HomeMy WebLinkAboutReso 46-2017 (17-325)WHEREAS, on September 18, 201.5, SSFFD issued an ambulance billing Request for Proposal
("RFP") through regular mail service and posted in the bids and RFP page of the South San
Francisco website; and
WHEREAS, eight responsive proposals were received, and the three highest rated proposals were
interviewed; and
WHEREAS, after reviewing the materials presented during their interviews, staff recommended
Novato Fire Protection District ("NFPD") as the preferred consultant, and an Agreement with NFPD
was approved by the City on February 2016; and.
WHEREAS, NFPD's in depth knowledge of ambulance operations yielded benefits, but as time
progressed staff recognized the importance of automation for the transfer of patient care reports and
online financial reporting; and
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WHEREAS, the proposed cost of ambulance billing services as proposed by Wittman would be 4.25
percent for the first year and 4.50 percent for the second year; this new contract will supersede the
previous agreement beginning March. 16, 2017.
11-OW, THEREFORE, BE IT RESOLVED that the City Council of the City of South San Francisco
hereby takes the following actions:
Approves a two-year ambulance billing services agreement with Wittman Enterprises, LLC o)
Sacramento, California,at a rate of 4.25 percent of recovered revenue for the first year and 4.50
percent f.br the second year of recovered revenue, in a total not to exceed amount of $175,000.
City of South San Francisco Page 1
File Number. 17-325 Enactment Number. RES 46-2017
, I I IT nan. at a rate-7f -47/'-'Y percent ot recovered revenue fo—r-tfi-e-Ifr-s-t year and 4.5* percent for the
second year of recovered revenue, in a total not to exceed amount of $175,000, in a form
substantially similar to the draft Agreement attached hereto as Exhibit A, subject to approval as to
form by the City Attorney.
Authorizes the City Manager t o t ake any other related actions consistent with the intent of this
resolution.
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At a meeting of the City Council on 5/24/2017, a motion was made by Liza Normandy, seconded by
Richard Garbarino, that this Resolution be approved. The motion passed.
Yes: 5 Vice Mayor Normandy, Councilmember Garbarino, Councilmember
Matsumoto, Mayor Gupta, and Councilmember Addiego
Attest by Date t-rs In
Gabrielb gigue-1
City of South San Francisco Page 2
A to Resolubon
THIS AGREEMENT for consulting services is made by and between the City of South San Francisco
("City") and Wiftman E r iqes LLC ("Consultant") (together sometimes referred to as the "Parties") as of
4tt(j!�j 5,2_Q1 ? (the "Effective Date").
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1.2 Standard of Performance. Consultant shall perform all services required pursuant to this Agreement
in the manner and according to the standards observed by a competent practitioner of the profession in which
Consultant is engaged in the geographical area in which Consultant practices its profession. Consultant shall
prepare all work products required by this Agreement in a substantial, first-class manner and shall conform to
the standards of quality normally observed by a person practicing in Consultant's profession.
1.4 Time. Consultant shall devote such time to the performance of services pursuant to this Agreement at
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to satisfy Consultant's obligations hereunder,
Consultant and City acknowledge and agree that compensation paid by City to Consultant under this Agreement
is based upon Consultant's estimated costs of providing the services required hereunder, including salaries and
benefits of employees and subcontractors of Consultant, Consequently, the parties further agree that
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City of ScuUi San Francisco and Wittman Enterprises, LLC Page 1 of 22
. . . . . .. . . .
2.1 Invoices. Consultant shall submit invoices, not more often than once per month during the term of this
Agreement, based on the cost for services performed and reimbursable costs incurred prior to the invoice date.
Invoices shall contain the following information:
0 Serial identifications of progress bills (i.e., Progress Bill No. I for the first invoice, etc.);
The beginning and ending dates of the billing period;
A task summary contag the original contract amount, the amount of prior billings,
the total due this period, the balance available under the Agreement, and the
percentage of completion;
At City's option, for each work item in each task, a copy of the applicable time entries
or time sheets shall be submitted showing the name of the person doing the work, the
hours spent by each person, a brief description of the work, and each reimbursable
expense;
The total number of hours of work performed under the Agreement by Consultant and
each employee, agent, and subcontractor of Consultant performing services
hereunder, as well as a separate notice when the total number of hours of work by
Consultant and any individual employee, agent, or subcontractor of Consultant
reaches or exceeds eight hundred (800) hours, which shall include an estimate of the
time necessary to complete the work described in Exhibit C;
* The amount and purpose of actual expenditures f6irwlich, reimbursement is sought;
* The Consultant's signature.
2.2 M-o9!hJ.y_?Aym#ritj City shall make monthly payments, based on invoices received, for services
satisfactorily performed, and for authorized reimbursable costs incurred. City shall have thirty (30) days from
the receipt of an invoice that complies with all of the requirements above to pay Consultant. City shall have no
obligation to pay invoices submitted ninety (90) days past the performance of work or incurrence of cost unless
the invoice delay is due to a City request.
2.3 Final ' Paymeqj;� City shall pay the last ten percent (10%) of the total sum due pursuant to this
Agreement within sixty (60) days after completion of the services and submittal to City of a final invoice, if all
services required have been satisfactorily performed,
2.4 Total Paym#4 City shall pay for the services to be rendered by Consultant pursuant to this
Agreement. ''City shall not pay any additional sum for any expense or cost whatsoever incurred by Consultant in
rendering services pursuant to this Agreement. City shall make no payment for any extra, further, or additional
service pursuant to this Agreement.
