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HomeMy WebLinkAboutCity of Tamarac Resolution R-96-2701 Temp. Reso. #7594 1 10/22/96 Revision #1: 11/21/96 CITY OF TAMARAC, FLORIDA RESOLUTION NO. R-96- a?AV A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA, AUTHORIZING THE APPROPRIATE CITY OFFICIALS TO EXECUTE AN AGREEMENT BETWEEN THE CITY OF TAMARAC AND ADVANCED DATA PROCESSING, INC. FOR THE BILLING OF FEES FOR MEDICAL TREATMENT AND TRANSPORT PROVIDED BY THE CITY OF TAMARAC, AT A COST OF SEVEN PERCENT OF THE REVENUES COLLECTED; PROVIDING FOR CONFLICTS; PROVIDING FOR SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE DAIE WHEREAS, the City of Tamarac began emergency medical transport service on October 1, 1996; and WHEREAS, the City of Tamarac passed Resolution #96-221 establishing fees for service; and WHEREAS, the City of Tamarac awarded Request for Proposal #96-17 to Advanced Data Processing, Inc. for the billing of the medical service fees; and WHEREAS, Advanced Data Processing, Inc. must have an approved and executed contract outlining specific services to be rendered and establishing a rate of compensation for these services in order to perform work on behalf of the City of Tamarac; and WHEREAS, the City Commission of the City of Tamarac, Florida has deemed it to Temp. Reso. #7594 2 10/22/96 Revision #1: 11 /21 /96 be in the best interests of the citizens and residents of the City of Tamarac that Advanced Data Processing, Inc. become the billing agent for medical treatment and transport fees. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF TAMARAC, FLORIDA: SECTION 1 _ The foregoing "WHEREAS" clauses are hereby ratified and confirmed as being true and correct and are hereby made a specific part of this Resolution. SEC_ I T_O2:2: The appropriate City officials are hereby authorized to execute the Agreement between the City of Tamarac, Florida, and Advanced Data Processing, Inc. for billing of medical treatment and transport fees, for a total cost of seven percent (7%) of the revenue collected. (A copy of the Agreement is attached as Exhibit "1") SECTION 3: All resolutions or parts of resolutions in conflict herewith are hereby repealed to the extent of such conflict. S. E If any clause, section, other part or application of this Resolution is held by any court of competent jurisdiction to be unconstitutional or invalid, in part or application, it shall not affect the validity of the remaining portions or applications of this Resolution. 1 1 SECTION 5: passage and adoption. Temp. Reso. #7594 3 10/22/96 Revision #1: 11/21/96 This Resolution shall become effective immediately upon its PASSED, ADOPTED AND APPROVED this a / w d a d--1 11996. TAT ST: c CAROL A. EVANS CITY CLERK I HEREBY CERTIFY that I have approved this UTIJ t or MLZAJ r MITCHELL S. KRAfT CITY ATTORNEY c:\userdata\wpdata\res\7487. ms f RR MISHKIN VICE -MAYOR RECORD OF COMMISSION VOTE MAYOR DIST 1: DIST 2: DIST 3: =M,, 5C_jl�gE0 irr w DIST 4: OF et • "EXHIBIT 1" CONTRACT FD 96-03 PAGE 1 10/2/96 Revision #5: 11/21/96 CONTRACT BETWEEN THE CITY OF TAMARAC AND ADVANCED DATA -PROCEs9SING, INC. FOR MEDICAL BILLING SE VIC S. THIS CONTRACT, hereinafter "CONTRACT' OR "AGREEMENT', made and entered ce..nber into this day of Novambw 1996 by and between the CITY OF TAMARAC, a Florida Municipal corporation, with principal offices located at 7525 NW 88 Avenue, Tamarac, FL 33321, hereinafter referred to as the "CITY", and Advanced Data Processing, Inc., with principal offices located at 520 NW 165 Street, Suite 201, Miami, Florida 33169, hereinafter referred to as the "CONTRACTOR". PiTANVUE.SACIllIdU WHEREAS, the parties hereto now wish to enter into an agreement, pursuant to which the CONTRACTOR will render those professional services in connection with said project as hereinafter provided; 1 "e���,�ld • "EXHIBIT 1" CONTRACT FD 96-03 PAGE 2 10/2/96 Revision #5: 11 /21 /96 NOW THEREFORE, the parties hereto agree as follows: services of the CONTRACTOR to provide the CITY with medical billing services. 2. SCOPE -OF SERVICES. The CONTRACTOR shall perform and carry out the work tasks presented in the CITY's Request for Proposal ("UP"), number 96-17 published September 8, 1996 (Exhibit A), and CONTRACTOR'S proposal, dated September 20,1996 (Exhibit B), as summarized herein. All payments shall be paid directly to the City of Tamarac. The CONTRACTOR shall process the Civil Assist Fees in the same manner as outlined in the CITY's RFP and the CONTRACTORS proposal. 3. TIME-0-F__PERFORMANCE. This Contract shall be effective October 1, 1996 through September 30, 1997, unless otherwise terminated. The CITY may, at its sole discretion, renew this agreement for two (2) additional 1 (one) year terms under the same terms and conditions contained herein. 2 "EXHIBIT 1" CONTRACT FD 96-03 PAGE 3 10/2/96 Revision #5: 11 /21 /96 4. COMPENSATION AND METHOD OF PAYMENT,, The CITY reserves the right to request changes in the services within the general scope of the Contract to be performed by the City Manager and CONTRACTOR, and approved by City Commission, which shall specify the change ordered and the adjustment of time and compensation required therefore. Any services added to the scope of this Contract by a change order shall be executed in compliance with all other applicable conditions of this Contract. No claim for additional compensation or extension of time shall be recognized unless contained in the duly executed change order. The CONTRACTOR shall provide an invoice to the CITY for seven percent (7%) of the moneys collected during the previous month. The CITY shall issue a check for the amount invoiced, minus any disputed amount, within thirty (30) days of the receipt and acceptance of the invoice. 5. REPORTS, The CONTRACTOR shall provide the CITY with status reports as set forth in contractors proposal. r� 3 0 "EXHIBIT 1" CONTRACT FD 96-03 PAGE 4 10/2/96 Revision #5: 11/21/96 6. DATE TO BE FURNISHED BY CITY. The CITY will make available to the CONTRACTOR, for use in performance of services under this Contract, all available reports, studies or any other materials in its possession which may be useful to the CONTRACTOR. In addition, the CITY agrees to arrange for its personnel to be available on a timely basis for training by the CONTRACTOR. All material furnished by the CITY will not be disclosed to any party without the CITY's prior approval. 7. INDEPENDENT CONTRACTORS. The CONTRACTOR is an independent contractor and not an employee or agent of the CITY. The CONTRACTOR shall retain full control over the employment, direction, compensation and discharge of all persons assisting in the performance of service. The CONTRACTOR shall be fully responsible for all matters relating to payment of employees, including compliance with Social Security, withholding tax and all other laws and regulations governing such matters. The CONTRACTOR shall be responsible for its own acts and those of its agents and employees during the term of this contract. 8. INDEMNIFICATION, The CONTRACTOR shall indemnify and save the CITY 4 "EXHIBIT V CONTRACT FD 96-03 PAGE 5 10/2/96 Revision #5: 11/21/96 harmless from any and all claims, losses and causes of actions which may arise out of the performance of this Agreement as a result of an act of negligence, of the CONTRACTOR or its SUBCONTRACTORS. The CONTRACTOR shall pay all claims and losses of any nature whatsoever in connection therewith and shall pay all costs and judgements which may issue thereon. The above provisions shall survive the termination of this Agreement and shall pertain to any occurrence during the term of this Agreement and shall pertain to any occurrence during the term of this Agreement, even though the claim m ma after the termination hereof. a de Nothing contained herein is intended nor shall be construed to waive CITY's rights and immunities under the common law or Florida Statutes 768.28, as amended from time to time. 9. INSUBANCE. The CONTRACTOR shall maintain Worker's Compensation Insurance in compliance with Florida Statutes, Chapter 440. The CONTRACTOR shall maintain General Liability insurance in an amount no less than $1,000,000 with the CITY Of TAMARAC named as an additional insured. INSURANCE Companies selected must be acceptable to CITY. All of the policies 5 "EXHIBIT 1" CONTRACT FD 96-03 PAGE 6 10/2/96 Revision #5: 11 /21 /96 of insurance so required to be purchased and maintained shall contain a provision or endorsement that the coverage afforded shall not be canceled, materially changed or renewal refused until at least thirty (30) calendar days written notice has been given to CITY by certified mail. Prior to commencing work, the CONTRACTOR shall provide CITY with certified copies of all insurance policies providing coverage as required. The CONTRACTOR is required to submit a list of claims presently outstanding against their professional liability coverage. This information must be provided by and signed by the agent of the insurance carrier. If no outstanding claims exist, a statement to this fact must be provided by and signed by the agent of the insurance carrier. 10. OWNERSHIP OF DOCUMENTS. The CONTRACTOR agrees that all notes designs, drawings, specifications, models, photographs, reports, surveys, investigations and other data produced in the performance of this Agreement shall be the sole property of the CITY, including all rights therein of whatever kind except as may otherwise be provided hereinafter. • 0 "EXHIBIT 1" CONTRACT FD 96-03 PAGE 7 10/2/96 Revision #5: 11/21/96 11. ATTACHMENTS. The following named attachments are made an integral part of this Agreement: A. RFP published September 8,1996 (Exhibit A attached hereto and made a part hereof) B. Proposal dated September20,1996 (Exhibit B attached hereto and made a part hereof) 0 12. TERMINATION, The CITY may terminate this Contract at any time for any cause, including but not limited to, default by the CONTRACTOR or for circumstances beyond the control of the CONTRACTOR, upon written notice to the CONTRACTOR. Upon termination, the CONTRACTOR shall submit an invoice to the CITY in an amount which represents the cost of services actually performed or obligations incurred for which the CONTRACTOR has not been previously compensated to the date of termination. Upon payment of the sum found due, the CITY shall be under no further obligation to the CONTRACTOR, financial or otherwise. • 7 "EXHIBIT 1" CONTRACT FD 96-03 PAGE 8 10/2/96 Revision #5: 11 /21 /96 13. CHOII-E-OF„LAW. All questions pertaining to the validity and interpretations of this Contract shall be determined in accordance with the laws of Florida. Venue shall lie in Broward County, Florida. 14. ASSIGNMENT CONTRACT. The CONTRACTOR shall not assign this Contract, or any part thereof, without prior consent of the CITY. 0 15. NOTICES. Delivered or mailed to such party at their respective addresses as follows: To the CITY: Robert S. Noe City Manager City of Tamarac 7525 N.W. 88th Avenue Tamarac, FL 33321 Mitchell Kraft City Attorney City of Tamarac 7525 N.W. 88th Avenue Tamarac, FL 33321 0 To the CONTRACTOR: 1Z 5�� --,�>2 -� 1�` �J "EXHIBIT 1" CONTRACT FD 96-03 PAGE 9 10/2196 Revision #5: 11/21/96 Paul Franzelas Vice President Advanced Data Processing, Inc. 520 N.W. 165 Street Road, Suite 201 Miami, Florida 33169 16. INTEREST OF CONTRACTOR. It is agreed that the CONTRACTOR presently has no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of the CONTRACTOR'S services under this Contract. It is further agreed that in the performance of this Contract no person having any such interest shall be employed by the CONTRACTOR. 17. ENTIRE_ CONTRACT. This Contract contains the entire agreement between the parties. The CONTRACTOR represents that in entering into this Contract it has not relied on any previous oral and/or implied representations, inducements or understandings of any kind or nature. The remainder of this page left blank intentionally. �9 , 5�, - 2 ? 