HomeMy WebLinkAboutC2008-235 - 7/15/2008 - ApprovedEMS Fee Collection Agreement
Recitals
1. The City of Corpus Christi, a Texas home-rule municipal Corporation, ("Cit}~'), PO Box
9277, Corpus Christi, Nueces County, Texas 78469-9277, provides ambulance services to its citizens
through the Emergency Medical Services Division of the Fire Department, ("EMS"); and
2. The City has established certain fees for providing ambulance services ("EMS Fees") which
EMS Fees must be billed and collected for sound fiscal policy; and
3. The City needs a contractor with billing and collection experience, ability, and knowledge of
the industry to bill and collect the EMS Fees, including delinquent debt collection, rate adjudication
for Medicare/Medicaid, and electronic claims filing for Medicare, Medicaid, and Commercial
insurance; and
4. Southwest General Services of Dallas, L.L.C (SGS) 9441 LBJ Freeway, Suite 600, Dallas,
Texas 75243, submitted its Response to Request for Proposals, BI-0106-08, Accounts Receivable
Management and Delinquent Collection Services for EMS Fees on March 7, 2008, ("Response"),
which is incorporated herein for all purposes; and
5. In its Response, SGS represented that it has the experience, knowledge, and ability to
perform the services sought by the City; and
6. The City has evaluated all the Responses and detennined the Response of SGS is the best
value to the City.
In consideration of the payments and covenants herein, the City and SGS agree as follows:
1. Term. EMS Fee Collection Agreement ("Agreement") is for 3 years beginning on October 1,
2008 through September 30, 2011, subject to annual appropriation. This Agreement may be
extended on the same terms and conditions for two additional 1 year terms each starting on the first
2008-235
07/15/08
M2008-168
Southwest General Services
day of October and ending the last day of September in the following year upon the written request
of the City Manager, or designee, "Notice" sent to SGS at least 60 days prior to the end of each term
and SGS's written approval within 15 days thereafter; provided that the City Manager and authorized
agent of SGS ("SGS Agent") may negotiate the fees paid to SGS therefor.
If the City has not awazded a new EMS Fee Collection Agreement, or otherwise terminated this
Agreement, the City Manager or his designee may extend this Agreement on a month to month basis
until a new contract is awarded by City Council, or this Agreement is terminated. If the month to
month extension is exercised, the fees for services will remain the same as in the previous extension
period. Notice of termination during any month to month extension is reduced to 30 calendar days.
2. Fee. City will pay SGS 6% of the net fees collected for EMS services per month for its
services under this Agreement and SGS agrees to use due diligence and its best efforts to bill and
collect the maximum amount due the City. The consideration paid is based on SGS collecting a
minimum of $5.5 million for the City per annum using the City's fiscal year ("City FY"). For year 1
of the contract, SGS will guarantee collecting a minimum of $4.125 million for the City.
If SGS's collections for year 1 of the contract falls below $4.125 million, SGS will reimburse the
City 10% of the fees paid for services during yeaz 1, determined 12 months after the initial term of
the contract. If SGS's collections for years two through three of the contract, and all exercised
extensions, falls below $5.5 million, SGS will reimburse the City 10% of the fees paid for services
during that City FY, determined 12 months after the year in review is initiated.
The Contract Administrator will review SGS's EMS Fee collections each City FY, or portion thereof,
to determine whether SGS has collected the guaranteed annual minimum of $4.125 for year 1 of the
contract ,or $5.5 million for years two through three, and all exercised extensions. If SGS has not
collected the guaranteed annual minimum, the Contract Administrator will invoice SGS for the
amount of reimbursement due based on the agreed percentage of 10%, and SGS will pay the invoiced
amount within 30 calendar days after the date of the Contract Administrator's letter.
If SGS's EMS Fee collections for the last City FY; original contract, extension or month to month
extension; or portion thereof, are less than the guaranteed $5.5 million, City may withhold the last
month payment until the Contract Administrator has received all SGS's collection figures for that
City FY, or portion thereof, and compared it to the $5.5 million guarantee, or portion thereof, and
determined whether City is entitled to a reimbursement, which will be taken out of the last month
payment and the balance remitted to SGS within 30 days after receipt of all figures from SGS on
which to make the comparison.
3. Deposit Agreement. SGS covenants to deposit all EMS Fees collected at its Corpus Christi
office or P.O. Box for City no later than 24 hours after receipt by SGS, with Central Cashiering at
City Hall, the City's depository or as otherwise directed by the City Manager or his designee.
4. SGS Services. SGS will bill for and collect all EMS Fees in accordance with its Response,
which is incorporated by reference as if set out fully herein, this Agreement, and all applicable
federal and state debt collections laws and regulations. SGS' services also include delinquent debt
collection, rate adjudication for Medicare/Medicaid, electronic claims filing for Medicare, Medicaid,
and Commercial insurance, and financial reporting.
5. Adjustments to EMS Fees. After entry of the full EMS Fee into the SGS billing system and
receipt of an EMS Fee, SGS is authorized to adjust EMS Fees written off to Medicare, Medicaid,
Workers' Comp, Champus, Crime Victims Fund, and Nueces County patients to the maximum
allowable charge for each service rendered to such patient, and to the extent permitted by law to
automatically include any increases in the maximum allowable charge for such patients ("Adjusted
EMS Fees"). SGS must provide a monthly report, by category, of the number of Medicare,
Medicaid, Workers' Comp, Champus, Crime Victims Fund, and Nueces County patients and the
dollar amount of adjustments for each category, which identifies each EMS Fee. This report can be
combined with another existing report or may be a new report.
SGS must bill each Medicare or Medicaid patient for his/her deductible and Medicare and Medicaid
for the Adjusted EMS Fees, less deductible for each such patient.
The SGS Agent must request an adjustment for all other EMS Fees that it wants to adjust from the
Contract Administrator, who is the Fire Chief ("Fire Chief') or his/her designee. The Fire Chiefhas
the authority to adjust EMS Fees as necessary.
6. Data. SGS will provide the RescueMedic software to the City for use on the City's laptops
and PC's as required to enter patient data into the database. All licensing, rights and use privileges
will be made available to the City. All data is the property ofthe City. SGS will not release the data
without the written approval of the person to whom the data applies. SGS will return all data to the
Fire Chief within 30 days after termination or expiration of this Agreement.
7. Data Entry. Once the RescueMedic software system is in place and being used in the field,
EMS staff will send SGS the information as soon as possible. If additional information is needed to
bill a patient SGS will get and enter the information into the database. If data is incorrect or
incomplete SGS Agent will notify Fire Chief.
8. Reports. SGS must keep and maintain all required reports and make those reports available
to the City Manager at all reasonable times. SGS agrees to keep such other records and in the form as
the City Manager may reasonable require and to make them available at the City Manager's request.
The list of monthly reports currently required to be sent to the Manager of A/R-Collections is
attached and incorporated as Exhibit A.
SGS shall provide accurate reports and competent work.
SGS will provide all Texas Trauma Registry Reporting to the proper agency and will perform all
statistical reports it requires.
9. Audit. The City Manager or his designee may audit SGS's books at any reasonable time.
SGS will provide the City Manager access to its books at its office in Corpus Christi.
10. Local Office. SGS agrees to open a local office in Corpus Christi and to man that office with
adequate personnel to adequately service the City's customers. SGS further agrees to have a
supervisor available at the local office to answer any questions the Fire Chief or designee may have
throughout the term of the original contract period, annual extensions and month to month
extensions.
11. Notices. All notices required or permitted herein must be in writing and are deemed to be
delivered when deposited in the United States mail, postage prepaid, certified mail, return receipt
requested, as follows:
If to City:
City of Corpus Christi
PO Box 9277
Corpus Christi, TX 78469-9277
(361)887-7385
Attn: Fire Chief
If to SGS:
Southwest General Services of Dallas, LLC
9441 LBJ Freeway, Suite 600
Dallas, Texas 75243
(214)573-2901
Attn: Scott Fothergill
Chief Operating Officer
12. Compliance with Laws. SGS and City must comply with all applicable federal, state, and
city laws and regulations in performing this Agreement. SGS agrees to conform to City Manager's
requirements with regard to aggressive collection tactics on collection to the extent permitted by law.
SGS will file required reports and comply with City conflict of interest provisions.
13. EMS Services. SGS and City understand that City may provide EMS Services, may change
the EMS Services provided, or may cease to provide EMS Services. The parties agree that, if EMS
Services cease, neither party will have any further obligation under this Agreement. If the scope of
EMS Services or EMS Fees change to such an extent as to render performance on either part
impossible, then the City Manager and SGS will renegotiate this Agreement within 30 days or this
Agreement will be terminated without necessity for notice of termination as set out herein.
14. Termination. City Manager or SGS may terminate this Agreement at any time by giving 60
days written notice to the other party, but if the Agreement is terminated SGS is not required to meet
the fiscal yeaz minimum or have the 10% deducted for failure to meet the minimum collections. If
the agreement is terminated, the City will be required to reimburse SGS commissions (6%) for
amounts collected by SGS collection efforts up to one hundred twenty (120) days following the
termination date.
15. Relationship of Parties. This Agreement is for the billing and collection of EMS Fees due
the City as set out in Section 4 of this agreement "SGS Services" and the Response to RFP. SGS
is acting as the fiduciary agent of the City. This Agreement is a contractual agreement for SGS to
provide the billing and collection services stated in the Response. No other relationship is created,
except the fiduciary contractual relationship to bill and collect the EMS Fees due the City and
deposit them to City's credit for the consideration stated herein.
16. Bond Requirement. SGS covenants to maintain bonding and insurance coverages. SGS
will provide a Blanket Commercial Bond (for the City's protection against SGS's employee
dishonesty) for $500,000.
17. Contract Administrator. The Contract Administrator designated by the City is responsible
for approval of all phases ofperformance and operations under this Agreement including deductions
for non-performance and authorizations for payment. All of SGS's notices or communications
regarding this Agreement must be directed to the Contract Administrator, who is the Fire Chief, or
designee.
18. Independent Contractor. SGS will perform the services hereunder as an independent
contractor and will furnish such services in its own manner and method, and under no circumstances
or conditions may any agent, servant, or employee of SGS be considered as an employee ofthe City.
19. Insurance. Before activities can begin under this Agreement, SGS's insurance company(ies)
must deliver a Certificate of Insurance, as proof of the required insurance coverages and the fidelity
bond to the Fire Chief and Risk Manager. Additionally, the Certificate must state that the Fire Chief
will be given at least 30 days notice of cancellation, material change in the coverages, or intent not to
renew any of the policies by certified mail. The City must be named as an Additional Insured. The
City Attorney must be given copies of all insurance policies within 15 days of the City Manager's
written request therefor. Insurance requirements are attached and incorporated as Exhibit B, and
may be revised annually by the City Manager upon 30 days written notice to SGS.
20. Indemnification. SGS agrees that it will indemnify and hold City harmless of, from and
against all claims, demands, actions, damages, losses, costs, liabilities, expenses, and judgments
recovered from or asserted against City on account of injuries or damage to person or property to the
extent any such damage or injury may be incident to, arise out of, or be caused, either proximately or
remotely, wholly or in part, by an act or omission, negligence or misconduct on the part of City, its
officers, employees, or agents ("indemnitees") acting pursuant to this agreement with the express or
implied permission of SGS, or when any such injury or damage is the result, proximate or remote, of
the violation by Indemnitees, SGS or any of its agents, servants, employees, contractors, patrons
guests, licensees, or invitees of any law, ordinance, or governmental order of any kind. These terms
of indemnification shall be effective upon the date of execution ofthis agreement and whether such
injury or damage may result from the sole negligence, contributory negligence, or concun•ent
negligence of Indemnitees, but not if such damage or injury may result from negligence or willful
misconduct of Indemnitees. SGS covenants and agrees that, to the extent the law allows in case City
shall be made a party to any litigation against SGS or in any litigation commenced by anyparty other
than SGS relating to this Agreement, SGS shall and will pay all costs and expenses, including
reasonable attorney's fees and court costs incurred by or imposed upon City by virtue of any such
litigation.
21. Fiscal Year. All parties recognize that the continuation of any contract after the close of any
fiscal year of the City, which fiscal year ends on July 31 annually, is subject to appropriations and
budget approval providing for such contract item as an expenditure in that budget. The City does not
represent that the budget item will actually be adopted, that determination is within the sole
discretion of the City Council at the time each budget is adopted.
22. Taxes. SGS covenants to pay payroll taxes, Medicare taxes, FICA taxes, unemployment
taxes, and all other related taxes according to Circular E Employer's Tax Guide, publication 15, as it
may be amended. SGS must provide proof of payment of these taxes within 30 days after City
Manager's written request therefor. Failure to pay or provide proof of payment is grounds for the
City Manager to immediately terminate this Agreement.
23. Assignment. This Agreement shall be binding upon the parties, their legal representatives,
successors, and assigns. This Agreement must not be assigned without prior written consent of the
City Manager or designee.
24. Entirety. The entire Agreement of the parties is contained herein and this Agreement
supersedes all oral agreements and negotiations between the parties relating to the subject matter
hereof as well as any previous agreements presently in effect between the parties relating to the
subject matter hereof.
25. Severance. The provisions of this Agreement are severable. If any paragraph, section,
subdivision, sentences, clause, or phrase of this Agreement is for any reason held to be contrary to
the law or contrary to any rule or regulation having the force and effect of the law, such decisions
does not affect the remaining portions of the law, such decisions does not affect the remaining
portions of the agreement. However, upon the occurrence of such event, either party may terminate
this Agreement by giving the other party 60 days written notice. This Agreement is executed in
duplicate originals, any one of which, or a true copy thereof, have the same evidentiary value.
ATTEST:
Armando Chapa, City Secretary
Legal form approved ~,/~/ , 2008;
Mary Kay Fisher, City Attorney
Veronica Ocanas
Assistant City Attorney
dY COUNCIL
CITY OF CORPUS CHRISTI
George Noe, City Manager
Southwest General Services
Q _
By:
colt Fothergill
Chief Operating fficer
SECRETARY
ATTACHMENT "A"
FINANCIAL REPORTS
Monthly Financial Statement Comparing Two Years
Current Y-T-D of EMS Billing Reported by Charge Type, etc.
Monthly Report of EMS Billing Reported by Charge Type (Comparing Two
Years)
Current Month and Year-To-Date
Aged Accounts Receivable Report by Individual Charged
Aged Accounts Receivable Report by Billing Entity
Accounts Receivable Audit Totals
Daily Transaction Summary Register (By Unit) Medic Unit Designation For All
Existing Units.
Daily Transaction Summary Register (Total Units)
Transaction Register
Open-Item Posted Transaction Listing
Open-Item Posted Transaction Summary Listing
Open-Item Posted Transactions by Posting Date
Exhibit B
Insurance and Bond Requirements
Bond
A Blanket Commercial Bond, protecting City against SGS's employee dishonesty, for
$500,000 within two weeks of being awarded the contract, to be maintained for the term of
the Agreement, including any extensions or carry overs.
Attachment B
INSURANCE REQUIREMENTS
CONTRACTOR'S INSURANCE
A. Contractor must not commence work under this agreement until all insurance required herein has been
obtained and such insurance has been approved by the City's Risk Manager or designee ("Risk Manager").
Contractor must not allow any subcontractor to commence work until all similar insurance required of the
subcontractor has been obtained.
B. Contractor must furnish to the Risk Manager two (2) copies of Certificates of Insurance, showing the following
minimum coverage by insurance company(s) acceptable to the Risk Manager. The City must be named as an
additional insured for all liability policies and a blanket waiver of subrogation is required for all applicable
policies.
TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE
30-Day written notice of cancellation, non- Bodily Injury and Property Damage
renewal, material change or termination is Per occurrence/ aggregate
required on all certificates
Commercial General Liability including: $1,000,000 COMBINED SINGLE LIMIT
1. Commercial Form
2. Premises -Operations
3. Products/ Completed Operations
Hazard
4. Contractual Liability
5. Independent Contractors
6. Personal Injury-Advertising Injury
AUTOMOBILE LIABILITY--OWNED NON- $500,000 COMBINED SINGLE LIMIT
OWNED
OR RENTED
PROFESSIONAL LIABILITY to include: $1,000,000
1. Errors and Omissions
WHICH COMPLIES WITH THE TEXAS
WORKERS' COMPENSATION WORKERS' COMPENSATION ACT AND
SECTION II OF THIS EXHIBIT
EMPLOYERS' LIABILITY $100,000
C. In the event of accidents of any kind, Contractor must furnish the Risk Manager with copies of any reports of
such accidents within ten (10) day of the accident.
2006 EMS Collections Svc RFP ins req.
2-7-08 ep Risk Mgmt.
ADDITIONAL REQUIREMENTS
Contractor must obtain workers' compensation coverage through a licensed insurance company
obtained in accordance with Texas law. The contract for coverage must be written on a policy with
endorsements approved by the Texas Department of Insurance. The coverage provided must be in
an amount sufficient to assure that all workers' compensation obligations incurred by Contractor will
be promptly met.
III. On the Certificate of insurance:
• The City of Corpus Christi must be named as an additional insured for all liability
coverage and a blanket waiver of subrogation is required on all applicable policies.
• Should your insurance company elect to use the standard ACORD form, the
cancellation clause (bottom right) shall be amended by adding the wording "charxled
or" between "be" and "canceled", and deleting the words "endeavor to", and deleting the
wording after "IefY'. In lieu of modification of the ACORD form, separate policy
endorsements addressing the same substantive requirements are mandatory.
• The name of the project shall be listed under "Description of Operations".
• At a minimum, a 30-day written notice of material change, non-renewal, termination or
cancellation is required.
2008 EMS Collections Svc RFP ins req.
2-7-08 ep Risk Mgmt.
xs~s
Proposal Submission
SOUTHWEST
GENERAL
SERVICES
To The City Of Corpus Christi, Texas
For Accounts Receivable Management
And Delinquent Collections Services
For EMS
RFP BI-0106-08
Transmittal Letter
i.
~a
~SGS
5 March 2008
City Of Corpus Christi
Purchasing Division
City Hall, 41n Floor
1201 Leopard Street
Corpus Christi, Texas 78401
To Whom It May Concern/Purchasing Manager:
On behalf of Southwest General Services of Dallas, LLC, I would like to thank the City Of
Corpus Christi for the opportunity to submit our proposal in response to your Request for
Proposal for Accounts Receivable Management And Delinquent Collections Service For
Emergency Medical Services (EMS).
Southwest General Services is an experienced, seasoned provider of comprehensive EMS
Billing and Collection Solutions to public and private ambulance services. SGS was
formed in 1985 and our total billings exceed $200 million dollars on over 300,000 new
accounts annually. Currently, we provide EMS Billing and Collection Services to over forty
(40) providers across the country, including the cities of Dallas, Plano, Richardson,
Garland, and Mesquite in Texas, as well as Sedgwick County (Whicita), Kansas, and
Oshkosh, Wisconsin.
~ SGS provides an "all inclusive" EMS reimbursement solution that includes billing, early
= collections, delinquent collections, state reporting and electronic patient care reporting
~ (EPCR) via the Rescue Medic system. We are proposing to provide our "all inclusive"
~ solution to the City Of Corpus Christi as identified in our "Proposers Response" section.
~ For information regarding the Rescue Medic system please refer to our "Rescue Medic -
~ EPCR Solution" section within our proposal.
~ I, Scott Fothergill, Chief Operating Officer, am authorized to legally bind Southwest
~ General Services of Dallas, L.L.C., and have signed this letter. The proposal and the total
~ fixed-price contained therein shall remain firm for a period of ninety (90) days from the
~ proposal due date (March 7th, 2008). For any questions or comments about our proposal, I
~ am readily available by calling my office at 214-573-2901, or at my email address below.
~ Tha c you,
~ ott Fothergill, Chi Operating Officer
r~ sfothergillC~3southwestgeneral com
`~ 214.573.2901
~_
SGS + 9441 LBJ Freeway, Suite 600
~ r Dallas, TX 75243 + 866-573-2900 + Fax: 214-741-1430
SUPPLIER NUMBER
TO BE ASSIGNED BYZ'IT~
PURCHASING DIVISION
C~or oaf CITY OF CORPUS CHRISTI
chnati DISCLOSURE OF INTEREST
City of Corpus Christi Ordinance 17112, as amended, requires all persons or firms seeking to do
business with the City to provide the following information. Every question must be answered. If the
question is not applicable, answer with "NA". See reverse side for definitions.
COMPANY NAME:
P. O. BOX:
STREET ADDRESS: I yL(I L ~~ F(•e~l, v ~{c Q`>CITY: (~Q ~'a 5 ZIP: ~y~
FIRM IS: 1. Corporation [~ 2. Partnership ^
3.
S
of
e
O
w
ne
r
4. Association ^ 5. Other ^ ^
DISCLOSURE QUESTIONS
If additional space is necessary, please use the reverse side of this page or attach sepazate sheet.
1. State the names of each "employee" of the City of Corpus Christi having an "ownership interest"
constituting 3% or more of the ownership in the above named "fmn."
Name Job Title and Ciry Department (if known)
N~
2. State the names of each "official" of the City of Corpus Christi having an "ownership interest"
constituting 3% or more of the ownership in the above named "firm."
Name Title
N
3. State the names of each "boazd member" of the City of Corpus Christi having an "ownership
interest" constituting 3% or more of the ownership in the above named "firm."
Name Boazd, Comtnission or Committee
NSA
4. State the names of each employee or officer of a "consultant" for the City of Corpus Christi who
worked on any matter related to the subject of this contract and has an "ownership interest"
constituting 3% or more of the ownership in the above named "firm."
~ Name Consultant
I certify that all information provided is true and correct as of the date of this statement, that I have
not knowingly withheld disclosure of any information requested; and that supplemental statements
will be promptly submitted to the City of Corpus Christi, Texas as changnes occur. ~ p~
Certifying Person: oCc)~. ~ y~i ~) Title: ~~ic+ ~,p~~o~ y-rtice~
(Type m Print) ~
Signature of Certifying -- Date:
Person: o~ 02 FG~ U
DEFI TIONS
a. "Boazd member." A member of any boazd, commission, or committee appointed by the City
Council of the City of Corpus Christi, Texas.
b. "Employee." Any person employed by the City of Corpus Christi, Texas either on a full or part-
time basis, but not as an independent contractor.
c. "Firm." Any entity operated for economic gain, whether professional, industrial or commercial, and
whether established to produce or deal with a product or service, including but not limited to, entities
operated in the form of sole proprietorship, asself-employed person, partnership, corporation, joint
stock company, joint venture, receivership or tmst, and entities which for purposes of taxation aze
treated as non-profit organizations.
d. "Official." The Mayor, members of the City Council, City Manager, Deputy City Manager,
Assistant City Managers, Department and Division Heads, and Municipal Cour[ Judges of the City of
Corpus Christi, Texas.
e. "Ownership Interest " Legal or equitable interest, whether actually or constructively held, in a
firm, including when such interest is held through an agent, tmst, estate, or holding entity.
"Constmctively held" refers to holdings or control established through voting trusts, proxies, or
special terms of venture or partnership agreements."
f "Consultant." Any person or firm, such as engineers and azchitects, hired by the City of Corpus
Christi for the purpose of professional consultation and recommendation.
REQUEST FOR PROPOSAL ADDENDUM
CITY OF CORPUS CHRISTI
PURCHASING DMSION
Request for Proposal No. BI-0106-08 Addendum No. 1 Date February 25.2008
In reference to the above request for proposal for accounts receivable management and
delinquent collections service for EMS, the following change is to be noted:
1) The closing date for receipt of proposals has been changed. The new closing date for
receipt of proposals is March 7.2008. S:OOPM.