In no event shall Consultant submit any invoice for an amount in excess of the maximum amount of
compensation provided above either for a task or for the entire Agreement, unless the Agreement is modified
prior to the submission of such an invoice by a properly executed change order or amendment.
2.6 PayMerg..9f, Taxes. Consultant is solely responsible for the payment of employment taxes incurred
under this . Agreement and any similar federal or state taxes. Contractor represents and warrants that
Contractor is a resident of the State of California in accordance with California Revenue & Taxation Code
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Section 18662, as may be amended, and is exempt from withholding. Contractor accepts sole responsible for
verifying the residency status of any subcontractors and withhold taxes from non-California subcontractors as
required by law.
2.7 Pay!riq!1t,.qp
._9q, Termination. In the event that the City or Consultant terminates this Agreement
pursuant to Section 8, the City shall compensate the Consultant for all outstanding costs and reimbursable
expenses incurred for work satisfactorily completed as of the date of written notice of termination. Consultant
shall maintain adequate logs and timesheets in order to verify costs incurred to that date.
2.8 Authorization to Perform Services. The Consultant is not authorized to perform any services or incur
any casts _W6 r under '—t the terms "'of—this Agreement until receipt of authorization from the Contract
Administrator.
Section 3. INSURANCE REQUIREMENTS. Before beginning any work under this Agreement,
Consultant, at its own cost and expense, unless otherwise specified below, shall procure the types and amounts
of insurance listed below against claims for injuries to persons or damages to property that may arise from or in
connection with the performance of the work hereunder by the Consultant and its agents, representatives,
employees, and subcontractors. Consistent with the following provisions, Consultant shall provide Certificates
of Insurance, attached hereto and incorporated herein as Exhibit, 13, indicating that Consultant has obtained or
currently maintains insurance that meets the requirements of this section and under forms of insurance
satisfactory, in all respects, to the City. Consultant shall maintain the insurance policies required by this section
throughout the term of this Agreement. The cost of such insurance shall be included in the Consultant's bid.
Consultant shall not allow any subcontractor to commence work on any subcontract until Consultant has
obtained all insurance required herein for the subcontractor(s).
4.1 Workers' Compqp§k#9ri, Consultant shall, at its sole cost and expense, maintain Statutory Workers'
Compensation Insurance and Employees Liability Insurance for any and all persons employed directly or
indirectly by Consultant. The Statutory Workers' Compensation Insurance and Employers Liability Insurance
shall be provided with limits of not less than ONE MILLION DOLLARS ($1,000,000) per accident. In the
alternative, Consultant may rely on a self-insurance program to meet those requirements, but only if the
program of self-insurance complies fully with the provisions of the California Labor Code. Determination of
whether a self-insurance program meets the standards of the Labor Code shall be solely in the discretion of the
Contract Administrator (as defined in Section 10.9). The insurer, if insurance is provided, or the Consultant, if a
program of self-insurance is provided, shall waive all rights of subrogation against the City and its officers,
officials, employees, and volunteers for loss arising from work performed under this Agreement,
4.2 Commercial General and Automobile Liability Insurance.
4.2.1 General _Tikquirements. Consultant, at its own cost and expense, shall maintain commercial general
and automobile liability insurance for the term of this Agreement in an amount not less than ONE MILLION
DOLLARS ($1,000,000.00) per occurrence, combined single limit coverage for risks associated with the work
contemplated by this Agreement. If a Commercial General Liability Insurance or an Automobile Liability form or
other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the
work to be performed under this Agreement or the general aggregate limit shall be at least twice the required
occurrence limit. Such coverage shall include but shall not be limited to, protection against claims arising from
bodily and personal injury,. including death resulting there from, and damage to property resulting from activities
contemplated under this Agreement, including the use of owned and non-owned automobiles.
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4.2.2 Minintumm sc" of c9yeragq. Commercial general coverage shall be at least as broad as Insuranc-1
Services Office Commercial General Liability occurrence form CG 0001 or GL 0002 (most recent edition$)
covering comprehensive General Liability and Insurance Services Office form number GL 0404 covering Broad
Form Comprehensive General Liability. Automobile coverage shall be at least as broad as Insurance Services
Office Automobile Liability form CA 0001 (ed. 12190) Code 8 and 9. No endorsement shall be attached limiting
the coverage.
4.2.3 Additiona ' I r ' eqyire ' ♦ m ' en ' ts, Each of the following shall be included in the insurance coverage or added
as a certifiedd"orsement to the policy:
a. The Insurance shall cover on an occurrence or an accident basis, and not on a claims-made basis.
b. Any failure of Consultant to comply with reporting provisions of the policy shall not affect coverage
provided to City and its officers, employees, agents, and volunteers.
4.3 Professional Liability Insurance.
4.3.1 General Fqq L� Consultant, at its own cost and expense, shall maintain for the period covered
by this 4jn�e t professional liability insurance for licensed professionals performing work pursuant to this
Agreement in an amount not less than ONE MILLION DOLLARS ($1,000,000) covering the licensed
nrofessionals' errors and omissions. d,du ItIfli:i!
FIFTY THOUSAND DOLLARS $150,000 per claim.
