Okaloosa County BOCC — May 20, 2014 — Intermedix EMS Billing Contract 2014 — reading text

incurred by the prevailing party in connection with such action or proceeding. 25. CONSTRUCTION OF AGREEMENT. This Agreement has been negotiated by the parties and its provisions will not be presumptively construed for or against the other party. The headings and Section titles in this Agreement are for convenience only, and will not affect the construction or interpretation of this Agreement. 26. NO THIRD PARTY BENEFICIARIES. Except as expressly provided in this Agreement, nothing in this Agreement shall confer upon any person other than the parties and their respective successors and assigns, any rights, remedies, obligations or liabilities whatsoever. 27. COUNTERPARTS. The parties may execute this Agreement in one or more counterparts, each of which shall be an original, and which together shall constitute one instrument. [Signature page to Follow] IN WITNESS WHEREOF, the parties have caused this Agreement to be signed by their authorized representatives as of the Effective Date. ADVANCED DATA PROCESSING, INC., A SUBSIDIARY OF INTERMEDIX CORPORATION, a DELAWARE OKALOOSA COUNTY, FLORIDA CORPORATION By: : By: Name: Beemthemen= Src! U-/)aep Name: Charles K. Windes, Jr. Title: <Brewmdent Pr Cg.) Title: Chairman Witness:, .sasebfe Fa ett ‘e STATE OF FLORIDA COUNTY OF OKALOOSA This contract is accepted this day of 2014 and is effective on the 19th day of May 2014, ATTEST: COUNTY OF OKALOOSA, FLORIDA BY Gary Stanford Charles K. Windes, Jr., Chairman Deputy Clerk of Court Exhibit A Scope of Services Base Services and Obligations: A. — Intermedix shall provide revenue cycle management services for Client as described below. Intermedix shall, during the Term: 1. Prepare and submit initial claims and bills for Client promptly upon receipt thereof, and prepare and submit secondary claims and bills promptly after identification of the need to submit a secondary claim. 2. Assist Client in identifying necessary documentation in order to process and bill the accounts. 3. Direct payments to a lockbox or bank account designated by Client, to which Client alone will have signature authority. 4, Pursue appeals of denials, partial denials and rejections when deemed appropriate by Intermedix. 5. Respond to and follow up with Payors and respond to messages or inquiries from a Payor. 6. Provide appropriate storage and data back-up for records pertaining to Client’s bills and collections hereunder, accessible to Client at reasonable times. 7. Maintain records of services performed and financial transactions. 8. Meet, as needed, with representatives of Client to discuss results, problems and recommendations. 9, Provide any Client-designated collection agency with the data necessary for collection services to be performed when an account is referred to such agency. 10. Intermedix will support the provider in filing and maintaining required documentation and agreements with commonly-used Payors (e.g. Medicare, Medicaid, Champus, etc.). The Provider will maintain responsibility for enrollment, required documentation, and agreements with Out of State Payers, such as Out of State Medicaid programs, and other payors not commonly billed 11. Provide reasonably necessary training periodically, as requested by Client, to Client’s emergency medical personnel regarding the gathering of the necessary information and proper completion of run reports. 12. Utilize up-to-date knowledge and information with regard to coding requirements and standards, to comply with applicable federal, state and local regulations. 13. Provide a designated liaison for Client, patient and other Payor concerns. 14. Provide a toil free telephone number for patients and other Payors to be answered as designated by Client. 15. Facilitate proper security of confidential information and proper shredding of disposed materials containing such information. 16. Establish arrangements with hospitals to obtain/verify patient insurance and contact information. 17. Respond to any Client, Payor or patient inquiry or questions promptly. 18. Maintain appropriate accounting procedures for reconciling deposits, receivables, billings, patient accounts, adjustments and refunds. 19. Provide reasonable access to Client for requested information in order for Client to perform appropriate and periodic audits. Reasonable notice will be given to Intermedix for any planned audit and will be conducted during normal business hours of Intermedix, all at the Client's expense. 20. Provide timely reports facilitating required aspects of monitoring, evaluating, auditing and managing the Services provided. 21. Process refund requests and provide Client with documentation substantiating each refund requested. 22. Assign billing to patient account numbers providing cross-reference to Client’s assigned transport numbers. 23. Maintain responsibility for obtaining missing or incomplete insurance information. 24. Provide accurate coding of medical claims based on information provided by Client. 25. Negotiate and arrange modified payment schedules for individuals unable to pay full amount when billed. 26. Retain accounts for a minimum of six (6) months (unless otherwise specified by mutual agreement) and after six (6) months turn over accounts for which no collection has been made (unless insurance payment is pending) to an agency designated by Client. 27. Permit real-time read only electronic look-up access by Client to Intermedix’s SaaS Service to obtain patient data and billing information. 28. Maintain records in an electronic format that is readily accessible by Client personnel and that meets federal and state requirements for maintaining patient medical records. 