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HomeMy WebLinkAbout14-36 Resolution No. 14-36 RESOLUTION AUTHORIZING EXECUTION OF AN AGREEMENT WITH ANDRES MEDICAL BILLING FOR EMERGENCY MEDICAL SERVICE BILLING AND MANAGEMENT REPORTING BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN, ILLINOIS, that Sean R. Stegall, City Manager, be and is hereby authorized and directed to execute an agreement on behalf of the City of Elgin with Andres Medical Billing for emergency medical service billing and management reporting, a copy of which is attached hereto and made a part hereof by reference. s/David J. Kaptain David J. Kaptain, Mayor Presented: March 19, 2014 Adopted: March 19, 2014 Vote: Yeas: 9 Nays: 0 Attest: s/Kimberly Dewis Kimberly Dewis, City Clerk II 4 L ANDRES MEDICAL BILLING, Ltd. Business Associate Agreement City of Elgin & Andres Medical Billing, Ltd. This Business Associate Agreement ("Agreement") between the City of Elgin, Illinois, a municipal corporation and Andres Medical Billing, Ltd., an Illinois corporation (AMB) is executed to ensure that Andres Medical Billing, Ltd. will appropriately safeguard protected health information ("PHI") that is created, received, maintained, or transmitted on behalf of the City of Elgin pursuant to an agreement between the parties hereto, dated March 19, 2014, a copy of which is attached hereto and made a part hereof as Attachment A (hereinafter referred to as "Billing Agreement") in compliance with the applicable provisions of 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"), and with Public Law 111-5 of February 17, 2009, known as the American Recovery and Reinvestment Act of 2009, Title XII, Subtitle D - Privacy, Sections 13400, et seq., the Health Information Technology and Clinical Health Act, as amended (the "HITECH Act"). A. General Provisions 1. Meaning of Terms. The terms used in this Agreement shall have the same meaning as those terms defined in HIPAA. 2. Regulatory References. Any reference in this Agreement to a regulatory section means the section currently in effect or as amended. 3. Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with HIPAA. B. Obligations of Business Associate Andres Medical Billing, Ltd. agrees that it will: 1. Not use or further disclose PHI other than as permitted or required by this Agreement or as required by law; 2. Use appropriate safeguards and comply, where applicable, with the HIPAA Security Rule with respect to electronic protected health information ("e-PHI") and implement appropriate physical, technical and administrative safeguards to prevent use or disclosure of PHI other than as provided for by this Agreement; 3. Report to the City of Elgin any use or disclosure of PHI not provided for by this Agreement of which it becomes aware, including any security incident (as defined in the HIPAA Security Rule) and any breaches of unsecured PHI as required by 45 CFR §164.410. Breaches of unsecured PHI shall be reported to the City of Elgin without unreasonable delay but in no case later than 60 days after discovery of the breach; 4. In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), ensure that any subcontractors that create, receive, maintain, or transmit PHI on behalf of Andres Medical Billing, Ltd. agree to the same restrictions, conditions, and requirements that apply to Andres Medical Billing, Ltd. with respect to such information; 5. Make PHI in a designated record set available to the City of Elgin and to an individual who has a right of access in a manner that satisfies the City of Elgin's obligations to provide access to PHI in accordance with 45 CFR §164.524 within thirty (30) days of a request; 6. Make any amendment(s) to PHI in a designated record set as directed by the City of Elgin, or take other measures necessary to satisfy the City of Elgin's obligations under 45 CFR §164.526; 7. Maintain and make available information required to provide an accounting of disclosures to the City of Elgin or an individual who has a right to an accounting within 60 days and as necessary to satisfy the City of Elgin's obligations under 45 CFR §164.528; 8. To the extent that Andres Medical Billing Ltd. is to carry out any of the City of Elgin's obligations under the HIPAA Privacy Rule, Andres Medical Billing, Ltd. shall comply with the requirements of the Privacy Rule that apply to the City of Elgin when it carries out that obligation; 9. Make its internal practices, books, and records relating to the use and disclosure of PHI received from, or created or received by Andres Medical Billing, Ltd. on behalf of the City of Elgin, available to the Secretary of the Department of Health and Human Services for purposes of determining Andres Medical Billing, Ltd.'s and the City of Elgin's compliance with HIPAA and the HITECH Act; 10. Restrict