The City is currently developing responses to questions submitted and will issue out an
addendum in the near future addressing those questions.
"ALL OTHER TERMS AND CONDITIONS TO REMAIN THE SAME"
Buyer:
Michael attars,
Assistant Director of Finance
ACKNOWLEDGED BY:
`~-, ~ ~~~~,; ~~ _ _ ~~-ate
IRM NA ~~ UTHORIZED S NATURE DATE
One wpy must be returged to the Purchasing Division prior to the closing date of the
proposal or with your sealed proposal.
REQUEST FOR PROPOSAL ADDENDUM
CITY OF CORPUS CHRISTI
PURCHASING DIVISION
Request for Proposal No. BI-0106-08 Addendum No. 2 Date February 28.2008
In reference to the above request for proposal for accounts receivable management and delinquent
collections service for EMS, the following response to questions are submitted:
1) Question : How many EMS transports did the City make in 20067 2007?
Response: Calendar year 2006 - 30,910
Calendar Year 2007 - 32,561
2) Questions: What were the gross billings in dollars in 2007?
Response: Fiscal Year 2006-2007 - $10.7 million
3) Question: What was the City's net revenue from EMS billing in 2007?
Response: Fiscal Year 2006-2007 - $4.95 million
4) Question: What does the City charge as follows for EMS billing?
a. ALSI
b. ALS2
c. BLS
d. loaded mileage
Response: ALSI - $500
ALS2 - $550
BLS - $355
Loaded Mileage - $9/mile
5) Question: In 2006 and 2007, what was the City's payor mix (percentage) as follows:
a. Medicare
b. Medicaid
c. Private Insurance
d. Self-Pay
Response: For fiscal year 2006 - 2007, the payor mix is:
a. Medicare - 39%
b. Medicaid -13%
c. Private Insurance - 34%
d. Self-Pay-B%
6) Question : Who is the City's current vendor for EMS billing? What does that vendor charge
the City for services?
Response: Texas Medical Data Systems, Corpus Christi Texas is the current vendor.
Current charge rate is $13,650 per month fixed fee. 8% bonus on collections
greater than $2.8 million per year.
7) Question: How does the City's current vendor receive patient health insurance information?
Face sheets, directly from hospitals, other means?
Response: Patient reports, face sheets and hospital contact
Request for Proposal No. BI-0106-08 Addendum No. 2 Date Februar~28.2008
8) Question: What is the average loaded mileage distance within the City?
Response: Approximately 8-10 miles
9) Question: Do City EMS personnel utilize EMS RMS platform? If so, who is the vendor and
does the City send patient treatment and demographic information to its billing
vendor electronically from that software platform?
Response: The City's current RMS software is SafetyPad. Yes, the City sends patient
information electronically to the vendor.
10) Question: What percentage of the City's transports are coded BLS? ALS 1? ALS2?
Response: Fiscal Yaer 2006-2007
BLS - 61%
ALS 1 &ALS2 - 23%
11) Question: What are the City's primary transport hospitals?
Response: Christus Spohn -Memorial, Corpus Christi, Texas
Christus Spohn -Shoreline, Corpus Christi, Texas
Christus Spohn -South, Corpus Christi, Texas
Doctor's Regional, Corpus Christi, Texas
Bay Area Medical Center, Corpus Christi, Texas
12) Question : Are all City transport vehicles ALS-staffed?
Response:. Yes
13) Question: How many field units will the city requve to be in service including reserves?
Response: Medic Units (ambulances) - 8, 24/7
Peak Demand Unit -1
Reserve units - 4 ( The City also has 3 additional laptops that are used for data
collection)
14) Question: Are these field units inclusive of supervisor vehicles and fire apparatus in addition
to ambulances?
Response: The above quantities are the extent to which software licenses will be required.
IS) Question: In service requirements, Section IIA, the city is requesting that vendor must
provide a staffed local office. How does the City define Local? Local to Corpus
Christi, or local to Texas?
Response: Local is defined as local to Corpus Christi. Staff has found it beneficial to the
management of the contract to have a local office in Corpus Christi.
16) Question: What hardware/tablets does the City have available to nm the EMS Data
Collection Software on?
Response: Panasonic Toughbook
17) Question: What model of cardiac monitors is the City currently using?
Response: Zoll-M series
Request for Proposal No. BI-0106-08 Addendum No. 2 Date February 28, 2008
18) Question: Please provide a current payer mix of transports? How many of the total trips are
Medicare, Medicaid, Commercial inswance and private pay?
Response: See response to question number 5 above.
19) Question: How many total calls were taken in last 12 months?
Response: Calendar Year 2007 - 32,561
20) Question: How many total transports were completed in last 12 months?
Response: Colander year 2007 - 20,440 transports completed
21) Question: What does the City currently charge for ambulance services? (base rate, mileage,
non-resident surcharges, any supplies)?
Response: See attached lists titled "Ambulance Rates".
22) Question: Can you please give me total number of calls for 077
1. calls but no transport
2. Medicare inswed
3. Medicaid inswed
4. Commercial inswed
5. Uninsured
Response: Calendar year 2007 - 32,561 calls
1. Calls but no transports =6%
2. See response to question 5 .
3. See response to question 5
4. See response to question 5
5. See response to question 5
23) Question: What type of EMS data collection software is currently being used by EMS
personnel?
Response: SafteyPad
24) Question: Under Section A, Service Requirements, #2 requires the purchase of hardware and
software for all ambulances. Is the amount necessary 8 or 97
Response: The City is not requiring that any hardware be pwchased under the contract. The
City is requiring software be provided under the contract for a cost not to exceed
$60,000. The City is evaluating various data collection software packages and will
determine the software of choice prior to contract award. The question above
regarding "8 or 9" references the number of ambulances in service. Please see
response to question No. 13 above.
25) Question: Has the City already decided which system they would like to have in their
ambulances, or is it the responsibility of the bidder to provide a recommended
system as part of ow offer?
Response: See response to question No. 24 above. The bidder does not need to recommend a
software system.
Request for Proposal No. BI-0106-08 Addendum No. 2 Date February 28.2008
26) Question: If the City opted to utilize a vendor for their billing services but wanted a different
system than the one proposed, would the City ask that vendor to purchase and then
interface with the system that you want?
Response: See responses to questions Nos. 24 & 25. The City will select the EMS data
Collection software and the contractor will be responsible for any needed items
necessary for working/interfacing with the system.
27) Question: Would it be acceptable to propose a specific system but then include language
denoting our willingness to utilize a different system to interface with our billing
system if deemed to be in the best interest of the City?
Response: See responses to Questions Nos. 24, 25 and 26 above.
28) Question: From the requirements of a system not to exceed $60,000 in Question #2 and then
the follow up in #3 about software licenses not to exceed $35,000 in ensuing years,
it appears that the City's plan is to own the hazdware after the initial year of cost
amortization (otherwise the cost could be amortized over a longer period). Please
confirm that the City does intend to own the hardware after the cost is covered
during the first year of the contract.
° Response: No hardware is required. Software rights and licenses will be owned by the City
after the initial year. See response to Question No. 27.
29) Question: Question #6 requires that the contractor have a locally staffed office . Will the
City consider amending this requirement if the proposal is in the best interests of
Corpus Christi?
Response: 'Ilse City will require the contractor to have a locally staffed office in Corpus
Christi. See response to question No. 15.
30) Question: Would the City allow for asub-contracting relationship for some portion of our
hospital interface program with a local Corpus Christi firm such that if the
requirement for a local office is maintained, the requirement can be met through
ow sub-contracting relationship?
31) Response: The City will accept asub-contracting relationship provided all sub-contracting
firms are identified at the time of submission of the proposal response. See
responses to questions 15 and 29.
Request for Proposal No. BI-0106-08 Addendum No. 2 Date February 28, 2008
32) Question: Question No. 8 discusses the recommendation of fee structure to the City. Given
this question, we would like to ask for the following financial data in order to be able to produce a
specific financial model for Corpus Christi:
Question a. What are the current transport fees in Corpus Christi by HCPCS code, including
your mileage charge (AO-425) as well?
Response a. See attached lists titled "Ambulance Rates".
Question b. When is the last time these fees were changed?
Response b. July 27, 2004
Question c. Does the City currently have plans in place to raise your transport fees?
Response c. No.
Question d. What is the mix of BLS, ALS and ALS-2 calls provided by the City, and what is
the raw number of each of these levels of service types for the most recent
completed 12-month period.
Response d. See response to question No.10.
Raw numbers -ALS 1&2- 7,489, BLS 19,862
Question e. What is the trend expressed as a percentage in terms of growth rate of transports
over the past couple of years? We fully understand that you can't make
commitments to growth of transports, but do you expect this trend to continue in
Corpus?
Response e. 9% growth rate.
Question f. What is the fully mature mix of charges going out to your patients expressed as a
percentage for Medicare, Medicaid, Commercial Insurance and Self-pay?
Response f. Medicare - 29.93%, Medicaid -17.78%, Commercial -15.66 %, Self pay
3.51%, Misc. (workers comp etc.) -10.42%
Question g. What is the fully mix of payments coming in from your payers expressed as a
percentage for Medicare, Medicaid; Commercial Insurance and Self-pay?
Response f. Medicare - 38.6%, Medicaid -13%, Commercial - 38.4 %, Self pay 7.6%,
Misc. (workers comp etc.) - 3.21%
Question h. The RFP provides your Gross Charges and you payments for the past three years.
Can you also provide your gross and net collection peroentages during these same
periods?
Response h Refer to Section C -REQUEST FOR PROPOSAL RESPONSE, No. 12. T7te
column tilted "Billed" is the gross amount prior to any adjustments. The column
titled "Collected" is the net amount after all adjustments have been made.
Request for Proposal No. BI-0106-08 Addendum No. 2 Date February 28.2008
33) Question Question #] 0 requires reporting to Credit Bureaus.. Does the City have a contract
with a collection tympany that delinquent accounts are fumed over to? If so, we
would ask that this company report to the Credit Bureaus as their company
standing as a collections agency allows for them to do so.
34) Response The City does not have a separate collection company for uncollected accounts.
Requirements included in the RFP require the billing company to act as our
collection company.
35) Question Please confirm that question #12 is an either/or scenario, one being the delivery of
payments physically and the other being deposit of payments via ACH.
Response Yes the City will accept the delivery of payments physically or via ACH.
36) Question Under the Delinquent accounts section and in conjunction with ow question above
(question 34 above), are we able to utilize asub-contractor to provide collection
services? We believe there are benefits that accrue to the City by so doing, and we
intend to clarify these advantages in our proposal for the City's consideration.
Response The City will allow for sub-contractors. All sub-contractors must be identified in
the proposal and will .be held to the same standards.as the prime contractor.
3~ Question Who is currently providing ambulance billing services to the City of Corpus
Christi and what is the current rate being paid by the City for these services?
Response See response to question No. 6.
38) Question How is the City currently reporting patient care in the field?
Response Electronic reporting software, SafteyPad
39) Question How is the City currently sending patient care reports to the billing vendor?
Response See response to question 38.
40) Question Under the General Requirements a $500,000 Blanket Commercial Bond is
required. What are the specifications for this bond? Will you accept a letter of
credit?
Response The City will accept a Crime Policy/Fidelity Bond under the insurance certificate
with minimum coverage of $500,000 as meeting the above referenced blanket
commercial bond requirement.
Request for Proposal No. BI-0106-08 Addendum No. 2 Date FebruarL28.2008
"ALL OTHER TERMS ANA CONDITIONS TO REMAIN THE SAME"
Buyer:
(`ACKNOWLEDGED BY: ~p /
`1~u~. ~yt nrra~ ~•[Jicl ~~~ ~ `-- Of I ~~plya.-~v~~0`U'
NAME THORIZED SI TURE DATE
One copy must be returned to the Purchasing Division prior to the closing date of the proposal or
with your sealed proposal.
Assistant Duector of Finance
Request for Proposal No. BI-0106-08 Addendum No. 2 Date Februarv 28.2008
AMBULANCE RATES
BI-0106-08
Rates.
Basic life support rate (BLS) ... $355.00
2. Advanced Ilfe support rate
(ALS 1) ...500.00
(ALS 2-major medication) ...550.00
3. Neonate transport (charged to the requesting hospital) ...377.00
4. Neonate transport (additional charge for those calls which exceed
one (1) hour in length or any part thereof ...151.00
5. Out of city calls, basic life support ...411.00
6. Out of city calls, advanced life support ...548.00
7. Basic aid, no transport ...82.00
8. Advanced aid, no transport ...411.00
9. Basic aid, no transport, outside city limits ...116.00
10. Advanced aid, no transport, outside city limits ...479.00
Supplementary charges:
1. Emergency runs within or outside the city, but within Nueces County, requiring the
administration of oxygen, providing athirty-five dollar ($35.00) charge in addition to the
appropriate charge defined in rates above.
2. Providing a mileage charge of nine dollars ($9.00) per mile for those calls inside
the city limits and twelve dollars ($12.00) for those calls outside the city limits,
from patient pick-up point to the hospital.
3. Providing a fee for responding to a medical alarm which is a malfunction, no one at
home, no one injured, sixty dollars ($60.00).
4. Providing a charge of one hundred dollars ($100.00) for emergency medical
services provided to non-residents.
5. The city manager is authorized to establish charges, not to exceed the
reasonable cost of providing the service, for other supplementary services
such as providing standby equipment and crews at special events and
attending training courses.
8. Providing a charge of forty-five dollars ($45.00) for additional personnel when
needed to provide patient care during transport.
,..
REQUEST FOR PROPOSAL ADDENDUM
CITY OF CORPUS CHRISTI
PURCHASING DIVISION
Request for Proposal No. BI-0106-08 Addendum No. 3 Date March 4.2008
In reference to the above request for proposal for accounts receivable management and delinquent
collections service for EMS, the following clarifications are to be noted:
1) Amendment No. 2, response to question No. 1 is revised to read:
Response: Fiscal Year 2005-2006: 20.557
Fiscal Year 2006-2007: 20.440
2) Amendment No. 2, response to question No. 10 is revised to read:
Response: Fiscal Year 2006-2007
BLS - 61%
ALSI & ALS2 - 23%
3) Amendment No. 2, response to question No. 20 is revised to read:
Response: Fiscal Year 2006-2007 - 20,440 transports completed
4) Amendment No. 2, response to question No. 32(f) is revised to read:
Response: This data is not readily available.
5) Amendment No. 2, response to question No. 32(g) is revised to read:
Response ~ Medicare - 38.6%, Medicaid -13%, Commercial - 33.8 %. Self pay 7.6%,
Misc. (workers comp etc.) - 7%
"ALL OTHER TERMS AND CONDITIONS TO REMAIN THE SAME"
Buyer:
Michael Barrera,
Assistant Director of Finance
ACKNOWLEDGED BY:
/'~ l ° 0
1 u~~Wet~I' ll enPn(~ftV[GPS OI ~ '•~ / /~ V
FIRM NAME 7[ ,il„uc THORIZED SI TURE DATE
One copy must be returned to the Purchasing Division prior to the closing date of the proposal or
with your sealed proposal.
REQUEST FOR PROPOSAL ADDENDUM
Table of Contents
~SGS
Table Of Contents
Transmittal Letter i
Disclosure Of Interest Form
Addendum 1
Addendum 2
Addendum 3
Table Of Contents ii
Proposers Response
Question 1 1-2
Question 2 3-74
Question 3 75-96
Question 4 97
Question 5 98-101
Question 6 102-104
Question 7 105
Question 8 106-109
Question 9 110
Question 10 111-113
Question 11 114
Question 12 115
Question 13 116
Question 14 117
Question 15 118-128
RescueMedic - EPCR Solution 129-135
Appendices
Sample Statements
Sample Reports
TABLE OF CONTENTS //
CONFIDENTIAL-PROPRIETARY
Proposers Response
~~SGS
Proposers Response
1. Briefly describe the services you offer at this time and propose to offer
the City including a clear delineation of any alternatives.
Proooser's Response:
SGS provides an "all inclusive" EMS reimbursement solution that includes billing,
early collections, delinquent collections, state reporting and electronic patient
care reporting (EPCR) via the Rescue Medic system. We are proposing to
provide our "all inclusive" solution to the City Of Corpus Christi, which includes:
• PCR Review & QA
• US Postal Service Address Verification & Updates
• Hospital Information Network
• Document Processing/Data Entry
• Skip Tracing
• Customer Service
• Electronic & Paper Claims Filing
• Early-Out Collections
• Self-Pay Billing & Collections
• Medicare & Medicaid Appeal And Fair Hearings
• Payment Processing
• HIPPA Patient Privacy Notification
• Comprehensive Reporting
• Collection Agency Service
PROPOSERS RESPONSE
1
CONFIDENTIAL-PROPRIETARY
~~SGS
• Credit Bureau Reporting
• State Reporting
• Documentation Training
• Ambulance Billing Consulting
• Rescue Medic - EPCR Solution
From start to finish, SGS prides itself on its quality of work, it's strictest of ethics,
and superior services to both our clients and their patients. Through extensive
experience in the field of EMS Billing And Collections, proven results to our
clients, innovative measures within our processes, and unmatched quality of
customer service, SGS has shown for over twenty years that we are the leader in
EMS Billing and Collection Services.
PROPOSERS RESPONSE
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CONRDENTIAL-PROPRIETARY
L~SGS
2. Briefly describe your operating procedure for an Accounts Receivable
service.
Proaoser's Response:
Overview
Our reimbursement philosophy and proposed billing and collection process is a
proven system designed to maximize returns while providing the highest
standard of customer service and professionalism in dealing with the public and
maintaining the positive image of your agency. Our comprehensive .EMS
reimbursement package is designed to achieve its objectives through a
combination of thorough post-transport information gathering, patient contact
calls, direct third-party payer claim filing (Private Insurers, Medicare and
Medicaid), a rigorous "denial review" process, extensive "Skip Tracing"
techniques and the inclusion of SGS' internally licensed collection agency to
pursue delinquent accounts.
An important aspect of our success is our own custom developed billing and
collection software, EMIRS -Emergency Medical Information Reporting System,
was specifically designed for ambulance billing and collection services. EMIRS
was designed to enable SGS to pursue the collection of ambulance fees through
a flexible system of regular scheduled cycle letters, collection phone calls, and
electronic claims filing. EMIRS is a fully auditable billing & collection accounts
receivable management system that was designed in accordance with Generally
Accepted Accounting Principles by accounting professionals, EMS billing experts
and computer programmers with a background in the ambulance transportation
industry.
PROPOSERS RESPONSE 3
CONFIDENTIAL-PROPRIETARY
~~SGS
The relationships we have established with our clients, hospitals, Medicare,
Medicaid, and the major commercial insurance carriers we work with have also
contributed to our long running success. We have worked diligently over the
years with Medicare, Medicaid, HMO's, Commercial Insurance Carriers, and
Workman's Compensation Carriers in a continuing effort to minimize claim-filing
errors and to streamline our reimbursement process. SGS consistently contacts
these payers to monitor claim activity and to update our policies and procedures
relevant to the changes that have been implemented in these organizations.
In conclusion, SGS believes that the quality of the billing and collection service
selected by your agency should be of such stature that it would continue to
enhance the fine reputation that your agency enjoys. SGS is proposing an EMS
Reimbursement Solution that would improve the emergency ambulance
reimbursement system that has provided our clients with a continual increase in
collection revenue over the past twenty (20) years.
The functions and systems described hereinafter provide a methodical guide -
through SGS' Billing and Collection System along with a detailed analysis and
description of the individual steps involved in the process.
Field Documentation
Due to the nature of the service provided (Emergency Medical Services),
completion of field documents as it pertains to billing information is not a primary
objective of field personnel when rendering aid to a patient. The objectives of
field personnel and billing personnel are not congruent. This presents an
unusual and probably unavoidable initial constraint upon the reimbursement
function.
PROPOSERS RESPONSE 4
CONFDENT/AL-PROPRIETARY
~~SGS
Because payer identification at the beginning of the reimbursement process is
determined by billing information obtained in the field the initial billing can
sometimes be delayed until additional information can be gathered from other
sources. As a rule of thumb, the minimum information required to bill an account
is listed below along with additional information that helps expedite the process.
Minimum information needed:
• Patient first and last name
• Date of birth; age of patient
• Gender
• Address (number, street, city, state, zip)
• Responsible party (i.e. parent's name if patient is a minor)
• Incident Information (i.e. incident no., D.O.S., P-U location, hospital, etc.)
• Patient disposition (i.e. chief complaint, vitals, EKG rhythm, etc.)
• Charge information
• Authorization signature or applicable reason patient is unable to sign
Additional information needed to expedite the billing process:
• Phone number
• Social security number
• Medicare/Medicaid number
• Insurance company name, address, ID /group numbers
PROPOSERS RESPONSE
5
CONFIDENTIAL-PROPRIETARY
~~SGS
Aside from the patient demographic data, but equally as important, is the
documentation relating to the patient's condition that must also be documented in
the field to ensure the proper assignment of claims thereby minimizing the
number of "non-medically necessary" claim denials from Medicare and Medicaid.
Billing Information Skip Trace
SGS has developed a program that verifies the accuracy of patient addresses
obtained by EMS staff and/or SGS staff. We use a combination of CASS
certified software and Delivery Point Verification software to perform this function.
All patient addresses received from the City of Corpus Christi will be verified with
deliverable addresses publicized by the United States Postal Service. The
program will identify incomplete addresses and correct minor errors such as
incomplete street name and/or incomplete zip code.
After all addresses have been identified as "Complete" or "Incomplete", a
report/file is created that is separated by receiving hospital consisting of the
transport information and the status of the address. The report/file is then
forwarded to SGS' Hospital Research Representatives (HRR) to verify and obtain
information from the receiving hospitals' database.
PROPOSERS RESPONSE 6
CONFIDENTIAL-PROPRIETARY
~~SGS
Information Research Network
SGS' reimbursement system integrates an information network consisting of local
hospitals and on-line resources as part of the comprehensive EMS
reimbursement package. The professional working relationships we establish
with hospitals are an integral part of our success. SGS ertiploys Hospital
Research Representatives (HRR) for the purpose of obtaining billing information.
Their main objective will be to ascertain complete demographic and insurance
information from the receiving hospital. New information obtained is recorded
and transferred to Document Processing/Data Entry for acceptance into EMIRS.
In order to successfully retrieve this information from the receiving facilities, our
HRR's have the permissions by some of the facilities to access their databases
on-site at their business office. SGS prides itself on the superior ethical
relationships that we have with all of the facilities that we deal with to retrieve the
demographic and insurance information that is required to properly bill either the
patient or their insurance company.
In some cases, SGS has been able to successfully gain remote access to the
hospital's system via a secure VPN connection. SGS can sign a business
associates' agreement with the hospital to ensure that all information that is
exchanged is completely HIPAA compliant and only used for the purposes
designated.
PROPOSERS RESPONSE ~
CONFIDENTIAL-PROPRIETARY
~~SGS
Document Processing/Data Entry
Document Processing is responsible for preparing transports received for
acceptance into the system. Reviewing, verifying and updating information
obtained by Paramedics/EMTs and SGS' Hospital Research Representatives
accomplish this task. Financial/payer identification (Medicare, Medicaid,
Commercial Insurance or Private classification) occurs at this stage based on the
information gathered in the field, the receiving hospital, and on-line resources.
The report/file is forwarded to Data Entry for entry and acceptance into EMIRS.
Data Entry identifies existing accounts in the permanent database that match
new accounts in the temporary database, eliminating the possibility of generating
multiple accounts for one patient. Patient, insurance, transport and diagnosis
information are then imported/entered into the permanent database to be
accepted into the system.