4.3.2 Claims-made limitations. The following provisions shall apply if the professional liability coverage is
written on a claims-made form:
a. The retroactive date of the policy must be shown and must be before the date of the Agreement.
b. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years
after completion of the Agreement or the work, so long as commercially available at reasonable rates.
C. If coverage is canceled or not renewed and it is not replaced with another claims-made policy form with
a retroactive date that precedes the date of this Agreement, Consultant must provide extended reporting
coverage for a minimum of five (5) years after completion of the Agreement or the work, The City shall have the
right to exercise, at the Consultant's sole cost and expense, any extended reporting provisions of the policy, if
the Consultant cancels or does not renew the coverage.
d. A copy of the claim reporting requirements must be submitted to the City prior to the commencement of
any work under this Agreement.
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4.4.1 A tgbiljit of insurers. All insurance required by this section is to be placed with insurers with a
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Bests' rating of no less than A:VI 1.
4.4.2 Verification of ;overk e. Prior to beginning any work under this Agreement, Consultant shall famish
City with complete copies of all policies delivered to Consultant by the insurer, including complete copies of all
endorsements attached to those policies. All copies of policies and certified endorsements shall show the
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signature of a person authorized by that insurer to bind coverage on its behalf. If the City does not receive the
required insurance documents prior to the Consultant beginning work, it shall not waive the Consultant's
obligation to provide them. The City reserves the right to require complete copies of all required insurance
policies at any time,
4.4.3 Notice. of Reduction In or Cancellation of ,C,o,vqra.qe., A certified endorsement shall be attached to all
insurance obtained pursuant to this Agreement stating that coverage shall not be suspended, voided, canceled
by either party, or reduced in coverage or in limits, except after thirty (30) days' prior written notice by certified
mail, return receipt requested, has been given to the City. In the event that any coverage required by this
section is reduced, limited, cancelled, or materially affected in any other manner, Consultant shall provide
written notice to City at Consultant's earliest possible opportunity and in no case later than ten (10) working
days after Consultant is notified of the change in coverage,
Additional inwred,,,_p ' insurance. City and its officers, employees, agents, and volunteers shall
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be covered as additional insureds with respect to each of the following: liability arising out of activities performed
by or on behalf of Consultant, including the insured's general supervision of Consultant; products and completed
operations of Consultant, as applicable; premises owned, occupied, or used by Consultant; and automobiles
owned, leased, or used by the Consultant in the course of providing services pursuant to this Agreement. The
coverage shall contain no special limitations on the scope of protection afforded to City or its officers,
employees, agents, or volunteers.
A certified endorsement must be attached to all policies stating that coverage is primary insurance with
respect to the City and its officers, officials, employees and volunteers, and that no insurance or self-insurance
maintained by the City shall be called upon to contribute to a loss under the coverage,
4.4.5 Deductibles and Self-insured Retentions. Consultant shall disclose to and obtain the approval of
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City for the self-insured tentions and deductibles before beginning any of the services or work called for by
any term of this Agreement. Further, if the Consultants insurance policy includes a self-insured retention that
must be paid by a named insured as a precondition of the insurers liability, or which has the effect of providing
that payments of the self-insured retention by others, including additional insureds or insurers do not serve to
satisfy the self-insured retention, such provisions must be modified by special endorsement so as to not apply to
the additional insured coverage required by this agreement so as to not prevent any of the parties to this
agreement from satisfying or paying the self-insured retention required to be paid as a precondition to the
insurer's liability. Additionally, the certificates of insurance must note whether the policy does or does not
include any self-insured retention and also must disclose the deductible.
During the period covered by this Agreement, only upon the prior express written authorization of Contract
Administrator, Consultant may increase such deductibles or self-insured retentions with respect to City, its
officers, employees, agents, and volunteers. The Contract Administrator may condition approval of an increase
in deductible or self-insured retention levels with a requirement that Consultant procure a bond, guaranteeing
payment of losses and related investigations, claim administration, and defense expenses that is satisfactory in
all respects to each of them.
4.4.6 Subcontractors. Consultant shall include all subcontractors as insureds under its policies or shall
furnish separate certificates and certified endorsements for each subcontractor. All coverages for
subcontractors shall be subject to all of the requirements stated herein,
4.4.7 Wast[ng, ?q
lLipy. No insurance policy required by Section 4 shall include a "wasting" policy limit.
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4.4.8 Variation. The City may approve a variation in the foregoing insurance requirements, upon a
determination that the coverage, scope, limits, and forms of such insurance are either not commercially
available, or that the City's interests are otherwise fully protected.
4.5 Remedies. In addition to any other remedies City may have if Consultant fails to provide or maintain
any insurance policies or policy endorsements to the extent and within the time herein required, City may, at its
sole option exercise any of the following remedies, which are alternatives to other remedies City may have and
are not the exclusive remedy for Consultant's breach:
a. Obtain such insurance and deduct and retain the amount of the premiums for such
insurance from any sums due under the Agreement;
b. Order Consultant to stop work under this Agreement or withhold any payment that
becomes due to Consultant hereunder, or both stop work and withhold any payment,
until Consultant demonstrates compliance with the requirements hereof, and/or
c. Terminate this Agreement.