the use or disclosure of PHI if the City of Elgin notifies Andres Medical Billing, Ltd. of any restriction on the use or disclosure of PHI that the City of Elgin has agreed to or is required to abide by under 45 CFR §164.522; and 11. Since the City of Elgin is subject to the Red Flags Rule (found at 16 CFR §681.1 et seq.), Andres Medical Billing, Ltd. agrees to assist the City of Elgin in complying with its Red Flags Rule obligations by: (a) implementing policies and procedures to detect relevant Red Flags (as defined under 16 C.F.R. §681.2); (b) taking all steps necessary to comply with the policies and procedures of the City of Elgin's Identity Theft Prevention Program; (c) ensuring that any agent or third party who performs services on its behalf in connection with covered accounts of the City of Elgin agrees to implement reasonable policies and procedures designed to detect, prevent, and mitigate the risk of identity theft; and (d) alerting the City of Elgin of any Red Flag incident (as defined by the Red Flag Rules) of which it becomes aware, the steps it has taken to mitigate any potential harm that may have occurred, and provide a report to the City of Elgin of any threat of identity theft as a result of the incident. C. Permitted Uses and Disclosures by Business Associate The specific uses and disclosures of PHI that may be made by Andres Medical Billing, Ltd. on behalf of the City of Elgin include: 1. The preparation of invoices to patients, carriers, insurers and others responsible for payment or reimbursement of the services provided by the City of Elgin to its patients; 2. Preparation of reminder notices and documents pertaining to collections of overdue accounts; 3. The submission of supporting documentation to carriers, insurers and other payers to substantiate the health care services provided by the City of Elgin to its patients or to appeal denials of payment for the same; and 4. Other uses or disclosures of PHI as permitted by HIPAA necessary to perform the services that Andres Medical Billing, Ltd. has been engaged to perform on behalf of the City of Elgin. D. Termination 1. The City of Elgin may terminate this Agreement if the City of Elgin determines that Andres Medical Billing, Ltd. has violated a material term of the Agreement; provided, however, that this Agreement shall terminate upon the termination of the Billing Agreement for any reason. 2. If either party knows of a pattern of activity or practice of the other party that constitutes a material breach or violation of the other party's obligations under this Agreement, that party shall take reasonable steps to cure the breach or end the violation, as applicable, and, if such steps are unsuccessful, terminate the Agreement if feasible. 3.Upon termination of this Agreement for any reason, Andres Medical Billing, Ltd. shall return to the City of Elgin or destroy all PHI received from the City of Elgin, or created, maintained, or received by Andres Medical Billing, Ltd. on behalf of the City of Elgin that Andres Medical Billing, Ltd. still maintains in any form. Andres Medical Billing, Ltd. shall retain no copies of the PHI. If return or destruction is infeasible, the protections of this Agreement will extend to such PHI. 4.This agreement shall supersede, replace and render void any and all prior agreements between the parties hereto regarding the subject matter hereof, exclusive of the Billing Agreement, which shall remain in full force and effect. Agreed to this A 9 day of 2014 City o �% n Signature • / rint Name/Title: (44w4 .5s4d sTitritia, Sean Stegall, City Manager Andres Medi - I Billing, Ltd. Signature: Printed Name/Title: �■ Maryann Mahlman, LNHA, CHPSE Compliance/Security Officer ATTACHMENT A CITY OF ELGIN AGREEMENT FOR Proposal Number: 13-061 for: EMS Billing and Management Reporting This Agreement is made and entered into this 19tttlay of March , 2014 by and between the City of Elgin("the C "), unicjIial ra on Organized and existing under the laws of the State of Illinois, and Y'es M( ( 1 t 1I Yl C ., incorporated in the state of V nOst S and having a principal ¢lace of business at • "the CONTRACTOR"). ARTICLE I. DEFINITION. "THIS CONTRACT" as used herein shall mean this Agreement and all attachments hereto, the Request for Proposal (RFP) including all documents referenced therein and the Contractor's proposal response (proposal) thereto incorporated by reference herein and made a part hereof. The CONTRACTOR agrees to provide the goods and/or services all in accordance with the RFP and CONTRACTOR'S proposal. In the event there is a conflict between this Agreement and CONTRACTOR'S proposal or proposal documents, this agreement shall control and supersede any such CONTRACTOR'S proposal or proposal documents. ARTICLE II. SCOPE OF WORK. The CONTRACTOR