6 C, J C� "EXHIBIT 1" CONTRACT FD 96-03 PAGE 10 10/2/96 Revision #4: 11 /19/96 Revision #S: 11/21/96 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed on the day and year indicated below: ATTEST: By: Carol A. Evans, City Clerk US] CITY OF AMARAC By: (::�" )�w /L Larry M hkin, Vice -Mayor By Robert S. Noe, Jr., City Manager Date: 17,-11 Mitchell S. Kraft, City Attorney EXHIBIT "A" OF THE CONTRACT REQUEST FOR PROPOSAL 0 ;5-t 0 a - P, RFP NO. 96-17 Medical Billing Services CITY OF TAMARAC 7525 NW 88TH AVENUE TAMARAC, FLORIDA 33321-2401 • • E CITY OF TAMARAC, FLORIDA REQUEST FOR PROPOSAL NO. 96-17 The City of Tamarac (City) is issuing a Request for Proposal (RFP) to obtain the services of a qualified firm to provide a price agreement for the purpose of billing patients transported by the Fire Department. The City of Tamarac reserves the right to accept or reject any one or all proposals, or any part of any proposal, to waive any informality in any proposal, and to award the purchase in the best interest of the City of Tamarac. The Proposer is directed to deliver sealed bids to the City Clerk's Office, City of Tamarac, 7525 NW 88 Avenue, Tamarac, Florida 33321, on September 20, 1996, at or before 2:00 P.M. At this time the proposals will be opened, the names of all Proposers will be announced. All proposals shall be confidential pursuant to the Florida Statutes, Chapter 119, entitled Public Records, Section 119.07(3)(m). All Proposers and their representatives are invited to attend. The Proposer must show the RFP number, name, time and date of the RFP opening on the outside of the sealed RFP package. Delivery of the sealed proposals to the City Clerk's Office on or before the above date is solely and strictly the responsibility of the Proposer. Late proposals will be returned unopened to the Proposer. The Proposer shall submit one (1) original and 15 copies of the proposal. The original RFP must be manually and duly signed in ink by a Corporate Officer, Principal or Partner with the authority to bind the company or firm by his/her signature. Carol A. Evans, CIVIC, City Clerk SEAL PUBLISH: Sun Sentinel: Sunday, September 8, 1996 Sunday, September 15, 1996 CITY OF TAMARAC REQUEST FOR PROPOSAL (RFP) RFP NO. 96-17 REQUEST FOR PROPOSAL The City of Tamarac (city) is issuing a Request for Proposal (RFP) to obtain the services of a qualified firm to provide a price agreement for the purpose of billing patients transported by the Fire Department. The City of Tamarac reserves the right to accept or reject any one or all proposals, or any part of any proposal, to waive any informality in any proposal, and to award the purchase in the best interest of the City of Tamarac. EVALUATION The City will evaluate proposals and will select the proposer which meets the best interests of the City. The City shall be the sole judge of its own best interests, the proposals and the resulting negotiated agreement. The City's decisions will be final. The City's evaluation criterion may include but shall not be limited to consideration of the following: Verification of availability of qualified personnel Verification of availability of equipment Ability to meet set standards Expertise of human resources Qualifications of the firm Experience References from other municipalities providing similar services Understanding of the problem Technical soundness of proposal Scope of Work Einanciilk Cost Effectiveness Reasonableness of proposed price Evidence of insurance and/or bonding Other: Location of Firm Previous contracting experience with the City Performance under past contracts with the City WEIGHIED&RITERIA The following criteria and weights shall be utilized in the evaluation of the proposals: CRITERIA WEIGHT Personnel Expertise/Qualifications 20% Experience in Stated Criteria/Medical Billing 20% Govemmental/Municipal Experience 15% Technology and Equipment Availability 10% Collection Philosophy 10% Location 5% Price 20% • M • GENERAL TERMS AND CONDITIONS These general terms in this agreement (agreement) and conditions apply to all offers made to the City of Tamarac by all prospective Proposers (proposers) including but not limited to Request for Quotes, Request for Proposal and Request for Bid. As such the words "bid" and "proposal" are used interchangeably in reference to all offers submitted by prospective bidders. An award of bid will not be effective until 72 hours after the adoption by City Commission. 1. SUBMISSION OF THE PROPOSAL: The Proposer is directed to deliver sealed bids to the City Clerk's Office, City of Tamarac, 7525 N. W. 88th Avenue, Tamarac, Florida 33321, ON:_=/96 „ --- 0 BEFORE: 2 . At this time the Proposals will be opened, the names of all Proposers will be announced. All proposals shall be confidential pursuant to the Florida Statues, Chapter 119, entitled Public Records §119.07 (3)(m). All Proposers and their representatives are invited to attend. The Proposer must show the RFP number, RFP name, time and date of the RFP opening on the outside of the sealed RFP package. Delivery of the sealed proposals to the City Clerk's Office on or before the above date is solely and strictly the responsibility of the Proposer. Late Proposals will be returned unopened to the Proposer. It is the Proposer's responsibility to read and understand the requirements of this RFP. Unless otherwise specified the Proposer must use the proposal form furnished in the Proposal packet. Proposers are required to state exactly what they intend to furnish to the City via this Solicitation and must indicate any variances to the terms, conditions and specifications of this bid, no matter how slight. If variations are not stated in the proposal, it shall be construed that the proposal fully complies with all conditions identified in this RFP. The Proposer shall submit one (1) ORIGINAL and (15) copies of the proposal. The ORIGINAL RFP must be manually and duly signed in ink by a Corporate Officer, Principal, or Partner with the authority to bind the company or firm by his/her signature. All quotations must be typewritten or filled in with pen and ink. Proposals having erasures or corrections must be initialed in ink by the Proposer. All prices, terms and conditions quoted in the submitted proposal shall be firm for acceptance for sixty days from the date of the RFP opening unless otherwise stated by the City. 2. WITHDRAWAL OF PROPOSAL: Any Proposer may withdraw its proposal prior to the I* indicated opening time. The request for withdrawal must be submitted in writing to the City Clerks Office. 3 3. QUANTITIES: Quantities shown are estimates only. No guarantee or warranty is given or implied by the City as to the total amount that may or may not be purchased from any resulting contract. The City reserves the right to decrease or increase quantities as required. 4. PRICES, PAYMENTS AND DISCOUNTS: RFP prices shall be fixed and firm to the extent required under Special Conditions. Payment will be made only after receipt and acceptance of materials/services. Cash discounts may be offered for prompt payment. Proposers are encouraged to provide prompt payment terms in the space provided on the Proposal Form. If no payment discount is offered, the Proposer shall enter zero (0) for the percentage discount to indicate net 30 days. If the Proposer does not enter a percentage discount, it is understood and agreed that the payment terms shall be 2% 10 days, net 30 days effective on the date that the City receives an accurate invoice or accepts the product, whichever is the later date. Payment is deemed to be made on the date of the mailing of the check. 5. DELIVERY: All items shall be delivered F.O.B. destination to a specific City of Tamarac address (7525 N.W. 88 Avenue, Tamarac, FL 33321). All delivery cost and charges must be included in the proposal price. All exceptions shall be noted. Failure to do so may be •cause for rejection of the bid. The City reserves the right to cancel orders or any part thereof, without obligation if delivery is not made at the time specified in the proposal 6. BRAND NAMES: Manufactures' name, brand name, model number or make is used in these specifications for the sole purpose of establishing minimum requirements of quality, performance and design. APPROVED EQUAL is added to these specifications to avoid ruling out qualified competition. Where equal is bid, the Proposer must submit brochures or specifications in detail or provide samples. The City shall be the sole judge of equality. 7. SAMPLES AND DEMONSTRATIONS: When requested, samples are to be furnished free of charge to the City. If a sample is requested it must be delivered within seven days of the request unless otherwise stated in the proposal. Each sample must be marked with the Proposees; name and manufacturer's brand name. The City will not be responsible for returning samples. The City may request a full demonstration of any product or service before the award of a contract. All demonstrations will be done at the expense of the Proposer. 8. CONDITIONS OF MATERIALS: All materials and products supplied by the Proposer in conjunction with this RFP shall be new, warranted for their merchantability, fit for a particular purpose, free from defects and consistent with industry standards. The products shall be delivered to the City in excellent condition. In the event that any of the products supplied to the City are found to be defective or do not conform to the specifications, the City reserves the right to return the product to the Proposer at no cost to the City. 4 9. COPYRIGHTS OR PATENT RIGHTS: The Proposer warrants that there has been no violation of copyrights or patent rights in manufacturing, producing or selling the goods shipped or ordered as a result of this proposal. The seller agrees to hold the City harmless from all liability, loss or expense occasioned by any such violation. 10. SAFETY STANDARDS: The Proposer warrants that the product(s) supplied to the City conforms with all respects to the standards set forth in the Occupational Safety and Health Act and its amendments to any industry standards if applicable. 11. PERFORMANCE: Failure on the part of the Proposer to comply with the conditions, terms, specifications and requirements of the RFP shall be just cause for the cancellation of the RFP award. The City may, by written notice to the Proposer, terminate the contract for failure to perform. The date of termination shall be stated in the notice. The City shall be the sole judge of nonperformance. 12. DEFAULT: In the event that the Proposer defaults on the contract or the contract is terminated for cause due to performance, the City reserves the right to obtain the materials or services from the next lowest Proposer or other source during the remaining term of the contract. Under this arrangement the City will charge the Proposer any excess cost occasioned or incurred thereby and shall apply to any RFP bond required. 13. TERMINATION FOR CONVENIENCE OF CITY: Upon seven (7) calendar days written notice delivered by certified mail, return receipt requested, to the Proposer, the City may without cause and without prejudice to any other right or remedy, terminate the agreement for the City's convenience whenever the City determines that such termination is in the best interest of the City. Where the agreement is terminated for the convenience of the City the notice of termination to the Proposer must state that the contract is being terminated for the convenience of the City under the termination clause and the extent of termination. Upon receipt of the notice of termination for convenience, the Proposer shall promptly discontinue all work at the time and to the extent indicated on the notice of termination, terminate all outstanding sub -contractors and purchase orders to the extent that they relate to the terminated portion of the Contract and refrain from placing further orders and sub- contracts except as they may be necessary, and complete any continued portions of the work. 14. ASSIGNMENT and/or SUBCONTRACTING: The Proposer shall include a list of all subcontractors with the submitted proposal. In addition the Proposer shall list all parties that will be called upon to meet the requirements of the proposal including but not limited to Engineering Firms, Testing Services, Legal Firms and Consulting Services. The City shall approve all subcontractors and other service providers with the Proposer before the award of bid. The Proposer shall not transfer or assign the performance required by this proposal without the prior written consent of the City Manager. Any award issued pursuant to this proposal and monies that may become due hereunder are not assignable except with prior written consent of the City. 5 C� IS. EMPLOYEES: Employees of the Proposer shall at all times be under its sole direction and not an employee or agent of the City. The Proposer shall supply competent and physically capable employees. The City may require the Proposer to remove an employee it deems careless, incompetent, insubordinate or otherwise objectionable. Proposer shall be responsible to the City for the acts and omissions of all employees working under its directions. 16. TAXES: The City of Tamarac is exempt from all Federal, State, and Local taxes. An exemption certificate will be provided where applicable upon request. 17. COLLUSION: The Proposer, by affixing its signature to this proposal, certifies that its proposal is made without previous understanding, agreement, or connection either with any previous firms or corporations offering a Proposal for the same items, or with the City. The Proposer also certifies that its proposal is in all respects fair, without outside control, collusion, fraud, or otherwise illegal action. 18. RFP PREPARATION EXPENSE: The Proposer preparing a proposal in response to this RFP shall bear all expenses associated with its preparation. The Proposer shall prepare a RFP with the understanding that no claim for reimbursement shall be submitted to the City for the expense of RFP preparation and/or presentation. 19. SITE INSPECTION: It shall be the responsibility of the Proposer to inspect the site before submission of proposals. No plea of ignorance by the Proposer of conditions that exist or that may hereafter exist as a result of failure to fulfill the requirements of this contract will be accepted as the basis for varying the requirements of the City or the compensation to the Proposer. 20.OMISSION OF DETAILS: Omission of any essential details from these specifications will not relieve the Proposer of supplying such product(s) as specified. 21. INSURANCE REQUIREMENTS: Proposer agrees that he or she will, in the performance of work and services under this Agreement, comply with all Federal, State and Local laws and regulations now in effect, or hereinafter enacted during the term of this Agreement that are applicable to Contractor, its employees, agents or subcontractors, if any, with respect to the work and services described herein. Proposer shall maintain in full force and effect during the life of the contract, Workers, Compensation insurance covering all employees in performance of work under the contract. Proposer shall make this same requirement of any of its subcontractors. Proposer shall indemnify and save the City harmless from any damage resulting to them for failure of either Proposer or any subcontractor to take out or maintain such insurance. The following are required types and minimum limits of insurance coverage which the R • • [I Proposer agrees to maintain during the term of this contract: QENERAL LIABILITY Comprehensive Premises -Operations Contractual Liability Personal Injury Explosion and Collapse Underground Hazard Products/Completed Operations Broad Form Property Damage Independent Contractors Cross Liability and Severability of Interest Clause Comprehensive • -. Hired 1►GTiye 1 ; - -I MINIMUM 1,000,000 (Per Occurrence) IMUM,LIMITS 1,000,000 (Per Occurrence) STATUTORY Neither Proposer nor any subcontractor shall commence work under this contract until they have obtained all insurance required under this section and have supplied owner with evidence of such coverage in the form of a Certificate of Insurance and endorsement. Such certificates shall be approved by the City. ALL INSURANCE COMPANIES PROVIDED SHOULD: Be rated at least A VII per Best's Key Rating Guide; be licensed to do business in Florida. All policies provided should be Occurrence not Claims Made forms. The Proposer's liability insurance policies should be endorsed to add the City of Tamarac as an Additional Insured. The Proposer shall be responsible for all deductibles. The Proposer's liability insurance shall be primary to any liability insurance policies carried by the City. All of the policies of insurance so required to be purchased and maintained shall contain a provision or endorsement that the coverage afforded shall not be canceled, materially changed or renewal refused until at least thirty (30) calendar days written notice has been given to the City by certified mail. N r� u 22. INDEMNIFICATION: The Proposer shall indemnify and hold harmless the City of Tamarac, its elected and appointed officials and employees from any and all claims, suits, actions, damages, liability, and expenses (including attorneys' fees) in connection with loss of life, bodily or personal injury, or property damage, including loss of use thereof, directly or indirectly caused by, resulting from, arising out of or occurring in connection with the operations of the Proposer or his Subcontractors, agents, officers, employees or independent contractors, excepting only such loss of life, bodily or personal injury, or property damage solely attributable to the gross negligence or wilful misconduct of the City of Tamarac or its elected or appointed officials and employees. 23. CLARIFICATION TO TERMS AND CONDITIONS: Where there appears to be variances or conflicts between the General Terms and Conditions and the Special Conditions and/or Technical Specifications outlined in this RFP, the Special Conditions and/or the Technical specifications shall prevail. The Proposer shall examine all RFP documents and shall judge all matters relating to the adequacy and accuracy of such documents. Any inquiries, suggestions, or requests concerning clarificabon or solicitation for additional information shall be submitted in writing to the City of Tamarac City Clerk's Office. The City shall not be responsible for oral interpretations given by any City employee or it's representative_ An award of bid will not be effective until 72 hours after the adoption by City Commission. The City shall issue a written Addendum if substantial changes which impact the submission of the RFPs is required. A copy of such addenda will be mailed or distributed via facsimile transmission to each Proposer receiving the proposal. n SPECIAL TERMS AND CONDITIONS RFP NO. 96-17 "MEDICAL BILLING SERVICES" It is the intent of the City of Tamarac to establish a price agreement for the purpose of billing patients by the Fire Department. The City of Tamarac, Florida, will be providing Basic Life Support (BLS) and Advancement Life Support (ALS) services to the citizens and visitors of Tamarac on October 1, 1996. Starting October 1, 1996, the City of Tamarac may start billing for medical services rendered by the Fire Department. Approximately 3,700 transports are projected to occur during the City's Fiscal Year 1997. It is anticipated that the City of Tamarac will charge for Advance. Life Support transport services and for Basic Life Support transport services. In addition, the City of Tamarac anticipates charging per mile for each transport as required. The Fire Department is projecting this fee structure to result in approximately $400,000 in annual gross billings. A. Invoice patient, and/or other third party, responsible for payment of services rendered in accordance with time frames as stated herein. B. Responsible for collection, generation of any and all insurance forms, filings and record maintenance. C. Provide Tamarac's Finance Department with all monthly finance, billing and receivable reports as stated herein. D. Provide a Customer Service Representative to assist patients and/or other third party payees in all billing inquiries in a timely fashion as specified herein. E. Conduct any follow up required to obtain the necessary insurance information to process invoice for payments. F'l C • 2.3 SPECIFICATIONS The following requirements are the minimum specifications the City will require: A. The Vendor shall accept hard copy or electronic information pertaining to patients/payors billing documentation from the City, for all patients transported by. Tamarac Fire Department. B. The Vendor shall be responsible for the invoicing, collection, generation of any and all insurance forms and filings, record maintenance and reports. C. It shall be the responsibility of the Vendor to provide: 1. Account number 2. Invoice number 3. Invoice date 4. Name of Patient 5. Name of responsible person if different from patient 6. Complete address 7. Date of transport 8. Cost of transport including cost breakdown 9. Incident number D. The invoice will also contain a message stating "This is an invoice for services provided by the City of Tamarac". Sample of invoices to be provided. E. It is required that all invoicing and reporting systems be computerized. F. Mail bills/invoice forms to patients within five (5) days of receipt of the patient information. This is to include return envelope and address specified by the City of Tamarac. G. The Vendor shall be responsible for sending second notices at thirty-five days and third notices at sixty-five days. H. Provide EIectronic Claims Processing for Medicare and Medicaid. I. Mail proper insurance forms or electronic process to third party payor as required or requested by the patient. (This is to include envelope and address specified by the City of Tamarac). is J. Post all as received. payments 10 • K. Agrees to remit payments on a monthly basis by wire transfer into designated city depository. L. Respond to all patients requests and inquiries, either written or verbal. M. Comply with all applicable Federal, state and local laws as they apply to the services being provided, such as, but not limited to, the Federal Debit Collection Practices Law. This further includes all requirements to maintain confidentiality for all medical and patient information as related in state and local laws or rules and regulations. N. Agrees to negotiate and arrange modified payment schedules for those individuals unable to pay the full amount when billed. 0. Will maintain any and all documentation, records and patient information in a safe and secure manner that will allow inspection and audit by the City of Tamarac or its agents upon proper notification. P. Agrees to provide the City with a listing of all accounts past due 180 days or more (except where a modified pay -out schedule has been arranged), including all pertinent facts regarding the accounts. Accounts due 180 days or more may be withdrawn from the awarded proposer and returned to the City of Tamarac for further collection efforts. 0. Agrees to provide and furnish all material and personnel required for the performance of the agreement. R. Agrees to make every effort to locate and correct any incorrect billing address for billable patients. S. Agrees to maintain a working arrangement with all of the Tamarac Fire Department serviced hospitals and request that hospitals provide a copy of patient run sheets or be provided with demographic and insurance information. T. Agrees to include in the invoice mailing a citizen satisfaction survey and a retum, self-addressed and postage paid envelope. Said survey is expected to be no more than one page in length and of a size not to exceed 8-1/2" x 11". U. Agrees to an annual audit, at the expense of the proposer, by an auditor chosen by the City. 11 /' w 7 L' 2.4 RESEONSIBILITIE5 QE-THE CITY OE TAMARAC: A. The City of Tamarac will provide the necessary patient information to the awarded proposer on a weekly basis for those patients that have been transported by the Fire Department. B. The City of Tamarac will comply with all Federal, State and local laws, rules and regulations as applicable to the services being contracted for. C. The City of Tamarac will agree to use the successful firm for all medical billings exclusively for the service specified herein as long as the contract agreement is in force. D. The City of Tamarac will make every effort to obtain the proper billing address for all billable patients prior to forwarding to the firm. A. pjsJEib tg ion of Charges and Collections - This report will track the charges, payments and financial class mix of all patients for a given month. (Provide sample of this report) B. Aged egggiyable Ejegart - This report will have outstanding invoices sorted by date with amounts for thirty days, sixty days and ninety days. This report will provide totals for these categories. (Provide sample of this report) C. New Qum Ah2ha LiatM - This report lists all invoices alphabetically by patient name or responsible payor. (Provide sample of this report) D. Monthly Payment Listing - This report lists payment, bad checks, charge offs, write offs and refunds posted to each patient's account. (Provide sample of this report) E. Check _Edit _Lgtinq - This report lists all patients due refunds as a result of overpayment of account. (Provide sample of this report) F. And any mutually agreed upon additional reports as may be required. Fees quoted should reflect service from October 1, 1996 to September 30, 1997. The fees is quoted should reflect the total costs for all services to be provided and be of such detail to show the different fees for services provided. The proposer shall include sample bill forms and the messages that will be used on each successive bill mailed, as a part of the response. All text, format and color of printing and stock subject to approval by the City of Tamarac. Billings should be at intervals of initial billing, 35 and 65 days. • PUBLIC NOTICE OF REQUEST FOR PROPOSAL "MEDICAL BILLING SERVICES" RFP. NO.96-17 The City of Tamarac will receive proposals at the City Clerk's Office in City Hall, 7501 N.W. 88th Avenue, Tamarac, Florida, until 2 p.m. on September 20. 1996 The City of Tamarac is interested in establishing a contract/price agreement for the purpose of billing patients transported by the Fire Department. All proposals must conform to the instructions in the Request for Proposals. Interested proposers may obtain a copy of the complete Request for Proposal at the address below. City Clerk CITY OF TAMARAC 7525 N.W. 88th Avenue TAMARAC, FL 33321 0 �C ? 76 • REQUEST FOR PROPOSAL REQUEST FOR PROPOSAL - "MEDICAL BILLING SERVICES" SUBMITTED BY: Company Name: Address: City: State: Zip: Telephone:( ) —FAX:( 0 Delivery: calendar days after receipt of Purchase Order 0 BONDING: A cash bid guaranty or approved bid bond of $20,000.00 _ is required and shall be submitted with your Proposal. Additional bonding may be required in the Special Terms and Conditions of this invitation. The Bonding must be executed by a surety company authorized to do business in the State of Florida or secured in a manner satisfactory to the City of Tamarac. NOTE: To be considered eligible for award, one (1) ORIQML COPY OF THIS BID PROPOSAL FORM must be submitted.with the Bidders` proposal. NO BID INDICATION (IF "NO BID" IS OFFERED): Please indicate reason(s) why a Proposal is not being submitted at this time. Return this Form to avoid removal of Bidder from the City of Tamaracs' vendor listing. 