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Home My WebLink About2015-01-19-Resolutions 15-030_Ambulance Billing Service AgrTHE CITY OF WAUIME,IOWA RESOLUTION 15-030 APPROVING AN AGREEMENT WITH FIRE RECOVERY FOR AMBULANCE BILLINC SERVICES IN THE NAME AND BY THE A UTHOIUTY OF THE CITY OF IVA UKEE,IO8'A WHEREAS,the City of Waukee,Iowa is a duly organized municipality within Dallas County;AND, WHEREAS,Waukee Fire Department staff recorrnnend City Council approval of an agreement with Fire Recovery for ambulance billing services;AND, WHEREAS,in addition to ambulance billing tlirough Fire Recovery,the City will continue to use the State of Iowa income offset program as a way to recover unpaid costs associated with ambulance transport;AND, WHKRKAS,the City Attorney has reviewed the proposed agreement and finds it satisfactory. NOW THEREFORE BK IT RESOLVED by the City of %aukee City Council in session this 19'day of January,2015,that the Agreement for Ainbuiance Billing Services,attached hereto as Exhibit A,is hereby approved. illi .P card,ayor Attest: Rebecca D.Schuett,City Clerk ROLL CALL VOTE Shane Blanchard Brian Harrison Casey L.Harvey Shelly Hughes Rick Peterson AYK X X X X X NAY ABSENT ABSTAIN www.firerecoveryusa.corn This Agreement is entered into as of January 3,203 5 between the City of Waukee iowa, hereinafter referred to as City of Waukee and Fire Recovery USA,hereinafter referred to as FRUSA. WHEREAS,City of Waukee has determined that it is in their best interest to retain the services of an outside billing service to collect monies for Ambulance/EMS services rendered by City of Waukee. WHEREAS,FRUSA does hereby hold itself as being ready and able to perform a billing service program as described herein. NOW,THEREFORE,in consideration of the aforementioned promises and mutual covenants and promises stated herein,the parties hereby agree as follows FRUSA shall provide a separate and complete Accounts Receivable program within FRUSA's computer billing system for the exclusive purpose af collection of Ambulance/EMS services for City of Waukee. FRUSA will enter into said computer billing system,any and all ambulance trips received from City of Waukee.FRUSA shall abstract,from the documentation provided by City of Waukee,all diagnosis and procedure information necessary to determine the level and type of service provided,any billable diagnostic and therapeutic procedures performed,any billable supplies and ancillary services rendered,and the appropriate diagnosis codes to be billed for all ambulance run information provided by FRUSA by the client for that purpose. FRUSA will follow established billing industry guidelines,including those established by HCFA,HIPAA,and various ather government programs,for ambulance services.To ensure compliance,FRUSA will periodically audit,on a prospective and retrospective basis,a sample of City of Waukee's billing and clinical records.City of Waukee retains responsibility for providing accurate and complete documentation of clinical services provided.City of Waukee understands that FRUSA will code only from the documentation provided. FRUSA shall provide electronic billing of Medicare and Medicaid claims.It is the responsibility of City of Waukee to inform Medicare and Medicaid or any changes in the company's status. 3.FRUSA will bill any and all appropriate commercial or third party payers as directed by City of Waukee. 4.FRUSA will invoice all patients and all supplemental private pay patients as directed by Ci ty of Waukee and as required by the Federal Medicare Program. Payment invoicing will be done on a billing form specific for City of Waukee. Invoicing/collection activities will be conducted on the following schedule: within 3 days of receipt 30 days after 3"invoice 20 days after previous request 10 days after phone call 20 days after 2"invoice 30 days after final notice 1st invoice- Insurance request Automated phone call nd invoice Final notice Collections or W/0 review Collection agency or write off if no results from above as pre-determined by City of Waukee. 5.It is the responsibility of City o'f Waukee to contact receiving hospitals in an effort to obtain access to patient face sheets and/or patient insurance information; All monies received by FRUSA on behalf of City of I/I/aukee will be posted to the patients*accounts on a weekly basis and mailed to City of Waukee on a monthly basis.All checks will be made payable to City of Waukee.FRUSA cannot cash any checks and has no access to any City of Waukee bank accounts.It is the responsibility of City of Waukee to notify FRUSA (on any payments received at City of Waukee}within seventy-two (72}hours of all payments,correspondence, explanation of benefits,etc.relating to the services heretofore described. FRUSA will maintain 800-phone service for the purpose of run sheet and payment submission.This line will be available 24 hours a day. FRVSA will promptly respond to all City of Waukees'service recipient concerns related to all billing practices conducted herein. FRUSA will maintain an 800-phone line for the purpose of customer service.This line will be staffed Monday through Friday from 8:00 am to 7:00 pm Central time. FRUSA shall comply with all Federal and State regulations,ordinances and procedures governing ambulance collections. 