HomeMy WebLinkAboutCC Resolution 10706 (Third Party Billing Services)RESOLUTION NO. 10706
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL
AUTHORIZING THE CITY MANAGER TO EXECUTE AN AGREEMENT
WITH ALLIED INFORMATION AND SERVICES CORPORATION FOR
THIRD PARTY BILLING SERVICE FOR THE SAN RAFAEL FIRE DEPARTMENT
WHEREAS, the City of San Rafael Fire Department has the equipment and
personnel available for the provision of paramedic services in the City, and such service
availability is funded through the paramedic special tax; and
WHEREAS, medical insurance providers cover all or a portion of paramedic
transport service provided to their insureds; and
and
WHEREAS, the City by its paramedic tax ordinance is permitted to charge fees;
WHEREAS, the City's Fire Department can realize additional revenue to maintain
and increase its level or service to the community through the implementation of billing
the insurers of users of paramedic transport services;
NOW, THEREFORE, BE IT RESOLVED, that the City Council of the City of San
Rafael, does hereby authorize the City Manager to execute an agreement with Allied
Information and Services Corporation of Alameda, California, for the provision of Third
Party Billing Services for the Fire Department paramedic transport service, subject to
the review and approval of the City Attorney.
I, Jeanne M. Leoncini, Clerk of the City of San Rafael, hereby certify that the
foregoing Resolution was duly and regularly introduced and adopted at a regular
meeting of the City Council of said City held on Monday, the 18th day of September,
2000, by the following vote, to wit:
AYES: COUNCILMEMBERS: Cohen, Heller, Phillips and Mayor Boro
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: Miller
JE NE M. LEONCINI, City Clerk
IT� : a\/_MI I
THIS AGREEMENT entered into this 18th day of September, 2000, by and between the City of San
Rafael, an entity organized and existing under the Laws of the State of California, hereafter referred to as
"CITY," and, Allied Information & Services Corp. doing business at 2490 Mariner Square Loop, Suite
220, Alameda, California 94501 hereafter referred to as "CONTRACTOR."
CITY and CONTRACTOR hereby agree as follows:
1. SCOPE OF SERVICES
Contractor agrees to perform all those services described in Exhibit "A," attached hereto and
made a part hereof, in accordance with the terms and conditions stated herein.
In order to permit Contractor to render the services required hereunder, City shall, at its expense
and in a timely manner, provide such information in City's possession concerning the scope of services
as Contractor may require from time to time.
2. PAYMENT
For the services referred to in paragraph 1 herein, City will pay Contractor a total amount not to
exceed 8.5 percent of revenue collections on accounts processed after the inception of this agreement.
City shall make payments to Contractor in accordance with the provisions described in Exhibit "B,"
attached hereto and made a part hereof.
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a. The term of this Agreement shall begin on 07/01/2000 and end on 06/30/2002. The City's
Authorized Representative may extend the term of this contract by giving written notice.
b. Either party may terminate this Agreement upon (90) days prior written notice to the other if
the other party has substantially failed to fulfill its obligations under this Agreement, in a timely manner,
through no fault of the terminating party. City may terminate this agreement without cause upon thirty
(30) days prior written notice to Contractor. A written notice shall be deemed served upon sending said
notice in a postage paid envelope addressed to the other party to this Agreement and depositing the same
with the United States Post Office with postage paid. For purposes of this Agreement, all notices to the
City shall be addressed as follows:
City of San Rafael
(Fire Department)
(Attn.: Chief Robert Marcucci)
1039 C Street
San Rafael, CA 94901
For the purposes of this Agreement, all notices to Contractor shall be addressed as follows:
Mr. Patrick Ho, President
Allied Information & Services Corp.
2490 Mariner Square Loop, Suite 220
Alameda, California 94501
c. If either party terminates this Agreement before the Contractor completes the services in
Exhibit "A," in addition to any other rights and remedies provided by law or under this Agreement,
Contractor shall be entitled to compensation for services performed hereunder, through and including the'
date of termination, but not to exceed the payment according to the rate specified in Exhibit "B."
Contractor shall also be entitled to all reasonable costs incurred in connection with such services. In no
event will the amount paid exceed the full amount in paragraph 2 of this agreement.
4. INDEMNIFICATION
Contractor agrees to release, indemnify, hold harmless, and defend City, its officers, agents, and
employees from and against any and all claims, demands, liability, lawsuits, or other actions for damage
or injury to persons or property arising out of or in any way connected with the Contractor's operations
under this Agreement, or the performance of this Agreement by Contractor or its officers, employees,
partners, directors, or agents.
