2022/06/15 Council Agenda Packet

(a) The Provider agrees to provide Consultant the patient's "EHR" (Electronic Health Record), including patient name, address and pertinent billing and insurance information from the field, including a copy of the patient signature for authorization of benefits and responsibility for payment, authorizing billing of Medicare, Medicaid and any insurance the patient is a subscriber to. The Consultant will take reasonable steps to obtain such signatures if the Provider was unable to obtain them due to the circumstances in the field. The original patient signature must be maintained by the Provider and made available to the Consultant and/or insurance payers upon request. The amounts to be billed will be determined by the Provider and provided to the Consultant in writing. The Provider may increase such amounts from time to time by written notice to Consultant prior to the submission of affected EHR. "Automatic" annual increases should be communicated in writing as dollar amounts for confirmation each year. EHRs must be sent using a NEMSIS compliant XML format, or an additional fee may be charged. (b) The Provider agrees to furnish the Consultant the medical record number (MRN) and the patient's date of birth, correct name and other necessary demographic information, including any insurance information obtained. Copies of any payments made directly to the Provider will be forwarded to the Consultant for accounting purposes in a timely manner. The Provider agrees to generate any refund checks due to overpayments identified by the Consultant directly to the payer to which the refund is due, based on detailed information provided by the Consultant. The Provider shall provide additional information as may be required by insurance companies or other agencies in order to facilitate the Consultant's obligations to the Provider. (c) The Provider will furnish the following documents to the Consultant, as applicable: resolutions pertaining to this Scope of Services; specific write off policies; collections procedures; and rates and fees to be charged by the Provider and administered by Consultant as part of the Scope of Services performed under this Agreement. The Consultant will comply with these documents as they pertain to the Scope of Services. The Provider may change these documents from time to time by written notice to Consultant in advance of when the new policies, procedures and/or rates in the documents take effect. (d) The Provider agrees to complete registration with Consultant's vendors as applicable for Consultant to be able to fulfill its obligations to Provider. Such vendors may include e-payment and merchant services portal, remote deposit capture services, and clearinghouse registration. 1.2 Upon receipt of the EHRfrom the Provider, the Consultant shall: set up a patient account in Consultant's proprietary software application and create a patient record; perform all billing operations including follow up statements and any necessary rebilling of EMS patient transport services provided by the Provider to the subscriber's medical insurances, Medicare, Medicaid and any and all known secondary insurance providers; produce and forward CMS 1500 forms and/or electronic medical claims per payer's rules and regulations within the legal boundaries of all federal and state laws; produce and mail an initial invoice and subsequent 2