Burkeen explains. "We also were looking for a company with EMS experience and the ability to provide coding and documentation training." McKesson won the contract on the strength of its long experience in emergency medical services, its billing and reporting capabilities, and compliance expertise. Case Stud a Kesson has an entire tea°> leclikated to compliance. They provide a level of security you can't find with a smaller billing company. any EMS service that's not using Mck 'son needs o re-evaluate and ask whether it's etthng tl e most olts dollars." an urkeer EMS Chief Indian River County Fire Rescue Kesson Provider Technologies ilk 5 Windward Parkway Alpharetta, GA 30005 http://www.mckesson.com 1.800.981.8601 Results One of McKesson's first steps after partnering with Indian River was to establish electronic interfaces with each of the hospitals that receive Indian River patients. Before the first fiscal year was complete, Indian River's cash collections had jumped nearly 30%, The gross collection rate — another important benchmark that compares charges to collections — is now 66%, compared to a national average of about 50%. Through its partnership with McKesson, Indian River strengthened its compliance. "McKesson has an entire team dedicated to compliance/' Burkeen relays. "They provide a level of security you can't find with a smaller billing company. Any EMS agency that's not using McKesson needs to re-evaluate its decision and ask whether it's getting the most out of its dollars." Along with the enhanced financial performance and improved compliance, Indian River has experienced other benefits as a result of its relationship with McKesson. "The company has made the entire process painless," states Burkeen. "The management reports keep us up-to-date and we always know where our money is." Burkeen meets with the McKesson account manager monthly to review reports detailing gross and net charges, collections and accounts receivable. In addition, McKesson conducts on -site training sessions to help paramedics learn proper documentation methods for optimal billing. Thanks to Indian River's improved collections, the agency was able to acquire two new ambulances, Burkeen says. He adds that area citizens are the ultimate beneficiaries of McKesson's billing expertise. "We needed new vehicles to replace older ambulances on the fleet," explains Burkeen. "Because collections with McKesson were higher than expected, we were able to purchase replacements ahead of time to better serve the community." Copyright © 2007 McKesson Corporation and/or one of its subsidiaries. All rights reserved. All product or company names mentioned may be trademarks, service marks or registered trademarks of their respective companies. PRT314-11/07 McKESSON Press Release Contact: Ed Domansky 404.338.3710 Edward. domansky@ me kesson. com Florida EMS Agency Turns to McKesson Optimized collections, enhanced reporting key benefits for organization ATLANTA — Dec. 9, 2014 — Lee County Emergency Medical Services, a first responder and advanced life support (ALS) transport agency serving southwest Florida, has selected McKesson Business Performance Services (McKesson) to help improve collections, enhance reporting and strengthen regulatory compliance. McKesson was chosen to provide a full spectrum of revenue cycle management services following a rigorous RFP process. Services include coding, claims, collections, compliance, customer service, denial management and business intelligence reporting. Rob Farmer, Public Safety Director for Lee County, Florida, said McKesson was selected on the strength of the company's reputation in the EMS community nationwide, comprehensive reporting capabilities, and demonstrated commitment to customer service, both for EMS clients and for the agency itself. "As a taxpayer -funded agency, we have an obligation to help ensure that our collections are optimized and that our revenue cycle process is as tight as it can possibly be," Farmer said. "We have no doubt that McKesson will help us achieve these objectives. "At the same time, we are very enthusiastic about partnering with a company that has already shown a willingness to go the extra mile to provide the highest level of customer service. This commitment will not only strengthen our working relationship with McKesson, but most importantly, give the residents and visitors of Lee County the kind of professional and responsive service they deserve." Farmer added that McKesson's attention to detail throughout the billing system ramp -up greatly reduced concerns about any revenue fall -off during the transition. Lee County EMS responds to nearly 85,000 emergency calls and conducts more than 60,000 transports annually. The organization's 1,200-square mile service area includes the communities of Fort Myers and Cape Coral, as well as multiple, limited -access islands. Lee County has a population of approximately 650,000 annual residents, while the population nearly doubles to 1.3 million during the winter tourism season. Pat Leonard, president of McKesson Business Performance Services, said emergency medical service agencies nationwide are looking for ways to improve efficiencies in an era of budget constraints. "McKesson's experience in the EMS market and sizable client base has allowed us to fine-tune a revenue cycle management approach that is truly responsive to the day-to-day realities of EMS agencies," Leonard said. "We look McKesson Business Performance Services 5995 Windward Parkway Alpharetta, GA 30005 www.mckesson.com/BPS McKESSON Press Release forward to working with Lee County to help ensure that its services to the citizens of southwest Florida continue to be of the highest quality," About Lee County Emergency Medical Services Lee County EMS provides emergency medical services to Lee County, Florida. The agency responds to nearly 85,000 emergency calls and transports more than 60,000 patients annually. Lee County EMS covers more than 1,200 square miles and currently operates 37 ALS ambulances daily, a twin - engine transport helicopter, two non -transport ALS units and a paramedic bicycle team. The department has been recognized nationally for innovative programs such as the Sudden Infant Death Syndrome Watch Program, Age Link Program, Community Health Program, Automatic External Defibrillator 3 Public Facility Program, Learn to Swim Program and Florida's Best Business & Educational Partnership Excellence Award. For more information, visit www.safelee.org. About McKesson Corporation McKesson Corporation, currently ranked 15th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical -surgical supply management, healthcare information technology, and business and clinical services. For more information, visit www.mckesson.com. McKesson Business Performance Services 5995 Windward Parkway Alpharetta, GA 30005 www.mckesson.com/BPS Mauricio Chavez, Specialty Vice President — EMS Sample Client 1996 - 2004 Experience Miami -Dade County Fire Rescue Education 1990 - Present City of Miami. Fire Rescue 2014 - Present Lee County EMS 2001 - Present Indian River County Fire Rescue 1987 -.1989 Miami -Dade Community College Miami, FL ■ AA - Business Administration 1990-1992 Florida International University Miami, FL ■ Management Information Systems - BA - Business Administration Additional Worked as a Computer Operator, Computer Programmer, Client Manager, Director of Experience Operations and Specialty VP all within the EMS billing umbrella including direct client contacts since 1989. Mary J. Lopez, Director of Operations Sample Client 1996 — 2004 Experience Miami -Dade County Fire Rescue Education Additional Experience 1990 — Present City of Miami Fire Rescue 2014 — Present Lee County EMS 2001 Present Indian River County Fire Rescue 1972 — 1974 Miami -Dade Community College Miami, FL • AA — School of Health ■ Florida International University Miami, FL BA -School of Health Experience with medical billing systems and procedures, including billing EMS transports, radiology, pathology, and anesthesia since 1973. Expert in governmental and private payers rules and issues, YOUR LOGO HERE Dear DONALD DUCK, Account Information Account Number: Patient Name: Statement Date: Type of Service: Transport Date: Request for Information BPS*2635456.1 DONALD DUCK 09/04/2015 Ambulance 07/01/2015 On the above date you were transported by CLIENT NAME to ABC HOSPITAL. Please provide your insurance information on the back of this form so we may submit a claim for payment on your behalf. We need your signature to file your claim. Please complete the back of this form, sign below and return to CLIENT NAME. If you have questions please call us at 800-555-1234 8:00 AM - 7:00 PM, EST - MONDAY THRU FRIDAY. Thank you for your prompt response to this request. ASSIGNMENT OF CLAIM AND AUTHORIZATION — PROVIDE INSURANCE INFORMATION I request that payment of authorized Medicare, Medicaid or any other insurance benefits be made on my behalf to CLIENT NAME for any services provided to me now, in the past, or in the future. I agree to immediately remit to CLIENT NAME any payments that I receive directly from insurance or any source whatsoever for the services provided to me and I assign all rights to such payments to CLIENT NAME. I authorize CLIENT NAME to appeal payment denials or other adverse decisions on my behalf without further authorization. A copy of this form is as valid as the original. I understand CLIENT NAME is permitted to make uses and disclosures of protected health information for treatment, payment and health care operations. Patient Signature: Date: CONTACT US Phone: 800-555-1234 8:00 AM 7:00 PM, EST - MONDAY THRU FRIDAY Fold on line for proper window alignment YOUR CLIENT NAME i LO., e 999 MICKEY MOUSE i HERE ORLANDO, FL 12345 MED3*577*2635455CBPS 457884 279485 167108172 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 We need your assistance! You can help us, with just 3 easy steps: 1. Please sign and date the form above 2. Fill out your insurance information on the back of this form 3. Place completed form in return envelope provided and mail. Thank you! IIhIIhII"IIIiIL'IIIIIII,IiIIIIIIIIIIIIIIIIIuIIII'II'III'II"I CLIENT NAME 3131 NEINMARK DR STE 100 MIAMISBURG, OH 45342 Account Information YOUR LOGO HERE Patient's Date of Birth: Patients SSN: Account Number: BPS*2635456.1 Patient Name: DONALD DUCK Statement Date: 09/04/2015 Type of Service: Ambulance Transport Date: 07/01/2015 PRIMARY INSURANCE INFORMATION SECONDARY INSURANCE INFORMATION Company*: Company*: Telephone #: Telephone #: Address: City/St/Zip: Policy #: Group #: Address: City/St/Zip: Policy #: Group #: Policy Holder's Name: Policy Holder's Name: Relationship to Patient: Relationship to Patient: Insured's SSN: Insured's SSN: insured's Date of Birth: Insured's Date of Birth: * If you have Medicare or Medicaid and have a Managed Care replacement plan please provide that information above. If the services provided were a result of a work related or motor vehicle accident, please also provide the appropriate information below. AUTOMOBILE INSURANCE INFORMATION WORKER'S COMPENSATION INFORMATION Company: Employer: Telephone #: Employer Address: Address: City/St/Zip: City/St/Zip: Employer Phone #: Policy #: Workers Comp Carrier: Claim #: Carrier Phone#: Policy Holder's Name: Carrier Address: Relationship to Patient: City/St/Zip: Original Date of Accident: Policy #: State where Original Accident Occurred: Claim #: Original Date of injury: YOUR LOGO HERE CLIENT NAME provided AMBULANCE services to you. CUSTOM MESSAGE HERE Summary of Account Total Charges Insurance Payments Insurance Adjustments Patient Payments Account Adjustments AMOUNT YOU OWE Your prompt payment is appreciated! page for transaction details. Statement Date: Responsible Party: Account Number: Due Date: REQUEST FOR PAYMENT $ 1,202,25 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 1,202.25 Please see the following contact:tlie`pilllg,office easec; 0-555-1,2.34; 8 ON ra asstenciaen-EspanolIIameal.t YOUR L OGO HERE CLIENT NAME 999 MICKEY MOUSE ORLANDO, FL 12345 Temp - Return Service Requested MED3*577*2635445CBPS 457884 279485 167108162 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 Page 1 of 2 7/13/15 DONALD DUCK BPS*2635445.1 Upon Receipt Pa ByMai I -- Please detach and return bottom stub with your check y -- Include account number on check and correspondence Accouilf>5°. _,. _Patientz_`_:, BPS*2635445.1 DONALD DUCK Statement Datec:._..Amount;Due:=`, ,== D'lb 'Date''' Amount Paid 7/13/15 $ 1,202.25 Upon Receipt For your protection: Do not include the credit card information in the mail. Make CHECK payable and remit to: IIIIIIIIII'I'IIIhhIIhIII'IIIIIh111111II'II'IIhI CLIENT NAME 3131 NEWMARK DR STE 100 MIAMISBURG, OH 45342 .YOUR: T(��T � J. V U. :LOGO: :HERE: iu. rww'allner. Statement Date: Responsible Party: Account Number: Due Date: Page 2 of 2 7/13/15 DONALD DUCK BPS*2635445.1 Upon Receipt Patient: DONALD DUCK Account: BPS*2635445.1 Service Dt. Service Description Transport To: ABC HOSPITAL Transport From: 1234 HAPPY PLACE 12345 Qty Charges Primary: MEDICAID OF MA - MAS Secondary: Self Pay Payments Adjustments You Owe 07/01/15 A0429 BLS EMERGENCY TRANSPORT 151820007 07/01/15 A0425,MILAGE BLS You Owe 1 1200.00 0.00 1202.25 Please be aware that the above summary represents Ambulance services from your medical provider. You may receive a separate statement for services provided by the hospital. CHANGE OF: ❑ Address Primary Insurance ❑ Supplemental Insurance Complete this form or go online to www.peryourhealth,com to make changes, DONALD DUCK BPS*2635445.1 New Patient Address, City, State, Zip New Phone# Primary Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Supplemental Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Work connected Illness or Injury? ❑ Yes ❑ No Auto Accident? ❑ Yes ❑ No Date of Onset or Accident / /_ Employer Name Address, City, State, Zip YOUR LOGO HERE CLIENT NAME provided AMBULANCE services to you.CUSTOM MESSAGE HERE Summary of Account Total Charges Insurance Payments Insurance Adjustments Patient Payments Account Adjustments AMOUNT YOU OWE REQUEST $ 1,278.75 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 1,278.75 Your prompt payment is appreciated! Please see the following page for transaction details. YOUR LOGO HERE CLIENT NAME 999 MICKEY MOUSE ORLANDO, FL 12345 Temp - Return Service Requested M ED3*577*2635446CB PS 457884 279485 167108163 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 Statement Date: Responsible Party: Account Number: Due Date: FOR PAYMENT Page 1 of 2 7/13/15 DONALD DUCK BPS*2635446.1 Upon Receipt Pa ByMail -- Please detach and return bottom stub with your check y -- Include account number on check and correspondence BPS*2635446.1 DONALD DUCK State`"; erii'_bate' gent Al�nisunt.,D ue a.:`` Due;Date-:;= y" ; Atnou1it„Paid=`=., 7/13/15 $ 1,278.75 Upon Receipt For your protection: Do not include the credit card information in the mail. Make CHECK payable and remit to: IIIIIthhhIIIIIIIIIIhI'II'IIIIIIIIIIIIIhIhIIhIhhhIIhIIIIIII'lIIhII CLIENT NAME 3131 NEWMARK DR STE 100 MIAMISBURG, OH 45342 YOUR .tG HERE Statement Date: Responsible Party: Account Number: Due Date: Page 2 of 2 7/13/15 DONALD DUCK BPS*2635446.1 Upon Receipt Patient: DONALD DUCK Transport To: ABC Account: BPS*2635446.1 Transport From: 1234 Service Dt. 'Service Description 07/01/15 A0429 BLS EMERGENCY TRANSPORT 151820009 07/01/15 ,; A0425 MILEAGE BLS _. ,. 1200.00 HOSPITAL HAPPY PLACE 12345 Qty Charges Primary: TUFTS ASSOCIATED H Secondary: Self Pay Payments Adjustments You Owe You Owe Please be aware that the above summary represents Ambulance services from your medical provider. You may receive a separate statement for services provided by the hospital. CHANGE OF ❑ Address ❑ Primary Insurance ❑ Supplemental Insurance Complete this form or go online to www.peryourhealth.com to make changes. 1278.75 Iwoi 8,75 DONALD DUCK BPS*2635446.1 New Patient Address, City, State, Zip New Phone# primary Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Supplemental Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date _/ / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Work connected Illness or Injury? ❑ Yes ❑ No Auto Accident? D Yes ❑ No Date of Onset or Accident / / Employer Name Address, City, State, Zip YOUR LOGO HERE CLIENT NAME provided AMBULANCE services to you.CUSTOM MESSAGE HERE Summary of Account Total Charges Insurance Payments Insurance Adjustments Patient Payments Account Adjustments AMOUNT YOU OWE Statement Date: Responsible Party: Account Number: Due Date: REQUEST FOR PAYMENT $ 1,269.75 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 1,269.75 Your prompt payment is appreciated! Please see the following page for transaction details. YOUR LOGO HERE wwwwww CLIENT NAME 999 MICKEY MOUSE ORLANDO, FL 12345 Temp - Return Service Requested M ED3*577*2635447CBPS 457884 279485 167108164 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 Page 1 of 2 7/13/15 DONALD DUCK BPS*2635447.1 Upon Receipt PayByMail -- Please detach and return bottom stub with your check -- Include account number on check and correspondence BPS*2635447.1 DONALD DUCK Stateme t;bate_; ' Am& t;Due = .._=:;Dcik:pgte-,_.===. =:"Amount Paid 7/13/15 $ 1,269.75 Upon Receipt For your protection: Do not include the credit card information in the mail. Make CHECK payable and remit to: IIIIIIIIIIIJIIIllIIIIlIIIIIIIIIIuIuIIInIlIIIIIIIIIIIIuJIIIIIIIII CLIENT NAME 3131 NEWMARK DR STE 100 MIAMISBURG, OH 45342 YOUR HERE dit card on1lne arlytlme;3i ourhealth corm or.nf Statement Date: Responsible Party: Account Number: Due Date: Page 2 of 2 7/13/15 DONALD DUCK BPS*2635447.1 Upon Receipt Patient: DONALD DUCK Account: BPS'*2635447.1 Service Dt. Service Description Transport To: ABC HOSPITAL Primary: COMMERCIAL INS LAS Trans ort From: 1234 HAPPY PLACE 12345 Secondar Self Pa Qty Charges Payments Adjustments You Owe 07/01/15 A0429 BLS EMERGENCY TRANSPORT 151820010 1 1200.00 A0425MILEAGE BLS You Owe 0.00 1269.75 Please be aware that the above summary represents Ambulance services from your medical provider. You may receive a separate statement for services provided by the hospital. CHANGE OF: ❑ Address ❑ Primary Insurance ❑ Supplemental Insurance Complete this form or go online to www.peryourhealth.com to make changes. DONALD DUCK BPS*2635447.1 New Patient Address, City, State, Zip New Phone# Primary Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group Insurance, name of group (employer/union/association) Supplemental Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group Insurance, name of group (employer/union/association) Work connected Illness or Injury? ❑ Yes ❑ No Auto Accident? ❑ Yes ❑ No Date of Onset or Accident /__/_ Employer Name Address, City, State, Zip ----- YOUR LOGO HERE CLIENT NAME provided AMBULANCE services to you.CUSTOM MESSAGE HERE Summary of Account Total Charges Insurance Payments Insurance Adjustments Patient Payments Account Adjustments AMOUNT YOU OWE Statement Date: Responsible Party: Account Number: Due Date: REQUEST FOR PAYMENT $ 1,233.75 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 1,233.75 Your prompt payment is appreciated! Please see the following page for transaction details. ........... YOUR LOGO HERE CLIENT NAME 999 MICKEY MOUSE ORLANDO, FL 12345 Temp - Return Service Requested MED3*577*2635448CBPS 457884 279485 167108165 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 Page 1 of 2 7/13/15 DONALD DUCK BPS*2635448.1 Upon Receipt oambul.:-,... anceservices you, i ave.insurance antl'we`heye , ilta `J ar surance are,waiting: for,a:' posse=_ Pa ByMail -- Please detach and return bottom stub with your check y -- Include account number on check and correspondence Patie BPS*2635448.1 DONALD DUCK Statement )ate ': Amo`unt DUe ` -, - , ... - ,..., Due�Date:�_`;;;�> ' .... ~fit - _;'AmoUnt�Paid`= 7/13/15 $ 1,233.75 Upon Receipt For your protection: Do not include the credit card information in the mall. Make CHECK payable and remit to: IIIIiIIIiu'IIIiliiI'iIIIIIIIIiInI"111"II1IIIIIIIIIIIIIIIIhi1 CLIENT NAME 3131 NEWMARK DR STE 100 MIAMISBURG, OH 45342 Statement Date: Responsible Party: Account Number: Due Date: Page 2 of 2 7/13/15 DONALD DUCK BPS*2635448.1 Upon Receipt Patient: DONALD DUCK Account: BPS*2635448.1 Service Dt, Service Description Transport To: ABC HOSPITAL Transport From: 1234 HAPPY PLACE 12345 Qty Charges Primary: MEDICAID OF MA - MAS Secondary: Self Pay Payments Adjustments You Owe 07/01/15 A0429 BLS EMERGENCY TRANSPORT 151820011 07/0'i/15 , A0425„MILEAGE BLS - . You Owe 1 1200.00 337,5 z 0.00 1233.75 Please be aware that the above summary represents Ambulance services from your medical provider. You may receive a separate statement for services provided by the hospital. CHANGE OF: ❑ Address ❑ Primary Insurance ❑ Supplemental Insurance Complete this form or go online to www.peryourhealth.com to make changes. DONALD DUCK BPS*2635448.1 New Patient Address, City, State, Zip New Phone# Primary Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Supplemental Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Work connected Illness or Injury? ❑ Yes ❑ No Auto Accident? ❑ Yes ❑ No Date of Onset or Accident Employer Name Address, City, State, Zip YOUR LOGO HERE CLIENT NAME provided AMBULANCE services to you.CUSTOM MESSAGE HERE Statement Date: Responsible Party: Account Number: Due Date: REQUEST FOR PAYMENT Summary of Account Total Charges $ 1,245.00 Insurance Payments $ 0.00 Insurance Adjustments $ 0.00 Patient Payments $ 0.00 Account Adjustments $ 0.00 AMOUNT YOU OWE $ 1,245.00 Your prompt payment is appreciated! Please see the following page for transaction details. ay_mei YOUR LOGO HERE CLIENT NAME 999 MICKEY MOUSE ORLANDO, FL 12345 Temp - Return Service Requested MED3*577*2635449CBPS 457884 279485 167108166 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 Page 1 of 2 7/13/15 DONALD DUCK BPS*2635449.1 Upon Receipt PayByMail -- Please detach and return bottom stub with your check -- Include account number on check and correspondence - :7.P"t-d. BPS*2635449.1 DONALD DUCK Satement=Date 010f=Due°=2:,r D'ue'Dafie= '_ =' Alnduin_Paid'=, 7/13/15 $ 1,245.00 Upon Receipt For your protection: Do not include the credit card information in the mail. Make CHECK payable and remit to: CLIENT NAME 3131 NEWMARK DR STE 100 MIAMISBURG, OH 45342 Statement Date: Responsible Party: Account Number: Due Date: Page 2 of 2 7/13/15 DONALD DUCK BPS*2635449.1 Upon Receipt Patient: DONALD DUCK Account: BPS*2635449.1 Service Dt. Service Description Transport To: ABC HOSPITAL Transport From: 1234 HAPPY PLACE 12345 Qty Charges Primary: MEDICARE OF MASSAC Secondary: MEDICAID OF MA - MAS Payments Adjustments You Owe 07/01/15 A0429 BLS EMERGENCY TRANSPORT 151820013 07/01/15 A042aV11LEAGE BLS You Owe 1 1200.00 0.00' 1245.00 Please be aware that the above summary represents Ambulance services from your medical provider. You may receive a separate statement for services provided by the hospital. CHANGE OF: ❑ Address ❑ Primary Insurance ❑ Supplemental Insurance Complete this form or go online to www.peryourhealth.com to make changes. DONALD DUCK BPS*2635449.1 New Patient Address, City, State, Zip New Phone# Primary Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date __I / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group Insurance, name of group (employer/union/association) Supplemental Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Work connected Illness or Injury? ❑ Yes ❑ No Auto Accident? ❑ Yes ❑ No Date of Onset or Accident / / Employer Name Address, City, State, Zip YOUR LOGO HERE CLIENT NAME provided AMBULANCE services to you.CUSTOM MESSAGE HERE Summary of Account Total Charges Insurance Payments Insurance Adjustments Patient Payments Account Adjustments AMOUNT YOU OWE Your prompt payment is appreciated! page for transaction details, YOUR LOGO HERE nsuran'ce_ CLIENT NAME 999 MICKEY MOUSE ORLANDO, FL 12345 Temp - Return Service Requested MED3*577*2635450CBPS 457884 279485 167108167 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 Page 1 of 2 7/13/15 DONALD DUCK BPS*2635450.1 Upon Receipt Statement Date: Responsible Party: Account Number: Due Date: REQUEST FOR PAYMENT $ 1,222.50 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 1,222.50 Please see the following In Pa ByMail -- Please detach and return bottom stub with your check y -- Include account number on check and correspondence -==Acco'unt `'Pafia't t`'s BPS*2635450.1 DONALD DUCK :,8*,6 e-1,0 e AIY1b 0.0.:' u ,:= bOa.Date:=--;;. - Amounf Paid.:?; 7/13/15 $ 1,222.50 Upon Receipt For your protection: Do not include the credit card information in the mail. Make CHECK payable and remit to: "I'IIIIIIIIIIII'I'IIInIn1nl'IIIIIII"IIIIIIIl'JI''''1'' llJ"I CLIENT NAME 3131 NEWMARK DR STE 100 MIAMISBURG, OH 45342 YOUR LOGO HERE Statement Date: Responsible Party: Account Number: Due Date: Page 2 of 2 7/13/15 DONALD DUCK BPS*2635450.1 Upon Receipt Patient: DONALD DUCK Account: BPS*2635450.1 Service Dt. Service Description Transport To: ABC HOSPITAL Transport From: 1234 HAPPY PLACE 12345 07/01/15 A0429 BLS EMERGENCY TRANSPORT 151820014 07/01(15 A0425MILEAGE BLS „ + You Owe Qty 1 Charges 1200.00 22 50 Primary: MEDICAID OF MA - MAS Secondary: Self Pay Payments Adjustments 0.00 You Owe 1222.50 Please be aware that the above summary represents Ambulance services from your medical provider. You may receive a separate statement for services provided by the hospital. CHANGE OF: ❑ Address ❑ Primary Insurance ❑ Supplemental Insurance Complete this form or go online to www.peryourhealth.com to make changes. DONALD DUCK BPS*2635450.1 New Patient Address, City, State, Zip New Phone# Primary Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/assoclation) Supplemental Policy Holder Name Policy Holder Date of Birth /__/ Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Work connected Illness or Injury? ❑ Yes ❑ No Auto Accident? ❑ Yes ❑ No Date of Onset or Accident / / Employer Name Address, City, State, Zip YOUR LOGO HERE CLIENT NAME provided AMBULANCE services to you.CUSTOM MESSAGE HERE Summary of Account Total Charges Insurance Payments Insurance Adjustments Patient Payments Account Adjustments AMOUNT YOU OWE REQUEST $ 1,233.75 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 1,233.75 Your prompt payment is appreciated! Please see the following page for transaction details. YOUR LOGO HERE CLIENT NAME 999 MICKEY MOUSE ORLANDO, FL 12345 Temp - Return Service Requested MED3*577*2635450CBPS 457884 279485 167108168 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 Statement Date: Responsible Party: Account Number: Due Date: FOR PAYMENT mportart' .. testa wro in unt s'ili Fi`as`n i °outsta'ning ba Please make payment Immediate MES:SA Page 1 of 2 7/13/15 DONALD DUCK BPS*2635450.2 Upon Receipt PayByMail -- Please detach and return bottom stub with your check -- Include account number on check and correspondence Patient '= BPS*2635450.2 DONALD DUCK :8't*1-06.4.at6`' ,PAirm040.=Due'-;. `;,`'. Due;Date_ ;_ '`_A ountPa!,d,}? 7/13/15 $ 1,233.75 Upon Receipt For your protection: Do not include the credit card information in the mail. Make CHECK payable and remit to: I'Ii 111111Ili 1111Illl1I'llliI'IIII'IIIIIIifnldilliiiI'llli CLIENT NAME 3131 NEWMARK DR STE 100 MIAMISBURG, OH 45342 YOUR L HERE wwm.. Statement Date: Responsible Party: Account Number: Due Date: Page 2 of 2 7/13/15 DONALD DUCK BPS*2635450.2 Upon Receipt Patient: DONALD DUCK Account: BPS*2635450.2 Service Dt. Service Description Transport To: ABC HOSPITAL Transport From: 1234 HAPPY PLACE 12345 07/03/15 A0429 BLS EMERGENCY TRANSPORT 151840037 07/03j15 A0�25"'MILEAGE BLS You Owe Qty Charges 1 1200.00 Primary: BMC HEALTHNET Seconda Self Pay Payments Adjustments You Owe 0.00 1233.75 CHANGE OF: Please be aware that the above summary represents Ambulance services from your medical provider. You may receive a separate statement for services provided by the hospital. Address ❑ Primary Insurance ❑ Supplemental Insurance Complete this form or go online to www.peryourhealth.com to make changes. DONALD DUCK BPS*2635450.2 New Patient Address, City, State, Zip New Phone# Primary Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Supolementat Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date /--/— Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Work connected Illness or Injury? ❑ Yes ❑ No Auto Accident? ❑ Yes ❑ No Date of Onset or Accident _/ Employer Name Address, City, State, Zip LOGO; HERE _.....,,.m_.1 CLIENT NAME provided AMBULANCE services to you.CUSTOM MESSAGE HERE Summary of Account Total Charges Insurance Payments Insurance Adjustments Patient Payments Account Adjustments REQUEST $ 1,256.25 $ 0.00 $ 0.00 $ 0.00 $ 0,00 AMOUNT YOU OWE $ 1,256.25 Your prompt payment is appreciated! Please see the following page for transaction details. Page 1 of 2 7/13/15 DONALD DUCK BPS*2635452.1 Upon Receipt Statement Date: Responsible Party: Account Number: Due Date: FOR PAYMENT 1111 Oirtant Message YOUR LOGO HERE CLIENT NAME 999 MICKEY MOUSE ORLANDO, FL 12345 Temp - Return Service Requested MED3*577*2635452CBPS 457884 279485 167108169 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 PaMal -- Please detach and return bottom stub with your check y By -- Include account number on check and correspondence Accounte' n - BPS*2635452.1 DONALD DUCK State'ime1it`Date:;Amount DUe r: Due';Date `.:; ` Amou1lt;Paid 7/13/15 $ 1,256.25 Upon Receipt For your protection: Do not include the credit card information in the mail, Make CHECK payable and remit to: III1II1uIIII1IIIIIIIIIIIIIIIIIIIIIIII1IJIIIII'III1II1III1IuIIi1Il CLIENT NAME 3131 NEWMARK DR STE 100 MIAMISBURG, OH 45342 YOUR: t OGO HERE PayTb wwvv, i card thine an_ 'ourhealth co Statement Date: Responsible Party: Account Number: Due Date: Page 2 of 2 7/13/15 DONALD DUCK BPS*2635452.1 Upon Receipt Patient: DONALD DUCK Account: BPS*2635452.1 Service Dt. Service Description Transport To: ABC HOSPITAL Transport From: 1234 HAPPY PLACE 12345 07/01/15 A0429 BLS EMERGENCY TRANSPORT 151820021 07/01115 A0425MILEAGE $LS You Owe Qty ( Charges 1 1200.00 Primary: MEDICAID OF MA - MAS Secondary: Self Pay Payments Adjustments 0.00 You Owe 1256.25 Please be aware that the above summary represents Ambulance services from your medical provider. You may receive a separate statement for services provided by the hospital. CHANGE OF: ❑ Address ❑ Primary Insurance ❑ Supplemental Insurance Complete this form or go online to www.peryourhealth.com to make changes. DONALD DUCK BPS*2635452.1 New Patient Address, City, State, Zip New Phone# Primary Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Supplemental Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date __/ / _ Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Work connected Illness or Injury? ❑ Yes ❑ No Auto Accident? ❑ Yes ❑ No Date of Onset or Accident / /_ Employer Name Address, City, State, Zip YOUR L OGO HERE CLIENT NAME provided AMBULANCE services to you.CUSTOM MESSAGE HERE Statement Date: Responsible Party: Account Number: Due Date: REQUEST FOR PAYMENT Summary of Account Total Charges $ 1,202.25 Insurance Payments $ 0.00 Insurance Adjustments $ 0.00 Patient Payments $ 0.00 Account Adjustments $ 0,00 AMOUNT YOU OWE $ 1,202.25 Your prompt payment is appreciated! Please see the following page for transaction details, YOUR LOGO HERE CLIENT NAME 999 MICKEY MOUSE ORLANDO, FL 12345 Temp - Return Service Requested MED3*577*2635454CBPS 457884 279485 167108170 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 Page 1 of 2 7/13/15 DONALD DUCK BPS*2635454.1 Upon Receipt terrient=fo amli`%ilance servjc se :your4insu'r="ai'oe'carrier=dE Pa ByMail -- Please detach and return bottom stub with your check y -- Include account number on check and correspondence �4'Ac t ` �Coun - - - - ie �P nt ', - at BPS*2635454.1 DONALD DUCK Statement,,Date ' '`Arriou i#. D;ue' ; ;_„= Diie: Date _,Amount;P`a d,. .:. 7/13/15 $ 1,202.25 Upon Receipt For your protection: Do not include the credit card information in the mail. Make CHECK payable and remit to: IIIIIihIllrilhlllhluhhululillllluhlluiiluiiuuulllluliiililllllill CLIENT NAME 3131 NEWMARK DR STE 100 MIAMISBURG, OH 45342 YOUR LOGO HERE Statement Date: Responsible Party: Account Number: Due Date: Page 2 of 2 7/13/15 DONALD DUCK BPS*2635454.1 Upon Receipt Patient: DONALD DUCK Account: BPS*2635454.1 Service Dt. Service Description Transport To: ABC HOSPITAL Transport From: 1234 HAPPY PLACE 12345 07/01/15 A0429 BLS EMERGEN CY TRANSPORT 151820023 07i01/T5 N - A0,425J/IILEAC�;E BLS You Owe Qty 1 Charges 1200.00 Primary: MEDICARE OF MASSAC Secondary: MEDICAID OF MA - MAS Payments Adjustments 0.00 You Owe 1202.25 Please be aware that the above summary represents Ambulance services from your medical provider. You may receive a separate statement for services provided by the hospital. CHANGE OF: ❑ Address ❑ Primary Insurance ❑ Supplemental Insurance Complete this form or go online to www.peryourhealth.com to make changes. DONALD DUCK BPS*2635454,1 New Patient Address, City, State, Zip New Phone# Primary Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group Insurance, name of group (employer/union/association) Supplemental Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group Insurance, name of group (employer/union/association) Work connected Illness or Injury? ❑ Yes ❑ No Auto Accident? ❑ Yes ❑ No Date of Onset or Accident / / Employer Name Address, City, State, Zip YOUR LOGO HERE CLIENT NAME provided AMBULANCE services to you.CUSTOM MESSAGE HERE Statement Date: Responsible Party: Account Number: Due Date: REQUEST FOR PAYMENT Summary of Account Total Charges $ 1,242.75 Insurance Payments $ 0.00 Insurance Adjustments $ 0.00 Patient Payments $ 0.00 Account Adjustments $ 0.00 AMOUNT YOU OWE $ 1,242.75 Your prompt payment is appreciated! Please see the following page for transaction details. YOUR LOCO HERE CLIENT NAME 999 MICKEY MOUSE ORLANDO, FL 12345 Temp - Return Service Requested MED3*577*2635455CBPS 457884 279485 167108171 DONALD DUCK 3377 SPINDLETOP DR NW KENNESAW, GA 30144-7360 essai Page 1 of 2 7/13/15 DONALD DUCK BPS*2635455.1 Upon Receipt Pa ByMail -- Please detach and return bottom stub with your check y -- Include account number on check and correspondence ccoUn Patient .