10.FRUSA will submit a monthly accounts receivable aging report by payer category,which will include identifying all uncollected receivables,a payment receipt journal recap,and a monthly ticket survey,detailing all of the transports billed from the previous month.It is the responsibility of City of Waukee to verify these reports and provide FRUSA with any missing data.All reports currently within the software of FRUSA's billing system will be provided to City of Waukee at no additional cost. 11.FRUSA shall recognize and comply with the right of authorized City of Waukee representatives to review any and all payment records pursuant to claims and/or collection procedures conducted herein.City of Waukee shall have the right to audit such reports at reasonable times. 12.City of Waukee agrees to pay FRUSA in accordance with the following fee schedule for the aforementioned service so long as this Agreement has not been terminated: a,FRUSA shall be paid a fee of 5.00k of all payments collected on or before the Collections or W/0 review date provided in Paragraph 4 for each account placed with FRUSA by-the City. Payments to FRUSA shall be based upon revenues received in the preceding month prior to the Collections.or W/0 review date for each account.FRUSA will provide a monthly billing to City of Waukee calculating amounts owed to FR'USA based upon the above stated ' formula. Failure to pay'FRUSA within 30 days of the monthly bill may constitute immediate termination of the contract and possible legal action at the cost of City of Waukee. 13.If City of Waukee determines it is in their best interest to use a collection agency, City of Waukee will deal directly with the collection agency regarding their fees. 14.It is expressly understood and agreed that FRUSA is an independent contractor who shall at all times maintain insurance in force as herein provided and FRUSA shall in all events defend and save and hold harmless City of Waukee from any and all liabilities,obligations,debts,charges,or judgments arising from claims, injuries or debts,charges,or judgments arising from injuries or property damage claims attributable to the activities of FHUSA while engaged in the performance of its duties under this Agreement. 1S.This agreement shall be effective on the date hereof and shall remain in full force and effect for a term of one (1)year unless otherwise terminated as provided in this agreement.Thereafter,this Agreement shall be automatically renew for successive one (1)year periods unless notice of non renewal is provided by either party 90 days prior to the expiration of the current term. 16.FRUSA will maintain a one million dollars ($1,000,000.00)professional liability and general liability of at least one million dollars ($1,000,000.00),and workers compensation in an amount,which meets or exceeds the requirements of the State of Illinois. 17.Either party may terminate this agreement at any time by giving the other party ninety (90)days written notice.Notwithstanding the aforementioned,this agreement shall be subject to immediate termination by City of Waukee if FRUSA fails to maintain insurance as in paragraph 16.Except in the event of immediate termination or non renewal,if this contract is terminated by either party prior to the first (1)year term of the agreement,the City of Waukee will allow FRUSA to continue collections efforts on accounts placed with FRUSA prior to contract termination through the completion of the schedule in paragraph 4 for any such accounts,unless other arrangements have been agreed to by both parties in writing.The City of Waukee understands that they will be responsible to -pay FRUSA'their commission on their collections received prior to the Collections or W/0 review date specified in paragraph 4 on any such accounts,in accordance with paragraph 12. Proper notice may be given by certified or registered mail to: Patrick J.Mannix Chief Executive Officer Fire Recovery USA 3343 N.Ridge Avenue Arlington-Heights,lL 60004 OR TO: At termination of the Agreement it is the responsibility of FRUSA to return to City of Waukee any and all records and documents submitted to FRUSA,except as required by Federal Law. 18.The parties agree that the this agreement shall be construed in accordance with the laws of the State of iowa.The parties agree that any legal action to enforce this agreement shall be brought in the iowa District Court in and for Dallas County, iowa. IN WITNESS WHEREOF,the Responsible Party of City of Waukee and the Director of Operations of FRUSA have executed this agreement, CITY OF WAUKEE FIRE DEPARTMENT FIRE RECOVERY USA BY. DATE: BY I 49 ~QYaCAk Q,p