14 PROPOSAL CERTIFICATION: The undersigned hereby confirms that: 1. He/she is a duly authorized agent of the Company submitting the proposal; 2. He/she has read the General Terms and Conditions, the Special Conditions and any Technical Specifications which were made available to the Proposer in conjunction with the RFP and fully understands and accepts these terms unless specific variations have been expressly listed on the Proposal Form; 3. The Proposer will accept any awards made to it as a result of the Invitation for a minimum of sixty (60) calendar days following the date and time of the bid opening. BY: DATE: 0 MANUAL SIGNATURE OF AGENT TYPEDIPRINTED NAME OF AGENT TITLE OF AGENT Cl NOTE: Proposals without the manual signature of an authorized agent of the Proposer shall be deemed non -responsive and ineligible for award. `M 0 Company Name: Variations: The Proposer shall identify all variations and exceptions taken to the General Terms and Conditions, the Special Conditions and any Technical Specifications in the space provided below; provided, however, that such variations are not expressly prohibited in the RFP documents. For each variation listed, reference the applicable section of the RFP document. If no variations are listed here, it is understood that the Proposal fully complies with all terms and conditions. It is further understood that such variations may be cause for determining that the Proposal is non- responsive and ineligible for award: Section Variance Section Variance Section Variance . Section Variance Attach additional sheets if necessary. C� 16 C7 C� THIS CONTRACT, made and entered into this , day of 199_ by and between the CITY OF TAMARAC, a Florida Municipal corporation hereinafter referred to as the "CITY", and hereinafter referred to as the "CONTRACTOR". WITNESSETH: WHEREAS, the parties hereto now wish to enter into an agreement, pursuant to which the CONTRACTOR will render those professional services in connection with said project as hereinafter provided; NOW THEREFORE, the parties hereto agree as follows: 1. DEFINITION OF THE PROJECT. The objective of the project is to utilize the services of the CONTRACTOR to provide the CITY with medical billing services. 2. SCOPE OF SEAS. The CONTRACTOR shall perform and cant' out the work tasks presented in the CITY's Request for Proposal, dated (Exhibit A), and CONTRACTOR'S proposal, dated (Exhibit B), as summarized herein. All payments shall be paid directly to the City of Tamarac. 3. TIME QF PERFOEMANCE- This Contract shall be effective October 1, 1996 through 17 0 September 30, 1997, unless otherwise terminated. The CITY may, at its sole discretion, �J • renew this agreement for two (2) additional 1 (one) year terms under the same terms and conditions contained herein. 4. aQ PM ENS6JiON AND METHOD OF PAYMEj�T. The CITY reserves the right to request changes in the services within the general scope of the Contract to be performed by the City Manager and CONTRACTOR, and approved by City Commission, which shall specify the change ordered and the adjustment of time and compensation required therefore. Any services added to the scope of this Contract by a change order shall be executed under all applicable conditions as the Contract. No claim for additional compensation or extension of time shall be recognized unless contained in the duly executed change order. 5. REPORTS. The CONTRACTOR shall provide the CITY with status reports as set forth in proposal. 6. QATE TO QE FURNISHED QY CInL The CITY will make available to the CONTRACTOR, for use in performance of services under this Contract, all available reports, studies or any other materials in its possession which may be useful to the CONTRACTOR. In addition, the CITY agrees to arrange for its personnel to be available on a timely basis for training by the CONTRACTOR. All material furnished by the CITY will not be disclosed to any party without the CITY's prior approval. 7. INDEPENDEUI CONTRACTORS. The CONTRACTOR is an independent contractor and not an employee or agent of the CITY. The CONTRACTOR shall retain full control over the employment, direction, compensation and discharge of all persons assisting in the if? ! performance of service. The CONTRACTOR shall be fully responsible for all matters relating to payment of employees, including compliance with Social Security, withholding tax and all other laws and regulations governing such matters. The CONTRACTOR shall be responsible for its own acts and those of its agents and employees during the term of this contract. 8• INDEMNIELCADON, The CONTRACTOR shall indemnify and save the CITY harmless from any and all claims, losses and causes of actions which may arise out of the performance of this Agreement as a result of an act of negligence, of the CONTRACTOR or its SUBCONTRACTORS. The CONTRACTOR shall pay all claims and losses of any nature whatsoever in connection therewith and shall pay all costs and judgements which 0 may issue thereon. 9• INSUMNGE. The CONTRACTOR shall maintain Worker's Compensation Insurance in compliance with Florida Statutes, Chapter 440, and shall maintain Professional Liability insurance in an amount no less than $1,000,000. 10. =ERSHIP QF DOCUMENTS. The CONTRACTOR agrees that all notes designs, drawings, specifications, models, photographs, reports, surveys, investigations and other data produced in the performance of this Agreement shall be the sole property of the CITY, including all rights therein of whatever kind except as may otherwise be provided hereinafter. 11. 6MQIJMENTS. The following named attachments are made an integral part of this isAgreement: A. RFP dated 19 ! control of the CONTRACTOR upon written notice of the CONTRACTOR. on U p p termination, the CONTRACTOR shall submit an invoice to the CITY in an amount which represents the cost of services actually performed or obligations incurred for which the CONTRACTOR has not been previously compensated to the date of termination. Upon payment of the sum found due, the CITY shall be under no further obligation to the CONTRACTOR, financial or otherwise. 13. CHOICE OF LAW. All questions pertaining to the validity and interpretations of this Contract shall be determined in accordance with the laws of Florida. Venue shall lie in Broward County, Florida. 14. ASSIGNMEtIj OF CONTRACT. The CONTRACTOR shall not assign this Contract, or any part thereof, without prior consent of the CITY. 15. NOTICES. Delivered or mailed to such party at their respective addresses as follows: To the CITY: Stanley Hawthorne Finance Director City of Tamarac N.W. 88th Avenue Tamarac, FL 33321 To the CONTRACTOR: 16. INTEREST OF CQNTRACTOR. It is agreed that the CONTRACTOR presently has no interest and shall not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of the CONTRACTOR'S services under this Contract. It is further agreed that in the performance of this Contract no person having any such interest shall be employed by the CONTRACTOR. 20 r� 11 E 17. ENJIRE CONTRACT. This Contract contains the entire agreement between the parties. The CONTRACTOR represents that in entering into this Contract it has not relied on any previous oral and/or implied representations, inducements or understandings of any kind or nature. IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed on the day and year indicated below: Signed, sealed and delivered in the presence of: ATTEST: Robert S. Noe, Jr., City Manager UssRIA By: En Carol A. Evans, City Clerk 21 ACCEPTED BY CITY OF TAMARAC GRANTEE Date: M Norman Abramowitz, Mayor Robert S. Noe, Jr., City Manager Date: Approved as to form: By: Mitchell S. Kraft, City Attorney CITY OF TAMARAC INTEROFFICE MEMORANDUM NO.96-672 CITY ATTORNEY TO: Paul Forsberg, Assistant Fire DATE: November 14, 1996 Chief FROM: Marion Swenso ra e a '� RE Contract Between City of ,gLTamarac and Advanced THRU: Mitchell S. Kra Data Processing, Inc. City Attorney Our File: K96-031 I have reviewed the above -noted draft Contract, and suggest the following: Title should reflect what kind of Contract this is, e.g., Contract between the City of Tamarac and Advanced Data Processing, Inc. for Medical Billing Services. 1. In introductory paragraph after THIS CONTRACT, add "hereinafter "CONTRACT" or "AGREEMENT". 02. In introductory paragraph, add the following language: "with principal offices located at ..." for both the City and ADP. 3. In paragraph No. 2 after Request for Proposal add: ("RFP"). 4. In paragraph No. 4, last line on page 2, "under all applicable conditions as the Contract." needs to be clarified. 5. Paragraph No. 5, should be changed to add "contractors" before "proposal". 6. In paragraph No. 8 add the following language: The above provisions shall survive the termination of this Agreement and shall pertain to any occurrence during the term of this Agreement, even though the claim may be made after the termination hereof. 7. In paragraph 15, notice is mailed Certified Mail, to the City Manager and to the City Attorney. (Include their names and addresses.) 8. Signature page, eliminate ACCEPTED BY and the word GRANTEE, add date under City Attorney's signature. If ADP is a corporation, it is not necessary to have two (2) witnesses, only the corporate secretary's 0 signature and seal. After revising this Contract, I suggest you also have the Risk Manager review the document to insure compliance with the City's insurance requirements are met. If you have any questions or concerns, please do not hesitate to contact me. MSK/m Attachment �J 11 � J RESPONSE TO REQUEST FOR PROPOSAL FOR MEDICAL BILLING SERVICES RFP No. 96-17 CITY OF TAMARAC OFFICE OF THE CITY CLERK 7525 N.W. 88#h AVENUE TAMARAC, FLORIDA 33321-2401 W1161181 ADVANCED DATA PROCESSING, INC. 520 N.W.165 STREET ROAD,SUITE 201 0 MIAMI, FLORIDA 33169 (305) 945-2280 PAUL FRANZELAS, VICE PRESIDENT SEPTEMBER 20, 1996 C401by Advanced Data Processing 'fw'4 " of medSupport City of Tamarac Advanced Data Processing 20 September, 1996 r] r� TABLE OF CONTENTS Section 1. Introduction & Letter of Offer Section 2. General Requirements Section 3. Qualifications & Experience Section 4. Technical ■ Organization & Personnel ■ Background & Experience ■ References ■ Computer Systems Information ■ Rationale ■ Optimization ■ Scope of Work ■ Reports Provided Section 5. Financial & Other Information ■ Pricing ■ Sample Reports ■ Affidavits & Required Forms Completed u �J Section 1 - Introduction & Formal Offer 1.0 Introduction Advanced Data Processing is pleased with the opportunity to address your requirements in this proposal. We highlight here the following crucial and we believe to be most favored answers to each of the essentially weighted criteria: Experience ❑ Over fifteen years of serving Dade, Broward, Palm Beach, Hillsborough & Brevard Counties 0 Experience and history has been focused specifically on billing and collections for Municipal EMS Organizations. Collection Philosophy ❑ Demonstrated as the most successful in the business through its customer satisfaction and delivery. ❑ Quality of service is exemplified in methods employed, billing forms and reports produced and, personnel conduct on behalf of our clients. ❑ "Going -the -extra -mile" by our hospital liaison programs and our double -verification of patient information. ❑ Superior level of collections as a percentage of billing and cash flow produced for our clients. Technology & Equipment Availability ❑ Increased commitment to supporting EMS Organizations through its investment in technology and expertise. ❑ Use of "tried -and -proven" IBM Systems methods and technology. ❑ Proprietary systems software with advancements especially in electronic processing of insurance claims as first in Florida to support new "National Standard Format". ❑ Maintains operating and reserve capacity in its systems, facilities and people and is immediately prepared to add City of Tamarac without any disruption to current business. Section 1 Page 1 -7 City of Tamarac Advanced Data Processing 10 September. 1996 Expertise & Qualifications ❑ Significant years and quality of experience with focused expertise crucial to this. business and complimentary towards demonstrated success. ❑ Ongoing commitment staying abreast of ever-increasing changes in insurance processing and health care regulations. Commitment ❑ Poised to work closely with the City of Tamarac in attitude, readiness and location. ❑ Located just off the Florida Turnpike and Interstate 95 at the northern most area of Dade County already serving other South Florida & Central/West Coast areas. Pricing ❑ Top-notch services offered at an extremely competitive price. ❑ Puts forth both an aggressive desire to win the business and is balanced with the fair appraisal and assessment for a job to be well done. Section 1 Page 2 �6.-_� ?C City of Tamarac to1.1 Formal Offer Advanced Data Processing re: RFP No. 96-17 for "MEDICAL BILLING SERVICES" 10 September. 