HomeMy WebLinkAbout2008-065 IGA - EMS Account Services
EMS ACCOUNT SERVICES INTERGOVERNMENTAL AGREEMENT
2 This Agreement is entered into by and between the City of Springfield, an Oregon municipal corporation, acting by
3 and through its Department of Fire and Life Safety, hereinafter referred to as "Springfield" and the City of Ashland, an
4 Oregon municipal corporation, on behalf of its ambulance service, hereinafter referred to as "Ashland."
5 RECITALS
A.
ORS 190.010 provides that units of local government may enter into agreements for the performance of any
and all functions and activities that any partyto the agreement,itsbfficers, or agents have authority to
perform.
Provision of services for the remuneration specified in this Agreement will mutually benefit the parties to it.
Timely and accurate billing, collection, and patient account services for ambulance services are high
priorities for both Ashland and Springfield.
Ashland desires to enter into an Agreement with Springfield whereby Springfield will provide billing,
collection, and patient account services on behalf of Ashland for all billable patients serviced by the Ashland
Emergency Medical Services system.
Springfield is willing to furnish ambulance billing, collection, and patient account services to Ashland
according to the terms and conditions set forth herein.
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B.
C.
D.
E.
17 AGREEMENT
18 NOW, THEREFORE, in consideration of the above recitals and the covenants contained herein, the parties hereby
19 agree as follows:
20 1. Springfield Services to be Provided. Springfield agrees to provide the services described in EXHIBIT A,
21 which is attached hereto and made'a part hereof.
22 2. Ashland Responsibilities. Ashland agrees to perform the obligations and pay for the services performed
23 by Springfield in the manner and at the rate described in EXHIBIT B, which is attached hereto and made a
24 part hereof.
25 3. Contract Duration. This Agreement shall commence on March 25, 2008 and shall continue until June 30,
26 2009 unless extended, modified, or terminated as provided herein.
27 4. Extension. This Agreement may be extended for additional one-year periods upon compliance with the
28 provisions of paragraph 12 and with the following procedure:
29 4.1. The Springfield Contract Representative and the Ashland Contract Representative shall confer
30 regarding the proposed fee for services and, any other proposed Agreement revisions proposed by
31 either party.
32 4.2. If the parties, after negotiation, agree, an Agreement Modification that stipulates any and all
33 Agreement modifications shall be executed. The Agreement Modification shall be attached to this
34 Agreement.
35 5. Representatives. Each party shall appoint a Contract Representative to represent the party for the purpose
36 of extending this Agreement and giving or receiving any notices provided for in this Agreement and to
37 perform such other functions as are set forth in this Agreement and the Exhibits hereto. The initial Contract
38 Representatives are named in EXHIBIT C, which is attached hereto and made a part hereof. A party may
39 change its Contract Representative by notifying the other party in conformance with the provisions of
40 paragraph 9. Ashland shall appoint an Ambulance Service Representative to perform the Ambulance
41 Service functions stated on EXHIBIT B. The initial Ambulance Service Representative named on EXHIBIT
42 C may be changed in the same way that Contract Representatives are changed. One person may serve in
43 both representative capacities, if that person meets the qualifications to perform both functions.
44 6. Status. In providing services specified in this Agreement (and any associated services), both parties are
45 public bodies and maintain the public body status as specified in ORS 30.260. Both parties understand and
46 acknowledge that each retains all immunities and privileges granted them by the Oregon Tort Claims Act
47 (ORS 30.260 through 30.295) and any and all other s~tutory rights granted as a result of their status as
48 local public bodies. '
49 7. Indemnification. To the extent allowed by the Oregon Constitution and the Oregon Revised Statutes, each
50 of the parties hereto agrees to defend, indemnify, and save the other harmless from any claims, liability or
EMS Account Services Intergovernmental Agreement-City of Ashland
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damages including attorney fees arising out of any error, omission or act of negligence on the part of the
indemnifying party, its officers, agents, or employees in the perfonnance of this agreement.
Assignment. Neither party shall assign this contract in whole or in part, or any right or obligation
hereunder, without the other party's written approval.