shall provide the goods or services described in the RFP,at the prices and terms contained therein. ARTICLE III. DURATION. The CONTRACTOR shall commence the performance of THIS CONTRACT upon receipt of a fully executed contract from the City of Elgin. Term of THIS CONTRACT shall expire on February 27, 2019 with two year renewal mutually agreeable between City of Elgin and CONTRACTOR. ARTICLE IV. TERMINATION. The following shall constitute events of default under THIS CONTRACT: a) any material misrepresentation made by the CONTRACTOR to the CITY, b) any failure by the CONTRACTOR to perform any of its obligations under THIS CONTRACT including, but not limited to, the following: (i) failure to commence performance of THIS CONTRACT at the time specified in THIS CONTRACT due to a reason or circumstance within the CONTRACTOR's reasonable control, (ii) failure to perform THIS CONTRACT with sufficient personnel and equipment or with sufficient material to ensure the completion of THIS CONTRACT within the specified time due to a reason or circumstance within the CONTRACTOR's reasonable control, (iii) failure to perform THIS CONTRACT in a manner reasonably satisfactory to the CITY, (iv) failure to promptly re-perform within reasonable time the services that were rejected by the CITY as erroneous or unsatisfactory, (v) failure to comply with a material term of THIS CONTRACT, including, but not limited to the Affirmative Action requirements, and (vi) any other acts specifically and expressly stated in THIS CONTRACT as constituting a basis for termination for cause. The CITY may terminate THIS CONTRACT for its convenience upon fourteen(14)days prior written notice. ARTICLE V. DAMAGES. From any sums due to the CONTRACTOR for services,the CITY may keep for its own the whole or any part of the amount for expenses, losses and damages as directed by the Purchasing Director, incurred by the CITY as a consequence of procuring services as a result of any failure, omission or mistake of the CONTRACTOR in providing the goods and services as provided in THIS CONTRACT. ARTICLE VII AFFIRMATIVE ACTION. The CONTRACTOR will not discriminate against any employee or applicant for employment because of race,color,religion, sex, ancestry, national origin, place of birth, age or physical handicap which would not interfere with the efficient performance of the job in question. The CONTRACTOR will take affirmative action to comply with the provisions of Elgin Municipal Code Section 3.12.100 and will require any subcontractor to submit to the CITY a written commitment to comply with those provisions. The CONTRACTOR will distribute copies of this commitment to all persons who participate in recruitment, screening, referral and selection of job applicants and prospective subcontractors. The CONTRACTOR agrees that the provisions of Chapter 3.12 of the Elgin Municipal Code, 1976, is hereby incorporated by reference,as if set out verbatim. ARTICLE VIII. ASSIGNABILITY. The CONTRACTOR shall not assign, sell or transfer any interest in THIS CONTRACT without prior written consent of the CITY. ARTICLE IX. AMENDMENTS. There shall be no modification of the CONTRACT,except in writing and executed with the same formalities of the original. ARTICLE X. NOTICES. Any notice given under this CONTRACT shall be in writing and shall be deemed to have been given when hand delivered or deposited in the U.S. mail, certified or registered, return receipt requested, addressed, if to CONTRACTOR, at the address set forth above to the attention of the project manager or undersigned representative, and if to the City, to the attention of the City Manager, 150 Dexter Court, Elgin, IL 60120 or to such other address and/or authorized representatives as either party shall designate in writing to the other in the manner herein provided. ARTICLE XI INDEMNIFICATION. To the fullest extent permitted by law, Contractor agrees to and shall indemnify, defend and hold harmless the City, its officers, employees, boards and commissions from and against any and all claims, suits, judgments, costs, attorney's fees, damages or any and all other relief or liability arising out of or resulting from or through or alleged to arise out of any acts or negligent acts or omissions of Contractor or Contractor's officers, employees, agents or subcontractors in the performance of this CONTRACT, including but not limited to, all goods delivered or services or work performed hereunder. In the event of any action against the City, its officers, employees, agents,boards or commissions covered by the foregoing duty to indemnify, defend and hold harmless, such action shall be defended by legal counsel of the City's choosing. ARTICLE XII. PUBLICITY. The CONTRACTOR may not use, in any form or medium, the name of the City of Elgin for public