1996 Enclosed is Advanced Data Processing's response to your Request for Proposal (RFP No. 96-17) for "EMS TRANSPORTATION BILLING SERVICES". We believe this response answers all requirements with an offer to provide the finest available medical billing and collection services for a municipal EMS organization such as that of the City of Tamarac. The proposal was developed in keeping with standards and requirements as stipulated in the RFP and is made accordingly void of collusion with any other person or entity submitting a proposal pursuant to the RFP. The content of this Response to your Request for Proposal represents Advanced Data Processing's formal offer to provide the services requested by the City of Tamarac for Medical Transportation Billing Services and may be incorporated, in whole or part, into a written contract for such services. Our company, with over fifteen years serving Dade, Broward, Palm Beach, Hillsborough and Brevard Counties has demonstrated its commitment to the area at both city and county levels. In addition, considerable experience and history has been focused specifically on billing and collections for Municipal EMS Organizations and has produced specialized understanding of the requirements conveyed in your invitation to proposal. We are immediately prepared to add the City of Tamarac to our significant group of more -than - satisfied clients. We can do so without any disruption to our current business and begin processing your billing within one week of notice. Advanced Data Processing's collection philosophy is demonstrated as the most successful in the business through its customer satisfaction and delivery in terms of both quality and level of service. Our quality of service is exemplified in the billing forms and reports we produce, the methods we employ in both technology and process and, the way in which our personnel conduct themselves on behalf of our clients. In addition, we demonstrate "going - the -extra -mile" by our hospital liaison programs and our double -verification of patient information. Our level of service is superior in collection levels as a percentage of billing and the cash flow we have produced for our clients also demonstrates we can successfully handle the size of an account such as the City of Tamarac. Section 1 Page 3 V C� • • City of Tamarac Advanced Data Processine 10 September. 1996 We invite you to check not just two or three of our references, but all of them, if you like, including those for which we no longer perform. You will find we give the same excellent service to all our clients whether large or small. We are poised to work closely with the City of Tamarac not just in attitude and readiness but, in location as well. Located just off the Florida Turnpike and Interstate 95 at the northern most area of Dade County, and are no more than a half-hour from your location. Advanced Data Processing has proposed to the City of Tamarac a "top-notch" set of services to meet their needs... and, we have offered them at an extremely competitive price. We believe this indicates both an aggressive desire to win the business and, is balanced with the fair appraisal and assessment for a job to be well done. As such we appreciate the opportunity to provide you services with which you will be satisfied. Respectfully submitted, Advanced Data Processing, Inc. 520 N.W. 165th Street Road, Suite 201 Miami, FL 33169 (305) 945-2280 Authorizing Agent J Paul J. Franzelas, Vice President Section 1 Page 4 0 Section 3 - Qualifications & Experience Advanced Data Processing, Inc. was established in 1978 with the principal focus of providing computer -based services to companies and municipal organizations. The company offices are currently located at 520 NW 165th Street Road, Miami, Florida. 3.1 Organization & Personnel The principal founders of the company, Mr. Paul Franzelas and Mrs. Linda Franzelas, have been residents of Broward County for the past 22 years and actively engaged in PAL sports and civic activities. Advanced Data Processing's Principal Operating Officers are as follows: L. Franzelas, President - Linda Franzelas is President and Co-founder of Advanced Data Processing. Since 1984 and the inception of the company she has been responsible for directing collections and the supervision of billing operations. Prior to this, Mrs. Franzelas . had supervision experience with collection firms and was a private business owner. P.J. Franzelas, VP Operations - Paul Franzelas, Vice President of Advanced Data Processing, founded the Company in 1978. Since 1981 he has engaged the Company in the EMS and medical billing and collections business. Prior to this he held executive positions with other companies bringing to the company a total of over 25 years of experience in data processing and financial applications. Mr. Franzelas graduated from Nova University in 1978 and holds a B.S. in Business Administration with a major in Accounting. He also holds an A.A. degree in Computer Science. D. V. Passaro, V.P. Marketing/Sales - Donald Passaro has successfully held executive marketing and business planning positions with a number of companies in the computer and communications field. Having over 20 years of experience in marketing, he has also consulted to start-up companies in product and service businesses. Mr. Passaro's education includes Electrical Engineering and Applied Math at Georgia Tech and Florida Atlantic University in Boca Raton where he studied Computer Science. Section 3 Page 1 City of Tamarac Advanced Data Processing 10 September. 1996 b] 0 Operations Personnel - The Company is an Equal Opportunity Employer and maintains a multi -ethnic staff for the purpose of establishing payor contact in several languages. Advanced Data Processing has an on -staff consultant to keep abreast of changes in technical aspects of medical claims processing and insurance recovery. The Company's general operations are comprised of: Collection Processors, (15) employees. Data Entry Personnel, (7) Full/Part time employees. Section 3 Page 2 e i6-J 1r, City of Tamarac Advanced Data Processing 10 September. 1996 3.2 Background and Experience Advanced Data Processing, Inc. first began addressing the collection business by providing computer collection software and facility management for two of the largest Tour Operators in the United States; David Travels, Inc. and Vacation Travel Concepts, Inc.. Advanced Data Processing served these two businesses from 1975 to 1986, with their combined annual income in excess of 100 million dollars. The Company began serving municipal organizations in May of 1981, billing for City and County Rescue Services. Since then, our organization has specialized in Emergency Medical Transportation Billing and Collection Services (EMS) serving a considerable portion of South Florida's municipal EMS organizations. The company's IBM mainframe computer and IBM data entry workstations environment are programmed specifically for EMS Transportation Services. Our sophisticated computer application constantly updates and monitors patient accounts alerting collection personnel of accounts that need immediate attention. Our application and operations are tailored specifically to- provide optimum efficiency in . collections. Advanced Data Processing is a member of the American Guild of Patient Account Management (AGPAM), one of the many ways we keep abreast of methods and changes in the field of patient account management and claims processing. C� 3.3 Facilities In 1988, we purchased Office Facilities where our operations currently reside. In 1993, we purchased additional facilities supporting our expansion and growth. Advanced Data Processing having excellent financial status owns all of its principal facilities, computer systems and equipment and, has an interest in an additional 10,000 square feet of facilities within the same office complex. Advanced Data Processing has no major debt having as its only liability a 2-year remaining property mortgage for the amount of $20,000 dollars. Section 3 Page 3 / 6 - City of Tamarac Advanced Data Processing 10 September. 1996 3.4 Current References (CONFIDENTIAL) The following section lists references for the purpose of confirming our financial, professional and client standings. We believe you will find that Advanced Data Processing is of the utmost integrity in each of these aspects. We encourage you to inquire as to our stability, longevity, reliability and performance in each of these relationships. Financial References: Sun Trust of Plantation 8200 W. Broward Blvd. Plantation, Florida 33324 305-765-7652 Smith Barney Shearson 1000 E. Hallandale Beach Blvd. Hallandale, Florida 33009 Mr. Russell Bassett 305-457-1500 Professional Reference: Amado Garcia, CPA 9500 S. Dadeland Blvd. Miami, Florida 33156 305-670-9750 Section 3 Page 4 City of Tamarac Advanced Data Processing 10 September. 1996 0 Client References (CONFIDENTIAL) : 0 The following are a list of pertinent client references for which we perform extremely similar services to those requested by City of Tamarac. We encourage you to check every one of our references. Metro -Dade County Fire Department 6000 S.W. 87th Avenue Miami, Florida Mr. Roy Ratsky, CPA; Revenue Accountant 305-596-8925 January '92 - current (and) May '81 thru August '85. 44,400 Accounts Annually 3,700 Accounts Monthly City of Miami Fire Rescue 1121 N.W. 7th Street Miami, Florida 33136 Chief Freddy Hernandez 305-575-5280 January '93 - current land► December '86 thru March '90. 7,000 Accounts Annually 583 Accounts Monthly City of Miami Beach 2300 Pine Tree Drive Miami Beach, Florida 33140 Chief Luis Garcia 305-673-7120 October '94 - current 8,400 Accounts Annually 700 Accounts Monthly Brevard County 2725 St. Johns Street, Bldg D Melbourne, Florida 32940 Alan Escoffery, Finance Mgr 407-633-2056 May ' 96 - current 14,000 Accounts Annually 1,170 Accounts Monthly Section 3 Page 5 City of Tamarac Advanced Data Processing 10 September. 1996 �J City of Tampa 808 Zack Street Tampa, Florida 33602 Chief Bruce Savage 813-274-7005 May '95 - current 14,500 Accounts Annually 100 Accounts Monthly City of Pompano Beach P.O. Drawer 1300 Pompano Beach, Florida Chief James Bentley 305-786-4510 March 1994 - current 8000 Accounts Annually 666 Accounts Monthly City of Oakland Park 2100 N.W. 39th Street Oakland Park, Florida 33309 Chief Mark Nehiba 305-497-4100 March 1994 - current 2,500 Accounts Annually 208 Accounts Monthly City of Boca Raton 2333 W. Glades Road Boca Raton, Florida 33431 Chief Bruce Silk 407-367-6722 January '95 - current 4,200 Accounts Annually 350 Accounts Monthly City of Lauderdale Lakes 3461 N.W. 43rd Avenue Lauderdale Lakes, Florida 33319 Chief Cosimo Ricciardi 305-731-8544 October '95 - current 4,500 Accounts Annually 375 Accounts Monthly Section 3 Page 6 City of Tamarac Advanced Data Processing 10 September. 1996 0 Former Client References: C] City of Boynton Beach Fire Department 100 East Boynton Beach Blvd. Boynton Beach, Florida 33435 Chief Jim Ness 407-375-6332 January '93 - April '95 2,200 Accounts Annually 183 Accounts Monthly City of Greenacres Fire Department 5985 10th Avenue North Greenacres, Florida 33463 Mr. David Myles, Director of Finance 407-642-2013 February 1993 - July 1996 1,200 Accounts Annually 100 Accounts Monthly Section 3 Page 7 City of Tamarac Advanced Data Processing 10 September. 1996 3.5 Computer Systems Information Advanced Data Processing employs reliable and proven systems and facilities to provide the most dependable services possible. The following is an overview of our equipment and facilities: Computer Systems - Advanced Data Processing utilizes an IBM System/36 mainframe providing the main system resources for managing the data processing, data input/output & conversion and media/archive processes. In addition, we operate a UNIX -based environment which supports other data -entry medical billing services. We also employ several IBM- compatible PCs for general processing, desktop publishing and clerical support functions. Data Entry, Peripheral & Support - The following is a list of data entry, peripheral and support equipment owned and use to deliver the proposed services. Data Entry IBM 5251 type data entry station. 20 stations Wyse 60 type UNIX -based cluster terminals. 4 stations High-speed Keyed Entry Stations 10 stations PC -attached consoles. Media & Information Transfer - Cipher Magnetic Tape Drives (Bulk Data). 2 Drive Units Streaming Tape 0 50 & 25OMB►. 2 Drive Units Streaming Tape (4GB) 1 Drive Unit Data Entry Floppy Disk (various capacities). 10 Drive Units Printing - Invoice/Statement & Ins Claims. 5 Printers High-speed line printer. 1 Printer Mail Handling - Forms burster, Forms folder, Automatic envelope sealer/postage machine Section 3 Page 8 2 /c­�'�c 0 Section a -Technical • The following section outlines the essential billing functions to be performed. Also explained is the approach to be taken, identifying its distinguishing characteristics and rationale. Included are a description of work products to be provided, deliverables required for start-up and, description of items for which the City may provide assistance. 