Section 5. INDEMNIFICATION AND CONSULTANT'S RESPONSIBILITIES. The Consultant shall
indemnify, defend , and hold the City harmless including its officials, officers, employees, agents, and volunteers
from and against any and all losses, liability, claims, suits, actions, damages, and causes of action arising out of
any personal injury, bodily injury, loss of life, or damage to property, or any violation of any federal, state, or
municipal law or ordinance, to the extent caused, in whole or in part, by the willful misconduct or negligent acts
or omissions of the Consultant or the Consultant's employees, subcontractors, or agents, by acts for which they
could be held strictly liable, or by the quality or character of their work. The foregoing obligation of the
Consultant shall not apply when (1) the injury, loss of life, damage to property, or violation of law arises wholly
from the gross negligence or willful misconduct of the City or the City's officers, employees, agents, or
volunteers and (2) the actions of the City or its employees, subcontractor, or agents have contributed in no part
to the injury, loss of life, damage to property, or violation of law. It is understood that the duty of the Consultant
to Indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil
Code. Acceptance by City of insurance certificates and endorsements required under this Agreement does not
relieve Consultant from liability under this indemnification and hold harmless clause. This indemnification and
hold harmless clause shall apply to any damages or claims for damages whether or not such insurance policies
shall have been determined to apply. By execution of this Agreement, Consultant acknowledges and agrees to
the provisions of this Section and that it is a material element of consideration.
In the event that Consultant or any employee, agent, or subcontractor of Consultant providing services under
this Agreement is determined by a court of competent jurisdiction or the California Public Employees Retirement
System (PERS) to be eligible for enrollment in PERS as an employee of City, Consultant shall indemnify,
defend, and hold harmless City for the payment of any employee and/or employer contributions for PER$
benefits on behalf of Consultant or its employees, agents, or subcontractors, as well as for the payment of any
penalties and interest on such contributions, which would otherwise be the responsibility of City.
Section 6. STATUS OF CONSULTANT.
6.1 Indp1�pridqqt,,Contractor. At all times during the term of this Agreement, Consultant shall be an
indepen" i contractor and shall be an employee of City. City shall have the right to control Consultant only
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insofar as the results of Consultant's services rendered pursuant to this Agreement and assignment of
personnel pursuant to Subparagraph 1.3; however, otherwise City shall not have the right to control the means
by which Consultant accomplishes services rendered pursuant to this Agreement. Notwithstanding any other
City, state, or federal policy, rule, regulation, law, or ordinance to the contrary, Consultant and any of its
employees, agents, and subcontractors providing services under this Agreement shall not qualify for or become
entitled to, and hereby agree to waive any and all claims to, any compensation, benefit, or any incident of
employment by City, including but not limited to eligibility to enroll in the California Public Employees Retirement
System (PERS) as an employee of City and entitlement to any contribution to be paid by City for employer
contributions and/or employee contributions for PERS benefits.
6.2 Pon.s.ult.ant-No Agent. Except as City may specify in writing, Consultant shall have no authority,
express or implied, to act on behalf of City in any capacity whatsoever as an agent or to bind City to any
obligation whatsoever.
Section 7. LEGAL REQUIREMENTS.
7.1 Governing Law. The laws of the State of California shall govern this Agreement
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7.2 C lia wit A able Laws. Consultant and any subcontractors shall comply with all laws
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applicable to the performance of the work hereunder.
7.3 Other Governmental fl*9pIations,,., To the extent that this Agreement may be f6nded by fiscal
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assistance from another governmental entity, Consultant and any subcontractors shall comply with all applicable
rules and regulations to which City is bound by the terms of such fiscal assistance program.
7.4 Licenses and Permits. Consultant represents and warrants to City that Consultant and its employees,
agents, and any subcontractors have all licenses, permits, qualifications, and approvals, including from City, of
what-so-ever nature that are legally required to practice their respective professions. Consultant represents and
warrants to City that Consultant and its employees, agents, any subcontractors shall, at their sole cost and
expense, keep in effect at all times during the term of this Agreement any licenses, permits, and approvals that
are legally required to practice their respective professions. In addition to the foregoing, Consultant and any
subcontractors shall obtain and maintain during the term of this Agreement valid Business Licenses from City.
7.5 Nondiscrimination, and Eual_porunityw. Consultant shall not discriminate, on the basis of a
person's race, religion, color, national origin, age, physical or mental handicap or disability, medical condition,
marital status, sex, or sexual orientation, against any employee, applicant for employment, subcontractor, bidder
for a subcontract, or participant in, recipient of, or applicant for any services or programs provided by Consultant
under this Agreement. Consultant shall comply with all applicable federal, state, and local laws, policies, rules,
and requirements related to equal opportunity and nondiscrimination in employment, contracting, and the
provision of any services that are the subject of this Agreement, including but not limited to the satisfaction of
any positive obligations required of Consu* Kant thereby.
Consultant shall include the provisions of this Subsection in any subcontract approved by the Contract
Administrator or this Agreement.
Section 8. TERMINATION AND MODIF-tCAT-1911.
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8.1 Termination. City may cancel this Agreement at any time and without cause upon written notification
to Consultant.
Consultant may cancel this Agreement for cause upon 30 days' written notice to City and shall include in such
notice the reasons for cancellation.
