BILLING SERVICE AGREEMENT
THIS AGREEMENT made and entered into as of March 29, 2024, by and between Professional Ambulance Billing LLC, a New York limited liability company having its principal place of business at 8610 Main Street, Williamsville, NY 14221, and the Town of Webster Emergency Medical Service, with its offices located at 1000 Ridge Road, Webster, NY 14580 (hereinafter the "Provider").
WITNESSETH WHEREAS, the Provider and Professional Ambulance Billing LLC wish to establish a professional relationship for ambulance Basic and Advanced Life Support billing services whereby Provider apparatus, equipment and personnel will be utilized by Provider, which services by Provider will be billed by Professional Ambulance Billing LLC as provided herein; and, WHEREAS, the Provider supplies certain ambulance services to the residents and visitors of its primary and mutual aid territories; WHEREAS, the Provider desires to be reimbursed, to the extent legally permissible, by the individuals utilizing the Provider’s ambulance and Basic and Advanced Life Support services, by such individuals or through their government and/or private health insurance carriers; and, WHEREAS, Professional Ambulance Billing LLC has experience in revenue recovery for services as a third-party billing service and is willing to provide such service to the Provider for a fee; and, WHEREAS, the Provider desires to have Professional Ambulance Billing LLC provide certain revenue recovery services (as described herein) as a third-party billing service. NOW, THEREFORE, in consideration of the foregoing promises and the usual covenants and promises contained herein, the parties agree as follows: 1.
Work To Be Performed and Services to Be Rendered
(A)
Professional Ambulance Billing LLC shall provide revenue recovery services on behalf of the Provider. The provider hereby designates Professional Ambulance Billing LLC as the exclusive provider of Provider's billing services for the term of this contract, and for each renewal or extension thereof. Professional Ambulance Billing, LLC shall utilize its best efforts to comply with industry standards of professional ambulance billing.
(B)
Professional Ambulance Billing LLC shall serve as the Provider's authorized agent for the purpose of obtaining the necessary agency authorizations, provider numbers and insurance company contracts required for revenue recovery.
(C)
Professional Ambulance Billing LLC will mail or electronically transmit a claim to the insurance carrier of the patient in accordance with federal, state, or other applicable requirements. In the absence of insurance information or a patient's signature, correspondence will be sent to the patient only to obtain the required billing information. At no time will Professional Ambulance Billing LLC issue any bill to a known uninsured person.
(D)
Professional Ambulance Billing LLC shall upon receipt of any payment by or on behalf of the individual(s) who received the service, direct deposit the said payment in a bank account established designated by the Provider based within 10 business days of receipt. All funds shall belong to Provider.
(E)
Professional Ambulance Billing LLC shall provide initial and, where requested, ongoing training to the Provider’s members and employees in the use of its system at no charge to Provider.
2.
Obligations of Provider/Contractor
(A)
Provider’s contractor shall provide accurate, complete, and detailed medical, treatment, patient care, and mileage and transportation information for patients. In no way shall Professional Ambulance Billing LLC be required to verify the accuracy of any such information provided.
(B)
Use its best efforts to obtain accurate billing and insurance information.
(C)
Timely submit Patient Care Reports to Professional Ambulance Billing LLC.
(D)
Cooperate with Professional Ambulance Billing LLC in all respects with regard to the collection of information and the submission of accurate bills.
3.
Compensation and Fees (A)
The Per the stated agreement between PVAC and the Town of Webster EMS, there will be no monetary charge for billing services provided by PAB to the Town of Webster EMS, which includes all necessary credentialing support and reporting requirements. All fees will be billed to PVAC per our normal customary charges under our current agreement between PVAC and PAB. The Town of Webster EMS and PAB will adhere to all services and responsibilities as set forth in this agreement for both parties except for the payment terms stated above. As a courtesy to the Town of Webster EMS, in the event a charting software is required, PAB will provide such software at no charge to the Town of Webster EMS.
(B)
4.
The contractor shall, on behalf of the Provider, pay Professional Ambulance Billing LLC's invoice in the next normal check production/accounts payable cycle, but in no event more than thirty (30) calendar days from the date of the invoice from Professional Ambulance Billing LLC. Reports Reports shall be emailed to the Provider (at the designated email addresses for such purposes) each calendar month by Professional Ambulance Billing LLC. The reports shall include charge detail, credit and collection detail and an aged patient receivable report as of the end of each month. Professional Ambulance Billing LLC will provide timely customized reports as necessary to facilitate any audit requirements.
5.
Limitation of Liability
(A)
Should any action arise from inaccurate or inappropriate billing based on inaccurate or inappropriate information which the Provider has provided to Professional Ambulance Billing LLC, the Provider shall be jointly and severally responsible for any and all actions, costs, judgments, fines, and fees. Provider shall jointly and severally defend, indemnify, and hold Professional Ambulance Billing, LLC harmless for any such acts where the acts or omissions of Provider were due to Professional Ambulance Billing's unintentional conduct.
(B)
Professional Ambulance Billing, LLC shall defend, indemnify, and hold Provider harmless for any lawsuits, actions, judgments, fines, or other costs or fees arising solely out of Professional Ambulance Billing, LLC's acts or omissions.