advertising unless prior written permission is granted by the CITY. ARTICLE XIII. APPROPRIATIONS. The fiscal year of the CITY is the 12 month period ending December 31. The obligations of the CITY under any contract for any fiscal year are subject to and contingent upon the appropriation of funds sufficient to discharge the obligations which accrue in that fiscal year and authorization to spend such funds for the purposes of the contract. If, for any fiscal year during the term of the CONTRACT,sufficient funds for the discharge of the CITY'S obligations under the contract are not appropriated and authorized, then the CONTRACT shall terminate as of the last day of the preceding fiscal year, or when such appropriated and authorized funds are exhausted, whichever is later, without liability to the CITY for damages, penalties or other charges on account of such termination. ARTICLE XIV. NO AGENCY. This CONTRACT shall not be construed so as to create a joint venture,partnership, employment or other agency relationship between the parties hereto, except as may be specifically provided for herein. ARTICLE XV. CONFLICT. In the event of any conflict between the terms provided in any attachments hereto and the body of this CONTRACT, the terms and provisions of this CONTRACT shall control. ARTICLE XVI. ENTIRE AGREEMENT. This CONTRACT embodies the whole agreement of the parties. There shall be no promises, terms, conditions or obligations other than those contained therein; and this CONTRACT shall supersede all previous communications, representations,or agreements, either verbal or written,between the parties. ARTICLE XVII. COMPLIANCE WITH LAWS. Notwithstanding any other provision of this CONTRACT it is expressly agreed and understood that in connection with the performance of this CONTRACT that the CONTRACTOR shall comply with all applicable Federal, State, City and other requirements of law, including, but not limited to, any applicable requirements regarding prevailing wages, minimum wage, workplace safety and legal status of employees. Without limiting the foregoing, CONTRACTOR hereby certifies, represents and warrants to the CITY that all CONTRACTOR'S employees and/or agents who will be providing products and/or services with respect to this CONTRACT shall be legal residents of the United States. CONTRACTOR shall also at its expense secure all permits and licenses, pay all charges and fees and give all notices necessary and incident to the due and lawful prosecution of the work, and/or the products and/or services to be provided for in this CONTRACT. The CITY shall have the right to audit any records in the possession or control of the CONTRACTOR to determine CONTRACTOR'S compliance with the provisions of this section. In the event the CITY proceeds with such an audit the CONTRACTOR shall make available to the CITY the CONTRACTOR'S relevant records at no cost to the CITY. The entity submitting this bid or proposal hereby warrants and represents that to the extent it may be applicable, it is registered with the Illinois Secretary of State's Office or has been incorporated in the State of Illinois; and such entity further hereby warrants and represents that it is in good standing in the state of its incorporation or organization. Without limiting the foregoing,CONTRACTOR hereby certifies, represents and warrants to the CITY that all CONTRACTOR'S employees and/or agents located in the United States, who will be providing products and/or services with respect to this CONTRACT, shall be legal residents of the United States. The person signing THIS CONTRACT certifies that s/he has been authorized by the CONTRACTOR to commit the CONTRACTOR contractual and has been authorized to execute THIS CONTRACT on its behalf. IN WITNESS WHEREOF the parties have hereto set their hands the day and year first above written. C CTOR CITY OF LGIN ame and Title Se R. Stegall 403�qt.-7 City Manager FEIN NO. ..A0 COST PROPOSAL Levels of Support Resident Percentage Nonresident Percentage Fee Fee Basic life support $442.75 4.75% $692.75 4.75% emergency(BLS) Advance life support $525.75 4.75% $900.00 4.75% emergency(ALS-1) Advanced life $760.00 4.75% $1,135.00 4.75% support emergency (ALS-2) Advanced life $300.00 4.75% $400.00 4.75% support(ALS) refusal Mileage(as $10.00 per mile 4.75% $10.00 per mile 4.75% measured from the or portion or portion location of the thereof thereof ambulance call to the hospital) • The industry standard is to charge a percentage of dollars collected. This ensures the company's efforts to maximize receivables. AMB will charge the City of Elgin 4.75% of all dollars collected. Our fee is an all-inclusive fee! There are no hidden costs or extra charges for our service. We only receive payment when you do. See Section 6 for a sample contract. 7