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HomeMy WebLinkAboutCC Resolution 11576 (Fire Dept. Third Party Billing Service)RESOLUTION NO. 11576 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 (TERM OF AGREEMENT FROM 7/1/04 AND ENDING ON 6/30/06) 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 Oakland, 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 21St day of June, 2004, by the following vote, to wit: AYES: COUNCILMEMBERS: Cohen, Heller, Miller, Phillips & Mayor Boro NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: None JEA NE M. LEONGINI, City Clerk AGREEMENT THIS AGREEMENT entered into this 21st day of JUNE, 2004 , 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 7750 Pardee Lane, Suite 200, Oakland, California 94621 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 7.75 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. 3. TERM a. The term of this Agreement shall begin on 07/01/2004 and end on 06/30/2006. The City's Authorized Representative may extend the term of this contract by giving written notice. b. Either party may terminate this Agreement upon ninety (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 Bruce Martin) 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. 7750 Pardee Lane, Suite 200 Oakland, CA 94621 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 insureds. 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 a Certificate of Insurance in the form of Exhibit "C" or the insurance carrier's standard form endorsement in the form of Exhibit "C." Contractor shall provide City an endorsement to each policy naming City, its officers, agents, and employees as additional insureds. The Certificate of Insurance and endorsements shall be approved as to form and sufficiency by City of San Rafael City Risk Manager. Forward all insurance documents to City Risk Manager'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 Risk Manager. Forward all insurance documents to City Risk Manager'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 2 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 origin. 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. IIWlU 1 30_I]u I BIZI &I 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. 15. BUSINESS ASSOCIATE PROVISIONS ALLIED INFORMATION & SERVICES CORP. (AIS) shall carry out its obligations under this Agreement in compliance with the privacy regulations pursuant to Public Law 104-191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F — Administrative Simplification, Sections 261, et seq., as amended ("HIPAA"), to protect the privacy of any personally identifiable protected health information ("PHI") that is collected, processed or learned as a result of the Billing Services provided hereunder. In conformity therewith, AIS agrees that it will: a. Not use or further disclose PHI except as permitted under this Agreement or required by law; b. Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by this Agreement; c. Report to the City of San Rafael Fire Department any use or disclosure of PHI not provided for by this Agreement of which AIS becomes aware; d. Ensure that any employees, agents or subcontractors to whom AIS provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to AIS with respect to such PHI; e. Make PHI available to the City of San Rafael Fire Department and to the individual who has a right of access as required under IEPAA; f. Incorporate any amendments to P111 when notified to do so by the City of San Rafael; g. Provide an accounting of all uses or disclosures of PHI made by AIS as required under the HIPAA privacy rule; h. Make its internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining AIS' and the City of San Rafael Fire Department's compliance with HIPAA; and i. At the termination of this Agreement, return or destroy all PHI received from, or created or received by AIS on behalf of the City of San Rafael Fire Department. 2. The specific uses and disclosures of PHI that may be made by AIS on behalf of the City of San Rafael Fire Department include: a. The preparation of invoices to patients, carriers, insurers and others responsible for payment or reimbursement of the services provided by the City of San Rafael Fire Department to its patients; b. Preparation of reminder notices and documents pertaining to collections of overdue accounts; c. The submission of supporting documentation to carriers, insurers and other payers to substantiate the health care services provided by the City of San Rafael Fire Department to its patients or to appeal denials of payment for same; d. Release of billing records for judicial and administrative proceedings as required by a court or administrative order, or in response to a subpoena or other legal process; e. Release of pre -hospital care reports in response to a subpoena or other legal process. (This provision will not be included if AIS is not specifically authorized by the Fire Department to act in such capacity); f. Other uses or disclosures of PHI as permitted by HIPAA privacy rule. 16. NON -ASSIGNMENT Contractor shall not assign any of its duties or responsibilities to any other person or entity without prior written consent of City. 17. 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. 18. WAIVER 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 000, By: ROD GOULD Title: City Manager Attest: 0 a X 0, , NO 112.1,116M Title: City Clerk rONTRACTOR By: Tax I.D, No. 94-3087401 lg7 By:Incorporated DY �s (N)o GARY/GGHIA I Title: City Attorney Subject of Contract: Title -F12 (r&--rT 7 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 ambulance 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. £) 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. 10 PROJECT ORGANIZATION San Rafael Fire Department Claims Unit Research Unit Date Input Unit Insurance Billing Medicare/Medi- Unit Cal Unit Special Third Party Billing Unit Project Manager Customer Service Unit Account Representatives Audits Unit Account Account Audits Representatives Payment Update 11 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. 12 EXHIBIT B SCHEDULE OF RATE FOR SERVICE A. 7.75 percent on all revenues collected for accounts dated after the inception of this agreement. 13 EXHIBIT C CERTIFICATE OF INSURANCE - Furnish upon execution of contract. 14 ACCRD CERTIFICAT' 7F LIABILITY INSURANC _ DATE (MMID D/YYYY) I ALLIEDI 03/09/04 PRODUCER THIS CERTIFICATE IS ioSUED AS A MATTER OF INFORMATION ISU Concal Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE www.concal.com HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO 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 NAIC # INSURED INSURER A: SAFECO Insurance Company INSURER B: Preferred Employers Ins Co ALLIED INFORMATION & SERVICE I Patrick Ho INSURER C: 7750 Pardee Ln I INSURER D. Oakland CA 94621 ( 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 IN5K AUU'L POLICY NUMBER LTR INSRE TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRA-(lUN LIMITS DATE (MMIDD/YY) DATE (MM/DO/YY) GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X X COMMERCIAL GENERAL LIABILITY 02BO81129950 UAMAUt IU KtN I tU 03/01/04 03/01/05 I PREMISES (Ea occurence) $ 1000000 CLAIMS MADE rX] OCCUR I MED EXP (Any one person) $ 1000000 PERSONAL BADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 1000000 7 POLICY n JECOT- n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 A X ANY AUTO 02CC9839204 11/17/03 11/17/04 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS _ BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Employee 02CC9B39204 11/17/03 11/17/04 PROPERTYDAMAGE Dishonesty $100,000 (Per accident) $ I GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT I $ ANY AUTO OTHER THAN EA ACC I $ AUTO ONLY: AGG I $ EXCESSIUMBRELLA LIABILITY I EACH OCCURRENCE I $ IOCCUR FICLAIMS MADE I AGGREGATE Is I $ DEDUCTIBLE I $ RETENTION $ I I $ WORKERS COMPENSATION AND I (TORY LIMITS ( I UER B EMPLOYERS' LIABILITY WKN1052453 03/27/04 03/27/05 I E.L. EACH ACCIDENT 1$1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I E.L. DISEASE - EA EMPLOYEF.I $ 1000 0 0 0 Des. describe under I E.L. DISEASE POLICY LIMIT I $ 100 000 0 SPECIAL PROVISIONS below - OTHER A Business Personal 02BO81129950 03/01/04 03/01/05 Property 212000 Property Spec Form $250 ded DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder is named as additional insured. *10 Day notice of cancellation for non-payment of premium. CERTIFICATE HOLDER CANCELLATION + CITYSRA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN City of San Rafael NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DOS SHALL Risk Management Division IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THEIN , , ITS AG TS OR PO Box 151560 San Rafael CA 94915 REPRESENTATIVES. AUTHORIZED REPRESENTATIV c ACORD 25 (2001/08) © ACOF�O ORA ION 198