5. INSURANCE
a. The Contractor shall maintain comprehensive general liability automobile liability, and (if
any licensed professional performs services under this agreement) professional liability insurance
policies in the minimum amount of $1,000,000.00 to cover any claims arising out of Contractor's
performance of services under this Agreement. Said insurance, except professional liability, shall name
the City, its officers, agents, and employees as additional insures. All said insurance policies shall
provide that the insurance carrier shall not cancel, terminate or otherwise modify the terms and
conditions of said policies except upon thirty (30) days prior written notice to the City; shall be
evidenced by the original Certificate of Insurance attached to an endorsement in the form of Exhibit "C"
or the insurance carrier's standard form endorsement in the form of Exhibit "C" or the insurance carrier's
standard form endorsement evidencing coverage, and shall be approved as to form and sufficiency by
City of San Rafael City Attorney. Forward all insurance documents to City Attorney's Office.
b. If Contractor employs any person it shall carry workers' compensation insurance and shall
provide a certificate of insurance to the City. The workers' compensation insurance shall provide that the
insurance carrier shall not cancel, terminate or otherwise modify the terms and conditions of said
insurance except upon thirty (30) days prior written notice to the City; shall provide for a waiver of any
right of subrogation against City to the extent permitted by law; and shall be approved as to form and
sufficiency by City Attorney. Forward all insurance documents to City Attorney's Office, City of San
Rafael.
6. CONFORMITY WITH LAW AND SAFETY
a. Contractor shall observe and comply with all applicable laws, ordinances, codes and
regulations of governmental agencies, including federal, state, municipal and local governing bodies,
having jurisdiction over the scope of services or any part hereof, including all provisions of the
Occupation Safety and Health Act of 1979 and all amendments thereto, and all applicable federal, state,
municipal and local safety regulations. All services performed by Contractor must be in accordance with
these laws, ordinances, codes, and regulations. Contractor shall indemnify and save City harmless from
any and all liability, fines, penalties and consequences from any noncompliance or violations of such
laws, ordinances, codes, and regulations.
b. Accidents: If a death, serious personal injury, or substantial property damage occurs in
connection with the performance of this Agreement, Contractor shall immediately notify the City by
telephone. Contractor shall promptly submit to City a written report, in such form as may be required by
City, of all accidents which occur in connection with this Agreement. This report must include the
following information: (1) name and address of the injured or deceased person(s), (2) name and address
of Contractor's subcontractor, if any, (3) name and address of Contractor's liability insurance carrier, and
(4) a detailed description of accident and whether any of City's equipment, tools or material were
involved.
7. AFFIRMATIVE ACTION
Contractor hereby agrees to comply with the provisions of City's policies regarding affirmative
action as amended from time to time. Contractor shall not in any manner discriminate against any
individual or entity based upon race, sex, color, religion, or national orgin.
8. INDEPENDENT CONTRACTOR
For purposes of this Agreement and at all times during the term of this Agreement, Contractor
shall be an independent contractor and not an employee of the City. The City shall not have the right to
control when, where and how the service is rendered, but shall have the right to specify the results of the
service rendered pursuant to this Agreement. Contractor hereby certifies that its taxpayer identification
number is: 94-3087401. Contractor must pay the state and federal government all state and federal
income and other taxes due.
9. ATTORNEYS FEES
If any action at law or inequity is brought to enforce or interpret the provisions of this
Agreement, the prevailing party shall be entitled to reasonable attorney's fees in addition to any other
relief to which it may be entitled.
10. GOVERNING LAW
This Agreement shall be governed by the laws of the State of California.
11. AMENDMENTS
The terms and conditions of this Agreement shall not be altered or otherwise modified except
upon a duly executed written amendment to this Agreement.
12. ENTIRE AGREEMENT
a. The terms and conditions of this Agreement and all exhibits attached hereto or documents
expressly incorporated by reference therein represent the entire Agreement between the parties hereto
with respect to the subject matter hereof, and this Agreement shall supersede any and all other prior
agreements regarding the subject matter between the City and Contractor, either oral or in writing. No
other agreement, statement, or promise relating to the subject matter of this Agreement shall be valid or
binding except upon a duly executed written amendment to this Agreement.
b. Should any conflicts arise between the terms and conditions of this Agreement and the terms
and conditions of any exhibits attached hereto or documents expressly incorporated therein, the terms
and conditions of this Agreement shall control.
13. CONFLICT OF INTEREST PROHIBITED
Neither Contractor nor any person who is an employee, officer, director, partner, or member of
Contractor shall have served as either an elected officer, an employee, or a Board, Committee or
Commission Member of City. Contractor shall comply with City's conflict of interest code.