Notices. Any notices pennitted or required by this contract shall be deemed given when personally
delivered or upon deposit in the United State mail, postage fully prepaid, certified, and return receipt
requested, addressed to the representative designated in EXHIBIT C. Either party may change its address
by notice given to the other in accordance with this paragraph.
Integration. This Agreement embodies the entire agreement of the parties. There are no promises, terms,
conditions, or obligations other than those contained herein. This contact shall supersede all prior
communications, representations, or agreements, either oral or written, between the parties. This contract
shall not be amended except in writing, signed by both parties.
Interpretation. This Agreement shall be governed by and interpreted in accordance with the laws of the
state of Oregon
Modification. This Agreement or any of its Exhibits may be modified at any time by mutual consent of
parties. No change or modification of this Agreement or any of its Exhibits shall be valid or binding upon the
parties hereto unless such a change or modification is in writing signed by all the parties hereto.
Termination. Upon 180 days prior written notice delivered to the persons designated in EXHIBIT C, either
party, without cause, may terminate its participation in this Agreement.
Obligations upon Termination. Except for Default pursuant to paragraph 15, upon termination, Springfield
shall continue to perform all services set forth in EXHIBIT A for all ambulance incidents occurring prior to the
termination date except that instead of turning problem accounts over to a collection agency or small claims
court, these accounts shall be returned to Ashland for further processing. Upon completion of all services at
termination, Springfield shall return all books, accounts, and records to Ashland that relate solely to billing
accounts received from Ashland. After termination, Springfield shall have no obligation to render further
services for Ashland except that Springfield shall continue to forward payments received on Ashland
accounts to Ashland.
Default. In the event that Ashland shall fail to comply with any term or condition or fulfill any obligation of
this Agreement, Springfield may terminate the Agreement upon 30 days written notice to Ashland's Contract
Representative. In the event that Springfield shall fail to comply with any term or condition or fulfill any
obligation of this Agreement, Ashland may terminate the Agreement upon 30 days written notice to
Springfield's Contract Representative. Springfield shall turn over to Ashland all receipts, books, accounts,
and records in the possession of Springfield that relate solely to billing accounts received from Ashland. In
such event, Springfield shall have no obligation to render further services to Ashland except that Springfield
shall continue to forward payments received on Ashland's accounts to Ashland. The provisions of
paragraph 14 shall apply in connection with an Agreement termination made under this provision.
Waiver and Breach. The waiver by either party of any breach or violation of any provision of this
Agreement shall not be deemed a waiver of such term or condition in the future.
Attorney Fees. In the event of any action to enforce or interpret this Agreement, the prevailing party shall
be entitled to recover from the losing party such additional sums as the court may adjudge for reasonable
attorney fees plus all costs and disbursements at trial, on any appeal, or upon review.
Notice of Adverse Action. Each party shall notify the other in writing, within five days of receiving any
written or oral notice of any adverse action naming or otherwise involving the other.
Severability. Invalidation of any tenn or provision herein by judgment or court order shall not affect any
other provision, which shall remain in full force and effect.
Force Majeur. Neither party to this Agreement shall be held responsible for delay or default caused by fire,
riot, acts of God, and/or war that are beyond that party's reasonable control. Ashland may tenninate this
Agreement upon written notice after determining such delay or default will reasonably prevent successful
performance of the Agreement.
Exhibits. Each Exhibit, if any, to this Agreement is made a part of this Agreement as though set forth fully
herein. Any provision of any Exhibit that is in conflict with any provision of this Agreement shall take
precedence and supersede the conflicting provision of this Agreement.
EMS Account Services Intergovernmental Agreement-City of Ashland
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103 BY THE SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE BELOW, EACH PARTY ACKNOWLEDGES THAT
104 HE/SHE HAS READ THIS AGREEMENT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
105 CONDITIONS.
106 IN WITNESS WHEREOF, THE PARTIES HERETO HAVE EXECUTED THIS AGREEMENT.
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CITY OF SPRINGFIELD, OREGON:
Brian Evanoff
Print Name
Administrative Services Bureau Manager
Title
March 26, 2008
Date
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EMS Account Services Intergovernmental Agreement-City of Ashland
108EMS Account Services Intergovernmental Agreement
109 EXHIBIT A
110 Springfield Services. Springfield agrees to perform the following services:
111 1. Perform billing and collection services under this Agreement on behalf of and in the best interests of Ashland
112 according to the policies, rates, schedules, and instructions established by Ashland.