4.0 Rationale Advanced Data Processing prides itself in developing operations methods and systems support tailored specifically to EMS billing and collections requirements. Our methods and systems are refined to provide maximum efficiency in the collection of your receivables. The following outlines some of the most important distinctions in how we provide such superior services. Hospital Support - The principal ingredient in effectively maximizing our collection success is having access to medical insurance records from the transported hospitals. Our company with your assistance will maintain a working arrangement with all of the major hospitals in your area. These hospitals will be requested to provide a copy of their patient facesheets or patient demographic and insurance information. Additionally, we will send our own personnel to retrieve required information from their computers. For smaller hospitals, we will arrange to have them provide us such information via fax or phone request. Electronic Claims Processing - Medicare, Medicaid & many other carrier claims are processed by us and submitted electronically to insure accurate and fast collections. As the first EMS service company in Florida to electronically file Medicaid claims, we continually stay abreast of changes in insurance submission standards and upgrade our capabilities as such changes require. We are already one of the few service companies submitting claims to Medicare in the new "National Standard Format". Section 4 Page 1 �1.,`/(p-...1 1110 City of Tamarac Advanced Data Processine 10 September. 1996 • In -House Programming - Since all of our computer programming is done 'in-house', we have the ability to immediately modify our computer programs to maintain the state-of-the-art in our collections system. Automated Patient Linkin - When a new patient is entered into the system, the first thing the system does is to determine if the patient has previously been transported. The database is searched for Medicare numbers, Medicaid numbers, and Private Insurance information. If we find this information in our history file, we can immediately use this information to process a claim, thus eliminating the time needed to research patient information. We call this our 'Patient Linkage Feature'. Automated Pa or Monitoring & Claim Resubmission - The system monitors all claims having been filed to insurance payors identifying those not having yet paid. These claims are flagged and automatically resubmitted. At a regular interval a trace letter is sent to the 0 responsible carrier if the claim has still not been paid or response received. • Effective Statements - We provide easy -reading, comprehensive statements to patients and include for convenience a courtesy return payment envelope. The front of the statement describes all charges and payments. A request on the statement for the patients Medicare and/or Medicaid number is clearly indicated. The reverse side of the statement has clearly marked entry blocks for information needed to file private insurance claims. Skiptracing - We use various methods of Skiptracing to locate patients who have left the area, or patients with invalid billing addresses and phone numbers. For incorrect addresses returned to us by the Post Office, we attempt to obtain a valid update from the hospital. If the hospital does not have better address information, we check these patients electronically against the U.S. Post Office's National Change Of Address (NCOA) files, whose records are updated quarterly. The (NCOA) files are used by all mailing list companies to keep their lists current. Section 4 Page 2 !� �e"z�z 7 a City of Tamarac Advanced Data Processing 10 September. 1996 • 4.1 Optimized Flow The following diagram shows the major patient billing cases and their flow of activities employing the previously mentioned techniques to optimize the billing and collection process. Obviously, the sooner that valid patient information is obtained, the quicker and more assured is collection. Accordingly, in cases where less information is initially provided, the billing process is not detained to wait for information update. Rather, a bill is generated as just one form of patient contact through which, oftentimes, the patient themselves will fill -out the appropriate data on our easy -to -return billing form. This data is used to update the patients' billing information and a new billing is generated. Where incomplete information is provided, the techniques described are used to update the information in the quickest manner possible. Rebilling is then performed where required. Excellent working relationships are maintained with the hospitals to obtain this information and in some cases we provide updated information to the hospitals in reciprocity. The best . case should be noted is where the best information obtainable at the time is provided up- front by the EMS attendants. Although this is sometimes not practical and is understood, the described approach accommodates this in an optimal way. Section 4 Page 3 10 September. 1996 C� 1� r /y -._2 76 City of Tamarac Advanced Data Processing Diagram - Optimized now approach Case 1 Case 2 Case • no phone YHRSForm • valid phone HR5 Form • valid phone HRS Form info • no facesheet • no facesheet • valid facesheet from Hosp from Hasp from Hosp generate & end port bill visit Hospital locate patient data generate & end pint bill contact patient verify insurance visit Hospital update patient data Section 4 Page 4 generate & send Insurance Claim generate & end pint bill contact patient hl or Hospital verify insurance visit Hospital for Double Verify City of Tamarac Advanced Data Processing 10 September, 1996 r� u C� 4.3 Scope of Work Advanced Data Processing will perform specific services with the principal goals of; 1) recovering the greatest amount of fees in the shortest possible time and, 2) the largest total amount with minimized cost to recover. Advanced Data Processing will utilize collected billing information provided by the City as the basis for: ❑ Billing to and collecting from the transported individual, Medicare, Medicaid, insurance companies or, other appropriate third party payors for services provided by the City and maintaining incident -based accounting to assist in this process. ❑ Preparing the required management and financial reports including information on delinquent accounts for the City's analysis of the services provided. Advanced Data Processing will provide the following Basic Services: ❑ Mail an invoice to each transported individual at the current prevailing rate for transportation services. ❑ File all insurance claim forms for all patients based upon information received from the patient or obtained from research we perform at health care facilities. ❑ Provide required paperwork to Medicare, Medicaid, insurance companies or, third party payors. ❑ Mail copies of invoices to patients, Medicare, Medicaid, insurance companies or, other third party payors, when requested. ❑ Mail a series of follow-up invoices to patients, as necessary. ❑ Re -file Medicare, Medicaid or insurance claims, as necessary to obtain payment. ❑ Record customer payments from lock box collections. ❑ Prepare monthly management/financial reports. ❑ Negotiate and agree upon modified pay out schedules within City -established guidelines for those individuals unable to remit the full initial -billed amount. ❑ Notify the City of past due accounts by providing a listing of such accounts and pertinent detail. ❑ Any other services agreed to between the parties, in order to effectively collect all fees. Section 4 Page 5 c' � /(, -/() City of Tamarac Advanced Data Processing 10 September. 1996 is4.3.1 Maintaining Customer Accounts Data collection & entry - All information pertaining to patients / payors for accounts under our billing/collection whether hard copy or electronic form will be obtained from your office for the purpose of assisting in their collection. Advanced Data Processing will determine the optimum method for information transfer employing electronic or communications methods as feasible. Information will then be entered and maintained on our data processing system to assist in this process. All information will be treated as proprietary. Manual data entry is keyed in the most rapid and reliable manner possible. Advanced Data Processing has maintained its original expertise in bulk data entry and processing and consequently has an advantage in the ability to process large volumes of input data such as patient incident & demographics as well as payment processing. All data received is entered into the system's database within three (3) days after receipt. It is then passed on for immediate verification and bill generation. Information Verification - All processed patient incident and billing/payor information is processed for first stage verification using three methods; 1) automated "front-end edits", 2) "patient -linkage" and, 3) manual review by insurance recovery specialists. Automated "front-end edits" look for certain inconsistencies in information that can be flagged and corrected. Items ranging from complete address, social security & date -of -birth to insurance IN are checked by the system and flagged either for correction or hospital verification. As previously described, when a new patient is entered into the system, our system's "Patient -Linkage" feature determines if the patient has previously been transported. The database is then searched for valid Medicare numbers, Medicaid numbers, and Private Insurance information on which payments have been processed. If we find this information in our history file, we can immediately use this information to process a claim, thus eliminating the time needed to research patient information. Section 4 Page 6 �7 City of Tamarac Advanced Data Processing 10 September. 1996 • • Beyond even these two automated methods used to filter perhaps otherwise "lost" or delayed collections (especially from commercial and Federal payors), we also employ manual methods to further screen the entered fresh billing information. Our insurance recovery specialists review each bill for claim processing. In many cases we can spot invalid insurance information or incomplete data that would result in a rejected claim. This information is corrected either immediately or, after obtaining valid information from a number of sources. In many cases we utilize on-line verification where our system automatically, communicates multiple records to the insurance carrier and obtains from the carrier the correct filing identification. In other cases, telephone calling and/or hospital interrogation is employed. Section 4 Page 7 City of Tamarac Advanced Data Processing 10 September. 1996 is4.3.2 Invoicing & Collecting E Bill generation & mailing - Bills will be printed immediately upon completion of input, verification and editing of the supplied billing information and mailed or communicated to patients/payors. Bills for which we transmit via Electronic Communications are sent in batch form directly to the carrier providing payment processing by the carrier within approximately 15 days after receipt. Transmission to Medicare employs the most up-to-date National Standard Format and utilizes Medicare's "Medigap" feature to the greatest extent possible. This feature provided by Medicare automatically forwards secondary payor information to the supplemental insurance carrier ensuring faster payment of the 20% not paid by Medicare. Other carriers are billed via paper HCFA-1500 forms and sent directly to the appropriate insurance carrier. Because of the overall volume we process, we are able to batch forms to more popular carriers obtaining faster bulk processing. Self -mailing invoices - Bills to self pays are printed on a pre-printed invoice and sent in a double window envelope containing a convenient self -mailer. The invoice sent also has a convenient place for the patient to return updated insurance information which is used to refile on the behalf of the patient. The following figures provide an example of a completed patient bill and paper insurance claim (bill). Patient/payor data verification - The information collected throughout the process will be verified on a case -by -case basis and updated as required for the purpose of establishing contact with the patient/payor. Follow-up & multiple notices - Phone contact will be made on a routine basis to follow-up on notices sent without response or for payments not received. In certain cases, multiple contacts will be made. In no way will harassment be used to force payment. All phone conversations and correspondence are made as a representative of the client. Cycle billing - Several cycles are managed by our system to produce maximum collections. Regular (monthly) cycle billing is performed on self -pay accounts and accounts showing a patient pay balance. These cycles handle routine invoicing for payment arrangements as well as generation of dunning messages for slow or no -pay accounts. Patient invoices are rebilled Section 4 Page 8 • E r. � v vc v City of Tamarac Advanced Data Processine 10 September. 