Loading...
HomeMy WebLinkAbout22-0912 Andres Medical Billing 2nd AmendSECOND AMENDMENT AGREEMENT FOR EMS BILLING AND MANAGEMENT REPORTING T�is S cond Amendment Agreement is hereby made and entered into as of the J� day of „ i 2022, by and between the City of Elgin, an Illinois municipal corporation (hereinafter referred to as the "City") and Andres Medical Billing, Ltd., an Illinois corporation (hereinafter referred to as "AMB"). WHEREAS, the City and AMB entered into an Agreement pursuant to City proposal 13- 06 E for EMS billing and management reporting dated March 19, 2014 (hereinafter referred to as the "Original Agreement"), attached hereto and made a part hereof as Attachment D; and WHEREAS, the City and AMB entered into an Amendment Agreement of the Original Agreement dated July 27, 2022 (hereinafter referred to as "First Amendment"), attached hereto and made a part hereof as Attachment C; and WHEREAS, the parties hereto have each determined it to be in their best interests to further amend the Original Agreement as previously amended by the First Amendment (collectively, the "Amended Agreement"). NOW, THEREFORE, for and in consideration of the mutual promises and covenants contained herein, and other good and valuable consideration, the sufficiency of which is hereby mutually acknowledged, the parties hereto hereby agree to further amend the Amended Agreement as follows: 1. AMB will provide additional services; namely, revenue enhancement services for the EMS supplemental reimbursement program as described in Attachment A "Contracted Services" and Attachment B "Fees", attached hereto and made a part hereof. 2. Conflict in Terms. Except as amended and/or modified by this Second Amendment Agreement, the Amended Agreement is hereby ratified and confirmed and all other terms of the Amended Agreement shall remain in full force and effect, unaltered and unchanged by this Second Amendment Agreement. Whether or not specifically amended by this Second Amendment Agreement, all of the terms and provisions of the Amended Agreement are hereby amended to the extent necessary to give effect to the purpose and intent of this Second Amendment Agreement. 3. Auhhorshin. The terms of this Second Amendment Agreement result from negotiations between the parties. This Second Amendment Agreement shall not be construed in favor of or against either Party by reason of authorship. 4. Severability. If any provision in this Second Amendment Agreement is found by a court of competent jurisdiction to be invalid or unenforceable, the remaining provisions in this Second Amendment Agreement shall continue in full force and effect. Waiver. The failure of a party to enforce a provision of this Second Amendment Agreement shall not constitute a waiver with respect to that provision or any other provision of this Second Amendment Agreement. 6. Counterparts. This Second Amendment Agreement may be executed in one or more counterparts, each of which shall be deemed an original and all of which counterparts together shall constitute the same instrument which may be sufficiently evidenced by one counterpart. 7. Authori . Each Party to this Second Amendment Agreement, and each individual signing on behalf of each Party, hereby represents and warrants to the other that it has full power and authority to enter into this Second Amendment Agreement and that its execution, delivery, and performance of this Second Amendment Agreement has been fully authorized and approved, and that no further approvals or consents are required to bind such Party. 8. Entire Agreement: Non -Reliance. The Amended Agreement, as amended by this Second Amendment Agreement, constitutes the entire understanding and agreement of the Parties with respect to the subject matter hereof, and supersedes any and all prior agreements, understandings or representations with respect thereto. Neither Party is relying upon any agreement or representation by the other Party except as set forth in the Agreement, as amended by this Second Amendment Agreement. 9. AVl2licable Law Jurisdiction, and Venue. This agreement is subject to and governed by the laws of the State of Illinois. Venue for the resolution of any disputes or the enforcement of any rights arising out of or in connection with this agreement shall be the Circuit Court of Kane County, Illinois. AMB hereby irrevocably consents to the jurisdiction of the Circuit Court of Kane County, Illinois for the enforcement of any rights, the resolution of any disputes and/or for the purposes of any lawsuit brought pursuant to this agreement or the subject matter hereof; and AMB agrees that service by first class U.S. mail to Andres Medical Billing, 3223 N. Wilke Rd., Arlington Heights, IL 60004 shall constitute effective service. Both parties hereto waive any rights to a jury. 10. Execution. This Second Amendment Agreement may be executed in counterparts, each of which shall be an original and all of which shall constitute one and the same agreement. For the purposes of executing this Second Amendment Agreement, any signed copy of this Second Amendment Agreement transmitted by fax machine or e-mail shall be treated in all manners and respects as an original document. The signature of any party on a copy of this Second Amendment Agreement transmitted by fax machine or e-mail shall be considered for these purposes as an original signature and shall have the same legal effect as an original signature. Any such faxed or e-mailed copy of this Second Amendment Agreement shall be considered to have the same binding legal effect as an original document. At the request of either party any fax or e-mail copy of this Second Amendment Agreement shall be re -executed by the parties in an original form. No party to this Second 2 Amendment Agreement shall raise the use of fax machine or e-mail as a defense to this Second Amendment Agreement and shall forever waive such defense. IN WITNESS WHEREOF, City of Elgin and AMB have executed this Second Amendment Agreement as of the date stated above. ANDRES MEDICAL BILLING_, LTD. CITY O By: G' Ric yard G. ;ipal, City Manager Its: .4 i' G Att r City inlerk Legal Dept\Agreement%Andres Medical Billing-2nd Amend Agr-9.1-22.doex 3 ATTACHMENT A SERVICES Pursuant to the terms and conditions of this Agreement, Andres Medical Billing shall provide the following contracted services: • Drafting and submitting a Public Notice of Intent (PNI) explaining the position for EMS supplemental reimbursement program; • Establishing program protocols and processes and draft a cost report document to be submitted to CMS for review and approval; • Submitting to CMS a State Plan Amendment (SPA) that defines the CPE reimbursement methodology; • Assisting with responding to any CMS requests for additional information as. part of the review and approval process; • Engaging DHS in order to gain their approval to move forward with a CPE and IGT program; • Preparing a fiscal impact study and presenting results to city/department stakeholders to demonstrate benefits of a supplemental payment program to the provider; • Identifying eligible costs and developing appropriate cost allocation methodologies to report only allowable costs for providing emergency medical services to Medicaid and, as applicable, uninsured populations; • Developing customized web portal to assist with cost report calculation and auditing process; • Conducting analysis of the provider's financial and billing data in order to prepare and submit annual cost reports, the mechanism for providers to receive additional revenue under the EMS supplemental reimbursement program; • Providing comprehensive desk review support, including but not limited to conducting reviews of all cost settlement files, performing detailed analysis of billing reports generated by Medicaid agencies to ensure that all allowable charges and payments are encompassed in the calculation of the final settlement, and drafting letters and providing supporting documentation to meet Medicaid requirements and expedite settlement; • Conducting comparative analysis to identify significant trends in billing and financial data; and • Provide ongoing audit support in the event of a state and/or federal audit of EMS supplemental reimbursement program cost report. Attachment B FEES The contingency fees to be paid associated with the respective successful implementation and generation of incremental Medicaid revenues as a result of the EMS supplemental reimbursement program are: Providers shall compensate Andres Medical Billing, Ltd. based on the number of Annual Medicaid Trips. Outlined below are the fees to be paid associated with the respective range of total Medicaid (Fee -for - Service and Managed Care) trips in a cost report (state fiscal) year. Annual Medicaid Trips Fixed Fee Cost per Submission Contingency Fee Option 1-60 $10,000 $20,000 $30,000 N/A 61-180 12% 181 + 12% As notated in the above model, if the Client has more than 60 annual Medicaid Trips, Client has the option of electing to pay the Fixed Fee Cost per Submission or the 12% Contingency per annual cost report submission and corresponding true -up, inclusive of enhanced incremental revenues received from GEMT program. All revenue realized by the Client from the EMS supplemental reimbursement program shall be paid in full directly to Client. from realized as a result of the EMS supplemental reimbursement program shall be determined by the cost settlement calculated through the state's approved Medicaid cost report. AMB will invoice Client based on payments from the EMS supplemental reimbursement program within thirty (30) days of reconciliation. Client will remit payment to Andres Medical Billing within thirty (30) days of invoice receipt.