In the event of termination, Consultant shall be entitled to compensation for services performed to the date of
notice of termination; City, however, may condition payment of such compensation upon Consultant delivering
to City all materials described in Section 91
8.2 Extension. City may, in its sole and exclusive discretion, extend the end date of this Agreement
beyond that provided for in Subsection 1.1. Any such extension shall require a written amendment to this
Agreement, as provided for herein. Consultant understands and agrees that, if City grants such an extension,
City shall have no obligation to provide Consultant with compensation beyond the maximum amount provided
for in Section 2 of this Agreement. Similarly, unless authorized by the Contract Administrator,.
8.3 Amendments. The parties may amend this Agreement only by a writing signed by all the parties.
8.4 AssigqMe"nd Subcontracting. City and Consultant recognize and agree that this Agreement
contemplates personal performance by Consultant and is based upon a determination of Consultant's unique
personal competence, experience, and specialized personal knowledge. Moreover, a substantial inducement to
City for entering into this Agreement was and is the professional reputation and competence of Consultant.
Consultant may not assign this Agreement or any interest therein without the prior written approval of the
Contract Administrator. Consultant shall not assign or subcontract any portion of the performance contemplated
and provided for herein, other than to the subcontractors noted in the proposal, without prior written approval of
the Contract Administrator.
8.5 Survival. All obligations arising prior to the termination of this Agreement and all provisions of this
Agreement allocating liability between City and Consultant shall survive the termination of this Agreement.
8.6 Options u1jon Breach 4y ��P�ylt;mt. If Consultant materially breaches any of the terms of this
Agreement, City's remedies shall include, but not be limited to, the following:
8.6.1 Immediately terminate the Agreement;
8.6.2 Retain the plans, specifications, drawings, reports, design documents, and any other work product
prepared by Consultant pursuant to this Agreement;
8.6.3 Retain a different consultant to complete the work described in Exhibit C not finished by Consultant; or
8.6.4 Charge Consultant the difference between the cost to complete the work described in Exhibit ,C that is
unfinished at the time of breach and the amount that City would have paid Consultant pursuant to Section 2 if
Consultant had completed the work.
Section 9. KEEPING AND STATUS OF RECORDS.
9.1 Records Created as Part of Consultant's Performance. All reports, data, maps, models, charts,
studies, surveys, photographs, memoranda, plans, studies, specifications, records, files, or any other
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documents or materials, in electronic or any other form, that Consultant prepares or obtains pursuant to this
Agreement and that relate to the matters covered hereunder shall be the property of the City. Consultant
hereby agrees to deliver those documents to the City upon termination of the Agreement. It is understood and
agreed that the documents and other materials, including but not limited to those described above, prepared
pursuant to this Agreement are prepared specifically for the City and are not necessarily suitable for any future
or other use. City and Consultant agree that, until final approval by City, all data, plans, specifications, reports
and other documents are confidential and will not be released to third parties without prior written consent of
both parties unless required by law.
9.2 Consultant's Books and Records. Consultant shall maintain any and all ledgers, books of account,
invoices, vouchers, canceled checks, and other records or documents evidencing or relating to charges for
services or expenditures and disbursements charged to the City under this Agreement for a minimum of three
(3) years, or for any longer period required by law, from the date of final payment to the Consultant to this
Agreement.
9.3 ' Insf2qqti9q,,And Audit of Records., Any records or documents that Section 9.2 of this Agreement
requires Consultant to maintain — '""—sh""'a"'I'l""'b'e—m'ad'e available for inspection, audit, and/or copying at any time during
regular business hours, upon oral or written request of the City, Under California Government Code Section
8546.7, if the amount of public funds expended under this Agreement exceeds TEN THOUSAND DOLLARS
($10,000.00), the Agreement shall be subject to the examination and audit of the State Auditor, at the request of
City or as part of any audit of the City, for a period of three (3) years after final payment under the Agreement.
9.4 Records Submitted in. Res an Invitation to.BId1,orRqqqpstf f!rqpqs�als. All responses to
a —-Proposals Submitted ............
Request for RFP) or invitation to bid issued by the City become the exclusive property of the City.
At such time as the City selects a bid, all proposals received become a matter of public record, and shall be
regarded as public records, with the exception of those elements in each proposal that are defined by
Consultant and plainly marked as "Confidential," "Business Secret" or "Trade Secret."
The City shall not be liable or in any way responsible for the disclosure of any such proposal or portions
thereof, if Consultant has not plainly marked it as a "Trade Secret' or "Business Secret," or if disclosure is
required under the Public Records Act.
Although the California Public Records Act recognizes that certain confidential trade secret information
may be protected from disclosure, the City may not be in a position to establish that the information that a
prospective bidder submits is a trade secret. If a request is made for information marked "Trade Secret" or
"Business Secret," and the requester takes legal action seeking release of the materials it believes does not
constitute trade secret information, by submitting a proposal, Consultant agrees to indemnify, defend and hold
harmless the City, its agents and employees, from any judgment, fines, penalties, and award of attorneys fees
awarded against the City in favor of the party requesting the information, and any and all costs connected with
that defense. This obligation to indemnify survives the City's award of the contract. Consultant agrees that this
indemnification survives as long as the trade secret information is in the City's possession, which includes a
minimum retention period for such documents.
Section 10 MISCELLANEOUS PROVISIONS.