As transports are being entered into the permanent database they become
available for medical necessity determinations and ICD-9 coding. SGS' medical
coding specialists view the accounts in a separate function to make medical
necessity determinations and apply ICD-9 codes. This process occurs almost
simultaneously with data entry.
Data entry is completed through a batch acceptance process that balances
transports received with transports entered. EMIRS generates a revenue report
of all new accounts accepted into the system detailing charges for base rate,
mileage, oxygen, disposable supplies, drugs and other services, if applicable.
PROPOSERS RESPONSE 8
CONFDENT/AL-PROPRIETARY
~~SGS
Electronic Claims Processing
All accounts that are entered and accepted into EMIRS are individually assigned
a billing/financial code that will determine the initial billing process flow for each
account. Some will go into a "Medicare/Medicaid" billing stream, others will go
into an °insurance" billing stream, and those that are identified with no insurance
coverage are assigned a "private-pay" billing code.
Accounts assigned with a Medicare, Medicaid and/or Commercial Insurance
billing code will be billed electronically on a daily basis. Electronic filing of claims
is executed through an Electronic Data Interchange (EDI) function, which
identifies new accounts that have been classified as Medicare, Medicaid, or
participating Commercial Insurance and creates and batches a file of electronic
claims. The claims are then sent electronically to their appropriate payer
destinations on a daily basis.
Third Party Billing
Southwest General Services' Third Party Billing Department (TPB) consists of:
• ICD-9 coding
• Commercial insurance
• Medicare
• Medicaid
• Workers compensation
• Government payer
PROPOSERS RESPONSE
9
CONFIDENTIAL-PROPRIETARY
~~SGS
Legal specialists.
Representatives in the Third Party Billing Department are responsible for
monitoring all third party account activity, and pursue on-going contact by
telephone, on-line, and correspondence with all third party payers. This
consistent auditing process allows SGS to identify and correct oversights that
have occurred within the billing process.
One of the most important functions within our auditing process is the review of
all Explanation of Benefits (EOB's). Initially, SGS' TPB representatives will
review transport documentation for all claims denied. When it is determined that
a transport was denied incorrectly, a review is submitted to the individual payer.
Transports in which documentation did not support medical necessity can still be
reviewed with additional documentation from the attending physician and/or the
receiving hospital.
SGS' TPB representatives are also responsible for billing worker's compensation
carriers. When processing worker's compensation claims, the date of injury,
employer, case number, and adjuster's name are required, with copies of patient
transport forms submitted with the claim to be considered for payment.
Accounts classified as "Legals," in which a "Letter Of Protection" or a "Lien is
received from an attorney are also handled by SGS' TPB Department. Upon
receipt, a provider must discontinue billing the patient and forward all
bills/correspondence to the attorney. When an attorney reaches settlement with
an insurance company, providers will be disbursed the funds for services
provided.
PROPOSERS RESPONSE 10
CONF/DENTIAL-PROPRIETARY
~ J~
SGS will not reclassify an account to legal status until a "Letter of Protection" or a
"Lien" is received. A TPB representative monitors accounts in legal status daily.
The TPB representative will send "Status" letters to attorneys requesting updates
on the status of the case every thirty (30) days. If a previously sent status update
is not received back from the attorney within the established deadline, then the
account is reclassified to a private pay where collections are pursued.
Medicare Billing Process
SGS would like to point out that we currently file over 100,000 initial/appealed
claims annually to Medicare. SGS will file all claims identified as Medicare within
24 hours after the account was identified as Medicare. SGS will submit all
Medicare claims utilizing the appropriate ambulance HCPC and ICD-9 codes
published by the Centers for Medicare and Medicaid Services (CMS).
SGS' Medicare representatives work Explanations Of Benefits (EOB's) daily.
Accounts that have been paid are reviewed to determine whether the co-
insurance amount was "Crossed-Over" to the supplemental insurance carrier or
not. If this amount was not "Crossed-Over," the Medicare rep will re-classify the
account and file the claim for the co-insurance amount.
There are times when Medicare will deny a claim for a number of reasons.
Claims that have been rejected will be reviewed to determine the course of action
to take, starting with researching the account to determine if it was filed correctly
or not and make the appropriate corrections. SGS has incorporated an
aggressive review/appeal process to counter this. For every denied claim for
"Non-Medically Necessary" we request ER Records and/or a "Physician's
PROPOSERS RESPONSE 71
CONFIDENTIAL-PROPRIETARY
~~SGS
Statement of Medical Necessity". Upon receipt of this additional documentation
we will file areview/appeal on the patient's behalf to Medicare for claim
reconsideration.
Medicaid Billing Process
SGS makes every attempt to identify/verify Medicaid eligibility utilizing a variety
of techniques, including the receiving hospital's database and/or the Medicaid
Carrier's eligibility website. We will file all claims identified as Medicaid within 24
hours that the account was identified as Medicaid electronically, utilizing the
appropriate ambulance HCPC and ICD-9 codes published by the Centers for
Medicare and Medicaid Services (CMS).
Claims that have been rejected will be reviewed to determine the course of action
to take by researching the account to determine if it was filed correctly or not and
make the appropriate corrections. If it is deemed that a claim was rejected
incorrectly, we will resubmit claim for payment with an appropriately documented
1500 form along with written documentation to justify the re-filing. The majority of
Medicaid claims that have been denied are for "Non-Medically Necessary";
"based on all documentation received transportation does not meet emergency
and/or non-emergency criteria". To counter this reality, SGS incorporates an
aggressive review/appeal process. For every denied claim for "Non-Medically
Necessary" we request ER Records and/or a "Physician's Statement of Medical
Necessity'. Upon receipt of this additional documentation we will file a
review/appeal to Medicaid for claim reconsideration.
PROPOSERS RESPONSE 12
CONF/DENTIAL-PROPRIETARY
~~SGS
SGS' Medicaid representatives work Explanation of Benefits (EOB's), daily. If a
patient has Medicaid coverage as their primary insurance, then providers must
write-off the remaining balance after Medicaid payment.
Insurance Billing Process
Southwest General Services will generate and submit electronic claims to all of
the participating Commercial Insurance Carriers. SGS will submit all insurance
claims identified as EDI participants within 24 hours after the account was
identified as insurance. SGS will submit all insurance claims utilizing the
appropriate ambulance HCPC and ICD-9 codes published by the Centers for
Medicare and Medicaid Services (CMS). For carriers who do not participate
and/or accept electronic claims, a 1500 form will be sent via the US Postal
Service.
SGS' Insurance representatives work EOB's, or Explanation of Benefits, daily. If
a partial payment is made, the EOB is reviewed to determine if the correct
amount was paid. If an incorrect payment was made or a claim was denied we
are in contact with the insurance company. Insurance claims are denied for a
variety of reasons; therefore, it is necessary in most cases to contact the
insurance company to determine an appropriate course of action. Claims that
have been rejected will be reviewed to determine the course of action to take. If
the claim was denied, the rep will research the account to determine if it was filed
correctly or not and make the appropriate corrections.
PROPOSERS RESPONSE 13
CONHDENT/AL-PROPRIETARY
}~SGS
All accounts identified as an Insurance account in which the insurance company
has not responded to our claim for payment within 60 days are auto converted to
apost-insurance private pay account code. Statements are then mailed in 30-
day intervals and are also queued-up for daily follow-up.
ICD-9 Coding
SGS is dedicated to providing the highest standard of professional coding and
billing services to all of our clients. All of SGS' ICD-9 coding specialists are
required to be certified by the American Academy of Professional Coders
(AAPC), and all certifications are kept current according to AAPC rules and
regulations. We use only legal and ethical means in all professional dealings,
and shall refuse to cooperate with or condone by silence, the actions of those
who engage in fraudulent, deceptive, or illegal acts.
All transports are coded before acceptance into the EMIRS billing system. As
transports are being entered into EMIRS they become available for medical
necessity determinations. Transport documentation is thoroughly reviewed by
SGS' ICD-9 coding specialists to determine the medical necessity of the
transport. Coders review chief complaint fields, vitals, past history, EKG
rhythms, reason for transfer fields, narratives, CMNs, PCS' etc., to determine the
appropriate codes and narratives to apply to the claim. ICD-9 codes and
narratives are then entered by the SGS specialists into the EMIRS billing system
and are ready for claim generation and submission.
PROPOSERS RESPONSE 14
CONFDENTIAL-PROPRIETARY
~~SGS
Customer Service
For over twenty years, Southwest General Services has taken pride in providing
outstanding customer service for all of our customers. All of SGS' customer
service representatives are professional and are trained to resolve inquiries in a
swift, compassionate, and efficient manner. We focus on guiding patients in the
resolution of their bills without offending or disrespecting them. We realize that
working with the public on behalf of an EMS provider requires extreme sensitivity
to the needs of the individual. Handling emergency medical service billing
inquiries not only requires sensitivity, professionalism, and compassion for the
aged and physically challenged, but also expertise in all areas of medical
insurance and other third party payment situations.
SGS provides its employees with the tools and training to carry out their tasks.
All employees are provided with an on-line computer so they can view and
update all inquiries on demand. Each on-line computer is capable of retrieving
data through optional inquiry functions to view account information and payment
history information. EMIRS allows our representatives to update demographic
and insurance information through "Patient Master Update" functions. When
new payer information is received, financial/billing codes are changed and
reclassification occurs. All inquiries are recorded in an on-line "Comment
Screen" to track account history. We also provide bi-lingual professional staff to
assist with Spanish speaking only patients.
PROPOSERS RESPONSE 15
CONFDENT/AL-PROPRIETARY
`~SGS
Skip Trace
Skip tracing is the process of finding a person who has "skipped" town or moved
since the last time of communication. SGS performs this task through utilization
of a number of information sources as well as the local hospital network. SGS
defines a skip trace account as an account in which the address and phone
number are deemed to be "Incomplete". The primary goal for a skip tracer is to
locate a correct address and phone number for incomplete accounts. SGS will
make every attempt possible to locate patient accounts with "Bad Addresses
and/or Bad Phone Numbers".
Data System Back-up
Southwest General Services maintains its data at its Dallas home office and at a
separate disaster recovery facility in Dallas, Texas. We use Stratus Technologies
servers, the world's most trusted provider of computer products, services, and
technologies that guarantee continuously available processing for applications
that must not fail. Stratus builds the ultimate reliability into its servers and
service. Stratus customers include 115 of the Global 500 companies in markets
that demand non-stop computing such as financial services, retail, travel, public
safety, healthcare, manufacturing and electronic commerce.
SGS can work with your agency to accommodate any other data security or
back-up specifications. We have our own in-house information technology staff
and more than 20 years experience in the safe handling of our customer's most
important information.
PROPOSERS RESPONSE 76
CONFDENTIAL-PROPRIETARY
~~SGS
*Please see the "Appendices" section of our proposal for samale
statements and letters.
Comprehensive Reporting
Southwest General Services agrees to provide your agency all requested reports
identified within the RFP. All reports generated will be compiled from the same
database used in the day-to-day operations of the billing and collection
production. This will produce reports that are accurate and consistent with
individual accounts on the system. Detailed reports of individual accounts or
transactions that support the above data will be available upon request for the
purposes of audits and write-off justifications. The types of reports they we are
proposing to provide include:
Accounts Receivable Reconciliation Report
This monthly report will identify the Accounts Receivable beginning balance
reported as the ending balance from the prior month. The report will show year-
to-date additions and deletions as well as current month additions and deletions.
Transport Reconciliation Report
This is a monthly report that will compare records received by SGS from the City
of Corpus Christi with the number of non-billable records identified, and the
resulting number of records billed by SGS.
PROPOSERS RESPONSE 17
CONFIDENTIAL-PROPRIETARY
~~SGS
Resort of Collections
A monthly report that will be used to verify and reconcile the bank deposit activity
with the collection posting activity provided by SGS. This report will reflect the
total daily bank deposit amount, amount posted to accounts from current
deposits, amounts posted as overpayments, and amounts posted as unidentified
payments.
Commission Invoice Resort
This is a monthly report that will verify the accuracy of the payments made by
your agency to SGS. This report should support the calculation of the
commission percentage fee invoiced. It will also include the total amount billed by
transport month, prior month cumulative collections by transport month, current
month collections by transport month, cumulative fees payable by transport
month, cumulative fees paid by transport month and net fees due by transport
month.
Vendor Performance Analvsis Resort
This is a monthly report that will summarize the results of the collection effort of
SGS. This report will list all activity for each Transport Month with collections
aged by transport month.
With regard to records received from the City of Corpus Christi, the report will list
total number of records received from the City of Corpus Christi, total number of
non-billable records received from the City of Corpus Christi, total number of
billable records received from the City of Corpus Christi, non-billable charges due
PROPOSERS RESPONSE 18
CONFlDENTIAL-PROPRIETARY
~~SGS
to Medicare, Medicaid, Tricare, and Workman's Compensation non-allowables,
non-billable charges due to City-exempt/request for write-offs, and the resulting
Gross Amount Billed.
With regard to collections, the report should include total amount collected by
collection method (i.e., Medicare/Medicaid, private insurance, and self-payment),
amount of overpayments resulting in refunds, Medicare/Medicaid recoupments,
amounts for returned checks, and/or amounts relating to posting errors, and the
resulting Net Amount Collected.
Finally, the report should include the Gross Collection Rate to date for each
Transport Month calculated by dividing the "Net Amount Collected" by the "Gross
Amount Billed" derived from the calculation methods stated above.
MedicarelMedicaid Activity Resort
This is a monthly report used to monitor all Medicare/Medicaid activity that
includes the number of assigned claims submitted and paid to include the
associated reduction in receivables due to the difference between the
Medicare/Medicaid profile and the current ambulance transport rate plus
itemizations, the total amount of payments received, and the number and percent
of rejected claims.
PROPOSERS RESPONSE 19
CONFIDENTIAL-PROPRIETARY
~SGS
Other reports that are provided include:
• Accounts receivable aging analysis -Monthly
• Fiscal Year Collections Comparison Summary -Monthly
• Report of Revenue Adjustments -Monthly
• Detail of Exempt Transports -Monthly
• Detail of Bad Debt /Allowance Summary -Monthly
• Other management reports - as needed/requested by the City are
available
* Please see sample reports in the "Appendices" section of our proposal.
PROPOSERS RESPONSE
20
CONADENTIAL-PROPRIETARY
~~SGS
Compliance Plan -Introduction
Through our history of providing billing and collection services for over 20 years,
we have determined that management methods ensure delivery of the best
results. This is accomplished by managing information through the following key
functions:
- Querying the process,
- Optimum scheduling of the billing process,
- Optimum scheduling of personnel, and
- Overseeing critical paths
SGS utilizes work groups in order to carry out the above stated critical key
functions allowing us to achieve collection rates above the industry average.
SGS' work group approach involves all members of the organization from record
clerks to the officers of the company. The operational and management work
groups meet on a daily basis to query the status of the billing system. These
groups examine "the pulse" of the billing process and take the necessary steps to
ensure it is functioning within established base-line time controls.
The departmental management groups meet at least weekly, and sometimes
more often during periods of "stress" within the system. These groups assure
that an optimum scheduling of the billing process is maintained in order for the
system to remain on track. These groups also discuss and analyze the current
scheduling level of personnel (e.g., illness, vacation, etc.) within the various
Departments. If increases or decreases of staff are needed, these groups make
the necessary adjustments.
PROPOSERS RESPONSE 21
CONFIDENTIAL-PROPRIETARY
~~SGS
Administrative work groups are assigned to continuous evaluation of the billing
and collection system. These work groups use various reports, historical data
and current data in monitoring and evaluating the system. These work groups
implement changes to improve productivity and carry out various quality control
measures. As the system "expands and contracts;' other work groups are
formed or various members of current groups are assigned to special projects.
All of SGS' billing and collection personnel must complete an initial weeklong
training program that covers all aspects of SGS' billing and collection system.
Once an employee has completed the initial training, he or she will work one-on-
one with a senior billing or collection specialist during their second week of
employment. In addition, all employees must complete a minimum of twenty-four
hours of continuing education every year. Employees choose from both internal
and external professionally presented billing and collection curriculum and
seminars.
PROPOSERS RESPONSE 22
CONFIDENTIAL-PROPRIETARY
~~SGS
Billing and Collection Compliance
At SGS, we believe that in order to effectively manage Emergency Medical
Services Billing and Collections, an organization must have policies and
procedures in place that are adhered to by all employees. We have created
policies for all facets of our business that we believe establish us as the premier
EMS Billing and Collection Company. Some of these policies are as follows:
• Employee Policy Manual
• Confidentiality Agreement
• HIPAA Privacy Policy
• Fraud & Abuse Policy
• Computer Account Policy
• Computer Usage Policy
• Systems Security Policy
SGS' management team closely monitors all billing and collection activity through
billing control reports designed to locate and correct collection variables within
the billing process. SGS utilizes these tracking mechanisms generated by
EMIRS, our call accounting system, and staff throughout the billing and collection
process to ensure our consistency and efficiency within our billing and collection
system.
SGS' computer program, EMIRS, has continually undergone various upgrades
and development since its inception in 1985. SGS fully understands the need to
maintain data integrity to effectively manage the billing and collection process of
PROPOSERS RESPONSE 23
CONFlDENTIAL-PROPRIETARY
~~SGS
the EMS business for all of its customers. During the past twenty years, SGS'
working relationship with all of our clients has resulted in a proven track record of
meeting and exceeding all billing and collection performances.
Management monitors billing and collection activity on a daily basis utilizing the
following internal reports:
• Daily Activity Controls
• Report of Transports Received and Billed
• Billing Information Skip Trace Report
• Hospital Network Report
• Revenue Reports
• Billing Control Report detailing Invoices, Statements, and Letters
• Electronic Claims Submission Report
• 1500 Claim Form Report
• Collector Call Volume Report
• Payment Posting Report
• Cash Distribution Summary by Collection Month
• Aged Financial Class Reports
• Performance Analysis Report
PROPOSERS RESPONSE
za
CONFIDENTIAL-PROPRIETARY
~~SGS
WEB EMIRS -INTERNET-BASED REPORTING SOLUTION
Overview
SGS' Internet-based application is designed for easier and more efficient access
to patient care reporting. Our application -EMIRS (Emergency Management
Information Reporting System) provides our customers the capabilities to access
our database in order to:
• Create, submit, and review patient care reports
• Access custom reports based on data within the patient care reports
• Provide Quality Assurance (QA)
• Report to State and National Agencies
Through a secure connection, as well as a dedicated username and password,
your agency's data and patient health information (PHI) is encrypted to ensure
security and patient privacy. Our system meets or exceeds all Federal patient
record guidelines and requirements. Since our connection is intemet-based,
your agency can access your database in real-time from virtually any computer at
anytime and anywhere you have Internet access.
Screens for the report information can be customized to meet your agency's
information tracking needs or match your current paper-type report forms. Our
EMIRS Web-based system interfaces with our EMIRS Billing and Collection
system - an innovative measure we have developed that is exclusive to
Southwest General Services' clients. The following pages provide an overview of
the features of our EMIRS Web-based system.
PROPOSERS RESPONSE $$
CONFIDENTIAL-PROPRIETARY
~~SGS
Main Menu
Once the user is logged into the system with their usemame and password, the
main menu screen will navigate to the needed entry screen. The standard
system displays the main menu options, split into two parts:
• Patient Lookup
• Reports
PROPOSERS RESPONSE
2s
CONFIDENTIAL-PROPRIETARY
~~SGS
Patient Lookup
From the Patient Lookup screen, users can retrieve information on a specific
patient using any of the following criteria:
• Patient Name and/or Patient Number
• Trip/Incident Number
• Phone Number
• Social Security Number and/or Date of Birth
• Date of Service
PROPOSERS RESPONSE
27
CONFlDENTIAL-PROPRIETARY
~~SGS
Reports
From the Reports Menu, the user may access a number of standard reports. We
can customize reports tailoring to the agency's requirements (based on the
information entered into the system). Reports are generated through a "Report
Generator" which allows the user to select a set of criteria to produce the
requested report. All reports are displayed in an Adobe Acrobat (.pdf) format.
PROPOSERS RESPONSE 28
CONF/ DENTIAL-PROPRIETARY
~~SGS
One of the standard reports the system generates is a "Supplies Report". This
report details the supplies that were submitted by the agency for QA and billing.
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PROPOSERS RESPONSE
29
CONFIDENTIAL-PROPRIETARY
~~SGS
The "Transports Received and Billed Report" shows the total number of
ambulance transports that were made and submitted for billing. Please see the
example below:
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PROPOSERS RESPONSE 30
CONFIDENTIAL-PROPRIETARY
~~SGS
Another standard report our clients can generate is the "Report Of Collections".
This report details the collections that have been posted for any given time
period. Please see the example below:
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PROPOSERS RESPONSE
31
CONFDENT/AL-PROPRIETARY
~~SGS
SGS' HIPAA PRIVACY POLICIES
POLICY.• Use of Computer and Information Systems and Equipment
PURPOSE
SGS is committed to protecting our staff members, the patients we serve,
and the company from illegal or damaging actions by individuals and the
improper release of protected health information and other confidential or
proprietary information.
The purpose of this policy is to outline the acceptable use of computer
equipment at SGS. These rules are in place to protect the employees and
patients of SGS. Inappropriate use exposes SGS to risks including virus attacks,
compromise of network systems and services, breach of patient confidentiality
and other legal claims.
SCOPE
This policy applies to employees, volunteers, members, contractors,
consultants, temporary employees, students, and others at SGS who have
access to computer equipment, including all personnel affiliated with third parties.
This policy applies to all equipment that is owned or leased by SGS.
PROCEDURE -USE AND OWNERSHIP OF COMPUTER EQUIPMENT
1. All data created or recorded using any computer equipment owned,
controlled or used for the benefit of SGS is at all times the property of
PROPOSERS RESPONSE 32
CONFlDENT/AL-PROPRIETARY
~SGS
SGS. Because of the need to protect the SGS computer network, the
company cannot guarantee the confidentiality of information stored on any
network device belonging to SGS, except that it will take all steps
necessary to secure the privacy of all protected health information in
accordance with all applicable laws.
2. Staff members are responsible for exercising good judgment regarding the
reasonableness of personal use and must follow operational guidelines for
personal use of Internet/Intranet/Extranet systems and any computer
equipment.
3. At no time may any pornographic or sexually offensive materials be
viewed, downloaded, saved, or forwarded using any Company computer
equipment. Please refer to the Company's policies regarding harassment.
4. For security and network maintenance purposes, authorized individuals
within SGS may monitor equipment, systems and network traffic at any
time, to ensure compliance with all Company policies.
SECURITY AND PROPRIETARY INFORMATION
1. Confidential information should be protected at all times, regardless of the
medium by which it is stored. Examples of confidential information include
but are not limited to: individually identifiable health information concerning
patients, company financial and business information, patient lists and
reports, and research data. Staff members should take all necessary
steps to prevent unauthorized access to this information.
PROPOSERS RESPONSE 33
CONFIDENTIAL-PROPRIETARY
`~SGS
2. Keep passwords secure and do not share accounts. Authorized users are
responsible for the security of their passwords and accounts. System
level passwords should be changed quarterly, and user level passwords
should be changed every 30 days.
3. All PCs, laptops, workstations and remote devices should be secured with
a password-protected screensaver, wherever possible, and set to
deactivate after being left unattended for ten (10) minutes or more, or by
logging-off when the equipment will be unattended for an extended period.
4. All computer equipment used by staff, whether owned by the individual
staff member or SGS, shall regularly run approved virus-scanning
software with a current virus database in accordance with company policy.
5. Staff members must use extreme caution when opening a-mail
attachments received from unknown senders, which may contain viruses.
UNACCEPTABLE USE
Under no circumstances is a staff member of SGS authorized to engage in
any activity that is illegal under local, state, or federal law while utilizing SGS
computer resources.
The lists below are by no means exhaustive, but attempt to provide a
framework for activities that fall into the category of unacceptable use.
PROPOSERS RESPONSE
34
CONFIDENTIAL-PROPRIETARY
~~SGS
SYSTEM AND NETWORK ACTIVITIES
The following activities are strictly prohibited, with no exceptions:
1. Violations of the rights of any person or company protected by copyright,
trade secret, patent or other intellectual property, or similar laws or
regulations, including, but not limited to, the installation or distribution of
"pirated" or other software products that are not appropriately licensed
for use by SGS.
2. Unauthorized copying of copyrighted material including, but not limited
to, digitization and distribution of photographs from magazines, books or
other copyrighted sources, copyrighted music, and the installation of any
copyrighted software for which SGS or the end user does not have an
active license is strictly prohibited.
3. Exporting system or other computer software is strictly prohibited and
may only be done with express permission of management.
4. Introduction of malicious programs into the network or server (e.g.,
viruses, worms, etc.).
5. Revealing your account password to others or allowing use of your
account by others. This includes family and other household members
when work is being done at home.
PROPOSERS RESPONSE
35
CONFIDENTIAL-PROPRIETARY
~~SGS
6. Using an SGS computer device to actively engage in procuring or
transmitting material that is in violation of the Company's prohibition on
sexual and other harassment.
7. Making fraudulent statements or transmitting fraudulent information
when dealing with patient or billing information and documentation,
accounts or other patient information, including the facsimile or
electronic transmission of patient care reports and billing reports and
claims.
8. Causing security breaches or disruptions of network communication.
Security breaches include, but are not limited to, accessing data of
which the staff member is not an intended recipient or logging into a
server or account that the employee is not expressly authorized to
access, unless these duties are within the scope of regular duties.
9. Providing information about, or lists of, SGS staff members or patients to
parties outside SGS.
E-MAIL AND COMMUNICATIONS ACTIVITIES
1. Sending unsolicited e-mail messages, including the sending of "junk mail"
or other advertising material to individuals who did not specifically request
such material (e-mail spam).
2. Any form of harassment via a-mail, telephone or paging, whether through
language, frequency, or size of messages.
PROPOSERS RESPONSE
3B
CONFIDENTIAL-PROPRIETARY
~~SGS
3. Unauthorized use, or forging, of a-mail header information.
4. Solicitation of a-mail for any other a-mail address, other than that of the
poster's account, with the intent to harass or to collect replies.
5. Creating or forwarding "chain letters", "Ponzi" or other "pyramid" schemes
of any type.
6. Use of unsolicited a-mail originating from within SGS networks of other
Internet/Intranet/Extranet service providers on behalf of, or to advertise,
any service hosted by SGS or connected via SGS' network.
Use of Remote Devices
The appropriate use of Laptop Computers, Personal Digital Assistants
(PDAs), and remote data entry devices is of utmost concern to SGS. These
devices, collectively referred to as "remote devices" pose a unique and
significant patient privacy risk because they may contain confidential patient,
staff member or company information and these devices can be easily
misplaced, lost, stolen or accessed by unauthorized individuals
• Remote devices will not be purchased or used without prior Company
approval.
• SGS must approve the installation and use of any software used on the
remote device.
PROPOSERS RESPONSE
37
CONFDENTIAL-PROPRIETARY
~~SGS
• Remote devices containing confidential or patient information must not be
left unattended.
• If confidential or patient information is stored on a remote device, access
controls must be employed to protect improper access. This includes,
where possible, the use of passwords and other security mechanisms.
• Remote devices should be configured to automatically power off following
a maximum of ten (10) minutes of inactivity.
• Remote device users will not permit anyone else, including but not limited
to user's family and/or associates, patients, patient families, or
unauthorized staff members, to use company-owned remote devices for
any purpose.
• Remote device users will not install any software onto any PDA owned by
SGS except as authorized by SGS.
• Users of company-owned remote devices will immediately report the loss
of a remote device to a supervisor or the Privacy Officer.
ENFORCEMENT
Any staff members found to have violated this policy may be subject to
disciplinary action, up to and including suspension and termination.
PROPOSERS RESPONSE
38
CONFIDENTIAL-PROPRIETARY
~~SGS
POLICY; Privacv Tralnlnp
Purpose
To ensure that all staff members of SGS including all employees,
members, volunteers, students and trainees (collectively referred to as "staff
members") who have access to patient information understand the organization's
concern for the respect of patient privacy and are trained in SGS' policies and
procedures regarding PHI.
Policy
1. All current staff will be required to undergo privacy training in
accordance with the HIPAA Privacy Rule prior to the implementation
date of the HIPAA Privacy Rule, which is April 14, 2003.
2. All new staff members will be required to undergo privacy training in
accordance with the HIPAA Privacy Rule within a reasonable time
upon association with the organization, as scheduled by the Privacy
Officer.
3. All staff members will be required to undergo privacy training in
accordance with the HIPAA Privacy Rule within a reasonable time after
there is a material change to SGS' policies and procedures on privacy
practices.
PROPOSERS RESPONSE
39
CONFlDENTIAL-PROPRIETARY
~~SGS
Procedure
1. The Privacy Officer or his or her designee will conduct the Privacy
Training.
2. All attendees will receive copies of SGS' policies and procedures
regarding privacy.
3. All attendees must attend the training in person and verify attendance
and agreement to adhere to SGS' policies and procedures on privacy
practices.
4. Topics of the training will include a complete review of SGS' Policy on
Privacy Practices and will include other information conceming the
HIPAA Privacy Rule, such as, but not limited to, the following topic
areas:
a. Overview of the federal and state laws concerning patient privacy
including the Privacy Regulations under the Health Insurance
Portability and Accountability Act of 1996 (HIPAA)
b. Description of protected health information (PHI)
c. Patient rights under the HIPAA Privacy Rule
d. Staff member responsibilities under the Privacy Rule
e. Role of the Privacy Officer and reporting employee and patient
concerns regarding privacy issues
f. Importance of and benefits of privacy compliance
g. Consequences of failure to follow established privacy policies
h. Use of SGS' specific privacy forms
PROPOSERS RESPONSE
ao
CONFIDENTIAL-PROPR/ ETARY
~~SGS
POLICY: Medical Records of Emplovees
Policy
To provide guidance to management and staff concerning the privacy of
medical records which involve staff members of SGS.
Procedure
SGS will, to the extent required by law, protect medical records it receives
about employees or other staff in a confidential manner. Generally, only those
with a need to know the information will have access to it, and, even then, will
only have access to as much information as is minimally necessary for the
legitimate use of the medical records.
In accordance with laws concerning disability discrimination, all medical
records of staff will be kept in separate files apart from the employee's general
employment file. These records will be secured with limited access by
management.
In accordance with the Privacy Rule of HIPAA, medical records that are
not considered employment records will be treated in accordance with the
safeguards of the Privacy Rule with respect to their use and disclosure.
Employment records are not considered to be protected health
information, or PHI, subject to HIPAA safeguards, including certain medical
records of employees that are related to the job. These employment records not
covered under HIPAA include, but are not limited to: information obtained to
PROPOSERS RESPONSE 41
CONHDENT/AL-PROPRIETARY
~~SGS
determine my suitability to perform the job duties (such as physical examination
reports), drug and alcohol tests obtained in the course of employment, doctor's
excuses provided in accordance with the attendance policy,.work-related injury
and occupational exposure reports, and medical and laboratory reports related to
such injuries or exposures, especially to the extent necessary to determine
workers' compensation coverage.
Nonetheless, despite the fact that such records are not considered HIPAA
protected, SGS will limit the use and disclosure of these records to only those
with a need to have access to them, such as certain management staff, the
Company's designated physician, and state agencies pursuant to state law.
With respect to staff members of SGS, only health information that is
obtained about staff in the course of providing ambulance or other medical
services directly to them is considered PHI under HIPAA. In other words, if SGS
provides ambulance service to an employee, the protections typically given to
such information of our ambulance service patients applies to the employee.
These protections are subject to HIPAA exceptions, such as in the situation in
which the staff member who used SGS was involved in awork-related injury
while on duty.
As another example, if we receive a staff member's medical record in the
course of providing the employee with treatment and/or transport, it does not
matter that SGS happens to be the employer -that record is PHI. If, however,
the employee submits a doctor's statement to a supervisor to document an
absence or tardiness from work, SGS does not need to treat that statement as
PHI. Other health information that could be treated as employment related, and
not PHI, includes medical information that is needed for SGS to cant' out its
obligations under the FMLA, ADA and similar laws, as well as files or records
PROPOSERS RESPONSE 42
CONFIDENTIAL-PROPRIETARY
~SGS
related to occupational injury, disability insurance eligibility, drug screening
results, workplace medical surveillance, and fitness-for-duty-tests of employees.
If you have any questions about how medical information about you is
used and disclosed by SGS, please contact our Privacy Officer.
POLICY: Electronic Patlenf Care Revorts
Policy
To ensure that all staff members of SGS properly dispose of all "paper"
used in the preparation of a patient care report (PCR) and to secure and restrict
PCR accessibility.
Procedure
SGS maintains strict requirements on the security and access of all PCRs
as well as the initial documentation created by the field providers in their
preparation of a PCR.
1. All preliminary documentation used by a crewmember to assist in the
creation or modification of a PCR is the sole property of SGS.
2. Each crewmember will be given a password to use SGS' computer
systems.
3. No crewmember may disclose his/her password to any other
crewmember.
4. Each crewmember is to access ONLY his/her PCRs unless directed
otherwise by the Privacy Officer or as permitted by management.
PROPOSERS RESPONSE 43
CONFIDENTIAL-PROPRIETARY
}~SGS
5. No crewmember is to log onto any computer or password protected
software under any user name other than his/her own.
6. A PCR may be amended by a crewmember upon approval by the Privacy
Officer or Management.
7. Printed PCRs are to go immediately to a Supervisor. PCRs must be either
hand delivered or placed in a lock box.
8. All scratch paper used by a crewmember in the preparation of a PCR must
be shredded immediately.
9. Inappropriate access or retention of PHI may result in disciplinary action,
including termination.
POLICY. Access. Security and Disclosure
Purpose
To outline levels of access to Protected Health Information (PHI) for
various staff members of Southwest General Services of Dallas, LLC ("SGS")
and to provide a policy and procedure on limiting access, disclosure, and use of
PHI. To provide policies outlining patient rights and SGS' responsibilities in
fulfilling patient requests. Security of PHI is everyone's responsibility.
PROPOSERS RESPONSE
44
CONFIDENTIAL-PROPRIETARY
~~SGS
Policy
SGS retains strict requirements on the security, access, disclosure and
use of PHI. Access, disclosure and use of PHI will be based on the role of the
individual staff member in the organization, and should be only to the extent that
the person needs access to PHI to complete necessary job functions.
When PHI is accessed, disclosed and used, the individuals involved will
make every effort, except in patient care situations, to only access, disclose and
use PHI to the extent that only the minimum necessary information is used to
accomplish the intended purpose.
Patients may exercise their rights to access, amend, restrict, and request
an accounting, as well as lodge a complaint with either SGS or the Secretary of
the Department of Health and Human Services.
PROPOSERS RESPONSE
45
CONFIDENT/AL-PROPRIETARY
~~SGS
Procedure -Role Based Access
Access to PHI will be limited to those who need access to PHI to carry out their
duties. The following describes the specific categories or types of PHI to which
such persons need access is defined and the conditions, as appropriate, that
would apply to such access.
Job Title Description of PHI to Be Conditions of Access to PHI
Accessed
EMT Intake forms from dispatch, May access only as part of completion
patient care reports of a patient event and post-event
activities and onl while actuall on du
Paramedic Intake forms from dispatch, May access only as part of completion
patient care reports of a patient event and post-event
activities and onl while actuall on du
Billing Clerk Intake forms from dispatch, May access only as part of duties to
patient care reports, billing complete patient billing and follow up
claim forms, remittance and only during actual work shift
advice statements, other
patient records from facilities
Field Intake forms from dispatch, May access only as part of completion
Supervisor patient Care reports of a patient event and post-event
activities, as well as for quality
assurence checks and corrective
counselin of staff
Dispatcher Intake forms, preplanned May access only as part of completion
CAD information on patient of an incident, from receipt of
address information necessary to dispatch a call,
to the closing out of the incident and
onl while on dut
Training Intake forms from dispatch, May access only as a part of training
Coordinator patient care reports and quality assurance activities. All
individually identifiable patient
information should be redacted prior to
use in training and quality assurance
activities
Department May access only to the extent
Managers necessary to monitor compliance and to
accomplish appropriate supervision and
mono ement of ersonnel
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Access to PHI is limited to the above-identified persons only, and to the identified
PHI only, based on the Company's reasonable determination of the persons or
classes of persons who require PHI, and the nature of the health information they
require, consistent with theirjob responsibilities.
Access to a patient's entire file will not be allowed except when expressly
permitted by company policy or approved by the Privacy Officer.
Disclosures to and Authorizations from the Patient
You are not required to limit your disclosure to the minimum amount of
information necessary when disclosing PHI to other health care providers for
treatment of the patient. This includes doctors, nurses, etc. at the receiving
hospital, any mutual aid provider, your fellow crewmembers involved in the call,
and any other person involved in the treatment of the patient who has a need to
know that patient's PHI. In addition, disclosures authorized by the patient are
exempt from the minimum necessary requirements unless the authorization to
disclose PHI is requested by the Company.
Authorizations received directly from third parties, such as Medicare, or other
insurance companies, which direct you to release PHI to those entities, are not
subject to the minimum necessary standards.
For example, if we have a patient's authorization to disclose PHI to Medicare,
Medicaid or another health insurance plan for claim determination purposes, the
Company is permitted to disclose the PHI requested without making any
minimum necessary determination.
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For all other uses and disclosures of PHI, the minimum necessary rule is likely to
apply. A good example of when the minimum necessary rule applies is when
your Company conducts quality assurance activities. In most situations it is not
necessary to disclose certain patient information such as the patient's name,
address, social security number, all PHI of the treated patient, in order to conduct
a call review. This sensitive information should be redacted or blacked out from
the PCR being used as a Q/A example.
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Comaanv Requests for PHI
If the Company needs to request PHI from another health care provider on a
routine or recurring basis, we must limit our requests to only the reasonably
necessary information needed for the intended purpose, as described below.
For requests not covered below, you must make this determination individually
for each request and you should consult your supervisor for guidance. For
example, if the request in non-recurring or non-routine, like making a request for
documents via a subpoena, we must review the request to make sure it covers
only the minimum necessary PHI to accomplish the purpose of the request.
Holder of PHI Purpose of Request Information Reasonably
Necessary to
Accom lish Pur ose
Skilled Nursing Facilities To have adequate patient Patient face sheets,
records to determine discharge summaries,
medical necessity for Physician Certification
service and to properly Statements and
bill for services provided Statements of Medical
Necessity, Mobility
Assessments
Hospitals To have adequate patient Patient face sheets,
records to determine discharge summaries,
medical necessity for Physician Certification
service and to properly Statements and
bill for services provided Statements of Medical
Necessity, Mobility
Assessments
Mutual Aid Ambulance or To have adequate patient Patient care reports
Paramedic Services records to conduct joint
billing operations for
patients mutually
treated/transported by
the Com an
For all other requests, determine what information is reasonably necessary for
each on an individual basis.
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Incidental Disclosures
The Company understands that there will be times when there are incidental
disclosures about PHI in the context of caring for a patient. The privacy laws
were not intended to impede common health care practices that are essential in
providing health care to the individual. Incidental disclosures are inevitable, but
these will typically occur in radio or face-to-face conversation between health
care providers, or when patient care information in written or computer form is left
out in the open for others to access or see.
The fundamental principle is that all staff needs to be sensitive about the
importance of maintaining the confidence and security of all material we create or
use that contains patient care information. Coworkers and other staff members
should not have access to information that is not necessary for the staff member
to complete his or her job. For example, it is generally not appropriate for field
personnel to have access to billing records of the patient.
However, all personnel must be sensitive to avoiding incidental disclosures to
other health care providers and others who do not have a need to know the
information. Pay attention to who is within earshot when you make verbal
statements about a patient's health information, and follow some of these
common sense procedures for avoiding accidental or inadvertent disclosures:
Verbal Security
Waiting or Public Areas: If patients are in waiting areas to discuss the service
provided to them or to have billing questions answered, make sure that there are
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no other persons in the waiting area, or if so, bring the patient into a screened
area before engaging in discussion.
Garage Areas: Staff members should be sensitive to that fact that members of
the public and other agencies may be present in the garage and other easily
accessible areas. Conversations about patients and their health care should not
take place in areas where those without a need to know are present
Other Areas: Staff members should only discuss patient care information with
those who are involved in the care of the patient, regardless of your physical
location. You should be sensitive to your level of voice and to the fact that others
may be in the area when you are speaking. This approach is not meant to
impede anyone's ability to speak with other health care providers freely when
engaged in the care of the patient. When it comes to treatment of the patient,
you should be free to discuss all aspects of the patient's medical condition,
treatment provided, and any of their health information you may have in your
possession with others involved in the care of the patient.
Physical Securi
Patient Care and Other Patient or Billing Records: Patient care reports should be
stored in safe and secure areas. When any paper records concerning a patient
are completed, they should not be left in open bins or on desktops or other
surfaces. Only those with a need to have the information for the completion of
theirjob duties should have access to any paper records.
Billing records, including all notes, remittance advices, charge slips or claim
forms should not be left out in the open and should be stored in files or boxes
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that are secure and in an area with access limited to those who need access to
the information for the completion of their job duties.
Computers and Entrv Devices: Computer access terminals and other remote
entry devices such as PDAs and laptops should be kept secure. Access to any
computer device should be by password only. Staff members should be
sensitive to who may be in viewing range of the monitor screen and take simple
steps to shield viewing of the screen by unauthorized persons. All remote
devices such as laptops and PDAs should remain in the physical possession of
the individual to whom it is assigned at all times. See the SGS Ambulance Policy
on Use of Computer Equipment and Information Systems.
Penalties for Violation
The Company takes its responsibility to safeguard patient information very
seriously. There are significant legal penalties against companies and
individuals that do not adhere to the laws that protect patient privacy.
Staff members who do not follow our policies on patient privacy will be subject to
disciplinary action, up to and including verbal and written warnings, suspension
and/or termination from the organization. The Company shall make every effort
to provide remedial education and training as to our. policies and procedures
when there is a first time violation of our policies.
QUESTIONS ABOUT THIS POLICY OR ANY PRIVACY ISSUES
The Company has appointed a Privacy Officer to oversee our policies and
procedures on patient privacy and to monitor compliance. The Privacy Officer is
also available to you for consultation on any issues or concerns you have about
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how our Company deals with protected health information. You should feel free
to contact the Privacy Officer at any time with your questions or concerns.
The Company will not retaliate against any staff member who expresses a good
concern or complaint about any policy or practice related to the safeguarding of
patient information and the Company's legal obligations to protect patient
privacy.
POLICY: Patient Reouests for Protected Health Information
Purpose
To ensure that all patients treated by SGS are apprised of their rights with regard
to PHI and that SGS provides the necessary tools to facilitate patient requests.
Policy -Notice of Privacy Practices (NPP)
SGS field providers will furnish a copy of SGS' NPP to the patient at or prior to
treatment in non-emergency situations and as circumstances permit after
treatment in an emergency. In non-emergency situations only, field personnel
should attempt to get a signed acknowledgement from patient or note why a
signature was not obtained.
Procedure -Non-emergency Transport
1. Provide a copy of the NPP to the patient.
2. Indicate on your trip sheet that a copy has/has not been given to the
patient, family member or with hospital staff.
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3. Have the patient sign an Authorization/Acknowledgement form.
4. An authorized personal representative of the patient may sign on the
patient's behalf.
5, If no signature can be obtained, please explain reason.
Procedure -Emergency Transport
1. Provide a copy of the NPP to the patient.
2. Indicate on your trip sheet that a copy has/has not been given to the
patient, family member or with hospital staff.
3. You do not need the patient to acknowledge receipt of NPP.
4. Be sure you obtain any other necessary signatures if possible.
5. If unable to obtain patient's signature, please provide reason.
Procedure -Refusals of Care
1. Provide a copy of the NPP to the patient.
2. Indicate on your trip sheet that a copy has/has not been given to the
patient, family member or with hospital staff.
3. Have the patient sign the Refusal form.
POLICY- Patient Access. Amendment or Restriction to PHI
Only information contained in the Designated Record Set (DRS) outlined in this
policy is to be provided to patients who request access, amendment and
restriction on the use of their PHI in accordance with the Privacy Rule and the
Privacy Practices of SGS.
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Procedure -Patient Access
1. Upon presentation to the business office, the patient or appropriate
representative will complete a Request for Access Form.
2. The Company employee must verify the patient's identity, and if the
requestor is not the patient, the name of the individual and reason that
the request is being made by this individual. The use of a driver's
license, social security card, or other form of government-issued
identification is acceptable for this purpose.
3. The completed form will be presented to the Privacy Officer for action.
4. The Privacy Officer will act upon the request within 30 days, preferably
sooner. Generally, the Company must respond to requests for access
to PHI within 30 days of receipt of the access request, unless the
designated record set is not maintained on site, in which case the
response period may be extended to 60 days.
5. If SGS is unable to respond to the request within these time frames,
the requestor must be given a written notice no later than the initial due
date for a response, explaining why SGS could not respond within the
time frame and in that case SGS may extend the response time by an
additional 30 days.
6. Upon approval of access, the patient will have the right to access the
PHI contained in the DRS outlined below and may make a copy of the
PHI contained in the DRS upon verbal or written request.
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7. The business office will establish a reasonable charge for copying PHI
for the patient or appropriate representative.
8. Patient access may be denied for the reasons listed below, and in
some cases the denial of access may be appealed to SGS for review.
9. The following are reasons to deny access to PHI that are not subject to
review and are final and may not be appealed by the patient:
a. If the information the patient requested was compiled in reasonable
anticipation of, or use in, a civil, criminal or administrative action or
proceeding;
b. If the information the patient requested was obtained from someone
other than a health care provider under a promise of confidentiality
and the access requested would be reasonably likely to reveal the
source of the information.
10. The following reasons to deny access to PHI are subject to review and
the patient may appeal the denial:
a. If a licensed health care professional has determined, in the
exercise of professional judgment, that the access requested is
reasonably likely to endanger the life or physical safety of the
individual or another person;
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b. If the protected health information makes reference to another
person (other than a health care provider) and a licensed health
professional has- determined, in the exercise of professional
judgment, that the access requested is reasonably likely to cause
substantial harm to that person;
c. If the request for access is made by a requestor as a personal
representative of the individual about whom the requestor is
requesting the information, and a licensed health professional has
determined, in the exercise of professional judgment, that access
by you is reasonably likely to cause harm to the individual or
another person.
' d. If the denial of the request for access to PHI is for reasons a, b, or
c, then the patient may request a review of the denial of access by
sending a written request to the Privacy Officer.
e. SGS will designate a licensed health professional, who was not
directly involved in the denial, to review the decision to deny the
patient access. SGS will promptly refer the request to this
designated review official. The review official will determine within
a reasonable period of time whether the denial is appropriate. SGS
will provide the patient with written notice of the determination of
the designated reviewing official.
f. The patient may also file a complaint in accordance with the
Procedure for Filing Complaints About Privacy Practices if the
patient is not satisfied with SGS' determination.
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11. Access to the actual files or computers that contain the DRS that may
be accessed by the patient or requestor should not be permitted.
Rather, copies of the records should be provided for the patient or
requestor to view in a confidential area under the direct supervision of
a designated SGS staff member. UNDER NO CIRCUMSTANCES
SHOULD ORIGINALS OF PHI LEAVE THE PREMISES.
12. If the patient or requestor would like to retain copies of the DRS
provided, then SGS may charge a reasonable fee for the cost of
reproduction.
13. Whenever a patient or requestor accesses a DRS, a note should be
maintained in a log book indicating the time and date of the request,
the date access was provided, what specific records were provided for
review, and what copies were left with the patient or requestor.
14. Following a request for access to PHI, a patient or requestor may
request an amendment to his or her PHI, and request restriction on its
use in some circumstances.
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Procedure -Patient Amendment
1. The patient or appropriate requester may only request amendment to PHI
contained in the DRS. A Request for Amendment Form must be
accompanied by any request for amendment.
2. SGS must act upon a Request for Amendment within 60 days of the
request. If SGS is unable to act upon the request within 60 days, it must
provide the requester with a written statement of the reasons for the delay,
and in that case may extend the time period in which to comply by an
additional 30 days.
3. All requests for amendment must be forwarded immediately to the Privacy
Officer for review.
Granting Requests for Amendment
1. If the Privacy Officer grants the request for amendment, then the
requester will receive a letter indicating that the appropriate amendment to
the PHI or record that was the subject of the request has been made.
2. There must be written permission provided by the patient so that SGS
may notify the persons with whom the amendments need to be shared.
SGS must provide the amended information to those individuals identified
by having received the PHI that has been amended as well as those
persons or business associates that have such information and who may
have relied on or could be reasonably expected to rely on the amended
PHI.
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3. The patient must identify individuals who may need the amended PHI and
sign the statement in the Request for Amendment form giving SGS
permission to provide them with the updated PHI.
4. SGS will add the request for amendment, the denial or granting of the
request, as well as any statement of disagreement by the patient and any
rebuttal statement by SGS to the designated record set.
Denial of Requests for Amendment
1. SGS may deny a request to amend PHI for the following reasons: 1) if
SGS did not create the PHI at issue; 2) if the information is not part of
. the DRS; or 3) the information is accurate and complete.
2. SGS must provide a written denial, and the denial must be in plain
language stating the reason for the denial; the individual's right to
submit a statement disagreeing with the denial and how the individual
may file such a statement; a statement that, if the individual does not
submit a statement of disagreement, the individual may request that
the provider provide the request for amendment and the denial with
any future disclosures of the PHI; and a description of how the
individual may file a complaint with the covered entity, including the
name and telephone number of an appropriate contact person, or to
the Secretary of Health and Human Services.
3. If the individual submits a "statement of disagreement," the provider
may prepare a written rebuttal statement to the patient's statement of
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disagreement. The statement of disagreement will be appended to the
PHI, or at SGS' option, a summary of the disagreement will be
appended, along with the rebuttal statement of SGS.
4. If SGS receives a notice from another covered entity, such as a
hospital, that it has amended its own PHI in relation to a particular
patient, the ambulance service must amend its own PHI that may be
affected by the amendments.
Procedure -Patient Restriction
1. The patient may request a restriction on the use and disclosure of their
PHI.
2. SGS is not required to agree to any restriction, and given the emergent
nature of our operation, we generally will not agree to a restriction.
3. ALL REQUESTS FOR RESTRICTION ON USE AND DISCLOSURE OF
PHI MUST BE SUBMITTED IN WRITING ON THE APPROVED
COMPANY FORM. ALL REQUESTS WILL BE REVIEWED AND
DENIED OR APPROVED BY THE PRIVACY OFFICER.
4. If SGS agrees to a restriction, we may not use or disclosed PHI in violation
of the agreed upon restriction, except that if the individual who requested
the restriction is in need of emergency service, and the restricted PHI is
needed to provide the emergency service, SGS may use the restricted
PHI or may disclose such PHI to another health care provider to provide
treatment to the individual.
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5. The agreement to restrict PHI will be documented to ensure that the
restriction is followed.
6. A restriction may be terminated if the individual agrees to or requests the
termination. Oral agreements to terminate restrictions must be
documented. A current restriction may also be terminated by SGS as long
as SGS notifies the .patient that PHI created or received after the
restriction is removed is no longer restricted. PHI that was restricted prior
to SGS voiding the restriction must continue to be treated as restricted
PHI.
POLICY -Accounting
To provide guidance to management and staff concerning the patient's right to
an Accounting and the types of uses and disclosures of PHI for which SGS is
required to document.
Procedure
1. All patient records will be kept by SGS for a period of six (6) years from
the date of service.
2. All patient accounting requests should be received directly from a
patient or personal representative.
3. SGS will provide a list of uses and disclosures of the patient's PHI,
made by SGS or by a Business Associate on SGS' behalf, for the last
six (ti) years or to the extent that SGS has maintained that patient's
information if less than six (ti) years.
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4. All uses and disclosures of a patient's PHI, made by SGS, must be
documented for accounting purposes except:
a. Disclosures to carry out treatment, payment and health care
operations;
b. For national security or intelligence purposes;
c. Uses and disclosures incident to an unaccountable use or
disclosure;
d. That occurred prior to the compliance date.
5. A common use or disclosure that must be accounted for and
information provided upon a request for accounting is the disclosure of
PHI in response to a subpoena, summons or warrant.
POLICY- PATIENT COMPLAINTS
Patients have the right to complain to the Company about any concerns they
may have concerning patient privacy. Any patient or family member who
expresses a concern or complaint to you should be directed to contact the
Privacy Officer. The Privacy Officer is responsible for receiving, investigating,
and documenting all complaints from patients concerning patient privacy issues.
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SGS - HIPAA Privacy Policies
POLICY: Confidentiality of Patient Information
and Staff Member Verification
Given the nature of our work, it is imperative that we maintain the confidence of
patient information that we receive in the course of our work. Southwest General
Services of Dallas, LLC ("SGS") prohibits the release of any patient information
to anyone outside the organization unless required for purposes of treatment,
payment, or health care operations, and discussions of Protected Health
Information (PHI) within the organization should be limited. Acceptable uses of
PHI within the organization include, but are not limited to, exchange of patient
information needed for the treatment of the patient, billing, and other essential
health care operations, peer review, internal audits, and quality assurance
activities.
I understand that SGS provides services to patients that are private and
confidential and that I am a crucial step in respecting the privacy rights of SGS'
patients. I understand that it is necessary, in the rendering of SGS services, that
patients provide personal information and that such information may exist in a
variety of forms such as electronic, oral, written or photographic and that all such
information is strictly confidential and protected by federal and state laws.
I agree that I will comply with all confidentiality policies and procedures set in
place by SGS during my entire employment or association with SGS. If I, at any
time, knowingly or inadvertently breach the patient confidentiality policies and
procedures, I agree to notify the Privacy Officer of SGS immediately. In addition,
I understand that a breach of patient confidentiality may result in suspension or
termination of my employment or association with SGS. Upon termination of my
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employment or association for any reason, or at any time upon request, I agree
to return any and all patient confidential information in my possession.
I have read and understand all privacy policies and procedures that have been
provided to me by SGS. I agree to abide by all policies or be subject to
disciplinary action, which may include verbal or written warning, suspension, or
termination of employment or of any membership or association with SGS. This
is not a contract of employment and does not alter the nature of the existing
relationship between SGS and me.
Signature:
Date:
Printed
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SGS' INFORMATION TECHNOLOGY USER ID ACCOUNT AND
PASSWORD POLICY
All employees of SGS will be assigned a unique user ID and password for all
company Information Systems related access. The following convention for user
IDs and passwords will be followed.
• All user ID will consist of the first letter of the employee's first name and
the first nine letters of the employee's last name. example: Marilyn
Monroe is MMonroe or Arnold Schwarzenegger is ASchwarzen.
User passwords will follow the super secure syntax and be a minimum of
five characters long. Super secure passwords will include the use of
mixed upper and lower case characters and contain at least one numeric
and one special symbol character. Example: PaSswOrd!
• Password aging will be every ninety days.
• Password history will be eight. The previous eight passwords may not be
used again.
• Passwords will be immediately be changed in the event an employee has
forgotten their password and/or if the password has been compromised
• Passwords may not be revealed to anyone else except for the system
administrator in an event access is need to a particular system for testing
account rights.
Certain employee's will be given Internet email access if it is deemed
necessary as part of their job function. The email address will use the following
convention:
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• The email address will be the first letter of the employee's first name and
the employee's entire last name followed by @Southwestgeneral.com:
example: Amold Schwarzenegger is
ASchwarzeneaaerna.Southwestgeneral.com
• Email addresses will only be given out for business purposes only.
In the event an employee has been terminated the following procedures
will be followed regarding user accounts.
• The terminated employee's user account will be disabled immediately on
their last day of employment at SGS.
• The terminated employee's email account will be forwarded to the
supervisor until such time as it is determined that the account is no longer
receiving business related emails.
• After such time, the terminated employee's account will be disabled.
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SGS' INFORMATION TECHNOLOGY ACCEPTABLE USE POLICY
SGS (THE COMPANY OR COMPANY) HAS ESTABLISHED AN ACCEPTABLE USE POLICY IN
RELATION TO THE USE OF COMPANY PROVIDED TECHNOLOGICAL ASSETS.
This policv includes:
^ The loading and/or executing of files or programs including, but not limited
to screen savers, games, or other applications from disks, CDs, the
Internet or other media is prohibited without prior written consent of
authorized company officials.
^ Modification of company-owned hardware, without the express written
consent of authorized company officials, is prohibited. Modifications
include, but are not limited to the installation or removal of any hardware
components.
^ For policy enforcement purposes it may be necessary from time to time for
network and systems administrators to make spot inspections of files and
email.
^ The Company does monitor and log access to Email and the Intemet.
^ Violations may result in discipline up to and including termination of
employment.
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Acceptable Use
^ All purposes related to carrying out the performance of your job including
research, collaboration, accounting, etc.
^ Interacting with customers and prospects.
Network Etiquette
All users are expected to abide by the generally accepted rules of network
etiquette. These include, but are not limited to the following:
1. Be polite. Your messages should not be offensive to others.
2. Use appropriate language. Do not swear, use vulgarities or any
other inappropriate language. Do not engage in activities that are
prohibited under state or federal law.
3. Do not reveal your personal address or phone numbers or those of
clients or colleagues.
4. Do not use the network in such a way as to engage in illegal
activities.
5. Do not use the network in such a way that you would disrupt the
use of the network by other users.
6. All communications and information (email, files, etc.) are the
property of the Company
7. Comply with any HIPAA requirements.
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Unacceptable Use
Examples of unacceptable use include but are not limited to:
1. Using our systems for any purpose that violates federal or state laws.
2. Seeking to gain unauthorized access to internal or external informational,
computational or communications resources.
3. Interfering or disrupting another information technology user's work as well
as information processing and network services or equipment. Such
interference or disruption includes, but is not limited to: harassment of
others; posting or mailing obscene materials; propagation of computer
worms or viruses and using the network to make unauthorized entry to
other computational information or communications devices or resources.
4. Wasting resources (people, capacity, computers, and networks).
5. Degrading the integrity of computer based information.
6. Compromising the privacy of users, and/or seeking to commit an illegal act
through the use of our systems.
7. Using the systems for private or personal business.
8. Misrepresenting your identity or affiliation in the use of information
technology resources.
9. Using someone else's identity and password for access to information
technology resources or otherwise attempting to evade, disable or "crack"
password or other security provisions of systems on the network.
10. Reproducing and/or distributing copyrighted materials without appropriate
authorization. Unauthorized copying may constitute plagiarism or theft.
11. Copying or modifying files belonging to others or to the company without
authorization. Modifying files without authorization (including altering data,
introducing viruses, or simply damaging files is unethical and may be
illegal).
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12.The loading and/or executing of files or programs from floppies, CD's. the
Internet, or other media is prohibited without prior written consent of the
authorized company officials.
13. Incitement to Lawlessness -The Company prohibits expression which: (a)
endangers or imminently threatens to endanger the safety of any citizen,
or (b) disrupts or obstructs or imminently threatens to disrupt or obstruct
the functions of others.
14. Defamation -The Company prohibits false expression that injures,
disgraces, or damages another's reputation or livelihood. Defamation
through oral expression is slander; defamation through written expression
is libel.
15.Obscenity -The Company prohibits obscene material which meets three
criteria: (a) whether the average person, applying contemporary
community standards would find that the work, taken as a whole, appeals
to prurient interest, (b) whether the work depicts or describes, in a patently
offensive way, sexual conduct, and (c) whether the work, taken as a
whole, lacks serious literary, artistic, political, or scientific value.
16.Invasion of Privacy -The Company prohibits expression that exploits the
woes, private personal characteristics, or private affairs of individuals.
Invasion of privacy is distinguished from defamation in that violating
someone's privacy usually involves information, whereas defamation
involves false information.
17.Indecency -The Company prohibits expression that describes in patently
offensive terms, as measured by community standards, sexual, sensual,
or excretory activities and organs.
18. Fighting Words -The Company prohibits insults delivered face-to-face or
electronic confrontations that provoke, are intended to provoke, or are
likely to provoke listeners to commit violence in response.
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19. Grossly Offensive Expression as to Personal Characteristics -The
Company prohibits expression directed against or about a person or group
because of race, ethnicity, religion, gender, age, handicap, veteran status,
or sexual orientation which has the purpose of reasonably foreseeable
effect of creating a demeaning, intimidating, or hostile environment for that
person or group.
Security
1. Security on any computer system is a high priority, especially when the
system involves many users. Users must never allow others to use
their password with the exception of the Information Technology group.
Users should also protect their password to ensure system security
and their own privilege and ability to continue use of the system.
2. If you feel you can identify a security problem on the Internet, you must
notify an Information Technology group member. Do not demonstrate
the problem to other users.
3. Do not use another individual's account.
4. Any user identified as a security risk for having a history of problems
with other computer systems may be denied access to our systems.
5. All software and files must be scanned with virus checking software
prior to execution or use on company computer systems.
6. Passwords will be changed every 90 Days.
PROPOSERS RESPONSE 72
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Privacy
1. For the purpose of enforcement of this policy, it may be necessary
from time to time for Information Technology group members to
make spot inspections of files and email.
2. Users are reminded that no computer should be considered safe
from intrusion. Intemet Email may pass through many computer
systems, and should not be considered a secure communication
unless encrypted. Even then, information is only as secure as the
encryption method.
3. No personal client information may be sent through the Internet
Email.
Comaliance
7. Ultimate responsibility for proper use or misuse of the network lies with
each individual user of the network.
8. Violations or perceived violations should be reported to your supervisor
or to IT.
9. The Company will cooperate with the appropriate legal authorities in
investigating claims of illegal activity, including but not limited to illegal
transfer or use of copyrighted material, postings or email containing
threats of violence, or other illegal activity.
10.The Company does monitor and log access to Email and the Intemet.
11.Each employee should treat Intemet activity with the same respect as
incoming and outgoing conrespondence, i.e., supervisory approval
should be requested prior to sending confidential correspondence.
PROPOSERS RESPONSE 73
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Conseauences
1. Violation of one or more of these policies could result in the immediate
loss of computer and network privileges.
2. Violations may result in discipline, up to and including termination of
employment.
Electronic Communications
Electronic communications (E-mail, Facsimile), including the contents of an
employee's computer, is lawfully identified as the property of the Company. Use
of this property should be limited to business purposes. Any deviations must
receive prior management approval. Employees who use this property and its
contents for personal, non-business reasons, not approved in advance by
management may be subject to discipline up to, and including termination.
Electronic communications are subject to random inspections. All passwords
and codes are to be disclosed to employee's supervisors to facilitate this access.
The Company for legitimate reasons may override passwords and codes at any
time.
I certify that I have read and understand SGS' Information Technology
Acceptable Use Policy. I will follow the rules set forth in this Policy and
understand the consequences if this Policy is violated.
Employee Signature Date
Printed Name
PROPOSERS RESPONSE 74
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3. Describe in detail your operating procedure for a Delinquent Collection
service.
Proposer's Response:
Overview
Southwest General Services will pursue private-pay accounts through ethical and
lawful means, while strictly following the collection guidelines as specified in the
"Fair Debt Collection Practices Act", "Fair Credit Reporting Act" including the
Consumer Credit Reform Act of 1996, and ail other laws applicable to this type of
activity. SGS has an internal policy with regards to the FDCPA and how it
applies to our collection process and account handling in our collection system.
We have attached this intemal policy to this section for your review.
SGS has been collecting past-due and delinquent ambulance accounts since
1985. During this time our collection process has evolved from collecting "Self-
Pay' accounts under our client's representation (Invoices/Statements with our
Client's name only on the notice) throughout the account collection life cycle to a
more effective method of collecting "Self-Pay" delinquent accounts under our
collection agency representation (dunning letters with our agency name on the
letter) at 90 to 270 days in the collection life cycle.
SGS can pursue private pay accounts through our Early Collection process
(under the representation of the City of Corpus Christi) and through our
Delinquent Collection process (under our internal collection agency's
representation, Southwest General Services). These processes are on the
following pages.
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Early Out Collections
SGS' Early-Out Collection function is responsible for pursuing "Past Due
Accounts" up to 90 - 120 days while in the private payer group. On a daily basis,
EMIRS "queues" a predetermined number of patient accounts onto each Self-
Pay Representative's (SPR) computer (usually 125-150 accounts). EMIRS
determines which accounts to queue based upon date of service, age of account,
financial class, etc.
All accounts queued are divided into three (3) areas of collections:
• Accounts Aged 31 days to 60 days-Past Due Accounts
• Accounts Aged 61 days to 90 days-Past Due Accounts
• Accounts Aged 91 days to 120 days-Seriously Past Due Accounts
This allows for the assignment of specifically aged accounts to particular levels of
intensity in the recovery process, i.e., the older the account, the more urgent that
payment in-full or payment arrangements are pursued. The queuing function of
EMIRS allows for the selection of priority accounts based on various criteria.
Some of the current criteria used by SGS are:
• Accounts remaining from previous day
• Accounts where "promise-to-pay date" is 5 days past due
• Accounts where "mail-return comments" were entered the previous day
• Accounts with the greatest amount due, all other things being equaled
PROPOSERS RESPONSE 76
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EMIRS uses a patient profile system that identifies employment status, insurance
status, date a patient promised to pay, and previous account payment histories.
This information will allow the SPR to determine methodology to be used when
contacting a patient, to identify the "probability" of collecting on an account and
whether previous accounts have been reported to national credit bureaus. SPR's
follow a set of guidelines when negotiating payment plans and obtain firm verbal
agreements before reclassifying accounts. Upon the conclusion of each contact
with a patient or an attempted contact with a patient, the SPR will enter an "exit
code" which acknowledges the action taken.
Along with the historical data record as part of the collection function within
EMIRS, SGS also has in place a mechanism to monitor, review, and rate our
collection representatives' efficiency on a daily basis. This is accomplished by
the combination of our Meridian One Communication System software package
and EMIRS, which creates an electronic record of every call routed through the
telephone system. From this data, various reports are generated allowing
supervisory personnel to monitor patient contacts made by collection
representatives.
All accounts that have not been resolved after 120 days will then be pursued by
SGS' internal collection agency (see our "Delinquent Collections" below). On a
daily basis accounts that fall into this category are auto-converted and re-
classified to delinquent status and pursued by our "Delinquent Collections
Department" (Collection Agency).
PROPOSERS RESPONSE ~~
CONFIDENTIAL-PROPRIETARY
~SGS
Delinquent Collections
SGS, a certified Third-Party Debt Collector, will pursue collection of delinquent
self-payer accounts aged 90 to 150 days and greater.
All accounts queued are divided into three (3) areas of collections:
• Accounts Aged 121 days to 150 days-Delinquent Accounts
• Accounts Aged 151 days to 210 days-Delinquent Accounts
• Accounts Aged 211 days to 270 days-Delinquent Accounts
This allows for the assignment of specifically aged accounts to particular levels of
intensity in the recovery process, i.e., the older the account, the more urgent that
payment in-full or payment arrangements are pursued. The queuing function of
EMIRS allows for the selection of priority accounts based on various criteria.
Some of the current criteria used by SGS are:
• Accounts remaining from previous day
• Accounts where "promise-to-pay date" is 5 days past due
• Accounts where "mail-return comments" were entered the previous
day
• Accounts with the greatest amount due, all other things being
equaled
EMIRS uses a patient profile system that identifies employment status, insurance
status, date a patient promised to pay, and previous account payment histories.
This information will allow the SPR to determine methodology to be used when
PROPOSERS RESPONSE 78
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~SGS
contacting a patient, to identify the "probability" of collecting on an account and
whether previous accounts have been reported to national credit bureaus.
SPR's follow a set of guidelines when negotiating payment plans and obtain firm
verbal agreements before reclassifying accounts. Upon the conclusion of each
contact with a patient or an attempted contact with a patient, the SPR will enter
an "exit code" which acknowledges the action taken.
SGS can pursue the collection of delinquent accounts up to 270 days through
phone contact, dunning letters, and credit bureau reporting. At the end of this
period the delinquent account is reported on the debtor's credit report with the
major credit reporting agencies. After approximately 360 days of no activity SGS
will refer these accounts for write-off or possible legal avenues for collection.
PROPOSERS RESPONSE 79
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SGS -FAIR DEBT COLLECTION CODE
The following is the SGS internal collection policy on the FDCPA.
FAIR DEBT COLLECTION PRACTICE ACT
WHAT IT DOES
PROPOSERS RESPONSE 80
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INTRODUCTION
In 1978 the federal government passed the Fair Debt Collection Practices Act.
The law was designed to eliminate unfair debt collections practices and to protect
reputable debt collectors from unfair competition.
Our policy is to comply with the standards in The Code.
Deflnition
The SGS Debt Collection Code is based on the principles of the Act. The Code
defines standard collection activities for all SGS employees. Per company
policy, you must comply with The Code whenever you work on debt collection for
SGS. The Code regulates:
• Communicating with the consumer
Communicating with third parties
• Ceasing communication with consumer
• Harassment and abuse
• False or misleading representations and forms
• Unfair practices
Validation of debts
• Multiple debts
PROPOSERS RESPONSE 81
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COMPLIANCE
You must comply with this code at all times and in every collection activity.
COMMUNICATING WITH THE CONSUMER -INTRODUCTION
The SGS Debt Collection Code covers communication with the consumer in
these areas:
• Hours of contact
• Attorney contact
• Contact at place of employment
Hours of Contact
The Code limits contact with the consumer to "reasonable hours" which are
defined as 8:00 am - 8:00 pm customer time.
Attorney Contact
Once you learn that an attorney represents the consumer, you may contact only
the attomey about the debt, unless he/she fails to respond within a reasonable
amount of time (no less then two weeks) or consents that you may contact the
consumer directly (you will need written permission from the attorney).
PROPOSERS RESPONSE 82
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Contact at place of emplovment
You cannot call the consumer at his/her place of employment if you know or have
reason to know that the employer does not permit this kind of call, or if the
customer verbally states "Do Not Call at place of employment."
Example:
The receptionist at the place of employment tells you that no personal calls are
permitted. You must respect that rule.
Note: You may be suspicious if the consumer tells you this, particularly if you or
other representatives of SGS have talked to the consumer at the place of
employment before. You must still refrain from calling the consumer at the place
of employment until you are sure that the employer does not prohibit calls, or the
customer verbally states "Do Not Call at place of employment."
PROPOSERS RESPONSE 83
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Whv We Use The Code - Back4round
The policies in The Code are based on the Fair Debt Collection Practices Act, 15
USC 1692. The .FDCPA outlines practices and procedures to allow creditors to
actively seek repayment-using methods that are fair to both creditors and
consumers. The FDCPA also provides for substantial monetary damages to be
levied against companies whose collectors do not comply.
It makes the law clear
The Code makes it easy for you to understand what you may and may not do
when trying to collect a debt. By following The Code, you avoid exposing SGS to
the possibility of legal damages.
It works for us
The FDCPA protects you and SGS from unfair competition.
COMMUNICATING WITH THIRD PARTIES -DEFINITION
A third party is a person, organization, or institution that is not part of the
contractual agreement between SGS and the consumer.
Legal Third Parties
The consumer is protected by a rule that limits who can discuss the debt. You
can discuss the consumers indebtedness only with the:
• Consumer
• Consumer's spouse
• Consumer's attorney
PROPOSERS RESPONSE 84
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• SGS' attorney
• Credit Bureau
Note: This limitation applies to messages left on answering machines because
you can't verify the consumer's identity or control who listens to messages on the
machine.
Note: This limitation applies to electronic forms of communication (example:
email) because you can't verify the consumer's identity or control who may
intercept the message. It is SGS' policy that you can only communicate with a
consumer via an electronic form after the consumer has explicitly authorized the
communication.
Rule
If you need to contact a third party about collecting the debt, you must have
either.
• Prior consent from the consumer in writing
• Permission of the court with jurisdiction over the debt
Whv we contact third aarties
Third party contacts are an important tool to find a consumer who moved without
giving us a new address. The Debt Collection Code permits you to contact any
third party while you are trying to locate the consumer, with certain limitations.
Limitations
The limitations on third party contacts cover:
PROPOSERS RESPONSE 85
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• What information you may ask for
• What information you may give
• How many times you may contract a third party
What you may ask for
You may ask a third party for only three pieces of information about the
consumer's location. You may ask for his/her:
• Address
• Phone number
• Place of employment
What you can sav
You should tell the third party:
• Your name
• That you are verifying location information
• That you work for SGS (only if he/she specifically asks).
Multiple contacts
You may contact a third party only once unless:
• A third party asks you to call back
• You believe that the third party may have learned more correct or
complete information since your first call
PROPOSERS RESPONSE 86
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Example:
A former employer does not yet have an address to send the consumer's final
paycheck and/or tax records. You may contact the employer again if you can
reasonably expect the employer to obtain this information.
WHEN TO CEASE CONTACT -RULE
You must cease contact if the consumer advises you that he/she:
• Refuses to pay the debt
• Asks or directs SGS to cease communication
If you receive this type of notification in writing, it must be placed in the
consumer's file and you should document it in the EMIRS system.
Note: The notification becomes effective when you receive it, verbally or in
writing, not on the postmark date or any earlier date the consumer may put on
the notification.
PROPOSERS RESPONSE 87
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Documenting in EMIRS
If the consumer tells you to stop calling at place of employment:
• Document this in the EMIRS system account comments screen
• Change the employer phone number status to "X - Do Not Call."
Note: Other available numbers can still be called.
If the consumer tells you to also stop calling him at home:
• Document in EMIRS comments
• Change the home phone number status to "X - Do Not Call."
• Advise the consumer to put the request in writing
Note: Other available numbers can still be called.
If the consumer requests no calls at any number:
• Document in EMIRS comment
• Change the all phone status codes to "X - Do Not Call."
• Advise the consumer to put the request in writing
• Advise the consumer of possible legal action
• Notify supervisor
If the consumer requests no communication/calls, no phone calls can be made
and no letters may be sent
PROPOSERS RESPONSE 88
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}~SGS
• Document in EMIRS comment
• Change the all phone status codes to "X - Do Not Call:'
• Change the account type to "X - Do Not Contact."
• Advise the consumer to put the request in writing
• Advise the consumer of possible legal action
• Notify supervisor
After Notification
If we receive notification to stop contact, you can:
• Tell the consumer by phone or mail that legal remedies may be taken if
the consumer refuses to pay
• Contact the consumer's attorney regarding the debt
Consumer still owes
The consumer can decide that we cannot contact him/her about a debt.
Although this is SGS' policy and the consumer has the right to take advantage of
it, refusing contact does not reduce the consumer's obligation to SGS or SGS'
client. The real result will be a quick move on our part to the more severe
remedies for delinquency.
Note: SGS' Debt Collection Code is designed to protect the consumer from
abuse, deception, and unfairness, not to allow him/her to escape paying a debt.
PROPOSERS RESPONSE 89
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HARASSMENT AND ABUSE -RULE
You may not directly or indirectly harass, oppress, or abuse a consumer.
What you cannot do
Under the prohibition of harassment and abuse you cannot:
• Threaten to injure the consumer or his/her property. You cannot do or
threaten anything that is against the law.
• Make public or punish a list of consumers who have allegedly refused to
pay debts unless it is to aconsumer-reporting agency. You also cannot
do or threaten any other action that would harm the consumer's
reputation, such as computer documentation.
• Use obscene or profane language, or call him/her names - no matter how
abusive the consumer may be to you.
• Call a consumer over and over within a short span of time, keep a
consumer on the phone for an unreasonable amount of time, or let the
phone ring repeatedly.
PROPOSERS RESPONSE 90
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FALSE OR MISLEADING REPRESENTATIONS -RULE
The prohibition of false or misleading representations means that you cannot lie
to the consumer about who you are or why you are calling
Who you are
You must tell the consumer truthfully who you are and whom you represent. You
may not tell the consumer that
• You are a deputy that will arrest him/her if the debt isn't paid
• You are an attorney calling about a lawsuit to be filed against him/her
• You operate or work for a credit reporting bureau calling about the
consumer's "terrible credit record"
• He/she has won a prize
• He/she is a beneficiary of a will
• You are from the Legal Department
Whv you are calling
You must let the consumer know every time you contact him/her that you're
trying to collect a debt and that you will use any information the consumer gives
you for that purpose. You must tell the consumer why you are calling as soon as
you're sure you've reached the right person.
Forms
Forms can be false or misleading as well. You cannot send the consumer a form
or letter unless it is generated and printed out of EMIRS.
PROPOSERS RESPONSE 91
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Collection letters and forms
You will be provided with samples of standard collection letters, forms and other
documents available in EMIRS. These forms have been reviewed and approved
by SGS' legal counsel. Never "invent" your own form! You may make an honest
mistake, which would expose you and SGS to legal action.
UNFAIR PRACTICES -RULE
Under the Debt Collection Code, you may not use unfair or unreasonable means
to collect or attempt to collect a debt.
Examples of unfair practices
These are example of unfair practices
• Threatening to take legal action (unless you have already obtained you
manager's agreement and approval to actually do so).
• Sending the consumer a collect telegram or C.O.D. package, which forces
the consumer to pay for collection efforts
• Using a postcard to communicate with the consumer about the debt. This
makes information about the debt and the delinquency available to anyone
who might see the postcard.
• Accepting a check postdated for more than five days after receipt. There
are special requirements for notifying the consumer of your intent to
deposit a postdated check. A check postdated for two or three weeks
does not represent payment until the bank honors it.
PROPOSERS RESPONSE 92
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• Do not call cellular phones
Note: You may not accept a postdated check and then deposit or threaten to
deposit it before the valid date.
Note: You may not accept a postdated check and then threaten to use it to file
criminal 'wuorthless check" charges.
WHEN TO VALIDATE THE DEBT -RULE
You must validate the debt if the consumer disputes or denies a debt by claiming
that:
• The transaction did not take place
• He/she was not a party to the transaction
How to validate the debt
In order to validate the debt you must provide a copy of the note signed by the
consumer to the consumer. Some consumers will attempt to repeatedly dispute
a debt in order to postpone collection activity. If this happens, remind the
consumer that the debt has been validated and that he/she cannot use this
excuse to delay payment.
PROPOSERS RESPONSE 93
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Disputes in writing
If the consumer disputes the debt in writing, no further collections may take place
until the debt has been validated.
Disputes not In writing
If the consumer disputes the debt during a telephone contact, you should validate
the debt to prevent future dispute; but there is no restriction on continuing
collection.
HOW TO APPLY PAYMENTS TO MULTIPLE DEBTS -INTRODUCTION
A consumer may have more than one account with SGS. If on contract becomes
delinquent others may also become delinquent. The Debt Collection Code
restricts how payment money may be applied to multiple accounts
Applying payments
The Code has two restrictions for applying payments to multiple accounts:
• You must apply the payment to the account or accounts as the consumer
chooses
• You can't apply any of the payment to an account the consumer is
disputing if the debt has not been validated
PROPOSERS RESPONSE 94
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THE SGS TELEPHONE CONTACT
All accounts with good phone numbers are required to have a minimum of two
collection phone calls a month until collected in full or probability of
reimbursement is minimal. Accounts are queued daily based upon "work-by"
dates in SGS' collection system. Collection agents typically work 125 - 150
accounts a day. The collector's primary objective is to obtain payment-in-full
(PIF) during the first talk-off (first conversation with debtor). SGS is capable of
accepting credit cards or check-by-phone. Unfortunately PIF is not always
possible. Therefore, the secondary goal is to make the best arrangements
possible.
Collectors attempt to establish arrangements based upon a repayment period of
no longer than six months. As a last resort an arrangement of $10 a month is
offered. SGS' standard account call queues are based upon account age.
Assignment of accounts by age allows SGS collection agents to prioritize and
facilitate the telephone collection process by giving consideration to the particular
goals of the collection call at a given point in time in the collection process i.e.,
the older the account, the less likely payment will be made and consequently
payment in full is strongly pursued. It is imperative during any call that payment
in full be the priority, however, when arrangements must be made they must be
reasonable enough for the debtor to be able to satisfy thereby reducing broken
promises and minimizing additional collection calls that must be made on the
account. In addition to working accounts in the aged collection queues,
collection agents must also stay current on the following accounts:
• Broken Promises - 3 days after promise date
RRC's (requests to return calls)
PROPOSERS RESPONSE 95
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THE SGS COLLECTION CALL
Step 1: Collectors Must Identify the Debtor
Collectors must be certain they are talking to the debtor, debtor's spouse or the
person responsible for paying the account and must also verify the spelling of the
name, address and place of employment and make corrections to account
information when necessary.
Step 2: Collectors Must Identify Who Thev Are
Upon positive identification of the debtor the collector must state their name and
that they are with Southwest General Services representing the City of XYZ
EMS. They must also clearly communicate to the debtor that they are attempting
to collect a debt. This satisfies FDCPA (Fair Debt Collection Practices Act) laws.
Step 3: Payment-In-Full Is Requested Today
Collectors are courteous but direct in their request for payment in full. `As you
know, Mr. Doe, your account with the City of XYZ for ambulance service is
seriously past due. We can accept check-by-phone or credit cards, how would
you prefer to make this payment?" Upon the conclusion of each contact with a
patient or an attempted contact with a patient, the collection representative will
enter an "exit code" which acknowledges the action taken. At this time the agent
would also schedule a specific time to call the debtor back if a call is requested
that is prior to SGS' default "next work-by" date.
PROPOSERS RESPONSE 96
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4. State the number of full time and part time employees assigned to each
service component.
Proposer's Response:
• Ticket Processing Center = 7 Full-Time Employees
• Customer Service Center = 6 Fuil-Time Employees
• Third-Party Billing Center = 8 Full-Time Employees
• Payment Posting/Accounts Receivable = 5 Full-Time Employees
• I.T. Services = 3 Full-Time Employees
• Delinquent Collections = 5 Full-Time Employees
• EPCR -Rescue Medic = 5 Fuli-Time Employees
Administration = 7 Full-Time Employees
PROPOSERS RESPONSE 97
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}~SGS
5. Provide information on any other municipal or similar account you
handle.
Proposer's Response:
Citv of Dallas
SGS has met or exceeded expectations in many of the communities we serve
where there has been a previous ambulance billing and collection vendor. We
have been providing ambulance transport billing and collection services to
the City of Dallas for more than 12 years, exceeding every requirement of
the contract -including collection percentages. SGS increased Dross
collections by 26% and 47% respectively in the first two vears of our contract with
the City of Dallas, when compared to the previous billing contractors
performance, at a collection rate of 62% annually.
SGS Performance Since 1994
PROPOSERS RESPONSE 98
CONFIDENTIAL-PROPRIETARY
1994 1996 1998 2000 2002 2004 2006
Year
~SGS
City of Richardson
In the City of Richardson, SGS doubled collections in the first year of our
contract when compared to the previous billing vendor - an increase in
actual cash of over $500,000. Over the life of the contract, SGS has continued
this quality service, increasing collections every year, at a collection rate of
72% annually.
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
Before '03= 04 '04-'05 '05= 06 '06= 07
SGS
^ Richardson
PROPOSERS RESPONSE 99
CONFDENT/AL-PROPRIETARY
~SGS
Citv of Plano
In the City of Plano, SGS increased collections in the first year of its contract
by over 25% - an increase in actual cash of over $500,000, and has continued to
increase revenue each year, at a collection rate of 76% annually.
3,500,000
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
^ Plano
~~g ~.~^~ ~~b ~~h t'06 ~07
t~ •O •O •O .O •O
t~0
~~
PROPOSERS RESPONSE 100
CONFIDENTIAL-PROPRIETARY
~SGS
Sedgwick County, Kansas
In Sedgwick County, Kansas (which includes Wichita), SGS increased
collections in the first year of our contract by 35% when compared to the
previous vendor - an increase in actual cash of almost 3 million dollars, at a
collection rate of 77% annually.
O Sedgwick County,
Kansas
PROPOSERS RESPONSE 101
CONFl DENTIAL-PROPRIETARY
Before SGS '06=07
~SGS
6. Provide a list of professional references and a brief summary of work
performed for each reference listed.
Proposer's Response:
AGENCY: CITY OF DALLAS
ADDRESS: 1500 Marilla Street, Room 2DS, Dallas, Texas 75201
SERVICES: Ambulance Billing and Collections and EPCR
COMMENCED: November 1994; EPCR in August 2004
CONTACT: Captain Danny Miller, Dallas Fire Rescue Dept. Contact
EMAIL: danny.miller@dallascityhall.com
PHONE: (469) 323-5482
AGENCY: SEDGWICK COUNTY E.M.S.
ADDRESS: 1015 Stillwell, # 7218, Wichita, KS 67213
SERVICES: Ambulance Billing and Collections
CONTACT: Dennis Mauk
EMAIL: dmauk@sedgwick.gov
PHONE: (316) 660-7972
AGENCY:
CITY OF RICHARDSON
ADDRESS: 136 N. Greenville Avenue, Richardson, Texas 75081
SERVICES: Ambulance Billing and Collections and EPCR
CONTACT: Battalion Chief Tim Mock
EMAIL: tim.mock@cor.gov
PHONE: (972) 744-5701
PROPOSERS RESPONSE 102
CONFIDENT/AL-PROPRIETARY
~SGS
AGENCY:
CITY OF OSHKOSH
ADDRESS: 215 Church Avenue, Oshkosh, Wisconsin 54901
SERVICES: Ambulance Billing and Collections
CONTACT: Chief Tim Franz
EMAIL: tfranz@ci.oshkosh.wi.us
PHONE: (920) 236-5235
AGENCY:
CITY OF CORSICANA
ADDRESS: 200 N. 12~' Street, Corsicana, Texas 75110
SERVICES: Ambulance Billing and Collections and EPCR
CONTACT: Chief Donald McMullan
PHONE: (903) 654-4956
AGENCY: CITY OF PLANO
ADDRESS: 1520 Avenue K, Plano, Texas 75074
SERVICES: Ambulance Billing and Collections
CONTACT: Ken Kline
EMAIL: kenk@gwmail.plano.gov
PHONE: (972) 941-7158
AGENCY: FRISCO FIRE DEPARTMENT
ADDRESS: P.O. Drawer 1100, Frisco, Texas 75034
SERVICES: Ambulance Billing and Collections
CONTACT: Ryan Wolford
EMAIL: rwolford@friscofire.com
PHONE: (972) 335-5525
PROPOSERS RESPONSE 103
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~SGS
AGENCY:
CEDAR HILL FIRE DEPARTMENT
ADDRESS: P.O. Box 96, Cedar Hill, Texas 75106
SERVICES: Ambulance Billing and Collections
CONTACT: Chief Stephen Pollock
EMAIL: Steve.pollock@CedarHilitx.com
PHONE: (972) 291-5100 x 2321
AGENCY: CITY OF GARLAND
ADDRESS: 200 North Fifth, Garland, Texas 75040
SERVICES: Ambulance Billing and Collections
CONTACT: Leon Jones
EMAIL: 1 i ones @ ci. garland.tx. us
PHONE: (972) 205-2686
AGENCY: CITY OF ROWLETT
ADDRESS: P.O. Box 99, Rowlett, Texas 75030
SERVICES: Ambulance Billing and Collections
CONTACT: Chief Randy Howell
EMAIL: rhowell@ci.rowlett.tx.us
PHONE: (972) 412-6234
AGENCY: TOWN OF PROSPER
ADDRESS: 407 1SI Street, Prosper, Texas 75078
SERVICES: Ambulance Billing and Collections and EPCR
CONTACT: Curtis Smith
EMAIL: Curtis.smith@prospe~re.com
PHONE: (972) 347-8484, ext. 805
PROPOSERS RESPONSE 104
CONFlDENTIAL-PROPRIETARY
}~SGS
7. Provide all pertinent bonding Information.
Proposer's Response:
SGS is properly insured and bonded and meets or exceeds all contractual
insurance obligations with all of our clients. Working through The Hutson
Insurance Group of Plano, Texas, all proper insurance policies are executed
through The Hartford. Upon being awarded the contract with the City of Corpus
Christi, SGS will provide all documentation necessary to fulfill the contractual
insurance obligations set forth by the City of Corpus Christi.
PROPOSERS RESPONSE 105
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}~SGS
8. Outline your internal plans such as any lockbox, methods for separation
of duties, safe-guarding cash payments, methods of posting cash,
balancing of daily receipts, use of messenger services, assurance of
protecting privacy of information about patients transported by CCEMS,
etc.
Proooser's Response:
Southwest General Services will receive all payments and correspondence via
any procedure the City Of Corpus Christi has in place.
Original payments are copied and batched for processing and distribution. All
mail is initially separated, recorded, and distributed to the appropriate desk within
eight hours of receipt. Reconciliation Services will complete the following tasks:
• Forward correspondence and explanation of benefits from Medicare,
Medicaid, Commercial Insurance, and Attorneys to the Third Party Billing
Department for processing.
Update all new insurance information received from patients and change
the Billing/Financial Codes to the appropriate payers.
• Record hardship letters, disability letters, bankruptcy notices, death
certificates and letters of dispute in the on-line comment screen and
forward to a supervisor/manager for review.
• Record returned mail from the post office for "bad address" in the on-line
comment screen and reclassify to a Skip Trace account.
PROPOSERS RESPONSE 106
CONFIDENTIAL-PROPRIETARY
~SGS
Payment Processing
The payment information and correspondence are initially forwarded to
Reconciliation Services for processing. Copies of payments are made and
batched along with accompanied correspondence (Medicare, Medicaid,
Insurance EOB's, etc.). All payments received that are not identifiable to any
open account shall be researched and recorded as such. Payments-are batched
and forwarded to the Payment Processing Department for posting to the system.
The following is an outline of the Payment Processing function:
• Verify payment amounts on checks and money orders.
• Record account numbers on all payments.
• the corresponding accounts utilizing SGS' billing ! payment code
classifications.
• Identify unfound payments and record with appropriate payment code.
• Research unfound payments.
• Edit, accept, and generate payment posting reports.
Once payments have been balanced with the original deposit and accepted into
the system, the payment batch itself is scanned into our system. The batches
are then labeled and stored in a locked storage with limited secured access.
PROPOSERS RESPONSE 1O7
CONFIDENTIAL-PROPRIETARY
}~SGS
Duplicate Payment Processing and Refunds
SGS monitors duplicate payments and credit balances on a daily basis using a
credit balance refund report, which reflects credit amounts and the date of
payment that created the credit. Detailed payment histories are then produced
and a thorough review is made to determine that all posting transactions are
correct (e.g., bad-debt write-offs, incorrect contractual adjustments, etc.).
The Patient Master database is searched for possible open accounts with the
same or similar names. Credit accounts involving a potential refund to a third-
party payer are reviewed for a misapplied or duplicate payment. If it is
determined that the patient to which a refund is due has an open balance, the
refund clerk will contact the patient seeking approval for a transfer of the credit
balance to the open balance. If the credit balance involves a Medicare assigned
claim and the patient denies the request for a transfer, a refund must be made.
Duplicate payments by a third-party payer are reviewed to assure that a payment
has not been misapplied and that, in fact, a duplicate payment was made.
Overpayments by more than one third party payer requires knowledge of
coordination of benefits clauses and primary payer source criteria. SGS
processes overpayment/multi-source payment refunds based on the following:
• When payment is received from both a group insurance company. and an
auto insurance company, the refund is issued to the patient.
• When iwo governmental agencies pay, it is necessary to determine which
is payer of last resort.
PROPOSERS RESPONSE 108
CONFIDENTIAL-PROPRIETARY
~SGS
• When Medicare and Medicaid pay as primary payer, the refund is issued
to Medicaid, as it is payer of the last resort.
• When payment is received from two different group policies (and the total
amount equals 100%) and an individual policy, the refund is issued to the
patient.
• When a check is received that has been made payable to the patient and
the client from an insurance company, the refund is issued to the patient.
• When payment is received from a group insurance and an insurance
company due to third-party liability, the group insurance is refunded.
• When Medicare and another source make payment, the refund is issued
based on Medicare as Secondary payer of guidelines.
• When Medicaid and another source make payment, the refund is issued to
Medicaid based on payer of last resort guidelines.
This list is provided as a general guideline as each refund due for
overpayments/multi-source payments is unique and must be reviewed carefully
to determine the correct recipient of the refund. If the refund clerk is uncertain as
to who is to receive the refund, the insurance or other payment source is
contacted for instructions. Once it has been determined that a refund is
appropriate, a Refund Request Form is completed. Supporting documentation
must include the payment histories on all invoices associated with the account
and photocopies of the supporting payment documents. The refund request is
then submitted for approval and then forwarded to the agency for payment.
PROPOSERS RESPONSE 109
CONFIDENTIAL-PROPRIETARY
}~SGS
9. Provide the names of person(s) responsible for contract services and
for serving as liaison to the Fire Department.
Proposers Response:
Scott Fothergill, SGS' Chief Operating Officer will be the main contact person
for the City of Corpus Christi.
PROPOSERS RESPONSE 110
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}~SGS
10. Proposers responding to this Request for Proposal must provide a
minimum of 2 professional references. The references must consist of
EMS based systems managed by municipal, county, or hospital based
S@rVICBS.
Proposer's Response:
AGENCY: CITY OF DALLAS
ADDRESS: 1500 Marilla Street, Room 2DS, Dallas, Texas 75201
SERVICES: Ambulance Billing and Collections and EPCR
COMMENCED: November 1994; EPCR in August 2004
CONTACT: Captain Danny Miller, Dallas Fire Rescue Dept. Contact
EMAIL: danny.miller@dallascityhall.com
PHONE: (469) 323-5482
AGENCY: SEDGWICK COUNTY E.M.S.