14. OWNERSHIP OF DOCUMENTS
Contractor agrees to return to City upon termination of this Agreement and in the same condition
as received, all documents, drawings, photographs and other written or graphic material, however
produced, received from City, its contractors or agents, and used by Contractor in the performance of its
services hereunder. All work papers, drawings, internal memoranda of any kind, photographs and any
written or graphic material, however produced prepared by Contractor in connection with its
performance of services hereunder, shall be and shall remain after termination of this Agreement, the
property of Contractor and may be used by Contractor for any purpose whatsoever. However, the
previous sentence shall not apply if the City or Contractor terminates this contract before the Contractor
completes all the services required under Paragraph 1. In this case, the latest set of draft documents shall
be and remain the property of the City.
Contractor agrees to allow City's representative access to review and copy all documents,
drawings, photographs, and other written or graphic material, however produced, upon reasonable notice,
during regular business hours.
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15. NON -ASSIGNMENT
Contractor shall not assign any of its duties or responsibilities to any other person or entity
without prior written consent of City.
16. RECORDS AND AUDIT
Contractor shall maintain all records related to its performance under this Agreement, and shall
make such records available to City for inspection and/or audit upon reasonable notice.
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City's acceptance of work or payment by City for that work, under this Agreement, shall not
constitute a waiver by City of any of the provisions of this Agreement. City's waiver of any breach of
this Agreement shall not constitute waiver of any other provision or/of a subsequent breach.
IN WITNESS WHEREOF, the City and Contractor have executed this agreement through their
duly authorized representatives as of this date first above written.
City of San Rafael
By:
Title: City Manager
Attest:
By:
Title: City Clerk
APPROVED AS TO FORM:
By:
Title: City Attorney
r
ACTOR
By:
Tax I.D. No. 94-3087401
Incorporated (Y)es (N)o
Subject of Contract:
Title frtss A&
EXHIBIT A
SCOPE OF SERVICES
1. Statement of Work: - This documents the City's and Contractor's mutual understanding of the scope
and magnitude of the project.
a.) Outline of authorized work:
The Contractor will produce statements and invoicing ( billing) for all qualified ambualnce
transportation with corresponding completed ambulance report forms. The Contractor will
produce cumulative and detailed accounts receivable reports in generally accepted accounting
format. Invoicing and/or reports will be produced on a monthly basis or in such other time frame
as is mutually agreed. The Contractor will not be the depository for monies received as a result
of the invoicing. The Contractor will provide all necessary personnel, tools, equipment and
product necessary for producing the invoicing and reports.
The Contractor will review and make recommendations, for change, if necessary, with respect to
the current ambulance report form(s) content, data collection procedures and billing amounts for
ambulance related services.
b.) Obiective(s):
The objective of this project is to maximize and make timely the collection of revenue due from
the provision of ambulance transportation and services provided by the City of San Rafael Fire
Department. Further, it is to provide for the review of and improvement(s) in the overall
ambulance billing process.
C.) Proiect organization:
The basic project organization is:
The Contractor's project manager in cooperation with the designated City person will provide
and oversee an integrated billing process for ambulance service(s). Through the use of in-house
and field staff the Contractor will process the ambulance report forms through a data processing
system in order to produce invoicing and corresponding report(s). Through additional in-house
staff the Contractor will post all monies received by the City and produce the necessary balance
billing, account registers and accounting documents as outlined.
d.) Proiect staffing:
Staffing for the project will be the responsibility of the Contractor. The City will provide
sufficient liaison personnel time in order that the ambulance report information is received by the
Contractor on a daily basis. Please see the attached organizational chart for the numbers of
persons and corresponding positions.
e.) Deliverables:
The Contractor will produce and cause delivery of all invoices, statements and reports as
required. ( Please see attached list of reports. ) In addition, the Contractor will provide the City
with a report on its review of the ambulance report form(s), billing amounts and other items the
Contractor believes will improve the billing process for ambulance services. This report will be
provided to the City no later than sixty (60) days after the beginning of the contract. The
Contractor will provide demographic reports on the accounts and corresponding billing
classifications. All reports due will be produced and provided to the City by the fifteenth (15th)
of the month following the date of service. This reporting will begin after the first month of the
beginning of the Contract.
2. Action Steps:
The following is an outline of steps to be taken by the Contractor and the City.
a.) The City, on a routine basis, will collect and place in trip number order all ambulance
report forms for the previous days service.
b.) On a routine basis the Contractor will retrieve and screen the ambulance report forms for
billing information and forward them to the Contractor's data processing staff.