6.
Confidentiality
(A)
Professional Ambulance Billing LLC, its employees and agents shall not disclose or use for benefit of other than the Provider, any and all information obtained from the Provider. Professional Ambulance Billing LLC shall be bound by the laws of confidentiality which bind the Provider in the Provider's jurisdiction.
(B)
The Provider, its members, employees and agents shall not disclose or use for benefit of other than Professional Ambulance Billing LLC, any and all written or tangible information developed as a result of this Agreement.
(C)
The Parties shall enter into a Business Associates Agreement in the form attached hereto for purposes of protecting patient confidentiality.
7.
Terms of Agreement This Agreement shall be effective for 3 years from the live date of Patient Care Reports (PCR) placements from provider. This Agreement shall automatically renew annually, for an additional one year period unless any party provides notice of termination no less than ninety (90) and no more than one hundred twenty (120) days prior to the expiration date of this Agreement.
8.
General
(A)
Professional Ambulance Billing LLC represents, warrants and agrees that it is and will continue to be compliant with all regulations of the Office of the Inspector General (OIG) and the New York State Office of the Medicaid Inspector General (OMIG). a. Each party warrants to the other that it will check the Office of the Inspector General's List of Excluded Individuals/Entities (LEIE) prior to making a decision to employ an individual or contract with an entity to provide items or services directly or indirectly payable by a federal health care program, will check the LEIE periodically to determine whether any of its personnel or contractors have been excluded from a federal health care program, will terminate any excluded person or contractor from performing work that it is directly or excluded person or contractor who has performed work for it under this contract during the period of the exclusion that was billed or would otherwise be billable to a federal health care program. b. Notwithstanding any other provisions of this Agreement, either party may terminate this agreement immediately upon the exclusion of the other party from any state or federal health care program.
(B)
This Agreement is the sole and entire understanding between the parties relating to the subject matter hereof, and supersedes all prior understandings, agreements, and documentation relating to the subject hereof. This Agreement may be amended only by an instrument executed by the authorized representatives of both parties.
(C)
This Agreement shall be interpreted in accordance with the laws of the State of New York.
(D)
Professional Ambulance Billing LLC and its representatives are independent contractors of the Provider, and Professional Ambulance Billing LLC and its representatives in no event will be considered an agent, employee or joint venture of, or with the Provider, or their representative or agents. The sole exception to this paragraph is for the purpose of obtaining necessary authorizations, provider numbers and insurance company contracts as cited in Section 1., paragraph (C) and for conducting billing services on behalf of the Provider.
(E)
Any waiver or modification of any provision of this Agreement shall be in writing. No waiver of any provision of this Agreement will constitute a waiver of any other provision hereof, whether or not similar, or a continuing waiver. The performance by any of the parties hereto of any act not required of it under the terms and conditions of this Agreement will not constitute a waiver of the parameter for and limitation on its obligation under this Agreement, and no such performance shall stop such party from asserting such parameters or limitations as to any further or future performance of its obligations.
(F)
Any notice required to be given under this Agreement shall be in writing and mailed certified mail, return receipt requested, registered mail, or overnight delivery service to the intended party as follows: TO: Professional Ambulance Billing LLC 8610 Main Street Williamsville, New York 14221 TO: Town of Webster Emergency Medical Service 1000 Ridge Road Webster, NY 14580
9.
Definitions
For the purpose of this Agreement, the following definitions shall apply: (A)
"Service" shall mean any ambulance, transportation or emergency medical service provided by the Provider or other individual(s), whether treated and/or transported by the Provider or its representatives.
(B)
"Information" shall mean a document containing the following: (i)
The date and time the service was rendered by the Provider or its representative(s) to an individual or individuals.
(ii)
The location where the service originated and occurred.
(iii)
The apparent reason why the service was requested (e.g., auto accident, heart attack, non-vehicle trauma, seizure, etc.)
(iv)
If the service is, in part or in whole, transportation, the destination of the service including the name of any hospital.
(v)
The name, address and gender of the individual(s) who received the service.
(vi)
The name and address of the legally responsible party if other than the individual(s) who received the service
(vii)
The date of birth of the individual(s) who received the service.
(viii)
An assessment of the illness/injury of the individual(s) who received the service.
(ix)
Whether the injury/illness to the individual who received the service is workrelated.
(x)
For service provided to an insured individual who is insured for any portion of the cost of the service, the name and address of the insurer and the insured's insurance identification number(s) including group and individual numbers, together with any signatures required for revenue recovery.
(xi)
Any supplemental insurance information requested by Professional Ambulance Billing LLC where the service is provided to an insured individual.
(xii)
Whether the Provider desires direct billing to a third party (such as a third-party payer) for the service provided to an insured individual(s).
The information required hereunder shall be supplied to Professional Ambulance Billing LLC based upon a mutually agreed upon schedule for all services provided by the Provider during the preceding period.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their duly authorized representative as of the date first written above.
Professional Ambulance Billing LLC
Town of Webster Emergency Medical Service
By:
By:
Charles Jordan Title:
Name:
President
Title:
Date:
Date: