R-1765 - 12/11/2018 - AGREEMENTS - Resolutions Exhibits REVIEW OF CONTRACTS
Award in Agency: T pe of Contract:
L tk l r1 i
Department: Program/A aunt Number:
Awarded Contract Price: Budgeted Amount:
ICL
[� under $20,000 $500,001 - $1,000,000
Q $20,000 - $500,000 Over $1,000,000
Name: Date:
Name: Date: l&7
Name: Date:
Name:
Date:
1 Three (3) Originals signed by other party Date/Initials I
Original provided to staff member for other party Date/Initials 1
i
Original provided to Official Files Date/Initials
Village of Oak Brook i Approved by Board of Trustees- Date/Initials:
1
AADRES MEDICAL BILLINC.Ltd.
This Agreement is entered into as of - 2018 2018 between
the Village of Oak Brook, hereinafter referred to as Oak Brook and Andres Medical
Billing, Ltd., hereinafter referred to as AMB.
WHEREAS, Oak Brook has determined that it is in their best interest to retain the
services of an outside billing service to collect monies for services rendered by Oak
Brook.
WHEREAS, AMB does hereby hold itself as being ready and able to perform a billing
service program as described herein.
NOW, THEREFORE, in consideration of the aforementioned promises and mutual
covenants and promises stated herein, the parties hereby agree as follows:
1. AMB shall provide an Accounts Receivable program within AMB's computer
billing system for the exclusive purpose of collections for Oak Brook.
AMB will enter into said computer billing system, any and all ambulance trips
received from Oak Brook. AMB shall abstract, from the documentation provided
by Oak Brook, all diagnosis and procedure information necessary to determine
the level and type of service provided, any billable diagnostic and therapeutic
procedures performed, any billable supplies and ancillary services rendered, and
the appropriate diagnosis codes to be billed for all ambulance run information
provided by AMB by the client for that purpose.
AMB will follow established billing industry guidelines, including those established
by State and Federal government programs, for ambulance services. Oak Brook
retains responsibility for providing accurate and complete documentation of
services provided. Oak Brook understands that AMB will code/bill only from the
documentation provided.
2. AMB shall provide electronic billing of Medicare, Medicaid, Insurance claims,
including 3rd party payors, when applicable. It is the responsibility of Oak Brook to
inform AMB of any changes in the company's status that would affect billing.
3. AMB will invoice all patients as directed by Oak Brook, in accordance with State
and Federal programs.
Patient invoicing will be done on a billing form specific for Oak Brook.
Invoicing/collection activities will be conducted on the following standard
schedule:
1st invoice within 3 days of receipt
Insurance request 30 days after 1St invoice
Automated phone call 20 days after insurance request
211 invoice 10 days after phone call
Final notice 20 days after 2nd invoice
Collections or W/O review 30 days after final notice
Bill schedules may vary based on parameters set by department.
Collection agency or write off if no results from above as pre-determined by Oak
Brook. If Oak Brook decides to use a collection agency AMB, without charges,
shall provide Oak Brook or the collection agency with records of its billing efforts.
AMB will not receive any funds in the event the collection agency succeeds in
collecting part or all of the charges for services rendered by Oak Brook.
4. All monies received by AMB on behalf of Oak Brook will be posted to the
patients' accounts on a schedule set forth by Oak Brook. All checks will be made
payable to Oak Brook. It is the responsibility of Oak Brook to notify AMB of any
payments and/or documents pertaining to billing received at Oak Brook relating
to the services heretofore described.
5. AMB will maintain an 800-phone line for the purpose of customer service. This
line will be staffed Monday through Friday from 8:30 am to 7:30 pm Central time.
AMB will promptly respond to all Oak Brooks' service recipient concerns related
to all billing practices conducted herein.
6. AMB will submit a monthly reports detailing the transports billed from the
previous month. It is the responsibility of Oak Brook to verify these reports and
provide AMB with any missing data. All reports currently within the software of
AMB's billing system will be provided to Oak Brook at no additional cost.
7. AMB shall recognize and comply with the right of authorized Oak Brook
representatives to review any and all payment records pursuant to claims and/or
collection procedures conducted herein. Oak Brook shall have the right to audit
such reports at reasonable times.
8. Oak Brook agrees to pay AMB in accordance with the following fee schedule for
the aforementioned services so long as this agreement has not been terminated.
a. AMB shall be paid a fee of(3.42%) of all payments
collected.
b. Payments to AMB shall be based upon revenues received in the
preceding month. AMB will provide a monthly billing to Oak Brook
calculating amounts owed to AMB based upon the above stated
formula.
C. Failure to pay AMB within 30 days of the monthly bill may constitute
immediate termination of the contract and possible legal action at the cost
of Oak Brook.
9. If Oak Brook determines it is in their best interest to use a collection agency, Oak
Brook will deal directly with the collection agency regarding their fees.
10. It is expressly understood and agreed that AMB is an independent contractor
who shall at all times maintain insurance in force as herein provided and AMB
shall in all events defend and save and hold harmless Oak Brook from any and
all liabilities, obligations, debts, charges, or judgments arising from claims,
injuries or debts, charges, or judgments arising from injuries or property damage
claims attributable to the activities of AMB while engaged in the performance of
its duties under this Agreement.
11. It is the sole determination of Oak Brook as to fees for services that will be
charged to its patients and/or facilities. It is recommended such fees should be
based on fair market value.
12. This agreement shall be effective on the date hereof and shall remain in full force
and effect for a term of five (5) years. Thereafter, this Agreement may be
extended for successive one (1) year periods for a maximum of three (3) years,
at the Village's sole discretion, unless terminated as hereinafter set forth. All
terms and provisions of this Agreement shall continue in full force and effect
unless otherwise modified. Either party may terminate this agreement at any time
by giving the other party ninety (90) days written notice. Notwithstanding the
aforementioned, this agreement shall be subject to immediate termination by Oak
Brook if AMB fails to maintain insurance as in part 13.
13. AMB maintains General Liability $1,000,000 per occurrence/$2,000,000
aggregate; Commercial Auto w/ hired non-owned coverage $1,000,000; Workers
Compensation $500,000/$500,000/$500,000; Professional Liability of
$1,000,000; Employment Practices Liability $250,000
AMB shall, while this Agreement is in effect, provide Oak Brook with Certificates
of Insurance showing the coverage provided for above and the general liability
policy shall name the Village of Oak Brook, its officers,employees and agents as
an additional insured. The Certificate of Insurance shall indicate that the
insurance cannot be canceled, suspended or reduced in amount or coverage
without at least 30 days' prior written notice to Oak Brook.
14. If this contract is terminated prior to its completion, Oak Brook allows AMB to
continue collections efforts for a period of 6 months following the contract
termination, unless other arrangements have been agreed to by both parties in
writing. Oak Brook understands that they will be responsible to pay AMB their
commission on their collections during this time period in accordance with section
8 (c).
Proper notice may be given by certified or registered mail to:
Patrick J. Mannix
Chief Executive Officer
Andres Medical Billing, Ltd.
3223 N. Wilke Road
Arlington Heights, IL 60004
OR TO:
At termination of the Agreement it is the responsibility of AMB to return to Oak
Brook any and all records and documents submitted to AMB, except as required
by Federal Law.
IN WITNESS WHEREOF, the Responsible Party of Oak Brook and an Authorized Agent
of AMB have executed this agreement.
VtL OF OAK BR ANDRES ME ICAL BI ,ING,LTD.
1
B .
DATE: l� �/a 'l �J DATE: