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Billing, Ltd., hereinafter refened to as AMB.
WHEREAS, Oak Brook has determined that it is in their best interest to retain theservices of an outside biling service to colect monies foiierice" renoereo uy oat
WHEREAS' AMB does hereby hord itserf as being ready and abre to perform a biringservice program as described herein.
NOW, THEREFORE, in consideration of the aforementioned promises and mutualcovenants and promises stated herein, the parties hereby agree as follows:
1 A.[UB shall provide an Accounts Receivable program within AMB,S computerbilling system for the exclusive purpose of colbltions'for Oak Brook. '
AMB will enter into said computer billing system, any and all ambulance tripsreceived from Oak Brook. AMB shall ab-stract, from ihe documentation proilAeO
.bJ^O_llP:"_*l :,t diagnosis and procedure iniormation necessary to determinerne tevet and type of service. provided, any billable diagnostic anj therapeuticprocedures performed, any biflabre suppries and ancilary services rend'ered, andthe appropriate diagnosis codes to be biled tor att amuuiance run information-' -
provided by AMB by the client for that purpose.
AMB wirr foflow estabrished biling industry guiderines, incruding those estabrishedby State and Federal govemmenl programj, for ambulance services. Oak Brookretains responsibility for providing accurate and complete documentation oiservices provided. oak Brook understands that AMB wi cooeruirionlyliom ttredocumentation provided.
2 AMB shafl provide erectronic biling of Medicare, Medicaid, Insurance craims,including- 3d p-arty payors, when afpricabre. rt is'the responsiolity of oak Brook toinform AMB of any changes in the company,s staG Gt woutO iff""i Oiffing.
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4AMB_will invoice all patients as directed by oak Brook, in accordance with stateand Federal programs.
Patient invoicing will be done on a billing form specific for Oak Brook.
lnvoicing/collection activities will be conducted on the following standardschedule:
1st invoice within 3 days of receiotlnsurance request 30 days aftLr 1, i;;;i;Automated phone call 20 days after insrrance ,eque"tz - lnvotce 10 days after phone callFinal notice ZO aays atter I; invoiceCollections or WO review aO aays atter frnai noiii!
Bill schedules may vary based on parameters set by department.
Collection agency or write off if no results. from above as pre_determined by OakBrook. lf Oak Brook decides to use a.collection
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iMB, *thout charges,shall provide Oak Brook or the collection
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,,iitn il"oid-s of its bilting efforts.AMB will not receive any funds in tne evenittte 'coif".tion
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,ucceeds incollecting part or all of the charges for services renaereO #6ak groot.
All.Jnoli:s received by AMB on behalf of Oak Brook will be posted to thepatients' accounts on a schedure set forth by oak Brooi. ntr'c-trecrs wi, be madepayable to Oak Brook. tt is the responsibitity of Oak aroot io notify nMB ;;ny -
payments and/or documents pertaining to billing received ai Oaf Aroof reAtiryto the services heretofore described.
AMB wiil majntain an 800-phone line for the purpose of customer service. Thisline will be staffed Monday through Fridav fro, 6so "ri"-i'ib pm centrar time.
IMP ytll promptly respond to a Oak Brooks' service recipient concems retatedto all billing practices conducted herein.
AMB will submit a monthly reports detailing the transports billed from theprevious.m.onth. tt is the responsibitity-of O;k Bdi 6 ;t ilese reporrs andprovide AMB with anv missino data. All reports cunentf, *it'f,in tn" software ofAMB's billing system wifl be piovicred to oak Brook at no additionar cost.6
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A.ttlB shall, while this Agreement ls ln effect, provide Oak Brook Wth Cerflflcatgsof lnsurance showing the mverage provided for auoreino tltr-e generar riabiritypolicy sha name the M age of.Gk Brook, ite omc€rs, ;il;;;. and agents asan additionar insured. The cerrific€t€ of rnsurance
"ni[iniiciie tnat tr.,einsurance cannof be canceled, susp€nded or redra"Oin urornj
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oow.agswithout at least 30 days, prior written notice to Oak grooX. -- "
I this contract is terminated prior to its completion, Oak Brook allows AMB locontinue cor€ctions €ffortE for a perrod of 6 months rJio*inj in-.'*ntrarttermination, untess other arenoements havo Oeen agreeO ii Ly-Uottr parties inwritins. oak Brook undersrandJtnar trrey wiri b;;;#;il;i;;ay AMB theircommission on their colections during this timo peribd in ...t-rirn." ,rrth seclonI (c).
Proper notice may be given by csrt i€d or register€d mail to:
Patrick J. Mannix
Chief Executlve Offlc€r
Andres M6dical Billing, Ltd.
3223 N. Wttke Road
Arlington Heights, lL 60004
OR TO;
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fAM8 b Юttm b Oak
to AMB,excepl as requiredby Federal Law
IN WITNESS wHEREOF,the RespOnsible Patty of oak BrOok and an A崚
ho∥zed Agentof AMB haVe executed this agreement
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