`=;: _: BPS*2635455.1 DONALD DUCK Stateirrleh DaEe .. e A9iiount, DUe: f�' , _-_--_bueDate'�';' -.- .. ,.. .,.Arpo'i�nkRaid 7/13/15 $ 1,242,75 Upon Receipt For your protection: Do not include the credit card information in the mail. Make CHECK payable and remit to: I��Il��ll��llrllllllllll���nu�lll�lililli�'��'ll�'ll�"�'�I'I�II CLIENT NAME 3131 NEWMARK DR S'TE 100 MIAMISBURG, OH 45342 YOUR LOGO HERE Statement Date: Responsible Party: Account Number: Due Date: Page 2 of 2 7/13/15 DONALD DUCK BPS*2635455.1 Upon Receipt Patient: DONALD DUCK Account: BPS*2635455,1 Service Dt. Service Description Transport To: ABC HOSPITAL Primary: MEDICAID OF MA- MAS Transport From: 1234 HAPPY PLACE 12345 Secondary: Self Pay Qty Charges Payments Adjustments You Owe 07/01/15 A0429 BLS EMERGENCY TRANSPORT 151820024 07/0111,5 A0425,MILEAGE BLS, .; You Owe 1 1200.00 0.00 x ^. 1242.75 Please be aware that the above summary represents Ambulance services from your medical provider. You may receive a separate statement for services provided by the hospital. CHANGE OF: ❑ Address [] Primary Insurance ❑ Supplemental Insurance Complete this form or go online to www.peryourhealth.com to make changes. DONALD DUCK BPS*2635455.1 New Patient Address, City, State, Zip New Phone# Primary Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone# If Group insurance, name of group (employer/union/association) Supplemental Policy Holder Name Policy Holder Date of Birth / / Relationship to Patient Policy Identification Group Identification Plan Code Policy Effective Date / / Insurance Company Name Address, City, State, Zip Insurance Phone # If Group insurance, name of group (employer/union/association) Work connected Illness or Injury? ❑ Yes ❑ No Auto Accident? ❑ Yes ❑ No Date of Onset or Accident Employer Name Address, City, State, Zip o erin ea thcare KINGS LANDING HMS Executive Summary Reports January 2016 Executive Summary KINGS LANDING EMS Practice January 2016 Account Period "=1/olume I Patients Procedures Gross Charges Adjustments Net Gross Collections . Adjustments Net Collection Rates Net GCR GCR* NCR* Lag* , ? Accounts Receivable %AR >120 Credit Balance Islet Bad Debt. Amount %* Ending AR Days in AR Feb-15 1,022 2,044 557,428 (123,046) 434,382 (449,455) 2,621 (446,835) 64-5% 77.7% 61.6% 1,703,491 78.1 37.3% (4,529) (118.083) 19.8% Mar-15 1,148 2,294 625,407 (140,766) 484,641 (485,821) 3,728 (482,093) 67.3% 822% 65.8% 1,621,490 69.9 41.1% (8,863) (84,549) 17.7% Apr-15 1,304 2,603 718,811 (105,064) 613,747 (407,649) 11,237 (396,412) 67.8% 83.3% 62.8% 1,773,920 84.9 40.6% (4,776) (64,904) 15.5% May-15 1,640 3,274 896,009 (110,413) 785,596 (428,102) 2,301 (425,801) 63.8% 77.3% 68.6% 2,045,066 83.1 38.6% (8,020) (88,649) 13.8% Jun-15 1,450 2,896 794,325 (117,672) 676,653 (488,183) 4,216 (483,967) 63.0% 74.9% 58.3% 2,119,732 80.1 40.0% (9,840) (118,020) 12.4% Jul-15 579 1,158 316,950 (101,618) 215,333 (409,331) 3,154 (406,177) 66.5% 79.8% 54.6% 1,842,094 83.5 51.9% (16,010) (86,794) 14.4% Aug-15 1,241 2,482 681,196 (84,790) 596,405 (293,005) 4,700 (288,305) 63.3% 75.2% 58.7% 2,031,649 103.1 50.0% (14,497) (118,545) 13.9% Sep-15 1,367 2,732 741,988 (126,881) 615,107 (458,866) 4219 (454,647) 62.6% 74.5% 64.1% 2,026,989 106.0 49.5% (16,623) (165,119) 15.5% Oct-15 2,666 5,331 1,463,381 (107,867) 1,355,514 (415,685) 108 (415,577) 56.1% 65.4% 66.6% 2,831,849 89.3 36.8% (23,898) (135,078) 14.6% Nov-15 1,403 2,804 770,497 (200,642) 569,854 (749,455) 11,591 (737,863) 59.1% 69.4% 55.7% 2,584,841 79.0 42.9% (16,255) (78,999) 14.7% Dec-15 1,100 2,200 601,465 (126,593) 474,872 (553,105) 6,767 (546,338) 60.7% 71.4% 57.1% 2,425,607 77.8 48.0% (14,742) (87,768) 14.7% Jan-16 908 1,815 497,826 (107,693) 390,133 (403,946) 3,055 (400,892) 64.0% 76.1% 59.4% 2,378,070 115.7 54.9% (16,857) (36,778) 13.1% 12 With Total 15,828 31,633 8,665,281 (1,453,043) 7,212,237 (5,542,604) 57,697 (5,484,908) - - - - - - - (1,183,287) 14.9% CurrentFYTD 6,077 12,150 3.333.168 (542,794) 2,790,374 (2,122,192) 21,521 (2,100,670) - (71,753) (338,623) 14.3% Previous 4,425 8,845 2,404,562 (399,204) 2,005,358 (1,421,324) 18,883 (1,402,442) - - - - - - (5,416) (432,833) 221% FYTD Current12 1,319 2,636 722,107 (121,087) 601,020 (461,884) 4,808 (457,076) 64_0% 76.1% 61.0% 2,115,400 86.3 44.3% (12,909) (98,607) 14.9% Mth Avg Previous 12 1,209 2,418 661,796 (115,519) 546,278 (425,089) 4,880 (420,209) 64.2% 76.9% 63.4% 1,813,332 83.4 35.4% (1,687) (142,679) 22.3% Mth Avg Variance % 9.1% 9.0% 9.1% 4.8% 10.0% 8.7% (1.5%) 8.8% (0.4%) (1.1%) (3.8%) 16.7% 3.5% 25.1% 665.3% (30.9%) (33.5%) * GCR (Gross Collections / Gross Charges) and NCR (Net Collections / Net Charges) calculations are based on a maximum of 12 months of data. The Net GCR Lag (Net Collections / Gross Charges) is based on a maximum of 3 months of data with a 1 month Gross Charge lag. Net Bad Debt % is based on a 6 month average. Feb-15 Patients, Procedures (000) May-15 MEKESSON Aug-15 Nov-15 1,400 1,200 1,000 Feb-15 Charges, Collections (000) May-15 Aug-15 Executive Summary Empowering Healthcare Proprietary and Confidential Nov-15 11 110 105 10 95 9 -450 8 00 8 350 75 300 7 250 65 Feb-15 700 50 00 50 00 May-15 DAR, %AR > 120 Aug-15 Nov-15 Monthly Activity Trends KINGS LANDING EMS Practice 1,500.00 1,400,000 1,200,00 1,000,00u 800 00 600,000 400,000 200.000 -800,000 -600.000 -400,000 Feb-15 Feb-15 Mar-15 Mar-15 Apr-15 Apr-15 . uttu\����\tom May-15 May-15 Jun-15 Jul-15 Aug-15 Gross Charges Jun-15 Jul-15 Aug-15 Sep-15 Sep-15 Oct-15 Oct-15 ® Gross Collections • Charge Adjustments Net Bad Debt Nov-15 Nov-15 Dec-15 Dec-15 January 2016 Jan-16 Jan-16 Curr 12 Prev 12 _Feb-15 Mar-15 -Apr-15 - May-15 Jun-15 - Jul-15=- - Aug-15 Sep-15 - Oct-15 Nov-15_ Dec-15 Jan-16 MthAvg Mth Avg Gross Charges Charge Adjustments Gross Collections Net Bad Debt 557,428 625,407 718,811 (123,046) (140,766) (105,064) (449,455) (485,821) (407,649) (118,083) (84,549) (64,904) 896,009 (110,413) (428,102) (88.649) 794,325 (117,672) (488,183) (118,020) 316,950 (101 618) (409, 331) (86 794) 681,196 (84,790) (293,005) (118,545) 741,988 (126,881) (458,866) (165,119) 1,463,381 (107,867) (415,685) (135,078) 770,497 (200,642) (749,455) (78,999) 601,465 (126,593) (553,105) (87,768) 497,826 (107,693) (403,946) (36,778) 722,107 (121,087) (461,884) (98,607) 661,796 (115,519) (425,089) (142,679) MSKESSON Monthly Activity Trends .rper er'rc ti; at,r, e Proprietary and Confidential Accounts Receivable Aging KINGS LANDING EMS Practice 40% 35% 0-30 Days 31-60 Days 61-90 Days 91-120 Days 121-150 Days 151-180 Days 181-210 Days 210+ Days _ Total Days in AR %AR > 120 5 AR > 120 0-30 Da s -60 Da s 61-90 Da s -120 Da s 121-150 Da s 51-180 Da s 181-210 Da s 210+ Days January 2016 tV 0 623,528 271,594 173,713 141,058 78,089 68,060 347,449 1,703,491 78.1 37.3% 634,656 495,575 273,992 185,500 144,403 79,688 63,494 378.838 1,621,490 968 456,467 378,887 217,290 165,120 88,776 63107 403,307 1,773,920 0 578,869 426,861 250,141 197,659 110,653 54,874 426,010 2,045,066 0 629,754 367,903 274,195 217,318 120,292 62,612 447,658 2,119,732 -Jul-2015 0 243,271 373,918 268,389 240,714 166,799 81,554 467,449 1,842,094 Aug-2015 -Sep-2015 Oct-2015 222,325 522,926 269,790 233,060 192,344 85,055 506,148 2,031,649 2.210 308,659 453,645 259,513 220,420 166,052 94,315 522,175 2,026,989 403,074 689,724 464,773 233,527 230.978 151,416 98,028 560,329 2,831,849 Nov-2015 459,238 468,977 316,007 232,798 194,994 195,244 102,484 615,099 2,584,841 Dec-2015 304,073 449,188 252,528 255,199 208,722 169.651 122,978 663,268 2,425,607 20,369 575,181 262,490 213,606 232,635 197.428 148.028 729,333 2,378,070 99,161 478,460 363,794 236,138 202,257 143,036 87,049 505,505 2,115,400 (94.9%) (16 6%) (43.5%) (8.5%) 0.7% 30.4% 51.0% 30.0% (16.0%) 69.9 41.1% 666,423 84.9 40.6% 720,309 83.1 38.6% 789,195 80.1 40.0% 847,880 83 5 51.9% 956,516 103 1 50.0% 1,016,608 106.0 49.5% 1,002,962 89.3 36.8% 1,040,751 79.0 42.9% 1,107,821 77.8 48.0% 1,164,618 115.7 54.9% 1,306.424 87.5 44.3% 937,847 29.6% 49.5% 25.5% MSKESSON Accounts Receivable Aging Emecnver,n9 Heattx?tare Proprietary and Confidential Payor Mix Trends by Quarter - Charges KINGS LANDING EMS Practice 11 Jan-Mar2015 ■ Apr-Jun2015 ® Jul-Sep2015 Oct-Dec2015 Jan-Jan2016 00 January 2016 PayoLGroup� =-Aprniun2Q15 =--__- Jul-Sep2O Oct-Dec2015 Jan-Jan2Q16 , 12 Mth Avg AUTO INS BCBS COMMERCIAL HMO NON MEDICARE INDIGENT CARE MEDICAID MEDICARE OTHER SELFPAY SPECIAL BILLS VVORKERS COMP 2% 5% 14% 0% C/ 9% 56 ;, 0% 12% 0% 0% 2% 6% 16% 0% 0% 8% 51% 0r 15% 0% 0% 2% 6% 14% 0% 0% 10% 52% 0% 16% 0% 1% 2'/0 5% 14% 0% 0% 8% 52% 0% 18% 0% 0% 2% 4/ 11% 0% 0% 8% 55% 0% 20% 0% 0% 2% 5%. 14 5o 0% 0% 8% 53% 0% 16% 0% 100% 100% 100%. 100% 100% 100% Payor Mix Trends by Quarter - Charges Brpotrrng HeaL'hcare Proprietary and Confidential MSKESS©N Collection Statistics (Based on Encounter Entry Month) KINGS LANDING EMS Practice January 2016 Charges -Collecfions Other Adj AP, Balance �® Monthly 12 Mth (gefic) Avg Coil/ Procedure % of Gross Charges Charge Month Gros_ Procedures (a) Adj (b) Net (c=a+b) Gross (d) Adj (e) Net (f=d+e) % Unresolved Charge Adj Net Coll Other Adi 12 !Prior Mths i 7,91,557 4 5 29,01 . (1344628) , , 6596929 - - , , (5,091,106) n$317 (5,037,789) (1,343,073) 216,068 76.4% - 75.7% 173.63 --2.72% 16.93°% 63.43% 16.91% Feb-15 2,044 557,428 (93,260) 464,168 (361,188) 3,724 (357,464) (79,647) 27,057 77.0 % 76.2% 174.88 4.85% 166.73 % 64.12 % 14.28% Mar-15 2,294 625,407 (112,010) 513,397 (399,399) 6,087 (393312) (92,021) 28,065 76.6% 75.8% 171.45 448% 17.90% 62.88% 14.71% Apr-15 2,605 719,213 (110,944) 608,269 (449,904) 4,822 (445,082) (123,234) 39,953 73.2% 75.4% 170.86 5.55% 15.42% 61.88% 17.13% May-15 3,274 896,506 (134,389) 762, 117 (555,136) 3,448 (551,688) (151,083) 59,346 72,4% 75.0% 168.51 6.61% 1499% 61.53% 16.85% Jun-15 2,895 793,455 (121,997) 671,458 (474,843) 4,175 (470,668) (133,442) 67,348 70.1% 74.0% 162.58 8.48% 15.37% 59.31% 16.81% Jul-15 1,158 316,950 (46,292) 270,658 (182,413) 1,143 (181,270) (44,956) 44,432 67.0% 72.7% 156.54 14.01% 14.60% 57.19% 1418% I Aug-15 2,482 681,196 (106,920) 574,275 (407,046) 2,135 (404,910) (59,446) 109,919 70.5 % 71.6 % 163.14 16.13°'0 15-69% 59.44% 8 72 % Sep-15 2,731 ( 741,958 (116,659) 625.299 (429,109) 3,680 (425,430) (8,285) 191,585 68.0% 69.9% 155.78 25.82% 15.72% 57.33'0 1.11% Oct-15 5,331 1,463,381 (205.482) 1,257,899 (806,110) 5,676 (800.434) 0 457,465 63.6% 66.9% 150-15 3126% 14-04% 54.69% 0.00% Nov-15 2,804 i 770,497 107.600) 662,896 I (406,492) 0 (406,492) 0 256,405 61.3% 62.8% 144.97 33.27% 13.96% 52.75% 0 00% Dec-i5 2,200 I 601,465 (75,803) 525,662 (272,214) 0 (272,214) 0 253,448 51.8% 52.2% 123.73 42.13 % 12.60 % 4525 % 0 00% ' f9n-16 1.815 497,826 (5,560) 492,265 (24,068) a (24,068) 0 468,197 4.9% 5.8% 13.26 94.04% 1.11% 4.83% 0.00%' j 24 Mth Total 60,648 I 16,606,838 (2,581,544) 14,025,293 (9,859,029) 88,208 (9,770,820) (2,035,186) 2,219,287 - - 161.11 13.36 % 15.54% 58.83% 12.25% Ala has been summarized at the encounter accounting period level. Amounts displayed in each column may not reconcile to deliverables generated rising posting period. The 24 Mth Total row is the sum of data represented on this report which is a maximum cf 24 months. The tot0, amount displayed in the AR Balance column may or may not equal the client's ending AR balance depending on how many months of data are available. Prior 12 Mths % of Gross Charges % Unresolved • Charge Adj ❑ Net Coll ❑ Other Adj MSKESSON NCR - 12 Mth Avg Prior 12 Mar-15 May-15 Jui-15 Sep-15 Nov-15 Jan-16 Mths Collection Statistics (Based on Encounter Entry Month) Empo,wring neatthcare Proprietary and Confidential Kings Landing Fire Rescue New Billing Report May 2014 AL - ALL CHILDRENS HOSPITAL Patient ID Patient Name ;, Incident Date Payor Code Input Code Procedure Description .. Mod Code Diag Code Charges 1821 MargaeryTyreii 08/21/13 0140 1 ALS1 EMERGENCY TRANSPORT RH 786.50 0.00 1821 Margaery 1 yrell 08/21/13 0140 13 MILEAGE RH 786.50 0.00 Account Total 0.00 18923 Stannis Baratheon 11/22/13 0140 1 ALS1 EMERGENCY TRANSPORT RH 786.09 0.00 18923 Stannis Baratheon 11/22/13 0140 13 MILEAGE RH 786.09 0.00 Account Total 0.00 19036 Tormund Giantsbane 11/30/13 0100 1 ALS1 EMERGENCY TRANSPORT' RH 786.2 0.00 19036 Tormund Giantsbane 11/30/13 0100 13 MILEAGE RH 786.2, 0.00 Account Total 0.00 19521 Khal Drogo 02/04/14 4160 1 ALS1 EMERGENCY TRANSPORT SH 780.39 0.00 19521 Khal Drogo 02/04/14 4160 13 MILEAGE SH 780.39 0.00 Account Total 0.00 19972 Ramsay Bolton 03/26/14 4960 1 ALS1 EMERGENCY TRANSPORT HH 789.00 0.00 19972 Ramsay aolton 03/26/14 4960 13 MILEAGE NH 789.00 0.00 Account Total 0.00 (AL) ALL CHILDRENS HOSPITAL 5,022.00 BF - BAYFRONT MED CENTER Patient ID Patient Name Incident' Date ,'Payor Code Input -Code Procedure Description Mod Code Diag Code Charges 16593 Arya Stark 01/23/13 0140 1 ALS1 EMERGENCY TRANSPORT SH 786.09 0.00 16593 Arya atarK 01/23/13 0140 13 MILEAGE SH 786.09 0.00 Account Total 0.00 16802 Jaime Lannister 02/19/13 0100 1 ALS1 EMERGENCY TRANSPORT RH 959.01 0.00 16802 Jaime Lannister 02/19/13 0100 13 MILEAGE RH 959.01 0.00 Account Total 0.00 17140 Cersei Lannister 04/02/13 1100 1 ALS1 EMERGENCY TRANSPORT RH 786.50 0.00 17140 uerSel Lannister 04/02/13 1100 13 MILEAGE RH 786.50 0.00 Account Total 0.00 17350 Daenerys Targaryen 04/28/13 0140 1 ALS1 EMERGENCY TRANSPORT RH 879.8 0.00 17350 uaenerys 1 argaryen 04/28/13 0140 13 MILEAGE RH 879.8 0.00 Account Total 0.00 Kings Landing Fire Rescue 1,641,500.96 Kings Landing Rescue Patient Patient Name Patient Address Patient Patient Patient Zip Incident Date Payment Date Check Number Payment Batch Name of Payor Number City State Amount Number 12345 Shae 12345 Gendry 12345 Ygritte 12345 Margaery Tyrell 12345 Stannis Baratheon 12345 Missandei 12345 Davos Seaworth 12345 Tormund Giantsbane 12345 Melisandre 12345 Gilly 12345 Jeor Mormont 12345 Talisa Stark 12345 Khal Drogo 12345 Eddard Stark 12345 Ramsay Bolton 12345 Tyrion Lannister 12345 Cersei Lannister 12345 Daenerys Targaryen 12345 Arya Stark 12345 Jon Snow 12345 Sansa Stark 12345 Jaime Lannister 12345 Sandor Clegane 12345 Tywin Lannister 12345 Tyrion Lannister 12345 Cersei Lannister 12345 Daenerys Targaryen 12345 Arya Stark 12345 Jon Snow 12345 Sansa Stark 12345 Jaime Lannister 12345 Sandor Clegane 12345 Tywin Lannister 12345 Theon Greyjoy 12345 Joffrey Baratheon 12345 Catelyn Stark 12345 Bran Stark 12345 Petyr Baelish 12345 Varys 12345 Robb Stark 12345 Brienne of Tarth 12345 Bronn 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street 7955 NW 12th Street Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Dora! Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Doral Dorai Doral FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 33126 06-29-13 02-28-14 03-25-10 07-29-11 03-19-14 03-20-14 03-20-14 03-23-14 03-24-14 03-27-14 03-31-14 04-01-14 04-02-14 04-03-14 04-04-14 04-05-14 04-04-13 10-15-13 10-29-13 11-21-13 12-24-13 02-11-14 03-05-14 03-11-14 10-19-13 10-27-13 10-29-13 12-29-13 04-18-14 04-18-14 04-19-14 04-19-14 04-19-14 04-19-14 04-19-14 04-19-14 04-19-14 04-19-14 04-19-14 04-20-14 04-21-14 04-21-14 05-07-14 05-16-14 05-19-14 04-11-14 05-16-14 05-16-14 05-16-14 05-16-14 05-16-14 05-20-14 05-29-14 05-29-14 05-29-14 05-29-14 05-29-14 05-29-14 05-07-14 05-06-14 05-06-14 05-29-14 05-14-14 05-27-14 05-15-14 05-13-14 05-13-14 05-05-14 05-06-14 05-06-14 05-15-14 05-22-14 05-15-14 05-15-14 05-22-14 05-15-14 05-15-14 05-22-14 05-15-14 05-15-14 05-22-14 05-27-14 05-28-14 05-28-14 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 8675309 -315 - 318 -10 -31.86 -10 -320.28 -329.02 -351.47 -383.43 - 369.4 - 345.85 -414.05 - 283.57 - 345.85 - 277.5 -333.59 -665.56 -652.08 - 616.45 - 596.22 -648.23 - 766 -621 -300 -9304.41 337 Total - 92.7 345 AARP PAYMENT - 69.97 345 AARP PAYMENT -88.02 -93.55 117.38 - 117.38 -169.38 169.38 - 169.38 - 82.3 82.3 -82.3 -368.3 368.3 -368.3 -351.47 - 124.4 - 145.45 337 VICTIMS COMPENSATION 337 VICTIMS COMPENSATION 337 VISA/MC-CREDIT CARD PAYMENT 337 VISA/MC-CREDIT CARD PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WELLCARE HMO PAYMENT 337 WORKMANS COMP PAYMENT 337 WORKMANS COMP PAYMENT 337 WORKMANS COMP PAYMENT 337 WORKMANS COMP PAYMENT 337 WORKMANS COMP PAYMENT 337 WORKMANS COMP PAYMENT 337 WORKMANS COMP PAYMENT 337 WORKMANS COMP PAYMENT 345 AARP PAYMENT 345 AARP PAYMENT 345 AETNA 345 AETNA 345 AETNA 345 AETNA 345 AETNA 345 AETNA 345 AETNA 345 AETNA 345 AETNA 345 AETNA 345 AETNA 345 AETNA 345 AETNA 345 AETNA .yment Repo May 201 Kings Landing Fire Rescue Unit Number Number of trasnports Gross Charges 123B 159A 397A 545A 546B 558B 569C 713A 735A 785C 786B 789A 852A 859A 951 C 965C Total 318 $ 140 256 $ 76 256 $ 76 31 $ 16 31 $ 21,700 31 $ 16 31 50 256 76 500 $ 140 250 $ 140 785 $ 140 159 $ 16 789 $ 552,300 201 76 159 $ 50 78 $ 16 4,131 $ 575,028 Unit Report May 2014 Kings Landing Fire Rescue Patients Financial Class May 2014 Custom Payor Group, Name (Primary)- Jun-2013, Jo 2013 Aug-2013 Sep-20' Oct-2013 Nov-2013 Dec-2013 Jan-2014 -Feb-2014 Mar-2014 Apr-2014 May-2014 AUTO INS 36 22 37 26 24 30 29 47 42 35 15 27 370 2% BCBS 78 40 73 81 82 66 85 108 113 71 56 54 907 6% COMMERCIAL 142 66 140 146 125 125 153 202 212 136 128 114 1,689 11% MEDICAID 122 59 104 125 100 93 102 138 175 134 72 87 1,311 9% MEDICARE 630 367 668 719 709 660 768 929 1,041 750 554 545 8,340 55% OTHER 3 5 7 5 3 10 5 3 1 2 46 0% SELFPAY 201 106 142 179 167 155 189 273 335 282 241 208 2,478 16% UNBILLABLE 2 2 2 3 3 3 4 2 5 2 3 2 33 0% WORKERS COMP 5 2 8 3 2 4 2 6 8 3 4 6 53 0% Total: 1,219 665 1,179 1,289 1,217 1,139 1,333 1,715 1,936 1,416 1,074 1,045 15,227 Gross Charges Custom Payor Group Name (Primary)" - Jun-2013 - - Jul-2013 Aug-2013 Sep-2013 Oct-2013 - Nov-2013 Dec-2013 ' Jan-2014 Feb-2014 Mar-2014 Apr-2014 May-2014 Total % 2% AUTO INS 19,973 11,679 19,794 14,159 12,298 16,083 15,672 25,020 21,845 18,546 7,673 14,144 196,887 BCBS 43,597 22,469 40,925 45,635 46,609 36,868 47,256 60,305 62,788 39,008 30,944 30,181 506,584 6% COMMERCIAL 79,001 36,330 77,611 81,249 69,722 69,705 84,153 112,724 117,865 74,808 69,827 63,638 936,634 11% MEDICAID 67,160 32,310 57,721 68,143 55,281 52,328 57,628 77,779 95,439 73,653 39,263 47,296 724,001 9% MEDICARE 348,355 201,157 367,803 394,829 392,397 364,102 424,139 510,345 571,402 412,374 303,253 298,226 4,588,382 55% OTHER 1,658 590 2,684 4,377 2,840 1,657 584 5,601 2,982 1,718 507 1,063 26,262 0% SELFPAY 112,811 59,451 78,960 98,590 92,912 88,121 104,329 151,403 183,851 154,240 131,427 112,672 1,368,766 16% UNBILLABLE 1,011 1,010 1,136 1,532 1,513 1,448 1,952 1,007 2,460 942 1,442 1,018 16,470 0% WORKERS COMP 2,930 944 4,384 1,662 1,024 2,176 1,336 3,188 4,360 1,810 2,529 3,463 29,805 0% Total: 676,495 365,938 651,016 710,176 674,595 632,489 737,050 947,373 1,062,992 777,101 586,863 571,703 8,393,791 Kings Landing Fire Rescue Gross Collections Financial Class May 2014 Custom Payor Group Name (Prr) imay Jun-2013 Jul-2013 Aug-2013 Sep-2013 Oct-2013 Nov-2013 Dec 2013 Jan-2014' Feb-2014 Mar-2014 Apr-2014 May-2014 Total AUTO INS (10,994) (14,477) (11,672) (8,207) (9,646) (10,858) (10,569) (14,257) (15,460) (12,872) (13,383) (18,005) (150,401) 3% BCBS (36,229) (40,573) (33,300) (19,785) (38,555) (26,062) (24,700) (42,599) (30,492) (37,551) (29,183) (32,704) (391,732) 7% COMMERCIAL (42,709) (52,522) (33,466) (45,966) (52,870) (40,823) (49,754) (61,050) (54,528) (65,556) (56,763) (55,270) (611,278) 12% MEDICAID (24,270) (17,500) (9,447) (18,628) (27,493) (12,762) (18,210) (24,824) (24,667) (17,989) (18,291) (11,473) (225,554) 4% MEDICARE (286,081) (258,743) (183,889) (271,277) (315,759) (294,996) (368,130) (486,140) (287,693) (382,648) (316,330) (271,669) (3,723,355) 71% OTHER (328) (1,749) (1,228) (1,092) (897) (1,972) (239) (990) (480) (1,139) (2,074) (668) (12,856) 0% SELFPAY (9,231) (8,149) (9,157) (10,315) (9,351) (12,081) (7,448) (11,294) (11.990) (8,882) (9,085) (7,754) (114,736) 2% UNBILLABLE 0 0 0 0 0 0 0 0 0 0 0 0 0 0% WORKERS COMP (2,453) (538) (2,140) (3,196) (5,078) (1,615) (1,116) (2,553) (467) (1,789) (1,571) (2,963) (25,479) 0% Total: (414,598) (400,811) (285,743) (380,084) (459,748) (401,169) (481,179) (643,707) (425,778) (531,228) (446,969) (402,370) (5,273,385) Net Collections Custom Payor Group Name. (Primary)' Jun-2013 Jul`-2013 Aug-2013 Sep-2013 . Oct-2013. Nov-2013 Dec 2013 Jan-2014 Feb-2014 Mar-2014 Apr 2014 May-2014 Total AUTO INS (8,769) (13,956) (11,672) (8,160) (9,646) (10,184) (10,094) (14,257) (15,032) (12,872) (12,759) (17,912) (145,315) 3% BCBS (34,866) (40,398) (32,709) (19,735) (38,410) (25,821) (23,896) (42,599) (29,969) (37,391) (29,172) (32.632) (387,599) 7% COMMERCIAL (41,761) (52,352) (33,441) (45,966) (52,007) (39,759) (49,604) (61,050) (54,049) (65,471) (56,140) (55,130) (606,731) 12% MEDICAID (24,270) (17,310) (9,447) (18,628) (27,493) (12,436) (18,210) (24,824) (24,667) (17,989) (18,291) (11,473) (225,038) 4% MEDICARE (280,518) (257,248) (182,280) (270,295) (313,991) (292,361) (366,261) (484,961) (283,284) (380,039) (306,944) (270,147) (3,688,331) 71% OTHER (328) (1,398) (1,228) (1,092) (897) (1,972) (239) (990) (480) (1,139) (2,074) (668) (12,505) 0% SELFPAY (8,635) (8,149) (9,157) (10,315) (9,351) (11,577) (7,448) (11,294) (11,990) (8,842) (9,085) (7,464) (113,306) 2% UNBILLABLE 0 0 0 0 0 0 0 0 0 0 0 0 0 0% WORKERS COMP (2,453) 232 (2,140) (3,196) (5,078) (1,074) (1,116) (2,553) (95) (1,789) (1,571) (2,963) (23,795) 0% Total: (403,905) (397,053) (283,432) (379,006) (456,973) (395,183) (477,880) (642,528) (419,566) (528,336) (436,325) (400,251) (5,220,439) Adjustments Kings Landing Fire Rescue Financial Class May 2014 Custom Payor Group Name (Primary) Jun-2013 Jul-2013 Aug-2013 Sep-2013 Oct-2013 ` Nov-2013 Dee-2013 Jan-2014 ' Feb-2014 Mar-2014 Apr-2014 May-2014 Total % AUTO INS (339) (167) (1,016) (2,062) (164) 695 (380) (437) (418) (462) 293 (629) (5,085) 0% BCBS (2,145) (2,729) (2,447) (2,002) (1,710) (2,247) (1,325) (1,542) (1,091) (8,102) (2,527) (1,372) (29,238) 2% COMMERCIAL (9,144) (12,130) (6,411) (11,263) (8,876) (9,720) (10,369) (9,770) (10,792) (11,941) (8,827) (7,825) (117,068) 8% MEDICAID (50,878) (34,440) (20,437) (39,474) (57,631) (26,499) (39,702) (52,173) (51,333) (38,336) (39,389) (23,725) (474,019) 32% MEDICARE (61,172) (54,556) (38,811) (63,163) (67,832) (67,287) (74,682) (104,217) (60,376) (77,524) (71,870) (55,183) (796,674) 54% OTHER (181) (1,273) (950) (4,739) (1,025) (1,451) (253) (780) (572) (592) (1,350) (563) (13,730) 1% SELFPAY (3,143) (3,210) (8,488) (6,930) (606) (3,700) (1,965) (1,648) 719 (4,572) (2,330) (1,913) (37,786) 3% UNBILLABLE (53) 0 0 (117) (458) (404) 0 (432) 0 (508) 350 (1,721) (3,344) 0% WORKERS COMP 7 86 (120) (7,912) (35) 0 (10) (9) 0 (119) (22) (69) (8,202) 1% Total: (127,049) (108,418) (78,680) (137,663) (138,337) (110,614) (128,685) (171,006) (123,863) (142,158) (125,671) (93,000) (1,485,145) Kings Landing Fire Rescue Billing Adjustment Report May 2014 Patient Number Patient Name Incident Adjustment Type of Adjustment Date Amount 12345 Shae 12345 Gendry 12345 Ygritte 12345 Margaery Tyrell 12345 Stannis Baratheon 12345 Missandei 12345 Davos Seaworth 12345 Tormund Giantsbane 12345 Melisandre 12345 Gilly 12345 Jeor Mormont 12345 TalisaStark 12345 Khal Drogo 12345 Eddard Stark 12345 Ramsay Bolton 12345 Tyrion Lannister 12345 Cersei Lannister 12345 Daenerys Targaryen 12345 Arya Stark 12345 Jon Snow 12345 Sansa Stark 12345 Jaime Lannister 12345 Sandor Clegane 12345 Tywin Lannister 12345 Jaime Lan nister 12345 Tyrion Lannister 12345 Cersei Lannister 12345 Daenerys Targaryen 12345 Arya Stark 12345 Jon Snow 12345 Sansa Stark 12345 Jaime Lannister 12345 Sandor Clegane 12345 Tywin Lannister 12345 Theon Greyjoy 12345 Joffrey Baratheon 12345 Catelyn Stark 12345 Bran Stark 12345 Petyr Baelish 12345 Varys 12345 Robb Stark 12345 Brienne of Tarth 12345 Bronn 12345 Shae 12345 Gendry 12345 Ygritte 09-18-13 09-30-13 09-13-13 09-21-13 09-21-13 09-21-13 09-18-13 09-27-13 09-27-12 09-27-12 09-17.13 09-13-13 09-05-13 09-13-13 09-19-13 09-13-13 09-03-13 09-06-13 09-04-13 09-05-13 09-18-13 09-18-13 09-18-13 09-30-13 09-27-13 09-30-13 09-04-13 09-24-13 09-27-13 09-06-13 09-06-13 09-06-13 09-16-13 09-16-13 09-06-13 09-06-13 09-06-13 09-06-13 09-06-13 09-06-13 09-06-13 09-06-13 09-06-13 09-06-13 09-06-13 09-06-13 1.51 COLL W/O PMTS 10 REFUND TO PATIENT -576.96 BANKRUPTCY WRITE-OFF -100 COLLECTOR WRITEOFF CREDIT -100 COLLECTOR WRITEOFF - CREDIT -82.15 COLLECTOR WRITEOFF CREDIT 2.33 COLL W/O PMTS -265.51 MEDICARE LOA 0 MEDICARE LOA 812.63 MEDICARE LOA -179.22 MEDICARE LOA -142.65 MEDICARE LOA -280.63 MEDICAID LOA -166.81 MEDICARE LOA -367.3 MEDICAID LOA - 141.53 MEDICARE LOA -181.05 HMO/OTHER CONTRACTUAL W/O - 299.15 HMO/OTHER CONTRACTUAL W/O -172.01 MEDICARE LOA -289.29 MEDICAID LOA -398.52 LIMIT OF ALLOWANCE WRITEOFF 398.52 LIMIT OF ALLOWANCE WRITEOFF -398.52 HMO/OTHER CONTRACTUAL W/O 82.35 REFUND TO FREE FORM - 146.02 HMO/OTHER CONTRACTUAL W/O 88.02 REFUND TO INSURANCE COMPANY -301.75 HMO/OTHER CONTRACTUAL W/O -167.64 MEDICARE LOA - 175,21 MEDICARE LOA -6.91 MEDICARE LOA - 142.19 MEDICARE LOA -6.63 MEDICARE LOA -145.23 MEDICARE LOA -6.77 MEDICARE LOA -68.68 MEDICARE LOA -5.81 MEDICARE LOA -141.67 MEDICARE LOA. -6.61 MEDICARE LOA -143.2 MEDICARE LOA -6.67 MEDICARE LOA -151.58 MEDICARE LOA -7.05 MEDICARE LOA -155.14 MEDICARE LOA -7.21 MEDICARE LOA -149.55 MEDICARE LOA -6.96 MEDICARE LOA Kings Landing Fire Rescue Refund Listing May 2014 Patient Patient Name Number Incident Original Bill . Total Amount Paid Date Amount Refund Date Paid Amount 12345 Shae 12345 Gendry 12345 Ygritte 12345 Margaery Tyrell 12345 Stannis Baratheon 12345 Missandei 12345 Davos Seaworth 12345 Tormund Giantsbane 12345 Melisandre 12345 Gilly 12345 Jeor Mormont 12345 Talisa Stark 12345 Khal Drogo 12345 Eddard Stark 12345 Ramsay Bolton 12345 Tyrion Lannister 12345 Cersei Lannister 12345 Daenerys Targaryen 12345 Arya Stark 12345 Jon Snow 09-18-13 09-30-13 09-13-13 09-21-13 09-21-13 09-21-13 09-18-13 09-27-13 09-27-12 09-27-12 09-17-13 09-13-13 09-05-13 09-13-13 09-19-13 09-13-13 09-03-13 09-06-13 09,04-13 09-05-13 $450 $500 $600 $1,000 $800 $600 $700 $850 $900 $1,000 $450 $500 $600 $1,000 $800 $600 $700 $850 $900 $1,000 $900 12-18-13 $1,000 12-30-13 $1,200 12-13-13 $2,000 12-21-13 $1,600 12-21-13 $1,200 12-21-13 $1,400 11-18-13 $1,700 12-27-13 $1,800 12-27-12 $2,000 11-27-12 $900 11-17-13 $1,000 12-13-13 $1,200 12-05-13 $2,000 12-13-13 $1,600 12-19-13 $1,200 12-13-13 $1,400 12-03-13 $1,700 11-06-13 $1,800 12-04-13 $2,000 11-05-13 $450 $500 $600 $1,000 $800 $600 $700 $850 $900 $1,000 $450 $500 $600 $1,000 $800 $600 $700 $850 $900 $1,000 Kings Landing Fire Rescue Report of Accounts Receivable May 2014 BEGINNING ACCOUNTS RECEIVABLE NUMBER OF ACOUNTS: PLUS: GROSS CHARGES LESS: GROSS COLLECTIONS LESS: TOTAL ADJUSTMENTS 1. LIMIT OF ALLOWANCE 2. REFUNDS 3. RETURNED CHECKS 5. UNBILLABLES 6. BAD DEBT WRITE-OFFS 7. BAD DEBT RECOVERY 8. MISC DEBITS 9. MISC CREDITS ENDING ACCOUNTS RECEIVABLE MTD Amount FYTD Amount 4,982,307.32 4,731,796.17 7,117 6,459 1,641,500.96 13,469,399.94 (928,227.17) (6,927,387.18) (490,102.44) 4,798.40 10.00 (3,735.83) (429,308.17). 25,356.33 0.00 0.00 (3,206,608.41) 68,405.49 684.07 (19,179.39) (3,491,808.21) 177,296.92 0.00 0.00 4,802,599.40 4,802,599.40 CONFIDENTIAL AND PROPRIETARY MASTER SERVICES AGREEMENT Client: Contract Number: This MASTER SERVICES AGREEMENT (this "MA") is effective as of the latest date in the signature block below (the "Effective Date") between PST Services, Inc., ("Service Provider") and ("Client"), consisting of the MA Terms and Conditions and all Exhibits, Schedules, and Amendments. This MA governs all the Services described on a Service Schedule that is included in this MA during the term. Subject to the terms and conditions of this MA, Client agrees to purchase from Service Provider, and Service Provider agrees to provide Client with, the service(s) listed in the table below (individually, a "Service" and collectively, the "Services"). The description of each Service provided under this MA and any additional terms and conditions relating to such Service are set forth in the Serrvi,c Schedule referenced in the table below and attached hereto. SERVICES SERVICE SCHEDULE Scope of Services - Emergency Medical Services Squad Service schedule 1 This MA is executed by an authorized representative of each pa [CLIENT] By: Printed Name: Title: Date: Tax ID: :;Name: SERVICE PR IDER] Client: Service Provider: <Address> 5995 Windward Parkway <City>, <State> <Zip Code> t xr Alpharetta, Georgia 30005 Attention: <Insert dame or Title> Attention: President yes no ❑ If no, list invoice address below <Address> <City>, <State> <Zip Code> Attention: <Insert Name or Title> ave address With a copy to the General Counsel at the same address page lof 20 CONFIDENTIAL AND PROPRIETARY MA TERMS AND CONDITIONS Client: Contract Number: 1. Term 1.1 This MA will begin on the Effective Date and continues until termination or expiration of each Schedule or amendment attached hereunder, unless earlier terminated as set forth herein. 1.2 Further, this MA will remain in force so long as there is an active Service Schedule(s). 2 Services 2.1 Responsibilities, 2.1.1 Service Provider will perform the Services set forth Schedule(s) on behalf of Client. 2.1.2 Service Provider agrees to perform the Services practices in Client's specialty and geographic area, anc rules and regulations, including applicable third procedures. nl'the applicable Service n accorde ce with industry material applicable laws, payer polici and 2.1.3 Client will provide Service Provider with the ecessary data in the proper format to enable Service Provider to properly furnieh h0 Services an any information set forth in the Service Schedullp(s) oh a`jmelyf>basis and it .a format reasonably acceptable to Service Prover'(the Clirt eResPon ibilitiesy). Client authorizes, to the extent necessary, an: irects Service Providesoi`elease any or all necessary data and information (incluc it g, wiefinethb:t4'limitation, "lnd idually Identifiable Health Information as suc rterm isildd; ih 45 C.F.R. § 160.103) received by Service Provider. Further, re i.t shall li5 all necessary consents and agreement from patients to ensure tor,Service Prbbtaovider can comply with all applicable federal and state laws and regula E ns \providtp the Services including, but not limited to, HIPAA (as defined here), and ,the Telephone Consumer Protection Act (47 U.S.C. Section) and related regulatons, as well as similar state laws and regulations governing µtelqphorte comm nicatiofs with consumers. Client shall ensure that all information jt rovrdes ,to Service Provider may be used by Service Provider for elephone con(acts, including obtaining and maintaining a record of the consent as obtained�'frpm patients to receive telephone contacts from or on behalf of 2.2 Operating€Proce ur .1 Cliert `acknowledges (i) that the Services or obligations of Service Provider hereunder may be dependent on Client providing access to data, information, or sistance to Service Provider from time -to -time (collectively, "Cooperation"); and that ch Cooperation may be essential to the performance of the Services by ice -Provider. The parties agree that any delay or failure by Service Provider to fide the Services hereunder which is caused by Client's failure to provide timely -operation, as reasonably requested by Service Provider, shall not be deemed a each of Service Provider's performance obligations under this MA. 2.2.2 Client acknowledges that Service Provider has every incentive to perform the Services in a timely and proficient manner, but the timing and amount of collections generated by the Services are subject to numerous variables beyond Service Provider's control including, without limitation, (i) the inability of third parties or systems to accurately process data, (ii) the transmission of inaccurate, incomplete or duplicate data to Service Provider, (iii) untimely reimbursements or payer bankruptcies, (iv) late charge documentation submissions by Client, or (v) managed care contract disputes between payers and Client. 2.2.3 Service Provider will be the sole provider of the Services to Client. oaae 2 of 20 CONFIDENTIAL AND PROPRIETARY Client: Contract Number: 3 PAYMENT 3.1 Lockbox. An electronic lockbox will be maintained in Client's name at a bank designated by Client. All cash receipts will be deposited into the lockbox. Service Provider will have no ownership rights in the lockbox and will have no right to negotiate or assert ownership of checks made payable to Client. Client will be responsible for all fees associated with such lockbox. 3.2 Invoicing Terms. Beginning on the Commencement Date (as defined in each Service Schedule), Client will pay all fees and other charges in U.S. dollars within 30 days after the invoice date. Prior to the Commencement Date, Client further agrees to establish an automatic electronic funds debit arrangement for paying Service Proder's invoices. 3.3 Late Payments. Service Provider may charge Client interest _on `any overdue fees, charges, or expenses at a rate equal to the lesser of 1.5% per month or 4'he highest date permitted by law. Client will reimburse Service Provider for all reasonable costs ardyepenses incurred (including reasonable attorneys' fees) in collecting any overdue s_ 3.4 Suspension of the Services. Service Provider reserves the right to suspend performance of the Services (i) for nonpayment of sums owedo?Service Provider that are 30cays or more past due, where such breach is not cured within teb days after notice to C to"h`t, or (ii) if such suspension is necessary to comply with happlicabli ix law or order pf any governmental authority. 3.5 Fee Change. Either party may re (lest a fee cnage in tfie eten't of a material change in legislation, Client's business or other market conditions which„rsult in a material change in either the cost associated with Serylee Provider's provision of the Services or Service Provider's anticipated revenues under this IAA. In addition, Service Provider may request a fee change in the event (i) Clieiitfalls to is lose to Service Provider information relating to Client's practice, which information,ifdisclosed prior to the Effective Date, would have led Service Provider to propose a high fee or (ii) any of the information provided by Client to Service Provider upon which the racti assumptions set forth in any applicable Service Schedule are basedz . or pepomes naccUrate. In the event either party requests a change in the Fee, the requesting party wifi pwrovide'the non -requesting party with ninety (90) days' .. pr._written notice (t L. itA 'CI") of the requested change (the "Notice") and such fee change?wiil be effective,at the end of the Notice Period, If the non -requesting party provides#herect esting party written notice during any such Notice Period that any such fee change reuest is ia'eeceptable7to the non -requesting party, the Agreement will terminate at the end of the f ot[ee Period and the Fee in place at that time will remain in effect until p end of-4q/yoFkout Perid'd, if any. 4 GENERAL TERMS Cohflderitlality and Proprietary Rights. lJse andDisclosure of Confidential Information, Each party may disclose to the other party confidential information. Except as expressly permitted by this MA, Welt er party will: (i) disclose the other party's confidential information except (a) to employees or contractors who have a need to know and are bound by confidentiality terms no less restrictive than those contained in this MA, or (b) to the extent required by law following prompt notice of such obligation to the other party, or (ii) use the other party's confidential information for any purpose other than performing its obligations under this MA. Client will not disclose nor cause its employees, agents and representatives to disclose to anyone Service Provider's business practices, trade secrets or Confidential Information, except as legally required. Each party will use all reasonable care in handling and securing the other party's confidential information and will employ all security measures used for its own proprietary information of similar nature. Notwithstanding the foregoing, Client agrees that Service Provider may de -identify Client information consistent with the HIPAA Privacy Rule and use Client information and data from transactions received or created by Service Provider for statistical compilations or reports, nnna 3 of 2n CONFIDENTIAL AND PROPRIETARY Client: Contract Number: research and for other purposes (the "Uses"). Such Uses shall be the sole and exclusive property of Service Provider. 4.1.2 Use and Disclosure of Billing Software. (a) Client agrees that the software Service Provider uses to perform the Services (the "Billing System") is proprietary and confidential and that Service Provider is the sole owner or licensee of the Billing System. All report formats and reports generated by the Billing System are produced and will be made available to Client for internal operational purposes only. (b) Client will not disclose or cause its employees, a efts and representatives ��r to disclose to anyone the Billing System Ate* information it receives about the Billing System, except as legally r quired. (c) JOptionallAccess to Software. If Service Provider''grants Client or its employees or agents "read-only" or "direct acce's'' 6 the Billinggystem or other software provided by Service Provider by -a means,,,Clied agrees to the End User Terms and C6rt i(tions set forth in Exhibit D to this MA. 4.1.3 Period of Confidentiality. The rest ct ons orr use, disclosure and reproduction of confidential information set fQ thoinOSe tion 4 „ ,which are a s%rade secret (as that term is defined under apple:Age lawN be perpetual Q d with respect to other sia confidential information tirestriction� ill remal gin full force and effect during the term of this. MA and for^three yeas following hee termination of this MA. Following the termination of this MA, each party will, upon written request, return or am`§ -*party' ' %� destroy all of the herparty s tangible confidential information in its possession Ny fT. k` and will promptly cei-t y rn riting to the other party that it has done so. 4.1.4 jnlunctive Relief. The perties agree tftat.the breach, or threatened breach, of any provision cif this Section 4' 1 may cause reparable harm without adequate remedy at law 1pon ary such bkach of _threatened breach, the breached party will be entitled to Seek it jurtctiy erklief to prevent the other party from commencing or ontinuing any action crtsttt) ing such breach, without having to post a bond or er security and vihout °living to prove the inadequacy of other available Jothinis Section 4.1.4 will limit any other remedy available to either par 1.5 Retained Rights. ent's rights in the Services will be limited to those expressly grafted in this MA. Service Provider and its suppliers reserve all intellectual roperty,� rights not expressly granted to Client. All changes, modifications, rove'rrents or new modules made or developed with regard to the Services, tethersor not (i) made or developed at Client's request, (ii) made or developed in c:Operation with Client, or (iii) made or developed by Client, will be solely owned by ervice Provider or its suppliers. Service Provider retains title to all material, inated or prepared for Client under this MA. Client is granted a license to use such materials in accordance with this MA. For purposes of clarification, all data used in the reports prepared by Service Provider in the performance of Services for Client, and all rights and interests therein, shall be the sole property of Client. The form of the reports, work product, including processes and templates used to prepare such reports shall be the sole property of Service Provider. CONFIDENTIAL AND PROPRIETARY Client: Contract. Number: 4.2 Termination. 4.2.1 Termination for Default, Either party may terminate this MA by providing 30 days prior written notice of termination to the other party, if the other party (i) materially breaches this MA and fails to remedy or commence reasonable efforts to remedy such breach within 15 days, and materially cure within 45 days, after receiving notice of the breach from the terminating party, (ii) materially breaches this MA in such a way that cannot be remedied, (iii) commences dissolution proceedings or (iv) ceases to operate in the ordinary course of business. 4.2.2 Termination for Payment Default. Service Provider may terminate this MA immediately if Client defaults on its payment obligations4her this MA and such payment default is not cured within ten days of written ngtiCefrom Service Provider. 4.2.3 Termination by Service Provider. (a) Service Provider may immediately terminate this MA , ithout incurring any liability to Client if Service Provider does not receive the cleanktest file or completed implementation discovery packet withlikl,three mon f s of the Commencement Date of a Service Schedule; or (b) If Service Provider uses,third-party software to provide thi Services, Client agrees to execute adc itidhal dope ents,other thanithe MA, including but not limited to non rscifosure rt p oprietary4matert l documentation that is reasonably require by Service rovider o1' nyriofher third -party software licensor. If Client unwilling to sign such' additional documentation, Service Provider ray terminpte this MA 90 days after Service Provider presented the dgcumentiation to Client. 4.2.4 Termination by Client Clie may ten'rtjnate this MA immediately if Service Provider fails to cure any materia_i\breachof the "usiness Associate Agreement" (set forth on Exhibit= tO£tilis MA) within 30 d ys of Service Providers receipt of written notice from Clier`t s ecifying the bteach 4.2.5 Termination Pib edures Service Provider Billing System. In the event this MA or ervice Schedule is termi1 ated or expires, Client will notify Service Provider in ri g rho later thati e business days prior to the expiration or termination of the Sa vice ScheduleNof its'phoice of either the option set forth in sub -Section (a) below orb the pp. io'r s@t fbpth in sub -Section (b) below as a means of transferring its acbouhtseceivable from Service Provider to another provider of billing services (except as otherwise set forth in sub -Section (c) below, in which case only the rocetdures set forth in sub -Section (b) will apply). r3_r 1Norkout Period. Upon the effective date of termination/expiration, Service Provider shall cease to enter new patient and charge data into the Billing System on behalf of Client, but will continue to perform the Services identified in the applicable Service Schedule at the then -current rates hereunder, for a period of 90 days with respect to all of Client's accounts receivable arising from charges rendered prior to the termination date (such period hereinafter referred to as the "Workout Period"). After the Workout Period, Service Provider will discontinue processing such accounts receivable, and after full payment of all fees owed (1) deliver to Client a final list of accounts receivable and (2) provide reasonable transitional services, as set forth on Exhibit C to this MA. After completion of the above, Service Provider will have no further obligations to Client, except as expressly set forth in this MA. The parties agree that all applicable terms and conditions of this MA will be in full force and effect until the end of the Workout Period. CONFIDENTIAL AND PROPRIETARY Client: Contract Number: (b) Fees. For Client's accounts receivable for which Service Provider receives a Fee based on a percentage of the Net Collections, Client shall pay Service Provider, on or before the effective date of termination/expiration, a one-time fee equal to the average monthly invoice for the six (6) months immediately preceding the effective date of such termination multiplied by one and one-half (1.5). With respect to Client's accounts receivable for which Service Provider receives a Fee based on a set dollar amount, no additional fees shall be owed to Service Provider as of the effective date of termination/expiration. Upon the effective date of termination/expiration of this MA or Service Schedule, Service Provider shall be immediately relieved of its obligation to provide any further Services on behalf of Client. �, y After full payment of all fees owed, including but not`limited to the Services Rendered Fee, Service Provider will deliver to CI'ient a final list of accounts receivable and provide reasonable Transitional Services - as set forth on Exhibit C to this MA. After completion ofFtfp above, S§,rVice Provider will have no further obligations to Client, exceptzasexpressly set forth in this MA. The Services Rendered Fee does not limit`i'e" rights and remedies Service Provider may have against Client arising oCtt of any bread of this MA. (c) Default Selection. If (i) tries MA is (esminated by Service' Provider pursuant to the terms set forth eft Sec ion,4 2 2 or�.(ii) Client fairs to make the above- required selection i i ,the allo"tted times only the procedures set forth in Section 4.2.5(b,) vfiil( apply with% regards to anv termination/expiration transition. T 4.2.6 Survival of Provisions _Those pro ° isions of this MA that, by their nature, are intended to survive tetrt ation or e piration of this MA will remain in full force and effect, including, with6Ut`�limitation,IheJollowing Sections of this MA: 3 (Payment), 4.1 (Confidentiality), 4 (Limitation of Liability), 4.6.3 (Books and Records), and 4.10 4 25 Governing LevJ� Entire Agreement),. 4.3 Limitation of Liabili 4.3.1 ` Tbtal,,,Damages"7 e vice ProVIder's total cumulative liability in connection with, or I be limited to the sum of fees paid by Client to Service )'ovider clu ing the 12 iyionth period preceding the date of the claim, as applicable, whether b ed on .breach of contract, warranty, tort, product liability, or otherwise. Se Vice Provider wile have no liability for the inability of third parties or systems beyoid the control of Service Provider. elusion, of Damages. IN NO EVENT WILL SERVICE PROVIDER BE LIABLE TO N1'rUNDER, IN CONNECTION WITH, OR RELATED TO THIS MA FOR ANY SRECIAL, INCIDENTAL, INDIRECT, OR CONSEQUENTIAL DAMAGES, INCLUDING, BUT NOT LIMITED TO, LOST PROFITS OR LOSS OF GOODWILL, I -TETHER BASED ON BREACH OF CONTRACT, WARRANTY, TORT, PRODUCT LIABILITY, OR OTHERWISE, AND WHETHER OR NOT SERVICE PROVIDER HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGE. 4.3.3 Material Consideration. THE PARTIES ACKNOWLEDGE THAT THE FOREGOING LIMITATIONS ARE A MATERIAL CONDITION FOR THEIR ENTRY INTO THIS MA. 4.4 Internet Disclaimer. CERTAIN PRODUCTS AND SERVICES PROVIDED BY SERVICE PROVIDER UTILIZE THE INTERNET. SERVICE PROVIDER DOES NOT WARRANT THAT SUCH SERVICES WILL BE UNINTERRUPTED, ERROR -FREE, OR COMPLETELY SECURE, SERVICE PROVIDER DOES NOT AND CANNOT CONTROL THE FLOW OF DATA TO OR FROM SERVICE PROVIDER'S OR CLIENT'S NETWORK AND OTHER PORTIONS OF THE INTERNET. SUCH FLOW DEPENDS IN LARGE PART ON THE CONFIDENTIAL AND PROPRIETARY Client: Contract Number: INTERNET SERVICES PROVIDED OR CONTROLLED BY THIRD PARTIES. ACTIONS OR INACTIONS OF SUCH THIRD PARTIES CAN IMPAIR OR DISRUPT CLIENT'S CONNECTIONS TO THE INTERNET (OR PORTIONS THEREOF). ACCORDINGLY, SERVICE PROVIDER DISCLAIMS ANY AND ALL LIABILITY RESULTING FROM OR RELATED TO THE ABOVE EVENTS. 4.5 Civil Monetary Fine or Penalty. Service Provider will pay any civil or monetary fine or penalty and interest (but not overpayments) assessed against Client by Medicare, Medicaid or other third -party health insurance provider arising out of Service Provider's sole negligence or willful misconduct in the performance of its obligations under this MA. Overpayments received by Client are the sole responsibility of Clients,, 4.6 Audits. 4.6.1 Internal Audit by Client. Client may use its o yr jnternal ;resources ("Internal Auditors") to perform audits of Service Provider's aooLiracy,`and correctness of the accounting and internal controls performed and mamtained'by Service Provider. Service Provider will provide the Internal Auditors with mfor,`,mation that tffInternal Auditor determines to be reasonably necessary to perform and*com�ple e the audit procedures. Client agrees that an audit\ conducted under [his section will be conducted at such times and in a manner tf%at avoids undue disruption of Service Provider's operations. 4.6.2 Third -Party Audit by Clients Client may efgage, att is oriexpense, independent, external, third -party auditors ('Third Pa,r'jy Auditors"=),to perform audits of Service Provider's accurackand correctnessof the accounting and internal control performed and maintaned by4 Bury ce Provider. If Client engages Third -Party Auditors, who perforT, or are aasocated with a group who performs, billing and accounts receivable raanagement'services substantially similar to any of the i Services c.Jentified on'any Service Schedule to this MA, such Third -Party Auditors may no4itslt Service Prgider4se ocessing facility or audit the actual billing and collection $ c d ss Sery oe Provtc er will provide the information that the Third - Party Auditor;, tie to`�be reasonably necessary to perform and complete all udit procedures The f i `'rd-Party Auditors shall execute Service Provider's tdentiality Agreement ,'substantially in the form attached hereto as Exhibit B, e start ailitie audit. Client agrees that an audit conducted under this condured at such times and in a manner that avoids undue ibe Provider's operations. 