ADDRESS: 1015 Stillwell, # 7218, Wichita, KS 67213
SERVICES: Ambulance Billing and Collections
CONTACT: Dennis Mauk
EMAIL: dmauk@sedgwick.gov
PHONE: (316) 660-7972
AGENCY:
CITY OF RICHARDSON
ADDRESS: 136 N. Greenville Avenue, Richardson, Texas 75081
SERVICES: Ambulance Billing and Collections and EPCR
CONTACT: Battalion Chief Tim Mock
EMAIL: tim.mock@cor.gov
PHONE: (972) 744-5701
PROPOSERS RESPONSE 111
CONFDENTIAL-PROPRIETARY
~SGS
AGENCY:
ADDRESS:
SERVICES:
CONTACT:
EMAIL:
PHONE:
AGENCY:
CITY OF CORSICANA
ADDRESS: 200 N. 12"' Street, Corsicana, Texas 75110
SERVICES: Ambulance Billing and Collections and EPCR
CONTACT: Chief Donald McMullan
PHONE: (903) 654-4956
AGENCY:
CITY OF PLANO
ADDRESS: 1520 Avenue K, Plano, Texas 75074
SERVICES: Ambulance Billing and Collections
CONTACT: Ken Kline
EMAIL: kenk@gwmail.plano.gov
PHONE: (972) 941-7158
AGENCY:
FRISCO FIRE DEPARTMENT
ADDRESS: P.O. Drawer 1100, Frisco, Texas 75034
SERVICES: Ambulance Billing and Collections
CONTACT: Ryan Wolford
EMAIL: rwolford@friscofire.com
PHONE: (972) 335-5525
CITY OF OSHKOSH
215 Church Avenue, Oshkosh, Wisconsin 54901
Ambulance Billing and Collections
Chief Tim Franz
tfranz@ci.oshkosh.wi.us
(920)236-5235
PROPOSERS RESPONSE 112
CONFIDENTIAL-PROPR/ ETARY
~SGS
AGENCY:
CEDAR HILL FIRE DEPARTMENT
ADDRESS: P.O. Box 96, Cedar Hill, Texas 75106
SERVICES: Ambulance Billing and Collections
CONTACT: Chief Stephen Pollock
EMAIL: Steve.pollock@CedarHilltx.com
PHONE: (972) 291-5100 x 2321
AGENCY: CITY OF GARLAND
ADDRESS: 200 North Fifth, Garland, Texas 75040
SERVICES: Ambulance Billing and Collections
CONTACT: Leon Jones
EMAIL: ljones @ci.garland.tx.us
PHONE: (972) 205-2686
AGENCY: CITY OF ROWLETT
ADDRESS: P.O. Box 99, Rowlett, Texas 75030
SERVICES: Ambulance Billing and Collections
CONTACT: Chief Randy Howell
EMAIL: rhowell@ci.rowlett.tx.us
PHONE: (972) 412-6234
AGENCY: TOWN OF PROSPER
ADDRESS: 407 1ST Street, Prosper, Texas 75078
SERVICES: Ambulance Billing and Collections and EPCR
CONTACT: Curtis Smith
EMAIL: Curtis.smithC~prospe~re.com
PHONE: (972) 347-8484, ext. 805
PROPOSERS RESPONSE 113
CONFlDENTIAL-PROPRIETARY
~SGS
11.Identify how you will obtain legal advice regarding your collection
methods to assure that such methods will be in compliance with all
applicable local, state and federal law. Narrative must contain
assurances that the Contractor will comply with all such laws, methods
and procedures.
Proposer's Response:
SGS is currently a licensed collection agency in the State of Texas. SGS is in
compliance with all applicable local, state and federal laws concerning debt
collection activities. Please refer to our "Fair Debt Collection Policy" on pgs. 80 -
96 within this section of our proposal. We also have on retainer Cowles and
Thompson for all legal advice and services, with local offices in Dallas, Texas.
PROPOSERS RESPONSE 114
CONF/DENT/AL-PROPRIETARY
~SGS
72.Describe your fee structure and amounts for the services you propose
to provide to the City.
Proposer's Response:
Southwest General Services is offering the City of Corpus Christi a
Comprehensive EMS Reimbursement Solution, which includes our proposed
billing and collection services and the software, implementation, training, support
and maintenance for our proposed EPCR solution, RescueMedic. SGS is
proposing a Fixed Commission Percentage Fee on Net Collections (Gross
Collections less Refunds) as payment for services and products that we are
proposing to provide. Our Fixed Commission Percentage Fee will be invoiced at
the beginning of the month and based on the previous months net collections.
Our price is listed below.
- 6% of Net Collections
PROPOSERS RESPONSE 115
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~SGS
13.Confirm fees submitted above include the purchase of data capture
software and annual user subscription fees of software as required
under service requirements, Section A, Par 2 and 3.
Proaoser's Response:
SGS is proposing to provide Rescue Medic as part of our "all inclusive" package.
The cost of Rescue Medic is included in the 6% commission fee we are
proposing. Rescue Medic is priced on a per run basis. The per run price which
includes a 40% discount is $1.10 per run. The estimated annual cost of the
Rescue Medic system is $33,000. We would like to point out that the City of
Dallas Fire Rescue is currently utilizing Rescue Medic with an annual run volume
exceeding 180,000 runs.
PROPOSERS RESPONSE 118
CONHDENTIAL-PROPRIETARY
~SGS
14.The Contractor will list their collection rates for three comparative cities.
These collection rates will be listed in both methods as described
below:
Method 1
Raw Collection Rate % =Total Collections /Total billings (Total
collections in dollars divided by total dollars billed).
Method 2
Contractual Collection Rate % =Total Collections /Adjusted billings
(Total collections in dollars divided by total dollars billed after
subtracting adjustments. These are typically Medicare, Medicaid,
Commercial Insurance, Crime Victims, Indigent Care, etc.)
Proposer's Resaonse:
City of Plano, TX:
Collection Method # 1 - 64%
Collection Method # 2 - 76%
Seds~wick Countv. KS:
Collection Method # 1 - 55%
Collection Method # 2 - 77%
Citv of Richardson. TX:
Collection Method # 1 - 60%
Collection Method # 2 - 72%
PROPOSERS RESPONSE 117
CONFIDENTIAL-PROPRIETARY
~SGS
15.The Contractor is encouraged to provide the Clty with enough
managerial biography, company history, and billing experience to allow the
City to make a comfortable comparison of vendor qualifications.
Proposer's Response:
History
Founded in 1985, SGS is a national company that has more than 20 years of
experience in Ambulance Transport Billing and Collections. We bill in excess of
300,000 new ambulance transport accounts totaling over $200 million dollars
annually. During these many years of service to our customers, we have met all
Federal, State, and other requirements without fail. In each case, we have
increased the recoverable amounts for our customers. SGS has not and does
not currently perform ambulance billing and collection services for any NYC
providers.
Innovative Measures
SGS has developed and continues to
enhance our billing processes. We have
created an Information Gathering
SGS INNOVATIVE FEATURES
- Hospital information
Network inclusive of hospital databases
and on-line resources. This network
gives us the opportunity to verify and
obtain information at the beginning of the
billing process. We have also developed
an Address Verification Program that
screens patient addresses with the
Network
- Postal Reconciliation And
Verification Process
- Medicare Appeal Process
- Medicaid Appeal Process
- Self-Pay Collection
Process
PROPOSERS RESPONSE 118
CONF/DENTIAL-PROPRIETARY
~SGS
United States Postal Services database verifying the validity of all addresses. In
addition, SGS has developed a rigorous MedicarelMedicaid appeal process that
automatically appeals all non-covered Medicare/Medicaid claims.
Technical Capabilities and Procedures
SGS takes the view that the management of records is both a staff and data
processing function. SGS utilizes Microsoft Windows Server 2003 running
SQL Server 2000 that provides unsurpassed expandability, data integrity and
security coupled with unlimited reporting capabilities. SGS' custom developed
ambulance billing software system known as EMIRS (Emergency Medical
Information Reporting System), a proven multi-service fee billing and collection
program specifically designed for Ambulance Reimbursement. EMIRS
integrates into all major EPCR solutions, offering the potential for growth and
ready adaptation to technology changes.
Quality Personnel
With over two decades in the Ambulance Transport reimbursement industry,
SGS provides billing and collection for more than 300,000 new ambulance
transports each year. Our staff is fully trained in all areas of the law as it
pertains to CMS (Centers for Medicare and Medicaid) Rules and Regulations,
HIPPA guidelines, OIG (Office of Inspector General) guidelines, FDCPA (Fair
Debt Collection Practices Act), and the FCRA (Fair Credit Reporting Act).
All billing and collection staff team members must complete training courses
thoroughly covering the aforementioned laws, guidelines, and rules.
• Resumes of Key Personnel follow:
PROPOSERS RESPONSE 119
CONFIDENTIAL-PROPRIETARY
~SGS
Scott Fothergill
Chief Operating Officer
Southwest General Services March 1994-Present
• Director of Operations 1994-1997
• City of Dallas Project Manager since 1994
• Became COO in 1997
• Responsible for performance of billing and collection contracts
• Responsible for operational contract compliance
• Directly oversees the sales team
AT&T
June 1990-March 1994
• Management of warehouse team
• Organize and oversee assembly line personnel
• Monitor quality and efficiency of production
Education
• Southern Methodist University, Dallas, Texas
• Majored in Business Administration & Business Policy
PROPOSERS RESPONSE 120
CONFIDENTIAL-PROPRIETARY
}~SGS
Eric Fothergill
Chief Financial Officer
Southwest General Services March 1994-Present
• Began working various roles within the company including:
o Budgeting
o Accounting
o Monthly report analysis
o Compliance Manager
o Ticket Processing Supervisor
o Third Party Supervisor
• CFO since 1997
• Responsible for all financial aspects of SGS
• Directly oversees all accounts payable
• Directly oversees client reporting
AT&T July 1990-December 1994
• Trainer
• Development, delivery, and execution of curriculum
Education
• Southern Methodist University
• BBA in Accounting/Organizational Behavior & Business Policy
PROPOSERS RESPONSE 121
CONFIDENTIAL-PROPRIETARY
}~SGS
Nena Richmond
Billing And Collections Manager
March 1997-Present
• Oversees all billing and collection activity for all contracts
• Works with Implementation Team to verify a smooth transition
• Extensive knowledge of:
o Texas Department Of Health rules and statutes
o Medicare and Title XIX laws and rules
o Workers' Compensation rules
o Fair Debt Collection Practices Act
• Manages SGS' Customer Service department to resolve customer issues
• Medical coding specialist
• Hiring Manager
• Oversees auditing of accounts to maximize collected revenue
• SGS' Compliancy Officer
Education
• Baylor University
• Bachelor's Degree in English
PROPOSERS RESPONSE 122
CONFIDENTIAL-PROPRIETARY
~SGS
Stephanie Kennedy
Third-Party Insurance Supervisor
February 2000-Present
• Coordinates all Medicare, Medicaid, and Commercial Insurance
verification and eligibility
o Includes appeals and fair hearings
• Has established, and maintains, a positive rapport with health-care
insurance providers
• Assists with new client implementation
• Conducts thorough auditing of accounts to ensue all collections efforts are
exhausted
• Supervises handling of all claims filing, communication and processing of
EOBs, including Medicare, Medicaid, commercial insurance, workers'
compensation, auto & general liability.
• Supervises processing of all patient correspondence and disputes
• Well-versed and trained in EMS billing and collection industry policies
o Department of Health rules and statues
o Medicare laws and regulations
o Title XIX laws and regulations
o HIPPA laws
o Workers' compensation rules
o Fair Debt Collection Act
PROPOSERS RESPONSE 123
CONFIDENTIAL-PROPRIETARY
~SGS
Rachel Fothergill
Ticket Processing Center Supervisor
March 2000-Present
• Supervises all aspects of "front end" work
o Ticket entry
o Data processing
o Hospital Verification Network
o Address screening
o Initial insurance analysis
• Analysis of all reports pertaining to quality and integrity
• Experienced in cash processing and posting
• Works closely with ICD-9 coding Department
• Handles month end reporting QA
• Backup for refund department
Thorough understanding of entire process
PROPOSERS RESPONSE 124
CONFIDENTIAL-PROPRIETARY
}~SGS
Wendy Gary
Support Services Supervisor
May 1996-Present
• Directly oversees all functions involving:
o In-bound correspondence
o Cash Processing
o Duplicate Payment Processing
o Refunds
• Full understanding of all areas of the process to properly troubleshoot and
have resolution of any issues that may arise
Experience
Over 15 years of EMS billing and collection experience
Education
• Texas A&M University -Commerce
• Bachelor's Degree In English
PROPOSERS RESPONSE 125
CONFIDENTIAL-PROPRIETARY
~SGS
Rob Ervin
Business Development & Implementation
March 2003-Present
• Provides a smooth transition to new clients into SGS' system
• Coordinates and schedules any on-site training required by the client for:
o Documentation
o Web EMIRS
o Any recurrent needed
• Serves as the contact person during transitional period
o Working hand-in-hand with Nena Richmond
• Handled training for Dallas Fire, North Richland Hills Fire, Prosper Fire,
and others
• Application processes for client address/lockbox changes
• Heads up Client Implementation Team
• Liaison to EmergiData for Rescue Medic coordination
• Cross-trained in all areas, including tech support
Experience
• Over 10 years of training experience
o Certified trainer from the communications industry
PROPOSERS RESPONSE 126
CONFIDENTIAL-PROPRIETARY
~SGS
Nathan Crabb
IT Manager
July 2002-Presenf
• Writes all EDI, Reporting, Bulk Mail, and Data Import code
• Oversees all programming and maintenance of EMIRS, SGS' custom
billing and collections software program
• Verifies security and precision of the network
• Monitors integrity of reporting and correct operation of EMIRS itself
Experience and Certifications
• Over 10 years of system analyst and programming work
• Microsoft Certified Programmer
PROPOSERS RESPONSE 127
CONHDENT/AL-PROPRIETARY
~SGS
Marcus Kwan
EPCR -Rescue Medic Project Manager
July 2006-Present
• Oversees all of Rescue Medic project installs and continuous operational
activities
• Manages multiple, simultaneous implementation projects
• Develops implementation timelines
• Develops EPCR project scope of work
• Develops support guidelines and procedures
Experience and Certifications
• Over 12 years of network administration
• Microsoft Certified Systems Engineer NT 4 (MCSE) 1999
• Cisco Certified Network Professional (CCNP) 2001
Education
• Bachelor of Arts and Mathematics, Dec 1994
Southwestern University, Georgetown, TX
PROPOSERS RESPONSE 128
CONHDENT/AL-PROPR/ ETARY
RescueMedic EPCR Solution
~SGS
RESCUE MEDIC -EPCR SOLUTION
As part of our "all inclusive" package we are proposing to provide the City of
Corpus Christi, TX, the RescueMedic EPCR system. Our proposal includes
implementation and training of the RescueMedic system as well as 24 hour -
year round technical support.
Many municipalities, including the City of Dallas Fire Rescue Department,
responding to over 180,000 EMS calls annually, are currently utilizing the
RescueMedic system. The time saving features, ease of use and clear-cut
protocols have proven to be a distinct advantage for these EMS providers.
Included is an overview and features listing of the RescueMedic EPCR system.
T
R~sCT! e~
RESCUEMEDic-EPCR SOLUTION 129
CONHDENTIAL-PROPRIETARY
~SGS
Rescue Medic Overview
Emergidata's electronic patient care reporting system, RescueMedic PCR, is
quickly setting the standard for field data collection and reporting in the EMS
industry. It has gone through the rigorous NEMSIS testing process and has been
awarded the NEMSIS Silver certification.
Assessment
Chief Complaint
RESCUEMEO/c- EPCR SOLUTION 130
CONFIDENTIAL-PROPRIETARY
~SGS
RescueMedic PCR empowers an EMS organization to provide superior patient
care documentation, manage an efficient ambulance service and configure a
system designed to your organization's specific operational needs. It interfaces
with a number of CAD, billing and state reporting systems. Zoll M Series, Physio-
Control Lifepak and Philips defibrillator interfaces are available for easy
transmission of monitor data.
Vitals
RESCUEMED/C- EPCR SOLUTION 131
CONFIDENTIAL-PROPRIETARY
Demographic Information
~SGS
RescueMedic PCR provides the tools and capabilities needed to streamline
operations, reduce costs, and validate quality of care through timely and accurate
data collection and retention. It enables field personnel to electronically capture
and record comprehensive clinical data and allows ail approved personnel
access to those records immediately on-line. Powerful data mining and reporting
capabilities are at your fingertips using the RescueMedic web-based
Administrator module.
Administration and Configuration
'° EMS FieNl Date Solutions
Demo
_ w
RESCUEMEO~c- EPCR SOLUTION 132
CONFDENTIAL-PROPRIETARY
~} SGS
Additionally, the RescueMedic software suite offers potential field efficiencies by
reducing the documentation time-at-task thereby improving ambulance
turnaround and enabling more calls per day. Moreover, paramedics have
immediate access to protocols, which can be used to sharpen skills and improve
patient care. Information can be easily analyzed to measure protocol compliance
and to identify possible training /education opportunities.
Protocols
RESCUEMEDIC - EPCR SOLUnON 133
CONFIDENTIAL-PROPRIETARY
}~SGS
1~escu e~
FEATURE LIST
RescueMedic was created with the goal of reducing the amount of time required
to capture all relevant incident and patient information. RescueMedic uses the
following features to create efficiencies, reduce the time to complete data entry
tasks, and improve the integrity of collected data.
• Graphical, touchscreen driven, intuitive interface allows rapid data
entry
An open ended layout for inputs where virtually any input field is no
more than 2 clicks away from any point in the data entry process
• Quick buttons, pre-populated fields, type-ahead fields, and context
sensitive pick lists reduce the amount of time required for data entry
• RescueMedic will accept input from multiple input devices, including but
not limited to keyboard, mouse, touchscreen, touchpad, and mag stripe
readers
• Drivers Licenses following the AAMVA standard can be scanned to
capture patient information
• Vital, EKG, and Event information can be imported directly from Physio
Control and Phillips monitors
• Patient Care Reports can be printed from the portable unit to a local
printer, or it can be faxed directly to the receiving facility
RESCUEMED~c- EPCR SocunoN 134
CONHDENTIAL-PROPR/ ETARY
~SGS
• RescueMedic synchronizes incident data with a centralized server in near
real time with no user intervention required. Data upload capabilities use
industry standard SSL encryption and require Internet connectivity.
• The RescueMedic Administration Web Portal allows tickets to be viewed,
annotated, and submitted to a QA\QI process online before being released
to billing
• RescueMedic can provide exports directly to billing systems or services,
greatly reducing the billing cycle and improving collection rates
• RescueMedic is NEMSIS Silver Certified
• RescueMedic manages multi-patient incidents by providing the capability
of creating multiple incidents from one set of incident information
• Patient and incident information is stored both locally on the portable
device as well as on the server during the data entry process. Once the
Patient Care Report has been completed, the data is stored permanently
on the server only.
• RescueMedic requires validation of a PCR before completing it. The PCR
will not be allowed to be completed if any required fields are incomplete
• Patient refusal, HIPAA, and other regulatory forms can be
customized with specific verbiage
• RescueMedic complies with the Healthcare Insurance Portability and
Accountability Act (HIPAA)
• The RescueMedic Administration Web Portal allows designated users to
manage application users, stations, facility locations, units, and other
agency specific information
RESCUEMED~c- EPCR SOLUTION 135
CONFIDENTIAL-PROPRIETARY
Appendices
SAMPLE CITY EMS
S PO BOX 10000
CITY, ST 55555
il~l~~i~l~~l~l~~l~i~~l~l~~l~l~~l~l~~l~l~~l~l~~l~i~~l~l~~~~~
JOHN SOMEBODY
GO SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
ITEM
ITEM
ITEM
ITEM
ITEM
ITEM
ITEM
ITEM
T, EM
.I'EM
ITEM
ITEM
ITEM
ITEM
ITEM
TOTAL CHARGES
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$1,500.00
Insurance Name
Insurance Address:
Insurance Phone:
ID/Policy Number.
Group Number:
Policy Holder:
Remit al~ayments to:
CITY OF SAMPLE EMS
GO SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
1 $100.00
1 $100.00
1 $100.00
1 $100.00
1 $100.00
t $lao.oo
1 $100.00
t $loo.ao
1 $100.00
1 $100.00
1 $100.00
1 $100,00
1 $100.00
1 $100.00
1 $100.00
110-1 ooooao 000000
S 1,500.00 S 500.00 s 1,000.00
06/112003 06/132007 UPoNRECb'B't
Payment for ambulance service is due upon receipt
unless you had medical coverage at the time of
transport. If you had medical coverage please complete
the bottom portion of this bill and return it in the
enclosed envelope within.five (5) days. If you had no
medical coverage at the time of transport, please remit
payment in full at this time or call our office to make
suitable payment arrangements.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Insurance Payor Id:
Medicare Number:
Medicaid Number:
SSN:
Date of Birth:
Signature Requited:
Amount Enclosed:
Please include your patient no. on your check. Thank You!
06/132007 000000 000000
NN~I~I~Ipli~ihll~
~-~ SAMPLE CITY EMS
~i~.J~C~ S ~,j S PO BOX 10000
J -~ CITY, ST 55555
~I~~i~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~i~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
PAST DUE ACCOUNT
Charges : $1,500.00 Our records indicate you have not responded to our
Payments : asoo.oo prior request for information or payment for services
Balance : $1,000.00 Balance Due Now rendered. If you had medical coverage please complete
- the bottom portion of this bill and return it in the
enclosed envelope within five (5) days. ff you had no
medical coverage at the time of transport, please remit
payment in full at this time or call our office to make
suitable payment arrangements.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
tto-z 000000 000000
Insurance Name:
Insurance Address:
Insurance Payor Id:
Medicare Number:
Insurance Phone:
ID/Policy Number:
Group Number:
Policy Holder:
Remit all payments to:
CITY OF SAMPLE EMS
GO SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS. TX 75218
Medicaid Number:
SSN:
Date of Birth:
Signature Required:
Amount Enclosed:
Please include your patient no. on your check. Thank You!
06/13/2007 000000 1000000
B9~IMI~I~IIIII~IQI
SAMPLB CITY BMS
~'i~„ ~ 5~j S PO BOX 70000
~~ CITY, ST 55555
.I„I,I~~I~I~~I~I~~1~1~~1~1~~1~1~~1~1~~1~1~~I~1~~1~1„~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECTTY, TX 99999-9999
Charges: $1,500.00
Payments : $500.00
Balance ; $1,000.00 Past Due, Payable Now
Rearit all payments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
lla3 000000 oaoooo
$ 1,500.00 ~ E 500.00 $ I,000.00
SERIOUSLY PAST DUE ACCOUNT
Despite repeated attempts to obtain payment or
insurance information from you, your account remains
unpaid. If you do not remit payment in full or contact
us within ten (10) days to make suitable payment
arrangements, your account will be placed in a
delinquent status and further collection efforts will
continue. If you have already submitted payment,
please disregard this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your check. Thank You!
06/132007 000000 000000
II ~I ~ NI ~~ ~ ®I ~ 11 ~ u ~ M~
SAMPLE CITY EMS
S G S PO BOX 10000
t CITY, ST 55555
~I~~I~I„I,I~~I,I„ICI,~I,I~~I~I„I,I~~I,I„I~I„1~1~,~„
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWIIERE
SOMECITY, TX 99999-9999
~~s-i oooaoo 000000
S 1,500.00 S 500.00 S 1,000.00
Charges : $1,500.00 your insurance company has paid their portion, leaving
Payments : $500.00 a remaining balance. Please remit payment in full or
Balance : $1,000.00 Balance Due Now contact us within five (5) days to make suitable
payment arrangements. If you have already submitted
payment, please disregard this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Remit all payments to:
Please include your patient no. on your check Thank You!