1996 up to six (6) times. Other cycles handle rebilling of carriers and billing of secondary/tertiary payors. Medicare, Medicaid and private insurances are billed immediately and given 45-60 days to pay before rebilling. Insurance denials for reasons other than those that are resolveable are converted to self or patient pay and begin regular cycle billing. System checkpoints trap bills that would be in jeopardy of expiration due to insurance filing limitations. Carrier coordination - All coordination and correspondence with insurance carriers will be maintained. Settlements and adjustments (other than Medicare/Medicaid write-offs due to maximum allowable charge by Law) will require the authorization of your organization. Forms required for submission of claims and other forms occasionally required by carriers and other payors will be completed and filed by us on behalf of the City. Section 4 Page 9 le, 9� `� o City of Tamarac Advanced Data Processing 10 September, 1996 Patient Invoice - Sample (reduced size) STATEMENT 17iROUNII TRANSPORTATION METRO DADE: FIRE DEPARTMENT DEFT 7464 GATE 9/19/96 ACCOUNT NUMBER F1 D06 O1 M:[AM:[ � F�'I.. 33195�'7464 L AMOUNT PAID S OUR PHONE NUMBER IS... F-1 305--945-4072 MAKE CHECKS PAYABLE IN U.S. DOLLARS TO: ' I,UARD OF COUNTY C:OMMIS)SIONI:::F;S LP MA. 1\4 05 S Y FCG RD L' APT *1 RALE=IGH NC 2 L— 619006-01 15 METRO DEPT 7464 MIAMI, DADE FIRE DEPARTMENT FL 3319-Sr-7464 J TO INSURE PROPER CREDIT TO YOUR ACCOUNT' • PLEASE DETACH AND RETURN THIS STUB WITH YOUR CHECK E • PATIENT NAME: L A M A I N PHONE NUMBER, 919--8 .-3' EI'1 REFERRING DR.: PLACE OF SERVICE: FIRM DAl[ 1i11191itJRLtVTCE ` CLRAIlQ#Sf. MYM6lIT3:,, 2/15/96 FIRE RESCUE TRANSPORT 290.00 MILEAGE CHARGE 7.0 La3 7.50 52.50 OXYGEN ADMIN. CHARGE 25.00 FOR YOUF CONVENIENCE, WE NOW ACCEPT VISA OR MASTERCA D. IN ORDER TO AUTHORIZE FULL PA MENT USING YOUR CHARGE ACCOUNT, PLEASE FILL -CUT THE AREA BELOW AND RETURN THIS ENTIRE STATEMENT TO THE ADDRESS ABOVE. /--/VIS /--/MASTERCARD CREDIT CARD NUMBER ------- ------------ ----------- SIGNATU E--------------------------- EXPIRATION DATE MONTH ---- --YEAR-------- AVOID FLRTHER COLLECTION OR LEGAL ACTION. THIS ACCOUNT MUST DE PAID WITHIN 72 HOURS. FOR YOU CONVENIENCE,WE. CAN ARRANGE A MONTHLY PAYMENI FLAN. F'ROTECT YOUR VALUABLE CREDIT STATUS. IF YOU HAVE INSURANCE. PLEASE CALL US. DO NOT SEND COSH. SI USTEr TIENE SEGURO, POR FAVOR DE LLAMARNOS. PAY AMOUNT 367.50 PRNR YOUR MEDICARE NUMBER HERE mecr— JD • PRINT YOUR NOW PHONE NUMBER HERE BURN M PHONE • IF YOU HAVE INSURANCE OR PMU MMTE IN ANY PROGRAM WHICH WILL PAY FOR THESE SERVICES. PLEASE COMPLETE AND SIGN THE 111 E INIM OF OU BILL AND RE1U1N RE THE LNCLCiM ENVROK, IF THERE IS ANY PROBLEM REGARDING THE PAYMENT OF THIS BILL. CONTACT OUR ACCOUNT b 1 U U b—U 1 OFFICE AT ( ;05-94:5-»4072 ) WITHIN b DAYS TO MAKE ARRANGEMENTS. PLEASE SHOW ACCOUNT NUMBER ON ALL CHECKS. IMPORTANT YOU MUST SIGN REVERSE SIDE TO RECEIVE INSURANCE PAYMENT Section 4 Page 10 City of Tamarac Advanced Data Processing 10 September, 1996 6� C� reserved for HCFA farm CAC RAMSAY HMO ATTN.CLAIM DEPT P.O. BOX 14yoi5 MIAMI, FL 33114 ar IM U „ A HEALTH INSURANCE CLAIM FORM I Mi;0,LAHk: IAF.VHAIU ­,AMPU] �nAMPVA L �L-A �fnEH `•.N��I.L_ ��'N..Macn �r ..r.r.....•.mm �t. ,,r A A ,.r PLAN bLn nl. ... .. :4 FAW NI ,.__ tijN ar uArl'Nr„NAAIL LAIryTA•,Irtl/' 1'i:vr.pFj.]N1 NwM+hn.I N.IIIw Mb.w n�n�.rrr Il PAMENT:.., N-Iiryy A(E sFa A :,I,r.h:T N,\Ark l."iNrr, MA _ :d __ LAL. 3_ 0�_ 7i. M M. 55 PAIIkNF'. a�LNHL..', /l. ]nrrrrr PA *NT HL.AII()NSHIP I �NtuhVp - �r ..:r l OS SANDY FORKS RD o XX' _ J SANDY ..FOFIKS RD -_ 5.I W.x n.l I vlry, 41 ]rArE a PAr1ENr5ra .'s APT 01 x O RALEIGH NC I= ZIP I:UOE ELEPH(N+E.I: w.-ur A14W.v~ �iP �LLL r'i�Pl•. ,Nk .NI., 276 5 I'( 915) 8 5-3 81 SIVJ.II w, 276 5 919 8 6 81 —_ -- - a 7riEP -NSUPEU SNAAIE ,L.xl N.m.. FrIs1 Nam. Mg w "IMrr `u Ij PATIENT S r-L\N�lirl'N iiE LA lc:, "t]NSLFh U'i ••• 1-1'. ':Hr>NP Ur. iL`.A Nl1ML•LH M i 1 O W OTnEH INsJHW PI ~ r 1�•.�H I.A lLIt.Y DR IiROUP N1IMtlbH la EAIF`1 l)YMtNI', .•rNhENr�:;n 2REVIDL:1 •Ns:;�.LN A. •: a rES hxNO 03 06117 M •xx ul 2: (—OTIER W, k C. S UA It OF 8,H rH _..... yE. f L SJIv wL:..UI.'I r'r 'LACE Ililo. n 1. MI-ITI•-W, NAML••11--r L'IAMk MM _ - Q ,Fq X,x"'� MARRIOT'T .HOTEL 'MPLUYL,.]N•\I,rk'i{i —Hr](X NAME •JI HEH A�,. �I rF lll' •N.wHA/M.E hLAN N,LMe •IH rnr�l,r,\IA I.aML z I� —A —NU _ M tl,NSuHANC E PLAN NAME Q11 Mllj4HAM NAME IOtl. HESEn.EL 1.iP Li)I.AL .'.A; q•]111.N-10 hI '•`1' �� F.F •..I.;. ��,:. .nit... ,..r READ BACK OF FORM BEFORE COMPLETING • SIGNIFFD THIS FOAM. I IN! �.,•1. U S I H All IN )RfZEU PEH.11 A.. .,I,NA I.-J. r .r.u•� I 12. PATIENT 'S OR AUT"OFFIZED PERSONS SIGNA(URE I-Irwrli.110 I.NWW rN WnY..nrtcar lV artl.r..w.wMGn rwF.asWrT nwnl al lrrlq.,P mr wr.sto:flb MNM.,r4rrIN M.,sA..r. Ar �INnn•^Wr Ig paau II.A —. I — Ip w µW,n... al gorwr . —.- a•~ lu mVwd ,. W IM PWRY N.IR •/:-+4rs Ws:ynnWrl .rN.we- .Wl—t SIGNATURE ON FILE W/PROVIDER 2/15/76 SIGNATURE ON FILE W/PROVIDER SIGNED DA rE 'a. JIL.0 • IW DATE OF CURRENT w —Wm, LA 151E PA I IENI AA]r rAU .AME UN SIMII AR ALNE Sa III DA It � HA 1 ILN Ir)NAOI t Irj M)HF rN •,I:1,1•r/41 . •I A F��F1 DU Yr NVJUIIY �Arcnlrnn. OR DIVE FIRyT DATE MU CID N MM Lu rr AFM . 1. I r � 15 9 MVb / PHF.i:NAN1;Yr1.MPr FH(.A I 17 NAME OF REFERRING PHY51CLAN OR OrhER SOURCE 'a 10 NUMBEROF REFERRNNL: PHY31l.IAN IN 11GlP•:-I.'AIN MM i•() rr I.IM •• FkI•,yA 1'1 19 RESERVED FOR LAICAL USE 20 IXr TIDE LAB'• T S I.hAk- k 21 DIAGNOSIS ON rlATURE OF ILLNESS UH INJURY INELATE NEMS 1.2.7OH W FG ITEM:41; BYLINE. _'�. MBE MO AEyUBMISSKJN ORII'.1NAL HLF NI, �VAG BLEEA/22 WKS/2ND PREG ! L S'; 593-12- -- �__ PH.'MI AU TH•,1111A I N IN Nl,MtlhH PROCEUUHtS. SERVICkS •,H UYPLIESI hUSIS uIA.: i7'AV]�i I •.Ir11 rL ,P•1•'rl A A IEI SI OF ]EH VILETb N1 IrV. FraM pI r� 'Espy. Unu. .. Grw .0 LLN7E l-4 EMI., I — 1 rn '-• SLHARGE$ ,.rP l!i I AIM MM DD YY c .r J 'PT NI:PC$ M1YNIIF�ETR J ... ,.. r S 02 15 96! 02 J3 9A 41l 1 �31SO� �ti __.._..._ _ .. ._.gyp U. 02 15 961 02 15 96i 41 I I A03701 RH w i j r I a ..7 ' O Y ,b T(,rµl=HAw.k AMIA,NI MMI, I r 25 FEDERAL, rAx 10 NUMBER hSN EIN 25 PA TIE N T S ACCUUN T NU :' ZZLTTw7,,n,NMk N r+ — g— w nM'FII 5960005 �!R , 61 "6-01 XXVE$ NO 5 ' 367.50 1 31 ✓n"ICIAN S bUVYLIkA S SILLINU NAME AL,Ur k rY - , vL 71 SIGNATURE OF PHYSICIAN OR SUPPLIER 72 NAME AND ADDRESS OF FACILITY NNENE ]kH•ICES HERE INCLUDING DEDAEES OR CREDENTIALS RENDERED. wn/, man name w a.c.r 0..:t.II,Nw11r.I••1all.nw. WIII. lA.y,s. PARKWAY REGIONAL MED CTR I, PH Ea METRO DADE FIRE DEPARTMENT .4011 l/ Wx G." W,. m aQw.#wool1 160 NW 170 ST, N MIA BCH DEPT 7464 I i METRO DADE FIRE DEPA MIAMI, FL 33195-7464 ^.ILiNFD 9/ie/96 r,ArF PIN. A0508 30 --r5W5-4072 • - ,APPROVED BY AMA COUNCIL ON MEDICAL SERVICE &lit PLEASE PRINT OR TYPE F'AM HCFA FORM OWCH 150 15JL L"I•.i.1.1 .u,o Section 4 Page 11 ,P S'fel - I G City of Tamarac Advanced Data Processing 10 September. 1996 0 4.3.3 Payment Processing Receivables processing - Statements, bills, and electronic claims will be marked with payment address of your choice. It is recommended that a "locked -box" arrangement with the bank of your choice be used. The bank then receives all payments and processes them daily providing deposits directly to your account. Using this method, we do not directly handle any receivables, only the Explanation of Benefits (EOB), and copies of checks/money orders are sent to us along with any correspondence (denials, problems, & requests for further information). Receivables are generally posted within the same day we receive them. Receivables will be itemized and reconciled against bank deposits on a monthly closing basis. Payment collection & posting - All payments will be processed and posted with individual patient account balances maintained showing all payment amounts, check/money order number (if applicable) and date of payment. Information will be used for the purpose of either rebilling, follow-up or closing of the account. Unidentified payments - On occasion payments are received for which the identity is obscure or not immediately known (i.e. account number missing or incorrect, name provided is different than that originally filed, etc.). In these cases the receivable is processed to a suspense account so that processed receivables balance against the bank statement. These item are marked for research by a specialist who, through either database searching and/or contact of the original payor, obtains the necessary identification to properly post the item(s). Once the correct patient account has been located, a transfer is made from the suspense account to the appropriate patient account. A documentation trail is provided for such transfers. A/R Reconciliation - All accounts will be reconciled to reflect accurate balances outstanding against payments received and posted. Write-offs will also be posted where your office has provided prior agreement. 0 Section 4 Page 12 C� ' r�_ �6 270 City of Tamarac Advanced Data Processing 10 September. 1996 Rebilling and payment arrangements - Rebilling will be performed for accounts where partial payments are made or accounts where regular payments have been arranged. Details of such arrangements will be noted on the account. Refunds and returned checks - Refunds are generally processed on a monthly basis. Refund requests are presented to the City in a report format with supporting documentation provided. Checks returned as NSF can be processed in a manner determined by the City. Generally, a copy of the check is provided by the bank and we will attempt to collect the amount directly from the customer. Posting adjustments are made accordingly as a reversal entry and reflected on the month -end reporting. Reporting - All collections activity will be summarized and posted on a monthly basis. Reports are provided by the 10th of each month. Specific reports provided are identified in a later section. u • Section 4 Page 13 City of Tamarac Advanced Data Processing 10 September. 1996 0 4.3.4 Customer Service Enquiries A significant aspect of our ability to achieve high collection levels is our customer service perspective. Philosophy - Our client history shows "We are focused on our client's success improving their cash flow through constant innovation yet proven means and, providing the highest service levels attainable with professional respect by both the client and the community." We emphasize helpfulness towards the customer and respect as a representative of your organization. Consequently, our attendants are courtious and informative in a professional manner and never represent themselves as collectors or in any way that might be interpreted as intimidating or threatening. Training - Advanced Data Processing provides training and a stable environment for its attendants. They are skilled in understanding all aspects of insurance applicable to EMS transport billing so as to be helpful toward the customer. They are also trained in how to provide maximum assistance to the customer and when to transfer the call to a supervisor for handling difficult situations. We maintain a multi -ethnic staff .to handle calls in languages other than English. Support & availability - Phone lines specific to your customer requirements will be allocated with the number clearly provided on all bills and invoices. Included will be a facility providing toll -free access. Facilities and attendants are provided to ensure calls are not blocked. Rather, someone is available to answer calls Monday thru Friday (excluding Holidays) from 8:00 a.m. to 5:00 p.m. Statistics on phone activity are reviewed monthly to ensure proper level of phone availability is maintained. C ] Section 4 P2ge 14 I .. / � -7 C-) City of Tamarac Advanced Data Processing 10 September. 1996 • 4.3.5 Accounts Receivable Maintenance Receivables are processed and posted to individual accounts at which time the status of the account is updated. This updating controls the way in which the account must be subsequently processed ranging from closing paid -in -full accounts to filing secondary, refiling and invoicing or rebilling customers. Account Aging - Account activity is maintained and reflected on reports (see Section 5) provided which show daily activity for the month and aging of receivables. Accounts updated with valid payments are re -aged showing payment status as current. All accounts are summarized monthly and are reflected within categories showing their status as either current, 30, 60, 90, or 120 days. We utilize this information to focus our inquiry, rebilling and collection efforts on a routine basis. Accounting Controls - Receivables processed must balance by batch entry against bank deposits and/or other control totals in the case of adjustments. All batches processed are entered into a Control Log .All transaction batches entered for the month are balanced against month closing A/R reports and must match Controf Log totals for the month.. Reporting - Re provided which reflect daily/monthly receivables posting including Reports are adjustments and refunds. Reports are oriented towards balancing and reconciliation. Aging statistics are provided and oriented towards reflection of collection efficiency. Report examples and explanations are provided in Section 4.4. Section 4 Page 15 /C �' -,-::7,- 7 e City of Tamarac Advanced Data Processing 10 September. 1996 r� • 4.3.6 Billing Cycles The following are metrics used to determine processing and payment cycle times: ❑ Invoices for all classes are generated within a day of entering a new charge. ❑ Private insurances are given 45-60 days to pay after which time follow-up notices are generated and interrogation is performed. ❑ Insurance denials which are not correctable revert to self pay. Patient invoicing is immediate to processing of receivables and are processed generally the same day of receipt. ❑ Account aging begins from the time of invoice. Accounts are re -aged on the basis of payment. ❑ Electronic filing is used for Medicare/Medicaid payments so they are tracked sooner. Payment or denial hits the payment floor within 14-21 days of transmission. ❑ Medigap is used for fastest processing of claims secondary to Medicare. ❑ Non-Medigaps are filed within a day of receiving Medicare payment. ❑ Rebilling is performed up to six times on a monthly basis after which time they are turned over for collection. Section 4 Page 16 City of Tamarac Advanced Data Processing 10 September. 