113 2. Bill customers and/or insurance companies in a timely manner after receipt of completed patient billing
114 information from Ashland. Assist customers in the preparation of forms that are required by their insurance
115 companies.
116 3. Appeal denials based upon medical necessity when documentation supports the need for services rendered
117 by Ashland.
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Refer delinquent patient accounts to a collection agency, as appropriate.
Accept patient payments made with a VISA, MasterCard, Discover, or American Express credit cards.
Allow patients to pay their bills in installments when the patient meets criteria for the installment plan option.
Transfer all funds collected on Ashland accounts, whether received within the Agreement period or
thereafter, to Ashland after the month-end posting has been completed, according to the payment
disposition instructions established by Ashland. The transfer of funds shall consist of all monies received by
Springfield on account of ambulance services provided by Ashland, excluding any sums overpaid by the
customer or third party payer that Springfield shall refund.
Springfield shall put Ashland's billing data on the same computer as its own billing data and shall take all
reasonable precautions to protect said data. Springfield shall not be responsible for loss of Ashland data, or
any damages or loss to Ashland resulting from said loss of data, if that loss of data results from
circumstances beyond Springfield's control.
Provide the following data on a monthly basis:
9.1. Amount billed (categorized by non-member and member)
9.2. Number of patients billed (categorized by non-member and member)
9.3. Amount collected (categorized by non-member, member, ;and collection recovery)
9.4. Amount of write-downs and write-offs
9.5. Refunds made for overpayments
9.6. Other adjustments
9.7. Accounts receivable balance
Cooperate in the development or alteration of mutually acceptable billing and collection policies, procedures,
practices, or forms.
Assist Ashland in the formulation of ambulance rate structures and fees.
Assist Ashland in the analysis and development of managed healthcare agreements.
Minimize Ashland's reporting requirements to as great an extent as is reasonably possible.
Meet with Ashland's designated representatives to discuss problems and performance as needed.
Provide reasonably necessary mutually agreed upon training to appropriate Ashland field and administrative
staff regarding the gathering of necessary information and proper completion of run reports.
Provide mutually agreed upon additional services for special purposes, or for work outside the normal scope
of this Agreement.
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148 EMS Account Services Intergovernmental Agreement
149 EXHIBIT B
150 Ashland Payment and Obligations. Ashland agrees to make payment and perform as follows:
151 1. Establish the policies, rates, schedules, and instructions for the billing of Ashland's patients and the
152 disposition of payments received for Springfield to use when providing services to Ashland. Ashland may
153 modify or revoke its policies, rates, schedules, and instructions, at its discretion.
154 1.1. Ashland agrees that the policies, instructions, rates, schedules,. and payment disposition for
155 Springfield to use when providing services to Ashland shall be made in good faith and shall comply
156 with all applicable laws, rules, and regulations.
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Ashland shall negotiate in good faith any impact that modifications or revocations may have on
Springfield's ability to provide the services listed in EXHIBIT A or upon the price per patient billed
as listed in EXHIBIT B, paragraph 13.
Provide Springfield, in a mutually acceptable format, the necessary information and proper documentation
required to prepare and reach final adjudication of patient claims, to include:
2.1. Ensuring that all ambulance service incident reports use mutually agreed upon report forms and
are completed according to the mutually agreed upon instructions of Springfield.
1.2.
3.
Obtaining appropriate patient encounter, demographic, financial, and insurance information as
required to process patient account.
Obtaining an appropriate patient or patient representative signature for all billable patients in a
mutually acceptable form or format. Springfield shall not be held responsible for billing or
collections on accounts without aforementioned signature.
Obtaining a signed Physician Certification Statement (PCS) of Medical Necessity for non-
emergency services as required. Springfield shall not be held responsible for billing or collections
on accounts without aforementioned PCS.