10.1 Attorneys' Fees. If a party to this Agreement brings any action, including arbitration or an action for
declaratoi:elief,�'-Co'�en'fbr-ce or interpret the provision of this Agreement, the prevailing party shall be entitled to
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reasonable attorneys' fees in addition to any other relief to which that party maybe entitled. The court may set
such fees in the same action or in a separate action brought for that purpose.
110.2 Venue. In the event that either party brings any action against the other under this Agreement, the
parties agree that trial of such action shall be vested exclusively in the state courts of California in the County
San Mateo or in the United States District Court for the Northern District of California.
10.3 Spy.eirAbility, If a court of competent jurisdiction finds or rules that any provision of this Agreement is
invalid, void, or unenforceable, the provisions of this Agreement not so adjudged shall remain in full force and
effect. The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of
any other provision of this Agreement.
10.4 No -I lied Waiver of Breach. The waiver of any breach of a specific provision of this Agreement
does not constitute a waiver of any other breach of that term or any other term of this Agreement.
10.5 Successors an Assigns. The provisions of this Agreement shall inure to the benefit of and shall
.. . ....... ..
apply to and bind the successors and assigns of the parties.
10.6 Use of,&ecyq!qd_Froducts. Consultant shall prepare and submit all reports, written studies and other
printed material on recycled paper to the extent it is available at equal or less cost than virgin paper.
10.7 Conflict of Interest. Consultant may serve other clients, but none whose activities within the corporate
limits of City ' ' 'or ' ' whose ' '' business, regardless of location, would place Consultant in a "conflict of interest," as that
term is defined in the Political Reform Act, codified at California Government Code Section 81000 of seq.
Consultant shall not employ any City official in the work performed pursuant to this Agreement. No officer or
employee of City shall have any financial interest in this Agreement that would violate California Government
Code Sections 1090 et seq.
Consultant hereby warrants that it is not now, nor has it been in the previous twelve (12) months, an employee,
agent, appointee, or official of the City. If Consultant was an employee, agent, appointee, or official of the City
in the previous twelve (12) months, Consultant warrants that it did not participate in any manner in the forming
of this Agreement. Consultant understands that, if this Agreement is made in violation of Government Code
§1090 etseq., the entire Agreement is void and Consultant will not be entitled to any compensation for services
performed pursuant to this Agreement, including reimbursement of expenses, and Consultant will be required to
reimburse the City for any sums paid to the Consultant. Consultant understands that, in addition to the
foregoing, it may be subject to criminal prosecution for a violation of Government Code § 1090 and, if
applicable, will be disqualified from holding public office in the State of California.
10.8 Solicitation. Consultant agrees not to solicit business at any meeting, focus group, or interview related
to this Agreement, either orally or through any written materials.
10.9 Contract Administration. This Agreement shall be administered by Pprald KohImann Fire Chief
("Contract Administrator). All correspondence shall be directed to or through the Contract Administrator or his
or her designee.
10.10 Notices. All notices and other communications Mich are required or may be given under this
Agreement shall be in writing and shall be deemed to have been duly given (i) when received if personally
Consulting Services Agreement between [Rev:4.11.2017] Executed: June 15,2D17
City of South San Francisco and Wittman Enterprises, LLC Page 10 of 22
12
delivered; (ii) when received if transmitted by telecopy, if received during normal business hours on a business
day (or if not, the next business day after delivery) provided that such facsimile is legible and that at the time
such facsimile is sent the sending Party receives written confirmation of receipt; (iii) if sent for next day delivery
to a domestic address by recognized overnight delivery service (e.g., Federal Express); and (iv) upon receipt, if
sent by certified or registered mail, return receipt requested. In each case notice shall be sent to the respective
Parties as follows:
Consultant:
PO Box 269110
Sacramento, CA 95826
City:
Fire Chief Gerald Kohimann
480 North Canal Street
South San Francisco, CA 94080
EMS Chief Richard Walls
480 North Canal Street
South San Francisco, CA 94080
10.11 Professional Seal. Where applicable in the determination of the contract administrator, the first page
of a technical report, first page of design specifications, and each page of construction drawings shall be
stamped/sealed and signed by the licensed professional responsible for the report/design preparation. The
stamp/seal shall be in a block entitled "Seal and Signature of Registered Professional with reporYdesign
responsibility," as in the following example.
Seal and Signature of Registered Professional with
10.12 Integration, This Agreement, including all Exhibits attached hereto, and incorporated herein,
represents the entire and integrated agreement between City and Consultant and supersedes all prior
negotiations, representations, or agreements, either written or oral pertaining to the matters herein.
10.13 Countertuarts. This Agreement may be executed in multiple counterparts, each of which shall be an
original and all of which together shall constitute one agreement.
10.14 Construction. The headings in this Agreement are for the purpose of reference only and shall not limit
or otherwise affect any of the terms of this Agreement. The parties have had an equal opportunity to participate
in the drafting of this Agreement: therefore any construction as against the drafting party shall not apply to this
Agreement
consulting Services Agreement between [Rev:4.1120171
City of South San Francisco and Wittman Enterprises, LLC Page 11 of 22
13
Executed: June 15, 2017
The Parties have executed this Agreement as of the Effective Date.
CITY OF SOUTH SAN FRANCISCO Consultants
City Manager, Mike Futrell Wittman Enterprises, LLC
Attest:
Krista Martinelli, City Clerk
Approved as to Form:
City Attorney
2514799.1
Consulting Services Agreement between [Rev:4.11.2017] Executed: June 15, 2017
City of South San Francisco and Wittrnan Enterprises, LLC Page 12 of 22
14
Contract - Exhibit A
South San Francisco Fire Department
Business Associate Agreement
'etween South San Francisco Fire Department and Wittman Enterpris
1. Meaninq_gf Terms. The terms used in this Agreement shall have the sa
meaning as those terms defined in HIPAA.
2. jLeRu!pt2!:j Rtforences. Any reference in this Agreement to a regulato
section means the's'ec"tion currently in effect or as amended,
3. In rotation. Any ambiguity in this Agreement shall be interpreted to per
". ......... . . . I . . ...... .- —
compliance with HIPAA.
I - .
Rot use or further disclose PHI other than as permitted or required by this
Agreement or as required by law;
Mum
st wit it M., 0
K7ZX*] Sol 1-1143101-if IV . 0 4, -IW*i
Consulting Services Agreement betNeen
15
Z. 11 �
Contract - Exhibit A
3. Report to South San Francisco Fire Department any use or disclosure of PH I not
provided for by this Agreement of which it becomes aware, including any security
incident (as defined in the HIPAA Security Rule) and any breaches of unsecured
PHI as required by45 CFR§164.410. Breaches of unsecured PHI shall be
reported to South San Francisco Fire Department without unreasonable delay
but in no case later than 60 days after discovery of the breach;
4. In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), ensure that any
subcontractors that create, receive, maintain, or transmit PHI on behalf of
Wittman EnterrAses,-LI-C agree to the same restrictions, conditions, and
requirements that apply to Wittman Enter1jises, LLC with respect to such
information;
5. Make PHI in a designated record set available to South San Francisco Fire
Department and to an individual who has a right of access in a manner that
satisfies South San Francisco Fire Department's obligat i ions to provide access to
PHI in accordance with 45 GFR §1•4.524 within 3 0 da ys of a request;
W -1
8. To the extent that Wittman Ente dses, LLC is to carry out any of South San
... ..... . . . . .. ... ......... . J"", fp ., -- . - —
Francisco Fire Department's obligations under the HIPAA Privacy Rule, Wittman
'' a
Erit [pris es ' LL that
shall comply with the requirements of the Privacy Rule t
apply to South San Francisco Fire Department when A carries out that obligation;
S. Make its internal practices, books, and records relating to the use and disclosure of
PHI received from, or created or received by YVkrr!qR,,Err1pr�LrJses, �LC on behalf of
South San Francisco Fire Department, available to the Secretary of &-Department
of Health and Human Services for purposes of determining Wittman En r'
I-- . ... ...... .....
LLC and South San Francisco Fire De♦ artment's compliance with HIPAA and the
HITECH Act;
10. Restrict the use or disclosure of PHI if South San Francisco Fire Department
notifies Wittman EnteM!se�s, Q • any restriction on the use • disclosure of
PHI tha�t-S6 u't-hi-S'"a" in' "'Francisco Fire Department has agreed to or is required to
abide by under 45 CFR §164.522; and
If South San Francisco Fire Department is subject to the Red Flags Rule (found
at
• CFR §681.1 et seq.), )8�fttmgqj ritprp s,
agrees to assist South San
Francisco Fire Department in complying with its Red Flags Rule obligations by:
(a) implementing policies and procedures to detect relevant Red Flags (as
.... . .. . .......
Consulting Services Agreement between
City of South San Francisco and Willman Enterprises, LLC - Exhibit A
16
Page 14 of 22
Contract - Exhibit A
C. Permitted Uses and Disclosuros by Business Associate,
The specific uses and disclosures of PI-11 that may be made p !tqj !I L
6! j ris.e§,,
LL.Q. oin beh of South San Francisco Fire Department include:
The preparation of invoices to patierits, carriers, insurers and others responsible
for payment or reimburse urn ent of ttie services provided by South San Francisco
Fire Department to lit s patients;
2. ["reparation of reminder notices and docurnents pertaining to collections of
overdue accounts,
3. "1 he submission of supporting docurnentampon to carriers, insurers and other,
paye,rs to substantiate the healthcare services provided by South San Francisco
Fire, Department to its patients or to appeal deinials of payment for the same,- and
4. Other uses or disclosures of Pill as permitted by HI PAA necessary to Ip rfor m
the services that Wittman E er irise LLC has been engaged to pefform on
nt j_ _�ij
behalf of South Si��P`iirmcisco Hire Department.
D. Irermination
I., South San Francisco Fire Depadment may terms -iinate this Agreenlerit if South
San Francisco Fire. Department determines that Wittman EnterL p_s,j_.l C has
vllolated a material teirm of the Agreement or if the associated Consulting
Service,,,v; Agreement is terminated,
2, if either party knows of a patterr-a of activity or practice of the other party, that
constitutes a material breach or violation of the other party's obligations under
this Agreement,, that party shafl take reasonaNe steps to cure the breach or end
the vioWion, as applicable, and, if such steps are unsuccessful, terminate the
Agreement iffeasible.
3. Upon termination of this Agreement for any reason, Wittman Ent EL � I! I
e _q.! LQ
shall return to South San Francisco Fire Department c�r_d received
from South San Francisco Fire Departrnent, or- created, maintained, or received
. . . . ........ .............