1996 0 4.4 Reports -Management Information • Advanced Data Processing prides in providing essential statistics in concise easy -to - understand format. These reports provide our client with the same insight we use to manage and increase the efficiency of their collections. Monthly reporting is produced after month closing and provided to you by the loth of each month. We produce the following major reports: ❑ Collection Statistics -Summary ❑ Collection Statistics - by Payor Class ❑ Collection Statistics - Gross/Net Computation ❑ Account activity - Monthly Billing Report (Charges) ❑ Account activity - Monthly Payment Report (Receivables) ❑ Billing & Collections - Summary to Date, Monthly Running ❑ Accounts Receivable -Summary ❑ Monthly Refund Schedule ❑ Insurance Report - # of Bills with Outstanding Balance by Class ❑ Payment Report - % of Bills Showing Payment Examples of all reports are shown and explained in this section. In addition, statement message examples are provided. Advanced Data Processing will provide other reports as requested by the City on requested basis. Section 4 Page 17 7 City of Tamarac Advanced Data Processing 10 September. 1996 0 4.4 Reports - Management Information (cont'd) 1� u The following section provides a brief explanation of major reports provided and concludes with an example of each. The samples provided are not necessarily complete nor are they all live data. Confidential information such as names, contact and ID information are obscured to protect confidentiality. 1. Collection Statistics - Summary Provides a running month summary of charge, payment and adjustments for the closing month period showing gross and net collection percentages for each period. Summarizes totals for each type activity and computes average collections for both gross and net. Note: All payment activity is reflected against the original month billed in order to reflect true collection percentages. 2. Collection Statistics - by Payor Class Provides a running month summary for the closing month period of collections by Payor Class (Self Pay, Medicare, Medicaid, Private Insurance). The report also shows for each running month the mix or, % of total collected against that month's billings for each class. Also shows # of accounts billed and total # of accounts. Summarizes total amounts collected by class and % of total. 3. Collection Statistics - Gross/Net Computation Shows overall monthly computation of gross collection percentages providing # of accounts billed and accounts not billable. Total amounts are summarized. 4. Account activity - Monthly Billing Report (Charges) Shows all billing (new charges) processed alpha sorted by Last Name and summarized total billing for period. Section 4 Page 18 ;tl-,; i o City of Tamarac Advanced Data Processing 10 September. 1996 0 5. Account activity - Monthly Payment Report (Receivables) • Provides a batch oriented listing of all payments processed including check number and type of payment (self pay, medicare, medicaid, private insurance). Report reconciles against bank deposit and ties back to E013 detail for secondary filing, refund processing and adjustments. 6. Billing & Collections - Summary to Date, Monthly Running Shows receivables as applied to "original billed month". 7. Accounts Receivable - Summary Provide summary for period ending of Accounts Receivable showing gross billing, payments received/processed, reflected write-offs and adjustments, reversals and ending balance. 8. Monthly Refund Schedule Report provides by account detail of associated payments reflecting an overpayment and necessary refund to be processed. 9. Insurance Report - # of Bills with Outstanding Balance by Class Provides summary showing by running (billed) month the number of patient bills having an outstanding balance. Shows balance and number of bills outstanding by class. 10. Payment Report - % of Bills Showing Payment Provides for each billing month total patients, number having made no payments, number and percentage having made payment. 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R«R ¥<R n UM) o E k s . .§ O k E cn 2 � co E D D A LU E ;a. 60 m_ cc Ct 7 0 � u K 5 U ƒ ® p 0 � 7 0 0 q 0 S w ? 2 I �WFL 0-0- :3 « 0 O Lu � A 7. w ƒ R \ D > $ (D w rcrc ��¥ w $ ��� Poom n k Lu a l� ZL �LU0k3 f $O ��ƒ�g�P0 02p2w O e001 �Q$m� cc wk 7XWk�Luk ���-a - n $� 02OqMLU CL C R ��CL7>-�� �8Rw ) m- ?EmƒeLL0-1 2>- 0 N % 7 CL C / m R % § g 2 / k � ƒ � k k - i L. .q -1 v 0 Section 5 - Financial & Other Information 5.0 Cost of Service The following represents all costs associated with perfrorming the proposed services for the City of Tamarac: Cost of Service is based solely on the amount collected for the City and is an "Incentive - based" plan. Cost of Service 7% of Revenue Collected There are no additional set-up charges, per piece charges, processing charges, material costs nor, any other undisclosed charges with the following stated exception: Exception 1 - Price is based on no additional costs to Advanced Data Processing especially associated with any requested increase in its insurability. None of our clients . require any specialized policies such as performance bonds, errors or omissions policies. While we carry General Liability at the $1,000,000 level, Auto Liability and Workers Compensation Insurance, we do not carry any of the aforementioned special coverages. Instead, we have proposed a set of services which, in process, are proven to be effective and used by all of our clients. The proposed process uses a "lock -box" approach to handling of all receivables which is performed by the bank of your choice. This protects the City as the billing agent never directly handles any receivables. Lock - box service for a client the size of Tamarac generally costs about $300 dollars/month and can sometimes be negotiated as a no -charge item from your bank. Our experience has been that our current insurance coverage is more than adequate, especially since we do not directly handle any receivables. In addition, we have found it nearly impossible and extremely costly to obtain these types of coverages. If this is an absolute necessity, we will comply by requiring the City to both obtain a source for such insurance and absorb its cost. Exception 2 - With regard to the City's request for an independent audit (RFP Section is 2.3 U Page 11) - Advanced Data Processing is fully willing to comply with this request. Section 5 Page 9 Citv of Tamarac Advanced Data Processing 10 September. 1996 However, according to our experience, every municipality that has requested such an audit in the past has been willing to perform the audit using their own auditors. While we respect the City's desire to have this performed by an independent auditor, an audit applicable to the services provided to the City as requested in the RFP would represent an unknown cost. As such, Advanced Data Processing will extend to the City the following two options: Such audit can be either 1) provided by an independent auditor of the City's choice for which we will pay up to $1500 dollars toward such cost or, 2) we will provide openness for the City's own auditor to perform such examination/audit at their convenience and cost. 5.1 Deliverables Required for Start-up The following general deliverables and milestones are required for the successful commencement of billing and collections processing for the services to be performed and agre performed at no additional cost to the City: Forms Definition & Changes - All information required to process charge information and generate billing on behalf of the City will be provided by the City and reviewed. Any pursuant changes to forms and information will be identified and completed. EMC Filings - Forms required to establish electronic claims processing with various carriers, especially Medicare and Medicaid, will be completed and filed. "Locked Box" Bank Arrangement - Required forms and logistics required to establish receipt and delivery of receivables will be coordinated with selected bank. Database Setup - Database on Advanced Data Processing's system will be established for the purpose of tracking and maintaining all data for transactions processed on behalf of City of Tamarac. All system definition and setup will be completed to allow start of processing. Receive & Process First Charge Batch - Processing of charge items/transport incidents will begin within one (1) week of their receipt. Begin Processing Payments - Payment processing will begin immediately as they are received. �J Section 5 Page 10 C. & City of Tamarac Advanced Data Processing 10 September. 1996 5.1.1 Assistance Required from City The following are items which may require some assistance from the City of Tamarac in order to perform services proposed: Hospital Coordination - The cooperation of the various hospitals to which the City transports patients has already been identified as a key element in increasing collections for the City. Since the City is actually increasing the revenue of the hospitals by bringing patients to them, the City has a better leverage position with these hospitals. The City then plays a crucial role in working with Advanced Data Processing to secure such participation by the hospital as providing copies of ER and Admitting Face sheets, Telephone Verification of Patient Information, and Inside Use of Computer Facilities solely for Access of Patient Demographic & Insurance Data. Process & Form Review - The City will be requested to initially review all key forms and their information for the purpose of understanding the process flow and acknowledging that all specific requirements are met. Authorization - The City will be required initially, and on some follow-on occasions to . provide signature approval on certain documents. Short turn -around may be required on occasion. Write-offs & Refunds - Review and approval will be required by the City for all write-offs where the amount to be collected is substantially different from that of the charge(s). Refund requests due to insurance over payment will be processed only with review and approval by the City and will require a check to be generated by the City. 5.1.2 Assistance Provided to City Advanced Data Processing will provide initial training to City of Tamarac on all aspects of its service especially those involving start-up. Documentation will be provided on all forms executed, reports generated, aspects requiring coordination between our company and the City (e.g. refunds processing, batch submission, reconciliation, etc.). 5.1.3 Evidence of Financial Stability Advanced Data Processing having excellent financial status owns all of its principal facilities, computer systems and equipment and, has an interest in an additional 10,000 square feet of Section 5 Page 11 Citv of Tamarac Advanced Data Processing 10 September. 1996 facilities within the same office complex. Advanced Data Processing has no major debt having as its only liability a 2-year remaining property mortgage for the amount of $2O,OOO dollars. 5.1.4 Insurance Advanced Data Processing can comply with all general insurance requirements set forth by City of Tamarac in the RFP. We currently have General Liability Coverage, retain comprehensive auto insurance and also meet all Worker's Compensation requirements. We will provide copies of required insurance prior to beginning services if so awarded. 5.1.5 Current Levels of Bonding Advanced Data Processing, Inc., has not been required to provide any type of Bonding for our clients. • Section 5 Page 12 City of Tamarac Advanced Data Processine 10 September. 1996 • �J 5.2 - Other information 5.2.1 Business Entity Advanced Data Processing, Inc. is a legal business entity incorporated in and licensed to practice business by the State of Florida. The firm is locate at 520 N.W. 165th Street Road, Suite 201, Miami, FL 33169. 5.2.2 EEO Statement Advanced Data Processing ensures that, as an Equal Opportunity Employer under Affirmative Action, it does not discriminate for reasons of race, color, age, religion, sex, national origin, or handicapped status in any hiring nor operating policies against its employees nor applicants. Advanced Data Processing will comply with applicable Florida State Statutes and City of Tamarac Ordinances regarding Equal Opportunity and Affirmative Action. We will also complete any and all required local filings with the City in this regard. 6.2.3 Public Entity Crime Statement Neither Advanced Data Processing, Inc. nor its Officers have ever had any litigation or criminal action case filed against them, and have never been involved in any Litigation, or criminal misconduct whatsoever. 5.2.4 Federal Employer ID Number Advanced Data Processing, Inc. is registered with the Federal Government and the Internal Revenue Service under Tax Identification Number 59-2428993. Section 5 Page 13