2.5. Providing indication of the ambulance membership status of billable patients to ensure that member
patients are billed according to their membership terms of agreement.
2.6. Forwarding reports and other billing information forms to Springfield in a timely manner.
2.7. Both parties agree that Springfield will make reasonable efforts to verify and/or obtain information
needed to process patient accounts; however, Springfield is not responsible for errors or omissions
when relying on information provided by Ashland.
Designate a single person in an administrative position to receive and evaluate all complaints by Ashland
officials and employees regarding Springfield's performance under this Agreement. and share the
information with the appropriate Springfield Representative in a timely manner.
Refer all citizen inquiries regarding their accounts to Springfield.
Cooperate to the greatest extent possible with Springfield in its efforts to perform the services described in
EXHIBIT A.
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Provide the following to Springfield at time of Agreement execution:
6.1. Medicare, Medicaid, and any other insurance provider numbers assigned to Ashland.
6.2. Copy of most recent Ambulance Service License issued by the Oregon Health Division.
6.3. Copy of letter 147C from the Internal Revenue Service showing the legal name and tax
identification number or employer identification number for City of Ashland.
6.4. Power of Attorney to endorse payments received on behalf of, and payable to Ashland.
Minimize Springfield's reporting requirements to as great an extent as is reasonably possible.
Meet with Springfield's designated representatives to discuss problems and performance as needed.
Cooperate in the development or alteration of mutually acceptable billing and collection policies, procedures,
practices, or forms.
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Permit Springfield to review and comment on any contract or agreement that Ashland may enter into that
could affect ambulance fees, charges, or billing and collection practtces. Negotiate in good faith any impact
that the above-mentioned contracts or agreements may have on Springfield's ability to provide the services
listed in EXHIBIT A or upon the price per patient billed as listed in EXHIBIT B, paragraph 13.
Provide a liaison in or with Ashland's communication and dispatch center to assist with the approval/denial
process for non-emergency ambulance transfers.
If desired, provide, at Ashland's expense, a local telephone number or toll-free long distance number that
will automatically fOrward calista the Springfield Account Services office.
Pay Springfield for services rendered according to the following schedule:
13.1. For monthly patient account services provided to Ashland, the amount per patient billed on behalf
of Ashland as follows:
Ambulance Dates of Service Per Patient Billed Amount
July 1, 2005 through June 30, 2008...................................$35.32
July 1,2008 through June 30,2009...................................$36.00
13.1.1. Amount due for monthly services rendered by Springfield will be invoiced monthly.
Invoices will be sent to Ashland as soon as possible after month-end patient statistics
have been computed and will list the number of patients billed and the amount due to
Springfield.
13.2. Pay Springfield additional billing and collection costs incurred by Springfield for special purposes,
or for work outside the normal scope of this Agreement, if Ashland approved such additional costs
before being incurred.
13.3. Other than the fees and charges for services rendered as described in this Agreement, Springfield
shall have no financial interest in, nor is its compensation related to, the amounts billed and/or
collected on behalf of Ashland, regardless of whether amounts were actually collected.
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219 EMS Account Services Intergovernmental Agreement
220 EXHIBIT C
221 Representatives. As provided in paragraph 5, the following individuals are the designated representatives to
222 perform the functions set forth in this Agreement.
223 1. Springfield Contract Representative
224 Brian Evanoff, Administrative Services Bureau Manager
225 Springfield Fire and UfeSafety
. 226 225 North Fifth Street
227 Springfield OR 97477
228 Phone: 541-736-1019 FAX: 541-726-2297
229 e-mail: bevanoff@ci.springfield.or.us
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2.
Ashland Contract Representative
Contact
Title
Citv of Ashland
Agency
455 Siskiyou. Blvd.
Address
Ashland OR 97520
City State Zip
541-482-2770
Phone
541-488-5318
FAX
E-mail
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3.
Ashland Ambulance Service Representative
Contact
Title
City of Ashland
Agency
455 Siskivou. Blvd.
Address
Ashland OR 97520
City State Zip
541-482-2770
Phone
541-488-5318
FAX
E-mail
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EMS Account Services Intergovernmental Agreement-City of Ashland