29. Create, implement and comply with a Compliance Plan consistent with the Compliance Program Guidance for Third Party Medical Billing Companies 63 FR 70138; (December 18, 1998) promulgated by the Office of Inspector General of the Department of Health and Human Services (OIG). B. Client’s Responsibilities and Obligations: 1. From each person who receives EMS from Client (“Patient”), Client shall use its best efforts to obtain and forward the following information (“Patient Information”) to Intermedix: 0) the Patient’s full name and date of birth; (ii) = the mailing address (including zip code) and telephone number of the Patient or other party responsible for payment (“Guarantor”); (iii) the Patient’s social security number; (iv) the name and address of the Patient’s health insurance carrier, name of policyholder or primary covered party, and any applicable group and identification numbers; (v) the auto insurance carrier address and/or agent’s name and phone number if an automobile is involved; (vi) the employer’s name, address and Workers Compensation Insurance information if the incident is work related; (vii) the Patient’s Medicare or Medicaid HIC numbers if applicable; (viii) the Patient’s or other responsible party’s signed payment authorization and release of medical authorization form or other documentation sufficient to comply with applicable signature requirements; (ix) _ the call times, transporting unit, and crew members with their license level, ic. EMT-B, EMT-I, or EMT-P; (x) odometer readings or actual loaded miles flown such that loaded miles may be calculated; (xi) physician certification statements (PCS) for non-emergency transports that are to be billed to Medicare pursuant to CMS regulations; and (xii) any other information that Intermedix may reasonably require to bill the Patient or other Payor. 2. Client represents and warrants that all information provided to Intermedix shall be accurate and complete. Intermedix shall have no obligation to verify the accuracy of such information, and Client shall be solely responsible for such accuracy. Client agrees to indemnify and hold Intermedix, its agents, and employees harmless from any and all liabilities and costs, including reasonable attorneys’ fees, resulting from (a) any inaccurate or misleading information provided to Intermedix that results in the actual or alleged submission of a false or fraudulent claim or (b) any other actual or alleged violation of local, state or federal laws., including but not limited laws applicable to Medicare, Medicaid or any other public or private Payor or enforcement agency to the extent caused by the negligence, recklessness, or intentional wrongful conduct of the Client. 3. Client will provide Intermedix with necessary documents required by third parties to allow for the electronic filing of claims by Intermedix on Client’s behalf. 4. Client will provide Intermedix with its approved billing policies and procedures, including dispatch protocols, fee schedules and collection protocols. Client will be responsible for engaging any third party collection service for uncollectible accounts after Intermedix has exhausted its collection efforts. 5. Client will timely process refunds identified by Intermedix for account overpayments and provide to Intermedix confirmation, including copies of checks and other materials sent. 6. Client will provide a lock box or bank account address to Intermedix and will instruct the lock box or bank custodian agency to forward all documents to Intermedix for processing. 7. Client will provide Intermedix with daily bank balance reporting capabilities via the bank’s designated web site. 8. Client will cooperate with Intermedix in all matters to ensure proper compliance with laws and regulations. 9. Client represents and warrants that all of its employees, personnel and independent contractors involved in the delivery of EMS or otherwise performing services for Client: (i) hold the licensure or certification required to perform such services, (ii) have not been convicted of a criminal offense related to health care or been listed as debarred, excluded or otherwise ineligible for participation in a Federal health care program and (iii) are not excluded persons listed on any of the following: (a) the Office of the Inspector General List of Excluded Individuals and Entities; (b) the General Services Administration’s Excluded Parties List; and (c) the Office of Foreign Asset Control’s Specially Designated Nationals List. 10. Client agrees that it will forward to Intermedix copies of checks, or other payment documentation requested by Intermedix relating to the subject matter of this Agreement, within 10 days of the date of receipt of those payments. 11. Client agrees to notify Intermedix in the event that their Electronic Patient Care Reporting (ePCR) vendor performs any system upgrades. Notification may be made in writing to support@Intermedix.com. Exhibit B Business Associate Agreement This Business Associate Agreement (“BA Agreement”) supplements and is made part of the Underlying Agreement (as defined below). This BA Agreement is entered into between Okaloosa County, Florida (“Covered Entity”) and Advanced Data Processing, Inc., a subsidiary of Intermedix Corporation, a Delaware Corporation (“Business Associate”), effective as of the Effective Date of the Underlying Agreement. WHEREAS, Covered Entity and Business Associate have entered into, or plan to enter into, a separate agreement, entitled Agreement for Ambulance Billing and Related Professional Services, as of the Effective Date, or other documented arrangement (the “Underlying Agreement”), pursuant to which Business Associate may provide services for Covered Entity that require Business Associate to access, create and/or use Protected Health Information (“PHI”) that is confidential under state and/or federal law; and WHEREAS, Covered Entity and Business Associate intend to protect the privacy and provide for the security of PHI disclosed by Covered Entity to Business Associate, or collected or created by Business Associate pursuant to the Underlying Agreement, in compliance with the Health Insurance Portability and Accountability Act of 1996,