CITY OF SAMPLE EMS
C/O SOiJ1T-IWEST GENERAL SERVICES o6itsnao7 pp~~ 000g00y0q ~p 000000
DALLAS, TX 7 218 ~~~~~~I~~~il~gl~~~lll
~`F~SGS
SAMPLE CITY EMS
PO BOX 10000
CITY, ST 55555
,I..ICI,~I~I~,ICI„ICI,,I~I~,I,I~~I,I„ICI„I,I„I,i„~„
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
uz-z 000000 000000
a 1soo.oo a soo.oo s 1,000.00
PAST DUE ACCOUNT
Charges : $1,500.00 Our records indicate you have not responded to our
Payments : $500.00
prior requests for information or payment for services
Ba-ance : $1,000.00 Past Due, Payable Naw rendered. Your account is now past due and payable
immediately. Please remit payment in full or contact us
within five (5) days to make suitable payment
arrangements. If you have already submitted payment,
please disregard this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Remit all oayments to:
Please include your patient no. on your check. Thank You!
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES 06/132007 000000 000000
DALLAS, TX 875218 111~1~1111~1~1~1~
`~ S G S
SAMPLE CITY EMS
PO BOX 10000
CITY, ST 55555
i~u~~~n~~~n~i~n~~~u~i~n~i~n~~~u~~~u~i~u~~~nw
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
112-3 000000 000000
S 1,500.00 $ 500.00 S 1,000.00
06/11/2003 06/132007 UPON RECeD''r
SERIOUSLY PAST DUE ACCOUNT
Chazges : $1,500.00 Despite repeated attempts to obtain payment or
Payments : $500.00 insurance information from you, your account remains
Balance : SI,0o0.0o Seriousty Past Due, unpaid. If you do not remit payment in full or contact
Payable Now us within ten (10) days to make suitable payment
arrangements, your account will be placed in a
delinquent status and further collection efforts will
continue. If you have already submitted payment,
please disregazd this notice.
Remit all payments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your check. Thank You!
o6n3rzoo7 000000 000000
MAIIbI~I~Ii~IMl~ll~
SAMPLE CITY EMS
5 G S PO BOX 10000
CITY, ST 55555
II~I~~I~I~~I~I~~I~i~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
nal 000000 000000
S 1,500.00 S 500.00 S 1,000.00
Charges : $1,500.00 your insurance company has either paid their portion,
Payments : ssoo.oo denied the claim, or has not responded for ambulance
Balance : $1,000.00 Balance Due Now services provided to you. Tn an effort to resolve your
account, we will direct all future billings to you. Please
remit balance in full or contact us vrithin five (5) days
to make suitable payment arrangements. If you have
already submitted balance in full, please disregard this
notice.
Thank you for your cooperation!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Remi[ all navments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
Please include your patient no. on your check. Thank You!
06/13/2007 .000000 000000
SAMPLE CITY EMS
S G S PO BOX 10000
l --~ CITY, ST 55555
~~i~n~~~n~i~n~~~n~~~u~~~u~i~n~~~n~~~u~~~n~i~uui
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Chazges: $1,500.00
Payments : $500.00
Balance
$1,000.00 Past Due, Payable Now
Remit all navments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
1142 000000 000000
PAST DUE ACCOUNT
Our records indicate you have not responded to our
prior requests foi information or payment for services
rendered. Your account is now past due and payable
immediately. Please remit payment in full or contact us
within five (5) days to make suitable payment
arrangements. If you have akeady submitted payment,
please disregazd this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. - Fri. 8AM - SPM
Please include your patient no. on your check Thauk You!
a~~
p',.
061132007® 000~ryI00gg0gg qq~~ aooooo
p~~~~~~~~U~M~~~~lll
SAMPLE CITY EMS
S G S Po sox ~oooo
CITY, ST 55555
~~n~~~n~~~u~i~u~~~n~i~u~i~n~i~n~~~n~i~n~i~nm
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Charges: $1,500.00
Payments : $500.00
Balance : $1,000.00 Seriously Past Due,
Payable Now
1143 000000 000000
S 1,500.00 S 500.00 5 1,000.00
SERIOUSLY PAST DUE ACCOUNT
Despite repeated attempts to obtain payment or
insurance information from you, your account remains
unpaid. If you do not remit payment in fizll or contact
us within ten (10) days to make suitable payment
arrangements, your account. will be placed in a
delinquent status and fiuiher collection efforts will
continue. If you have already submitted payment,
please disregazd this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. SAM - SPM
---------------- ------------------------------------------- - -- - - ----------------------------------------------------------------------------
Faa enA for Borg puforeYOn
Remit all payments to:
Please include your patient no. on your check. Thank You!
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES oc~l3nao~ ®q~ YY'' po~00p~00pp0 AA 000000
DALLAS. TX 75218 ~g~~pllq~1!Ig~ll~~l!~
~-~ SAMPLE CITY EMS
~~-~ S G S PO BOX 10000
~-.~ CITY, ST 55555
II~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~i~l~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Insurance Payor Id:
Medicare Number:
Chazges : 51,500.00 Medicare paid their portion, leaving a remaining
Payments : 5500.00 balance. If you have supplemental insurance, complete
Balance : 51,000.00 Balance Due Now the bottom portion of this bill and return It ]n the
enclosed envelope. If you do not have supplemental
insurance, please remit payment in full or contact us
within five (5) days to make suitable payment
arrangements. If you have already submitted payment,
please disregard this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. SAM - SPM
Insurance Name: _
Insurance Address: _
Insurance Phone: _
ID/Policy Number:
Group Number: _
Policy Holder: _
Remit all payments to:
Medicaid Number:
SSN:
Date of Birth:
Signature Required:
u~a 000000 000000
s t,soo.oo s soo.oo s t,ooooo
oentnooa oensnoo~ ueoxascE~r
Amount Enclosed:
Please include your patient no. on your check Thank You!
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES ov1t9n007 aooooo 000000
DALLAS Tx 87 218 ~91~I~I~II~IIIIIVIII~
SAMPLE CITY EMS
S G 5 Po sox ~oooo
CITY, ST 55555
~I~~I~I~~i~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~~~~
JOHN SOMEBODY
GO SOMEBODY
123 SOMEWI-IERE
SOMECITY, TX 99999-9999
Charges
Payments
Balance
$ (,500.00
$500.00
$1,000.00 Past Due, Payable Now
Remit all oayments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
l~7-z o0000o I 000000
s t,soo.oo s soo.oo s taoo.oo
PAST DUE ACCOUNT
Our records indicate you have not responded. to our
prior requests for information or payment for services
rendered. Your account is now past due and payable
immediately. Please remit payment in full or contact us
within five (5) days to make suitable payment
arrangements. If you have already submitted payment,
please disregard this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your check. Thank You!
abnsnoo~ 000000 000000
~~SGS
SAMPLE CITY EMS
PO BOX 10000
CITY, ST 55555
~~u~~~u~i~u~,~nh~u~~~n~,~u~~~u~i~u~~~u~~~um
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Chazges : $1,500.00
Payments : $500.00
Balance : $1,000.00 Seriously Past Due,
Payable Now
Remit all ~yments to:
CITY OF SAMPLE EMS
GO SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 7s218
1
117-3 000000 000000
a l,sao.oo s soo.oo s t,ooo.oo
O6/1In003 06/13n007 UPONascsan
SERIOUSLY PAST DUE ACCOUNT
Despite repeated attempts to obtain payment or
insurance information from you, your account remains
unpaid. If you do not remit payment in full or contact
us within ten (10) days to make suitable payment
arrangements, your account will be placed in a
delinquent status and further collection efforts will
continue. If you have already submitted payment,
please disregard this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. - Fri. 8AM - SPM
Please include your patient no. an your check. Thank You!
osn3noo7 000000 000000
~SGS
SAMPLE CITY EMS
PO BOX 70000
CITY, ST 55555
Ii~l~~l~l~~l~l~~i~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Charges: $1,500.00
Payments : $500.00
Balance : $1,000.00 Balauce Due Now
Remit all payments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
1x1a 000000 000000
S 1,500.00 I S 500.00 S 1,000.00
06/11/20031 06/1312007 UPON aECBIPf
Medicare has denied the claim for ambulance services
provided to you because: Ambulance transportation
was not medically necessary at the time of transport.
Please remit payment in full or contact us within five
(5) days to make suitable arrangements.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your check. Thank You!
06/13/2007 000000 000000
SAMPLE CITY EMS
5 G 5 Po sox ~ o000
CITY, ST 55555
II~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Charges
Payments
Balance
$1,500.00
$500.00
$1,000.00 Past Due, Payable Now
Remit all navments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
i
tzi-z o0000o aaoooo
Our records indicate you have not responded to our
prior request of payment for services rendered. Your
account is now past due. Please remit balance due or
contact us within five (5) business days to make
suitable payment arrangements. If you have already
submitted payment, please disregard this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your check. Thank You!
ot~l3rzoo~~p gry opu0000g0 IIII 000000
p~~~l ~~ ~U ~~~ ~ W9~I~ ~ NI
SAMPLE CITY EMS
~•i+~ S('~jl S PO BOX 10000
~-.~ CITY, ST 55555
llull~ull'nl~lu~l'ulllnlllnh'uIl'nl~l u'l~un~
JOHN SOMEBODY
GO SOMEBODY
123 SOMEWHERE
SOMECITY. TX 99999-9999
Charges: $1,500.00
Payments : $500.00
Balance : 51,000.00 Seriously Past Due,
Payable Now
121-3 000000 000000
s I,soo.oo s soo.oo s taoo.oo
PAST DUE ACCOUNT
Our records indicate you have not responded to our
prior request of payment for services rendered. Your
account is now past due. Please remit balance due or
contact us within five (5) business days to make
suitable payment arrangements. If you have already
submitted payment, please disregazd this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. SAM - SPM
---------------- -- ----------------------------- - ----------- -
Fold uM iw daigpufondoo
Remit all payments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
Please include your patient no. on your check. Thank You!
~,
06/132007 000000 000000
~I~Il~lpl~l~lwlll~
SAMPLE CITY EMS
S G 5 Po sox ~oooo
CITY, ST 55555
~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I~I~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
tzs-~ 000000 aaoooo
s tsoo.oo s soo.oo s 1,000.00
Charges : $1,500.00 Medicaid has denied the claim for ambulance services
Payments : $500.00 provided to you because: The condition of the patient
Balance : $1,000.00 Balance Due Now at the time of transport did not require emergency
transportation. Please remit payment in full or contact
us within five (5) days to make suitable arrangements.
Remit all pavments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your check. Thank You!
06/13/2007 000000 000000
SAMPLE CITY EMS
S G S PO BOX 70000
~' -+ CITY, ST 55555
~~~~u~i~u~i~n~i~u~~~u~i~n~i~u~~~u~,~u~i~Yi~~~nu~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
char~e5: $l,soo.oo
Payments : $500.00
Balance : $1,000.00 Past Due, Payable Now
125-2 000000 000000 -
s l,sao.oo s soo.oo s t,0oo.00
06/112003 06/132007 uroN aE ~~'['
PAST DUE ACCOUNT
Our records indicate you have not responded to our
prior requests for information or payment for services
rendered. Your account is now past due and payable
immediately. Please remit payment in full or contact us
within five (5) days to make suitable payment
arrangements. If you have already submitted payment,
please disregard this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
------------------------------------------------------------------------------------------
--------------
FoW aM wr long pafonuon
Remit all navments to:
Please include your patient no. on your check. Thank You!
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES o5n32oo7 ryn~~pp 000000 IIII 000000
DALLAS. TX 716218 ~Nlll~l~l~l~l~l~llu
SAMPLE CITY EMS
~;,~ ~- S G S PO BOX 10000
~J CITY, ST 55555
~~i~u~~~n~i~u~~~u~~~u~~~u~i~u~~~u~i~u~~~u~i~wu
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Chazges: $1,500.00
Payments : $500.00
Balance : SI,000.00 Seriously Past Due,
Payable Now
Remit all payments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
. ~ i~,
,i
125-3 000000 000000
SERIOUSLY PAST DUE ACCOUNT
Despite repeated attempts to obtain payment or
insurance information from you, your account remains
unpaid. If you do not remit payment in full or contact
us within ten (10) days to make suitable payment
arrangements, your account will be placed in a
delinquent status and further collection efforts will
continue. If you have already submitted payment,
please disregazd this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri- 8AM - SPM
Please include your patient no. on your check Thank You!
o~l3noo~rr 00000®®0II 000000
6~~~~~~~~~~~~~1~~~ ~~~~
SAMPLE CITY EMS
~~~ S G S PO BOX 10000
CITY, ST 55555
Il~l~~i~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~rl~l~~l~l~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
~~ f4 I'II
~z7a 000000 000000
Charges : $1,500.00 Either your attorney has not responded to our request
Payments : $500.00 for litigation status, or they no longer represent you for
Balance : $1,000.00 Balance Due Now services provided on the above-mentioned date.
Therefore, we will direct all future correspondence to
-you. At this time your remaining balance is due in full.
If you are unable to pay your balance in full, please call
our office to make suitable payment arrangements.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Remit all payments to:
CITY OF SAMPLE EMS
GO SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS. TX 75218
Please include your patient no. on your check. Thank You!
06/132007 000000 000000
~`~SGS
SAMPLE CITY EMS
PO BOX 10000
CITY, ST 55555
~I~~I~I~~I~I~~I~I~~1~1~~1~1~~1~1~~1~1~~1~1~~1~1~~1~1~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Charges: $1,500.00
Payments : $500.00
Balance : $1,000.00 Past Due, Payable Now
Reroit all uavments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
Iz~•z 000000 000000
PAST DUE ACCOUNT
Our records indicate you have not responded to our
prior requests for information or payment for services
rendered. Your account is now past due and payable
immediately. Please remit payment in full or contact us
within five (5) days to make suitable payment
arrangements. If you have already submitted payment,
please disregazd this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. SAM - SPM
Please include your patient no. on your check. Thank You!
o6nsnoo~ gg o00pry00®B0~~ ® 000000
IA ~~~ (~~) ~ ~NA ~dl ~8~~~
~~SGS
SAMPLE. CITY EMS
PO BOX 10000
CITY, ST 55555
~~u~~~u~i~u~~~n~i~u~i~u~~~n~i~u~i~u~~~n~~~nm
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWI-IERE
SOMEC[TY, TX 99999-9999
Chazges: $1,500.00
Payments : $500.00
Balance : $1,000.00 Seriously Past Due,
Payable Now
Remit all t)8Vments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
127-3 000000 000000
I' i
$ 1,500.00 S 500.00 S 1,000.00
SERIOUSLY PAST DUE ACCOUNT
Despite repeated attempts to obtain payment or
insurance information from you, your account remains
unpaid. If you do not remit payment in full or contact
us within ten (10) days to make suitable payment
arrangements, your account will be placed in a
delinquent status and further collection efforts will
continue. If you have already submitted payment,
please disregard this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your Check. Thank You!
06/13/2007 000000 000000
~-~ SAMPLE CITY EMS
~.r~~C S C„-~ S PO BOX 10000
~--~ CITY, ST 55555
Il~l~~l~l~~l~l~~l,l~~l,l~~l~i~~l~l~~l~l~~l~l~~l~l~~l~l~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Charges : $1,500.00
Payments : $500.00
Balance : $1,000.00 Balance Due Now
Remit all Qayments to:
CITY OF SAMPLE EMS
C/O SOUTIiWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
tzsa aoaooo 000000
BREACH OF PAYMENT PLAN AGREEMENT
As of this date we have not received your payment as
agreed upon. If you are experiencing fmanacial
difficulty at this time we urge you to contact our office
immediately to discuss your options. If you are not,
then we expect your balance to be paid in full within
the next 10 days or further collection efforts will
commence.
Thank you for your cooperation!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your check. Thank You!
06/13/2007 000000 000000
rte,,-~ SAMPLE CITY EMS
~~` ~G S ~j"j S PO BOX 10000
~--~ CITY, ST 55555
II~I~~I~I~~I~I~~I~I~~I~I~~I~I~~I,I~~I~I~~I~I~~I,I~~I~I~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Charges: $1,500.00
Payments : $500.00
Balance : $1,000.00 Past Due, Payable Now
Remit all oavments to:
CITY OF SAMPLE EMS
C/O SOU"['HWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
izs-z 000000 000000
s lsoo.oo s sao.oo s t,ooo.oo
o6ninoo3 ob/i3nooz UPON RECEa'C
PAST DUE ACCOUNT
Our records indicate you have not responded to our
prior requests for information or payment for services
rendered. Your account is now past due and payable
immediately. Please remit payment in full or contact us
within five (5) days to make suitable payment
arrangements. If you have aheady submitted payment,
please disregard this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your check Thank You!
06/132007 000000 000000
~-~ SAMPLE CITY EMS
~i~c S G S PO BOX 10000
l -~ CITY, ST 55555
~~i~n~i~u~~~u~,~u~i~u~i~u~i~u~,~~, ~,~u~,~u~i~uai
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Charges : $1,500.00
Payments : $500.00
Balance : $1,000.00 Seriously Past Due,
Payable Now
Remit all payments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
128-3 000000 000000
SERIOUSLY PAST DUE ACCOUNT
Despite repeated attempts to obtain payment or
insurance information from you, your account remains
unpaid. If you do not remit payment in full or contact
us within ten (10) days to make suitable payment
arrangements, your account will be placed in a
delinquent status and further collection efforts will
continue. If you have already submitted payment,
please disregazd this notice.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your check. Thank You!
06/(32007®_..e~ 0p0000g0~ p~ ~N 000000
W N I®I ~ IA ~ HI ~~ ~ MI ~ W ~ Ip
!~' SAMPLE CITY EMS
~ir/C S G S PO BOX 10000
.~ -~ CITY, ST 55555
i~u~i~u~~~u~~~u~i~u~~~n~~~u~i~n~i~u~i~n~i~uui
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Charges: $1,500.00
Payments : $500.00
Balance : $1,000.00 Balance Due Now
Remit all payments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
130-1 000000 OOI0000
Medicaid has denied the claim for ambulance services
provided to the patient because: Ambulance
transportation was not medically necessary at the time
of transport and/or no prior authorization number was
provided. Pursuant to House Bill 111, payment is due
from the nursing facility or healthcare provider if prior
authorization was not provided. Please remit payment
in full or contact us within five (5) days to make
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. - Fri. 8AM - SPM
Please include your patient no. on your check. Thank You!
orvl3noo7 .000000 oooaoo
~NIN~~~~dl~®~~91~61~01
~SGS
SAMPLE CITY EMS
PO BOX 10000
CITY, ST 55555
~I~~I~I~~I~I~~I~I~~I~I~~i~l~~l,I„I~I„I~I„I~I~~I~I~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Charges: $1,500.00
Payments : $500.00
Balance : $1,000.00 Past Due, Payable Now
Remit all pavments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
130-2 000000 000000
s l.soo.oo a soo.oo a t,aoo.oo
PAST DUE ACCOUNT
Our records indicate you have not responded to our
prior request for payment of ambulance services you
requested for the patient identified above. Pursuant to
HB 111 section 4, an ambulance provider is entitled to
payment from a nursing facility or health care provider
if prior authorization is not obtained and provided by
the nursing facility/healthcare provider Therefore, you
are responsible for payment in full and payable
immediately.
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Please include your patient no. on your check. Thank Ycu!
I~
ac~l3noo7 000000 000000
~SGS
SAMPLE CITY EMS
PO BOX 10000
CITY, ST 55555
i~n~~~u~i~n~~~u~~~n~i~u~i~n~i~n~~~n~~~u~i~nui
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
~ ~i i
13013 000000 000000
a t,soo.oo s sao.oo s t,oao.oo
SERIOUSLY PAST DUE ACCOUNT
Charges : Sl,soo.oo Our records indicate you have not responded to our
Payments : g50o.oo prior request for payment of ambulance services you
Balance : Si,o00.00 Seriously Past Due, requested for the patient identified above. Pursuant to
Payable Now HB 111 section 4, an ambulance provider is entitled to
payment from a nursing facility or health care provider
if prior authorization is not obtained and provided by
the nursing facility/healthcaze provider Therefore, you
aze responsible for payment in full and payable
immediately_ _ ...
Thank you!
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. SAM - SPM
Remit all payments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
Please include your patient no. on your check. Thank You!
,~ _
06/132007 000000 000000
~p~ll~l~ll~l~l~l~
~' SOUTHVIIEST GENERAL SERVICES
~,~.J~ S G 5 PO BOX 180819
~/ -+ DALLAS, TX 75218
~I~~I~I~~I~I~~i~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~l~l~~~~~
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
ITEM
ITEM
ITEM
ITEM
ITEM
ITEM
ITEM
ITEM
TEM
EM
ITEM
1 $100.00
1 $100.00
1 $100.00
] $100.00
1 $100.00
1 $100.00
1 $100.00
1 $100.00
1 $100.00
I $100.00
1 $100.00
1 ~wo_na
1 $100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$100.00
$1.OA00
$100.00
ITEM
ITEM
ITEM
TOTAL CHARGES
$1,500.00
sota aooooo 000000
S 1,500.00 $ 500.00 S 1,000.00
~~
06/I t/2003 06/132007 ueoNaFCaBr
DELINQUENT ACCOUNT NOTICE
We aze contacting you regazding your obligation for
services provided by the City of Sample Ambulance
Service. We realize that you maybe experiencing
financial hazdship at this time and can not pay the
balance in fitll. If you can not submit payment in full
today, then we urge you to contact us today to take
advantage of one of our payment plan arrangements.
Please do not avoid this opportunity to satisfy your
abligatiQn. Contact u$ now! __._
For Customer Service Call: (214) 747-1431 (877) 747-1431
Mon. -Fri. 8AM - SPM
Southwest General Services is a collections agency and any information obtained from you will be used for the purpose
of collecting this debt.
Remit all payments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS, TX 75218
$100.00 $100.00
$100.00 $100.00
Please include your patient no. on your check. Thank You!
o6/t3noo~ oooaao 000000
!~r~-~ SOUTHWEST GENERAL SERVICES
~i7C 5 G S PO BOX 180819
y --~ DALLAS, TX 75218
~~~~n~~~u~~~u~~~u~i~u~i~n~~~u~~~u~~~n~i~u~i~uw
JOHN SOMEBODY
C/O SOMEBODY
123 SOMEWHERE
SOMECITY, TX 99999-9999
Chazges
Payments
Balance
$ t,soo.oo
$500.00
$1,000.00 Balance Due Now
BOl-2 000000 000000
s Isoo 0o S soo.oo S t,ooo.oo
~,
06/11!2003 06/132007 UPONasce>Pr
FINAL NOTICE
S WGS has attemptted to obtain payment from you for
services provided by the CITY OF SAMPLE
AMBULANCE SERVICE. It is not our intention to
hinder your credit rating, but rather to assist you in
satisfying your obligation by establishing a mutually
beneficial payment plan. This will be your last
opportunity to take full advantage of one of our
payment options. If you do not contact us within the
next "10", days to make payrrlent arrangements, we will
report your debt to the credit bureau.
Thank you for your cooperation!
For Customer Service Call: (214) 747-143.1 (877) 747-1431
Mon. -Fri. 8AM - SPM
Southwest General Services is a collections agency and any information obtained from you will be used for the purpose
of collecting this debt.
Remit all aavments to:
CITY OF SAMPLE EMS
C/O SOUTHWEST GENERAL SERVICES
P.O. BOX 180819
DALLAS. TX 75218
Please include your patient no. on your check. Thank You!
Y
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