6.3 Boaksland Records. If required by Section 952 of the Omnibus Reconciliation Act of 198O, 42 U.S.C. Section 1395x(v)(I)(i) and (ii), fora period of four years after the Services are furnished, the parties agree to make available, upon the written req\estyof the Secretary of Health and Human Services, the Comptroller General, or their representatives, this MA and such books, documents, and records as may be)pecessary to verify the nature and extent of the Services with a value or cost of 10,000 or more over a twelve month period. 4.7 WARRANTIES 4.7.1 Service Provider. (a) Prior to the Commencement Date. Unless Service Provider provided Services prior to the Commencement Date of any Service Schedule, Client will be responsible for all matters related to Client's practice prior to the Commencement Date, including, but not limited to, Client's billings, collections, third party reimbursements, accounts receivable and credit balances. (b) Disclaimer of Warranties. Service Provider disclaims any warranties or representations pertaining to the timing and amount of collections generated by the Services. Client acknowledges and agrees that Client is CONFIDENTIAL AND PROPRIETARY Client: Contract Number: solely responsible for refunding any overpayments and processing any unclaimed property payments. Service Provider will provide Client with written notice of unresolved credit balances of which Service Provider becomes aware (such as overpayments or unclaimed property). 4.7.2 Client. (a) Charges and Information. (I) Client represents and warrants that it will forward to Service Provider (pursuant to the applicable Service Schedule[s]) only charges for which Client is entitled to bill. Client agrees to monitor and to refrain from knowingly submitting, false or inaccurate information, charges, documentation on records to Service Provider and to ensure that the docq nentation provided by Client or an agent of Client to Service Provider supppTts the medical services provided by Client. Cliefcknowledgcs and agrees it has an obligation to report and correct,any`�ci'edible evidence of deficiencies on the part of Client. Clientlso acknowledges that Service Provider does not make a deferrnination ofmedical necessity for any claims., (ii) Client acknowledges anti agrees that Service `provider is not a collection agepcy Client represents and w r nts that any debt or account referred to Spry:ce Provider pursuant to this MA is not in default or delinquent ors not beenwriten off as bad debt. If any accounts a'r found tbe written` tiff; in default or otherwise delinquent, Clrnt agyees to immediately recall those accounts from Service Provige's responsibility under this MA. (b) Release of Information Cliei-1i represents and warrants that Client has obtained a release of anformatio. and insurance assignment of benefits frprn alI individuals for whom 'Client is submitting charges to Service or the provisionof the Services and will immediately notify Service Pr'OVA Ader if such release of information and insurance assignment of benefits is changed or revoked or if such individual refused/failed to execute--; rucb documents. Client further agrees to provide a copy of such ned docitr e, is upon Service Provider's request. 4.8 Business, social 'allies agree to the obligations set forth in Exhibit A. Exclusion F'om Federal Healthcare Programs. Each party warrants that it is not currently listed by a Feddcal agency as excluded, debarred, or otherwise ineligible for participation in coal health care program. Each party agrees that it will not employ, contract with, otherwise use, the services of any individual whom it knows or should have known, after reasonable' )nquiry, (i) has been convicted of a criminal offense related to health care (unless theindividual has been reinstated to participation in Medicare and all other Federal health care programs after being excluded because of the conviction), or (ii) is currently listed icy a Federal agency as excluded, debarred, or otherwise ineligible for participation in any Federal health care program. Each party agrees that it will immediately notify the other in the event that it, or any person in its employ, has been excluded, debarred, or has otherwise become ineligible for participation in any Federal health care program. Each party agrees to continue to make reasonable inquiry regarding the status of its employees and independent contractors on a regular basis by reviewing the General Services Administration's List of Parties Excluded from Federal Programs and the HHS/OIG List of Excluded Individuals/Entities. 4.10 Governing Law. This MA is governed by and will be construed in accordance with the laws of the State of Georgia, exclusive of its rules governing choice of law and conflict of laws and any version of the Uniform Commercial Code. Each party agrees that exclusive venue CONFIDENTIAL AND PROPRIETARY Client: Contract Number: for all actions, relating in any manner to this MA will be in a federal or state court of competent jurisdiction located in Fulton County, Georgia, 4.11 Claims Period. Any action relating to this MA and any claim for damages, including, but not limited to, a claim for recurring damages arising out of the same cause or event, other than collection of outstanding payments, must be commenced within six months after the date upon which the cause of action occurred. 4.12 Assignment and Subcontracts. Neither party will assign this MA without the prior written consent of the other party, which will not be unreasonably withheld, delayed or conditioned. Service Provider may, upon notice to Client, assign this MA to any affiliate or to any entity resulting from the transfer of all or substantially all of Service Pr9vider's assets or capital stock or from any other corporate reorganization. Service;Provider may subcontract its obligations under this MA. 4,13 Severability. If any part of a provision of this MA is found ilieganenforceable, ,it will be enforced to the maximum extent permissible, and the legaiify ar d� enforceabil ,y of the remainder of that provision and all other provisions of this MA will hbt e affecte 4.14 Notices. All notices relating to the parties' legal rtatdts and remedies urdethis MA will be provided in writing and will reference this Such notices will be deemed given if sent by: (i) postage prepaid registered or certified U S Post ?rail, then fie>working days after sending; or (ii) commercial courier, th n at the'time of receipt confirmed by the recipient to the courier on delivery. All notice*to a party will b sent to its address set forth on the cover page hereto, or to such other address as maybe designated bj that party by notice to the sending party. 4.15 Waiver. Failure to exercise o such right.. ht under this MA will not act as a waiver of 4,16 Force Majeure Except for the obl gatio i"to pay money, a party will not be liable to the other party for any fail re rk i elay caused in whole or in material part to any cause beyond its sole control, includ hg bof no Ili ittc_k to fire, accident, labor, dispute or unrest, flood, riot, war, rebellion, insurrection, salo#age terrorism, transportation delays, shortage of raw materials, energy, or machinery, acts of God or of the civil or military authorities of a state or natio?i\ or t%eti lability, duet. the aforementioned causes, to obtain necessary labor or facilities AmendmentMA may be modified, or any rights under it waived, only by a written document executed by the authorized representatives of both parties. To avoid doubt, this MAy not be,amended via electronic mail or other electronic messaging service, hard Party Beneficiaries. Except as specifically set forth in a Service Schedule, nothing in this MA will confer any right, remedy, or obligation upon anyone other than Client and Service Provider. 4.19 Relatieriship of Parties. Each party is an independent contractor of the other party. This MA will not be construed as constituting a relationship of employment, agency, partnership, joint venture or any other form of legal association, Neither party has any power to bind the other party or to assume or to create any obligation or responsibility on behalf of the other party or in the other party's name. 4.20 Non -solicitation of Employees. During the term of this MA and for a period of 12 months following the termination of this MA, each party agrees not to employ, contract with for services, solicit for ernployment on its own behalf or on behalf of any third party, or have ownership in any entity which employs or solicits for employment, any individual who (i) was an employee of the other or its parent, affiliates or subsidiaries at any time during the preceding 12 months and (ii) was materially involved in the provision or receipt of the Services hereunder without the prior written consent of the other party. Notwithstanding the CONFIDENTIAL AND PROPRIETARY Client: Contract Number: foregoing, upon any termination of this MA, Client may rehire any individual who was employed by Client on the Effective Date, and who was hired by Service Provider on or after such date. Each party agrees that the other party does not have an adequate remedy at law to protect its rights under this Section and agrees that the non -defaulting party will have the right to injunctive relief from any violation or threatened violation of this Section. 4.21 Publicity. The parties may publicly announce that they have entered into this MA and describe their relationship in general terms, excluding financial terms. The parties will not make any other public announcement or press release regarding this MA or any activities performed hereunder without the prior written consent of the other party. a-� 4.22 Construction of this MA. This MA will not be presumptively consttued for or against either party. Section titles are for convenience only. As used in this MA,�"will" means "shall," and "include" means "includes without limitation." The parties tray executekthis MA in one or more counterparts, each of which will be deemed an 4ori final and oniand the same instrument. 4.23 Conflict Between MA and Schedules. In the event of any conflict r, inconsistecy in the interpretation of this MA (including its Service Schedules and all A inie:n e dts executed hereunder), such conflict or inconsistency will `be resolved by giving precedence according to the following order: (a) the Amendment;, (b) the Se vice Schedule, (c) the MA Terms and Conditions and Exhibits, (d) documents)rtc'orporated by eference o> 4.24 Section Headings. The Section headings used are'or con lenience only and shall not be used in the interpretation of this MA. 4.25 Authority. Service Provider a Clientr present and warrant that they have the full power and authority to enter into this) IA, hat there are no restrictions or limitations on their ability to perform this MA, and that the peon executing this MA has the full power and authority to do so. 4.26 Entire Agreement � s MA, including Service Schedules, Exhibits, Amendments, and documents incorporat by fererence, is the complete and exclusive agreement between the parties with respectto�the ' -68 matter hereof, superseding and replacing all prior agreennetits,-,,communication, and u'-derstandings (written and oral) regarding its subject matter,,, CONFIDENTIAL AND PROPRIETARY Client: Contract Number: EXHIBIT A BUSINESS ASSOCIATE AGREEMENT ("BAA") This Business Associate Agreement ("BAA") is entered into by and between Service Provider and Client. Service Provider and Client may be individually referred to as a "Party" and, collectively, the "Parties" in this BAA. 1. DEFINITIONS "Breach" will have the same meaning given to such term in 45 C.F.R. § 164.402. "Designated Record Set" will have the same meaning as the term "designated record set" in 45 C.F.R. § 164.501. "Electronic Protected Health Information" or "Electronic PHI" will have the m'earjing givenito such term under the Privacy Rule and the Security Rule, including, but not limited to, 45 C.F. § 16Q 103, as applied to the information that Service Provider creates, receives, maintains or transmits from or of ;behalf of Clielnt. "Individual" will have the same meaning as the term "individuate'>slp 45 C.F.R. § 160 `f03 and wi"II include a person who qualifies as a personal representative in accordance 1jth 45 C.F.R. § 164 50 "Privacy Rule" will mean the Standards for Privacy of In Part 160 and Part 164, Subparts A and E. dentflable Health Information at 45 C.F.R. "Protected Health Information" or "PHI" will have _the same "`neaning as ;,the term "protected health information" in 45 C.F.R. § 160.103, as apptie l to the nformatlon created or received by Service Provider from or on behalf of Client.: q�"F'i' Cio-'WtS "Required by Law" will have the same meaning�as they erm "required by law" in 45 C.F.R. § 164.103. "Secretary" will mean the Secretary of the Department of Health and Human Services or his or her g desi nee. "Security Incident" will hay the meanie erm in 45 C.F.R. § 164.304. "Security Rule" will mea 't he SecuEt Standards., at 45 C.F.R. Part 160 and Part 164, Subparts A and C. 3^'� 3 }� "Unsecured PHI" will have the same rneanngjgiven to such term under 45 C.F.R. § 164.402, and guidance promulgated the[eunder. q Capitalized Terms. Capitalized terms used in this BAA and not otherwise defined herein will have the meanlnd's set forth in {fib Privab9 Rule, the Security Rule, and the HIPAA Final Rule, which definitions are incorporaied in this BAA by referece. 2. Permitted U?;esirand bisclosures of PHI 2.1 Uses and Disclosures of PHI Pursuant to MA. Except as otherwise limited in this BAA, Service Provider may use or disclose PHI to perform functions, activities or services for, or on behalf of, Client as specified in the MA, provided that such use or disclosure would not violate the Privacy Rule if done by Client. 2.2 Permitted Uses of PHI by Service Provider. Except as otherwise limited in this BAA, Service Provider may use PHI for the proper management and administration of Service Provider or to carry out the legal responsibilities of Service Provider. 2.3 Permitted Disclosures of PHI by Service Provider. Except as otherwise limited in this BAA, Service Provider may disclose PHI for the proper management and administration of CONFIDENTIAL AND PROPRIETARY Client: Contract Number: Service Provider, provided that the disclosures are Required by Law, or Service Provider obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and will be used or further disclosed only as Required by Law or for the purpose for which it was disclosed to the person (which purpose must be consistent with the limitations imposed upon Service Provider pursuant to this BAA), and that the person agrees to notify Service Provider of any instances of which it is aware in which the confidentiality of the information has been breached. Service Provider may disclose PHI to report violations of law to appropriate federal and state authorities, consistent with 45 C.F.R. § 164.502(j)(1). 2.4 Data Aggregation. Except as otherwise limited in this BAA, ServicenProvider may use PHI to provide Data Aggregation services for Health Care Operations of fhe Client as permitted by45 C.F.R. § 164.504(e)(2)(i)(B). rye 2.5 De -identified Data. Service Provider may de -identified RHI in accordance with the standards set forth in 45 C.F.R. § 164.514(b) and may useKor disclose such de -identified data unless prohibited by applicable law. 3. OBLIGATIONS OF SERVICE PROVIDER 3.1 Appropriate Safeguards. Service Provider,�wiH use ,appropriate safeguards and will, after the compliance date of the HIPAA f nalRule, cprnply wiEh t ie SecU ity Rule with respect to Electronic PHI, to prevent use or}disclosure of such information other than as provided for by the MA and this BAA. Excpt�as express7yprovided in_ the MA or this BAA, Service Provider will not assume any obligations o tent under the'Privacy Rule, To the extent that Service Provider is to Gerry out any oClient's obligations under the Privacy Rule as expressly provided in the, A qr this, RAA, Service Provider will comply with the requirements of the Privacy Rule:, that apply to Client in the performance of such obligations. 3.2 Reporting of Improper Use or Disclosure Security Incident or Breach. Service Provider will report to Client anylse "or disc eke of PHI not permitted under this BAA, Breach of Unsecured PHI or any Se uri£y lnci 4ent, without unreasonable delay, and in any event no more thgn 30 days following discove.r'; provided, however, that the Parties acknowledge and agree that}th s Section constitutes notice by Service Provider to Client of the ongoing existence and oceurrejice of "a tempted but Unsuccessful Security Incidents (as defined below) TgbAsuccespfu1 Seeur'.ty Incidents" will include, but not be limited to, pings and other broadcast attacks'"on ServicbProvider's firewall, port scans, unsuccessful log -on attempts, enials of seMce and any combination of the above, so long as no such incident results in unauthorized access, use or disclosure of PHI. Service Provider's notification to Client of a resh'WIlincli Vie: (i) the identification of each individual whose Unsecured PHI has been, reasnably2 believed by Service Provider to have been, accessed, acquired or disclosedkdring the Breach; and (ii) any particulars regarding the Breach that Client would need to irfolude in its notification, as such particulars are identified in 45 C.F.R. § 164.404. 3.3 SetVice'Provider's Agents. In accordance with 45 C.F.R. § 164.502(e)(1)(ii) and 45 C.F.R. § 164.308(b)(2), as applicable, Service Provider will enter into a written agreement with any agent or subcontractor that creates, receives, maintains or transmits PHI on behalf of Service Provider for services provided to Client, providing that the agent agrees to restrictions and conditions that are substantially similar to those that apply through this BAA to Service Provider with respect to such PHI. 3.4 Access to PHI. The Parties do not intend for Service Provider to maintain any PHI in a Designated Record Set for Client. To the extent Service Provider possesses PHI in a Designated Record Set, Service Provider agrees to make such information available to Client pursuant to 45 C.F.R. § 164.524, within ten business days of Service Provider's receipt of a written request from Client; provided, however, that Service Provider is not required to provide such access where the PHI contained in a Designated Record Set is CONFIDENTIAL AND PROPRIETARY Client: Contract Number: duplicative of the PHI contained in a Designated Record Set possessed by Client. If an Individual makes a request for access pursuant to 45 C.F.R. § 164.524 directly to Service Provider, or inquires about his or her right to access, Service Provider will either forward such request to Client or direct the Individual to Client. 3.5 Amendment of PHI. The Parties do not intend for Service Provider to maintain any PHI in a Designated Record Set for Client. To the extent Service Provider possesses PHI in a Designated Record Set, Service Provider agrees to make such information available to Client for amendment pursuant to 45 C.F.R. § 164.526 within 20 business days of Service Provider's receipt of a written request from Client. If an Individual submits a written request for amendment pursuant to 45 C.F.R. § 164.526 directly to Service Provider, or inquires about his or her right to amendment, Service Provider will eitherforward such request to Client or direct the Individual to Client. 3.6 Documentation of Disclosures. Service Provider agrees to'cocument $tjch disclosures of PHI and information related to such disclosures as would be required for Client to respond to a request by an Individual for an accounting of disclosuresof PHI ih accordance with 45 C.F.R. § 164.528. Service Provider will document, at a minimum, the following ibformation ("Disclosure Information"): (a) the date of the`drsclosure; (b) the name and, it known, the address of the recipient of the PHI; (c) a brief description of the PHI'dilosed; (d) the purpose of the disclosure that includes ap exilanaf on of the basis for suc disclosure; and (e) any additional information requir the AI,T,ECH Act and any implementing regulations. 3.7 Accounting of Disclosures. Services rovider a i ees to provide,to Client, within 20 business days of Service Provider's receipt of{x writtehvjequest from Client, information collected in accordance with Section 6 ofi_ this BAA, to permit Client to respond to a request by an Individual for an accounting ofdis losures of PHI in accordance with 45 C.F.R. § 164.528. If an Individual submits a writtepequest fo aunt accounting of disclosures of PHI pursuant to 45 C.F.R.§ 164.528 directly o Seri:$ e Provid.er, or inquires about his or her right to an accounting, Servree Provider will c trecf t lndividual to Client. 3.8 Governmental Access to`Records and records relating tort by Service sJjovider on bel Secretary defermiin ng Clientfs 3.9 Mitigation itigate a Service Prow ervice'Provider will make its internal practices, books is„closure of PHI received from, or created or received 'lent available to the Secretary for purposes of the ompliance with the Privacy Rule and the Security Rule. racticable, Service Provider will cooperate with Client's efforts to effect thatis known to Service Provider of a use or disclosure of PHI by e'f that is not permitted by this BAA. Mrnirn 'h Necessary. Service Provider will request, use and disclose the minimum amount PHI neessary to accomplish the purpose of the request, use or disclosure, in accordance�vith 45 C.F.R. § 164.514(d), and any amendments thereto. 3.11 HI,PAA Frn"al Rule Applicability. Service Provider acknowledges that enactment of the H''JAct, as implemented by the HIPAA Final Rule, amended certain provisions of HIPAA in ways that now directly regulate, or will on future dates directly regulate, Service Provider under the Privacy Rule and Security Rule. Service Provider agrees, as of the compliance date of the HIPAA Final Rule, to comply with applicable requirements imposed under the HIPAA Final Rule, including any amendments thereto. 4. Obligations of Client 4.1 Notice of Privacy Practices. Client will notify Service Provider of any limitation(s) in its notice of privacy practices in accordance with 45 C.F.R. § 164.520, to the extent that such limitation may affect Service Provider's use or disclosure of PHI. Client will provide such notice no later than 15 days prior to the effective date of the limitation. CONFIDENTIAL AND PROPRIETARY Client: Contract Number: 4.2 Notification of Changes Regarding Individual Permission. Client will obtain any consent or authorization that may be required by the Privacy Rule, or applicable state law, prior to furnishing Service Provider with PHI. Client will notify Service Provider of any changes in, or revocation of, permission by an Individual to use or disclose PHI, to the extent that such changes may affect Service Provider's use or disclosure of PHI. Client will provide such notice no later than 15 days prior to the effective date of the change. 4.3 Notification of Restrictions to Use or Disclosure of PHI. Client will notify Service Provider of any restriction to the use or disclosure of PHI that Client has agreed to in accordance with 45 C.F.R. § 164.522, to the extent that such restriction may affect Service Provider's use or disclosure of PHI. Client will provide such notice no later than 15 ays prior to the effective date of the restriction. If Service Provider reasonably believes tt dof any restriction agreed to by Client pursuant to this Section may materially impair Sere Providers ebility to perform its obligations under the MA or this BAA, the Parties will mutual agree upon any necessary modification of Service Provider's obligations under auch{agheements. 4.4 Permissible Requests by Client. Client will not request Service Prodder to useorv`'disclose PHI in any manner that would not be permissible,under the Privacy°Rule, the $Ocurity Rule or the HITECH Act if done by Client, except asp ermitted pursuant to t e provisions of Sections 2.2, 2.3, 2.4 and 2.5 of this BAA -Nth- 5. TERM AND TERMINATION 5.1 Term. The term of this BAA vvi when all of the PHI provided`br Provider on behalf of Client destroy PHI, Service Provider; with Section 5.3. commence3 client to estroyed it extend of the Effecye Date, and will terminate ervvice'vProvider, or created or received by Service eturned to Client. If it is infeasible to return or protections to such information, in accordance 5.2 Termination for;CauSe.._ Upon either Partys knclwledge of a material breach by the other Party of this BAAs ch Party may termmaf . this BAA immediately if cure is not possible. Otherwise, the rid caching* part? will provide written notice to the breaching Party detailing the nature of tl � breac1 Nana providing an opportunity to cure the breach within 30 businessdays Upon the expiration ;of such 30 day cure period, the non -breaching Party may tat,:6,4 mate this BAA if they breaching party does not cure the breach or if cure is not possible If termination is not, easible, the non -breaching party may report the breach or violation tbabe Se xcept °s provided in Section 5.3.2, upon termination of the MA or this BAA for any reason, Service Provider will return or destroy all PHI received from Client, or created or received by Service Provider on behalf of Client, at Client's expense, and will retain no copies of the PHI. This provision will apply to PHI that is in the ssession of subcontractors or agents of Service Provider. 5.3.2 If it is infeasible for Service Provider to return or destroy the PHI upon termination of the MA or this BAA, Service Provider will: (a) extend the protections of this BAA to such PHI and (b) limit further uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so long as Service Provider maintains such PHI. 6. COOPERATION IN INVESTIGATIONS The Parties acknowledge that certain breaches or violations of this BAA may result in litigation or investigations pursued by federal or state governmental authorities of the United States resulting in civil liability or criminal penalties. Each Party will cooperate in good faith in all respects with the other Party in CONFIDENTIAL AND PROPRIETARY Client: Contract Number: connection with any request by a federal or state governmental authority for additional information and documents or any governmental investigation, complaint, action or other inquiry. 7. SURVIVAL The respective rights and obligations of Service Provider under Section 5.3 of this BAA will survive the termination of this BAA and the MA. 8. AMENDMENT This BAA may be modified, or any rights under it waived, only by a written document executed by the authorized representatives of both Parties. In addition, if any relevant provision of the Privacy Rule, the Security Rule or the HIPAA Final Rule is amended in a manner that changes the obligatons of Service Provider or Client that are embodied in terms of this BAA, then the Parties agree to neg9ti`ate in good faith appropriate non -financial terms or amendments to this BAA to give effect to sich ise revd�obligations. 9. EFFECT OF BAA In the event of any inconsistency between the provisions of this BAA and the MA, the pro isiofis of this BAA will control. In the event that a court or regulatory agencyyvith authority over Service Provider or Client interprets the mandatory provisions of the Privacy Rule, the Security Ri.fle,,or the HIPA ,)Final Rule, in a way that is inconsistent with the provisions of this BAA, such interpretation �Wifl�control 1 .here provisions of this BAA are different from those mandated in the Privy y Rule, the Security RttLeL ot1h HIPAA Final Rule, but are nonetheless permitted by such rules as interpreted by courtspr agencies, -the provisions of this BAA will control. 10. GENERAL This BAA is governed by, and v/Q be construed n accordance with, the laws of the State that govern the MA. Any action relating to this BAD+ mus �e comjpenced )within one year after the date upon which the cause of action occrued. Client wil spot ass�grr this BAA without the prior written consent of Service Provider, which will not,be unreasonably withheld atf any part of a provision of this BAA is found illegal or unenforceable, it will b°e enforced to the maximum extent permissible, and the legality and enforceability of the remainder of that provision andall other provisions of this BAA will not be affected. All notices relating to the Parties' legal right s€and remedies•under is BAA will be provided in writing to a Party, will be sent to its address set forth in thetl, or t9ssuchaQther address as may be designated by that Party by notice to the sending Pa ty an will refer ncerthis BAA:''Nothing in this BAA will confer any right, remedy, or obligation upon anyone other than Client and Service Provider. This BAA is the complete and exclusive agreement between' the Parties with respect to the subject matter hereof, superseding and replacing all prior corned And understandings (written and oral) regarding its subject matter. CONFIDENTIAL AND PROPRIETARY EXHIBIT B CONFIDENTIALITY AGREEMENT Client; Contract Number: Service Provider and ® [insert name of Client] ("Client") have entered into an agreement whereby Service Provider provides certain services (the "Services") to Client (the "Master Services Agreement"). Client has entered into a contractual relationship with [insert name of person/entity performing the audit] ("Recipient") and instructs Service Provider to allow Recipient to review certain information in Service Provider's possession regarding Client's business and accounts receivable billing and collections performed by Service Provider ("Client Proprietary Information"). Therefore, in consideration of the mutual covenants and conditions contained in this Confidentiality Agreement (the "Confidentiality Agreement"), Recipient and Client agree as follows: A. During the course of Recipient's examination and review of Client Proprietary Information, Recipient may be exposed to or review certain proprietary information regarding Service Provider ("Service Provider Proprietary Information"). Service Provider Proprietary Information refers to ally and all datand information relating to the business of Service Provider which has value to Service Provideanr dis not generally known by its competitors or the public, including, without limitation, financial information, inventions -methods, techniques, actual or potential customers and suppliers, the Consulting Services Agreement, Service Provider's,.,',-usiness practices or other trade secrets or confidential information of Se ice Provider, all reporrt3formats d existing and future products and computer systems and software. Recipi`t acknowledges and agt'ees at all Service Provider Proprietary Information and all physical embodiments thereof',are confidential to ety,tce Provider and are and will remain the sole and exclusive property of zaervice Proyl er. All Service Provider Proprietary Information acquired by Recipient will be kept strictly confidential an will nAbe disclosee(o any other person or entity (including any entity affiliated with or any division of Recipier"` 7r B. Service Provider Proprietary Information downot includ information wlf ch (i) is publicly known or which becomes publicly known through no act or failure toract onythe part of Recipient; (ii) is lawfully obtained by Recipient from any third party entitled to dis�c1dSe such it forth ion; (iii) is in the lawful possession of Recipient prior to such information having been disclOrd to Rec pe t by Service Provider; or (iv) is independently developed by Recipient. C. Recipient further agrees twing Recistgagement by Client and for a period of one (1) year following any termination of RecipeI1ts�er gagemerit for whale\er reason, Recipient will not, directly or indirectly, on Recipient's own behalf or in the serJiceof, of on boralf of :iny other individual or entity, divert, solicit or hire away, or attempt to divert, solicit or hirayy y, to e-io fora y individual or entity, any person employed by Service Provider, whether or -not i ch employee. ,is full time- mployee, temporary employee, leased employee or independent contractoris39„,,Providell ether or not such employee is employed pursuant to written agreement and whether ®ot suchyernployee Isenployed for a determined period or at -will. D. Recipiert acknowledges teraF great`loss'and irreparable damage would be suffered by Service Provider if Recipient„should' beach or violate the terms of this Confidentiality Agreement. In the event Recipient breaches or violates4th s Confidentiality Agreement, Recipient agrees that Service Provider would not have an adequate remedy ��at law and tflefefore, thTt Service Provider would be entitled to a temporary restraining order and permarterit injunctforj to prevent e breach of any of the terms or provisions contained in this Confidentiality Agreement -in addition to a i monetary damages that may be available at law or equity. Recipient's obligations under this Confidentiality Agreement will survive indefinitely. E. Recipient rep esenfs and warrants that (i) it has the full power and authority to enter into this Confidentiality A ree i era, and (ii) the person executing this Confidentiality Agreement has the full power and authority to do so. IN WITNESS WHEREOF, Recipient has signed this Confidentiality Agreement as of the date below written. RECIPIENT: By: Print Name: Title: Date: SAMPLE (No Signature Required) CLIENT: [INSERT CLIENT NAME] By: Print Name:_ Title: SAMPLE (No Signature Required) Date: CONFIDENTIAL AND PROPRIETARY EXHIBIT C TRANSITION SPECIFICS Client: Contract Number: Upon termination or expiration of this MA, for any reason, Service Provider agrees to provide the following assistance to Client or Client's designated agent to transfer Service Provider's responsibilities under this MA and Service Schedule to Client or Client's designated agent ("Transitional Services"): Data specifications Technical and Operational contacts Test CD Final CD Utility file coc Patient information will be provided vla a vrite-protected CD. Detailed specifications will be provided to Client or Client's designated agent. Service Provider Support contacts will tie provided to answer questions regarding the specifications documentdocumenMtrand operational requirements. Questions ma'jr be presented by Client or its designee. A test CD will be provided containing 100 patient accounts and • , their associated tr'ansaet'i n actiVlty As04 include ,ail debit and"�c edit balance accounts �aofive' AR. Zero balance accounts will be to 'the}age of two years (based on the date the as placfed onKthe system). Patient demographic and transaction information his included. 1\be provided to Client or its designee for the Charge icodes, description and CPT (erring physician code, name and NPI (if available) eorming physician, code and name Location of service, code and description Transaction codes and description CONFIDENTIAL AND PROPRIETARY Client: Contract Number: EXHIBIT D END USER TERMS AND CONDITIONS Client acknowledges and agrees that all Services, computer software, programs, specifications and designs, documentation, manuals, methodologies, processes, and other materials, information, and the content of the foregoing accessed by Client that is provided by or on behalf of Service Provider or its licensors, and any copies thereof, (the "PST Proprietary and Confidential Information") are the proprietary, confidential and trade secret information of Service Provider, or its licensors, and shall remain so; and that such PST Proprietary and Confidential Information may be utilized by Client only to facilitate its use of the Services in accordance with the terms of this Exhibit and the MA. Client agrees, and will cause its employees, agents and representatives to, agree, that it/they (i) ry" shall not copy, modify, change, disassemble, or reverse engineer, aPST Proprietary and Confidential Information, and (ii) shall not disclose PST Proprietarysajd Confidential Information, except as legally required. Data from transactions received or created by Serviceirovider may be utilized by Service Provider for data aggregation and/or statistical ''oo #pilationsFor-reports, research, mpli and for other purposes (the "Uses") so long as such Uses are in coanceit 'all applicable laws e. and patient identifying information is de -identified consistent with the IIPPA_Privacy Rule, µand such Uses shall be the sole and exclusive property of Service Provider. Th parties agree not to disclose the terms of this Exhibit, either party's business practices or"ofher i r deVsecrets or confidential and trade secret information of the other party or its licensors, Cept as legally required. II. Client agrees, and shall cause its employees agents and� repres tatives0wagree, that it/they shall not: (a) transmit or share identification and(or passwordicodes to persohs,,other than the Authorized Users for whom such codes were generated; (b) pepm t�Authorizedk sers to share identification and/or password codes with others;((q) permit ,the identification and/or password codes from being cached in proxy servers and accessed by ind1ividtals who are not Authorized Users; (d) permit access to the Software through a single identification and/or password code being made available to multiple users on a network; or (e)4attmp.Qr permtany person without valid identification and/or password codes to attempt to access -Vie Softvu re. Clliei t agrees that (w) the Software embodies valuable and proprietary trade�.secrets bf §ervio,e Providier andor its licensors, (x) the identification and password codes issued by Service Provider hereunder constitute valuable confidential information, which is proprietary fofServtceaProvid, (y) any reports, report formats, documents, ideas or other discoveries madeor de'Velop d by Client during its use of the Software may be utilized by ClieQ onl t the Clientjfac lit where it is installed, onlyto facilitate its use of the Services hereunder in adc�ordanoeeyvith the ',:hit, of this Exhibit and theMA, only in accordance with user instructions and specif cat Qns providecby Service Provider and shall not be given or sold to or used on behalf of )any th rd p'arty,f and any reports, report formats, documents, ideas or other discoVerjes shall remain`the sole and exclusive property of Service Provider, and (z) Client agrees, an`d"will cause its employees, agents, subcontractors and representatives to" agree, that it/they shall of copy, modjty cha ge, disassemble, or reverse engineer any part or aspect of the Software. 111. The Software shall l;e in machine-readable object code and may only be utilized at the Client facility ller r where it is insta, solely for Client transactions for which Service Provider is to perform the Services; ,anal only in accordance with user instructions and specifications provided by Service Provider 0licnt shall obtain and maintain, at no cost or expense to Service Provider, the software/hardware required by Client to access the Software and acknowledges that Service Provider recommends no specific manufacturer and/or software that complies with its specifications. As between Service Provider and Client, all such Software is acknowledged to be subject to Section V of this Exhibit and the MA. SERVICE PROVIDER MAKES NO REPRESENTATIONS OR WARRANTIES, EXPRESSED OR IMPLIED, WITH RESPECT TO THE SOFTWARE AND DISCLAIMS ALL OTHER WARRANTIES, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND/OR FITNESS FOR A PARTICULAR PURPOSE. IV. Client users shall access the Software through a combination of user names and passwords as necessary to provide appropriate security. Client shall be solely responsible for assigning user CONFIDENTIAL AND PROPRIETARY Client: Contract Number: names and passwords to its users and for strictly maintaining the confidentiality of such user names and passwords. Client shall ensure that all of its users comply with all of the terms and conditions of this Exhibit and the MA. Client shall not permit any person or entity, other than its designated users, to use or gain access to the Services and shall provide reasonable safeguards to protect against unauthorized usage of or access to the Services. V. Client shall not use the Software in any manner, or in connection with any Client specific materials that (i) infringes upon or violates any intellectual property right of any third -party, (ii) constitutes a defamation, libel, invasion of privacy, or violation of any right of publicity or other third -party right or is threatening, harassing or malicious, or (iii) violates any applicable international, federal, state or local law, rule, legislation, regulation or ordinance, including without limitation. the Communications Decency Act of 1996, as amended, and will not initiate or otherwise pursus;development efforts that attempt to duplicate or re-create any functionality, processes or business'model concepts included in the Software. VI. Service Provider reserves the right to substitute alternative products prov fir g equivalent core functionality to the Software. 4 VII. Upon Client's ceasing use of the Software, the termination of this Exhibitand,the MA, d'r Service Provider's written request, Client shall cease using all Sej ice Provider provided Sbftwatre and related materials and promptly return same to Service Providerat Client's expense. Cent shall certify to Service Provider in writing that all copies (In any;fcrm or medi0of the materials re6eived, whether or not modified or incorporated into other materiel�r ave peon destroyyed or retarded to Service Provider. Termination of this Exhibit and the MA or any rJcense shall of relieve Client's ri,ligation to pay all fees incurred prior to such termination and shall of limit eitiie party from rsuing any other remedies available to it. VIII. Each party agrees that the other party and/,or its hcerisors do not have an adequate remedy at law to protect their respective rights under,,thisE,xhiblt and,will have the right to seek injunctive relief from any violation or threatened violate of this Exhibit with respect to their respective rights. SERVICE SCHEDULE 1 SCOPE OF SERVICES - EMERGENCY MEDICAL SERVICES SQUAD [PLACEHOLDER FOR SERVICE SCHEDULE] Certification Statement Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and retain a copy for your files. Prices should include all costs, including transportation to destination. The City reserves the right to accept or reject all or any part of this submission. Prices should be firm for a minimum of 180 days following the time set for closing of the submissions. In the event of errors in extension of totals, the emit prices shall govern in determining the quoted prices. We (I) certify that we have read your solicitation, completed the necessary documents, and propose to furnish and deliver, F.O.B. DESTINATION, the items or services specified herein. The undersigned hereby certifies that neither the contractual party nor any of its principal owners or personnel have been convicted of any of the violations, or debarred or suspended as set in section 18-107 or Ordinance No. 12271. All exceptions to this submission have been documented in the section below (refer to paragraph and section). EXCEPTIONS: McKesson has made several assumptions regarding the terms of the City's RFP. Please see the following page for our specific assumptions. We look forward to discussing with the City. We (1) certify that any and all information contained in this submission is true; and we (I) further certify that this submission is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a submission for the same materials, supplies, equipment, or service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms and conditions of this solicitation and certify that I am authorized to sign this submission for the subinitter. Please print the following and sign your name: SUPPLIER NAME: PST Services, Inc. a McKesson company ADDRESS: 7955 NW 12th Street, Suite 100 Doral, Florida 33126 PHONE: 305-229-4302 EMAIL: Mauricio.Chavez@McKesson.com McKesson.com SIGNED BY: TITLE: Specialty Vice President, EMS FAX. 305-229-4322 BEEPER• 305-970-2780 (cell phone) DATE: 05/12/2016 FAILURE TO COMPLETE, SIGN. AND RETIJRN TWS FORM SHALL DISOUALIFY TIT'S BID, Page 2 of 48 RFP Section RFP Language McKesson Assumption Certification, p. 3 Does the Proposer acknowledge that the Attached Professional Services Agreement is an example of the standard Agreement used in conjunction with the Services related to this solicitation and shall not be amended? PST Services, Inc. has made certain exceptions to the Professional Services Agreement, which are noted in its response to this RFP. In addition, PST may need to add terms and conditions to the Agreement that are specific to the EMS billing services PST shall provide. Terms and Conditions, 1. General Conditions, 1.22 Conflict of Interest, p. 10 Bidders/Proposers, by responding to this Formal Solicitation, certify that to the best of their knowledge or belief, no elected/appointed official or employee of the City of Miami is financially interested, directly or indirectly, in the purchase of goods/services specified in this Formal Solicitation. Any such interests on the part of the Bidder/Proposer or its employees must be disclosed in writing to the City. Further, you must disclose the name of any City employee who owns, directly or indirectly, an interest of five percent (5%) or more of the total assets of capital stock in your firm. Because PST Services, Inc. is a wholly owned subsidiary of McKesson Corporation, a publically traded company, it is not possible to verify if any City of Miami employee owns stock in McKesson Corporation. Revised Sample Contract, 5. Ownership of Documents, pp. 4 - 5 Contractor understands and agrees that any information, document, report or any other material whatsoever which is given by the City to Contractor, its employees, or any subcontractor, or which Is otherwise obtained or prepared by Contractor solely and exclusively for the City pursuant to or under the terms of this Agreement, is and shall at all times remain the property of the City. Contractor agrees not to use any such information, document, report or material for any other purpose whatsoever without the written consent of the City Manager, which may be withheld or conditioned by the City Manager in his/her sole discretion. Contractor is permitted to make and to maintain duplicate copies of the files, records, documents, etc. if Contractor determines copies of such records are necessary subsequent to the termination of this Agreement; however, in no way shall the confidentiality as permitted by applicable laws be breached. The City shall maintain and retain ownership of any and all documents which result upon the completion of the work and Services under this Agreement as per the terms of this Section 5. PST Services, Inc., assumes that the City owns its own data, but PST Services, Inc., retains ownership of its own intellectual property, as well as any forms and processes it creates. Emergency Medical Transport Billing & Collection Services City of Miami May 18, 2016 MSKESSON Certifications Legal Name of Firm: PST Senr±es,Inc, Entity Type: Partnership, Sole Proprietorship, Corporation, etc. C orporatibn Year Established: 1990 Office Location: City of Miami, Miami -Dade County, or Other M ism i-D ade County Business Tax Receipt Number: 2016000951 Business Tax Receipt Issuing Agency: C its,rofDoral,Fbrda Business Tax Receipt Expiration Date: S eptem ber3 0 , 2016 Please list and acknowledge all addendum/addenda received. List the addendum/addenda number and date of receipt (i.e. Addendum No. 1, 7/1/07). If no addendum/addenda was/were issued, please insert N/A. Addendum No.1,4/27%16;Addendum No.2,5AJ6/16;Addendum No.3,5/09/16;Addendum No.4,5/12/16 If Proposer has a Local Office, as defined under Chapter 18/Article III, Section 18-73 of the City Code, has Proposer filled out, notarized, and included with its RIP response the "City of Miami Local Office Certification" form? YES OR NO? (The City of Miami Local Office Certification form is located in the Oracle Sourcing system ("iSupplier"), under the Header/Notes and Attachments Section of this solicitation) N otapp±abb Has Proposer reviewed the attached Sample Professional Services Agreement? Yes Does the Proposer acknowledge that the Attached Professional Services Agreement is an example of the standard Agreement used in conjunction with the Services related to this solicitation and shall not be amended? Yes. Appendix B Fee Schedule The Proposer's price for providing the services outlined in the Scope of Services, for the term of the contract, including any extensions are as follows: Services to be Provided Price Per Account Account Collection Fee, Percentage (%) of Net Collections 4 5 Flat Fee for Medicaid related Collections $ a 50 per Medicaid Claim Notes: 1. Pricing shall be firm and fixed and inclusive of all required services and fees for the term of the Contract and any extensions thereof. 2. City of Miami is exempt from all taxes (Federal, State, and Local). Tax Exemption Certificate furnished upon request. Note: Net Collections means the total sum of all monies collected by or through the Proposer for all clinical services rendered by the Department, less amounts refunded or credited to a patient or third party payer as a result of over payments, erroneous payments or bad checks.