C.) The Contractor's Field Data Input staff will input all pertinent data to the Contractor's
data processing system.
d.) The Contractor's in-house staff will process the accounts and produce statements,
invoices and reports as required.
e.) The City will receive all payments due and forward facsimiles ( photocopies ) of the
payment information to the Contractors personnel for account update on a daily basis.
f.) The Contractor will post or credit the monies received by the City on account and
produce all corresponding reports and balance billing.
g.) The Contractor will process all third party payor billing forms as needed.
h.) The Contractor will meet as needed with the City staff ( Project Director ) or at least
monthly to discuss the projects process and to review the projects reports.
3. Review Point(s):
a.) The Contractor will review all demographic data and make recommendations for change
in billing procedures if necessary.
4. Departmental Participation:
a.) The City will provide a billing liaison person to Allied's Billing Personnel on a daily
basis during normal business hours.
PROJECT ORGANIZATION
San Rafael Fire Department
Claims Unit
Research Unit Data Input Unit
Insurance Billing MedicareNedi-
Unit Cal Unit
Special Third Party Billing
Unit
Project Manager
Customer Service Unit
Account Representatives
Audits Unit
Account Account Audits
Representatives
Payment Update
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REPORTS LISTING
1. Monthly listing of all accounts established in the system. The listing will include the following;
- Alpha order by Patient name
- Account Number
- Date of Service
- Total Charges
2. Quarterly Aged Trial Balance
3. Monthly Collection Report(s) ( Detail )
4. Monthly production & management report(s) showing;
Number of accounts
Number of payments received
Number of accounts returned by the City for cancellation
Total accounts aged by days
Percentage of Collections by financial classification
Any other information deemed necessary by the City
5. Quarterly pre -collection or delinquency report(s) showing accounts;
- returned for other collection process in alpha order.
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EXHIBIT B
SCHEDULE OF RATE FOR SERVICE
A. 8.5 percent on all revenues collected for accounts dated after the inception of this agreement.
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EXHIBIT C
CERTIFICATE OF INSURANCE - Furnish upon execution of contract.
13
ACORD CERTIFICQ = OF LIABILITY INSUI MCR ABI DATE(MM/DD/YY)
LIEDI 02/23/00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
ISTD Concal Insurance Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 2905 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Dublin CA 94568-0905
Phone: 925-803-2200 Fax: 925-803-2225 INSURERS AFFORDING COVERAGE
INSURED INSURER A: American States Insurance Co
ALLIED INFORMATION & SERVICE INSURER B: Golden Eagle Insurance Corp
Patrick Ho INSURER C:
2490 Mariner Square Loop, #220 INSURER D:
Alameda CA 94591
I I INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR TYPE OF INSURANCE POLICY NUMBER DATPOLE (MM/DDIYY) E DATE (MM/DDm�N LIMITS
GENERAL LIABILITY EACH OCCURRENCE j$1000000
A X COMMERCIAL GENERAL LIABILITY 02BOB11299 03/01/00 03/01/01 I FIRE DAMAGE (Any one fire) I $ 1000000
1 CLAIMS MADE ❑X OCCUR I MED EXP (Any one person) $ 5000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY n JEC [—]
LOC
AUTOMOBILE LIABILITY
A ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON -OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
OCCUR 1-1 CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
B EMPLOYERS' LIABILITY
OTHER
02BO811299
NWC55020900
PERSONAL &ADV INJURY I $ 1000000
GENERAL AGGREGATE 1$2000000
PRODUCTS-COMP/OPAGG 1$ 1000000
COMBINED SINGLE LIMIT
03/01/00 03/01/01 (Ea accident)
03/27/00 03/27/01
DESCRIPTION OF OPERATIONS/LOCATIONSA/EHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Certificate holder is named as additional insured
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
$1,000,000
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EACH OCCURRENCE $
AGGREGATE $
WUSIAIU-
OUTH-
RY_ LIMITS I ER
E.L. EACH ACCIDENT $ 1000000
E.L. DISEASE - EA EMPLOYEE $ 1000000
E.L. DISEASE -POLICY LIMIT $ 1000000
CERTIFICATE HOLDER I Y I ADDITIONAL INSURED; INSURER LETTER: _ CANCELLATION
CITYSRA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of San Rafael
It's officer,agents & Employee
Chief Marcucci
1039 C Street
San Rafael CA 94901
ACORD 25-S (7/97)
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
ACORD CORPORATION 1988