Consuft,q Sew bes Agreement between
My of South San Frandsm and ftman Erlorpdses, LIC - E hIM A
K . ... I .... . ........
M
Pag&15 of 22
d*J AT
Agreed to this - day of -, 2012
South San Francisco Fire Department Wi a Eqt ris
tt
m n �qp �
Signature: Signature:
""a 2P,,"'�,
.......... . . .
Title: Title:
........ . .
Date: Date
Consulting Services Agreement between
City of South San Francisco and Wittman Enterprises, LLC - Exhibit A
18
Page 16 of 22
Contract - Exhibit B
INSURANCE CERTIFICATES
Consulting Services Agreement between
City of South San Francisco and Wittman Enterprises, LLC -Exhibit B Page 17 of 22
19
WITTENT-01
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD1YYYY)
11110� 1 03/1712017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIEr
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEL
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
..... ........... . .. .... . . . .... . .. — ------ -------
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Western Elite Insurance Solutions
140 Diamond Creek Place
Roseville, CA 95747
K*M-TIOR
INSURED
INSURERS Continental Insurance Company
Wittman Enterprises LLC
INSURER C: Continental Casualty Company
PO Box 269110
INSURER D: State Compensation Insurance Fund
Sacramento, CA 95826
INS...U. . R. ....E..... R . . .E.... Federal Insurance Company
y
ER
JNSURER F:
_1
.... ...... -- - -------------------
COVERAGES CERTIFICATE NUMBER:
REVISION NUMBER:
THIS
IS TO CERTIFY THAT THE POLICIES
OF
INSURANCE
LISTED BELOW HAVE BEEN
ISSUED
TO THE INSURED
NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.
NOTWITHSTANDING ANY REQUIREMENT,
TERM OR
CONDITION OF ANY
CONTRACT
OR OTHER
DOCUMENT WITH RESPECT TO
WHICH THIS
CERTIFICATE
MAY BE ISSUED OR MAY
PERTAIN,
THE INSURANCE
AFFORDED BY
THE POLICIES
DESCRIBED
HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS
AND CONDITIONS OF SUCH
POLICIES.
LIMITS SHOWN
MAY HAVE BEEN
REDUCED BY
PAID CLAIMS.
INSR
TYPE OF INSURANCE
ADDL
IN 5ja.
.Q._
SUBR
� . . . .
POLICY NUMBER
. .......................... . .......... . ... . .......... . .... . .. . ...... .
POLICY E F F
[�D/XY
_ffl&L — _YXJ_.Lfl!1_
POLICY EXP
M DD/YY -X)(I
LIMITS
.. . ............ . . .. ......... . .
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
CLAIMS-MADE OCCUR
86020067360
07/01/2016
0710112017
DAMAGE TO RENTED
xmrreme) ,
$
300,000
10,000
MED EXP (Any one person)
$
4,000,000
PERSONAL & ADV INJURY
2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
[__] Ref El LOC
X POLICY ❑ PEST
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
$
$
2,000,000
. . ........ . ____ . . ........
............
. .........
. . . . .............................
. ....... . .... .
EPLI FIDUCIARY
$
10,OOAI
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
_(Eaaccident),
1,000,
X ANY AUTO
86020067395
0710112016
07/0112017
BODILY INJURY (Perpe
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)_
HT NON-,SWNED
P
$
A 1WS ONLY AUTO ONLY
(�OP.ER
(gt�AMAGE
$
. _ _ - .
U M_ a REL"L" A -U, A B X OCCUR
. . ........
EACH OCCURRENCE
$
2,000,000
EXCESS LIAB CLAIMS MADE
86020067431
07/0112016
07/0112017
AGGREGATE
$
2,000,000
ED -I X J RETENTION$ 10,000
$
D
WORKERS COMPENSATION
. .........
X OTH-
ER
AN D EMPLOYERS' LIABILITY
Y/N
9161868-2016
07/0112016
0710112017
1,000,000
ANY PROPRIETOR/PARTNERtEAECU11VE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
NIA
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
$
$
If yes, describe under
1,000,00 0
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
E E&O I Professional L 8247-8286
—
07101/2016 -6710112017 Each Claim/Agg
1,000,000
... . ...... — --- ------------
---- .. . . ...... — - - -------------------------
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
................ ------ .... . ... . .. ......... .. . ......... . ... ..
CERTIFICATE HOLDER
. ........... . ............ _ .... . ... . ...... ...... . . . ..........
CANCELLATION
City of South San Francisco
480 North Canal Street
South San Francisco, CA 94080-4608
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016103) 20 @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Exhibit C
SCOPE OF SERVICES
And
SUBMITTED PROPOSAL
Statement of Work: This documents the mutual understanding of the Parties as to the scope
of services contemplated by the Parties hereto commencing on June 15, 2017 and
completing on June 15, 2019. Upon execution, this agreement supersedes the short term
services agreement effective March 16, 2017.
A. Objective:
The objective of this project is to maximize the timely collection of revenue due from the
provision of emergency medical services provided by the City. Furthermore, the
objective is to provide for continuing review and improvement to the overall billing
process.
It is the intent of the Parties that they shall make all reasonable efforts to collect for any
emergency medical services provided by the City to residents or nonresidents of the
City. Consultant, in the course of identifying payment sources and a patient's ability to
pay for services, shall approach patients in a courteous, sensitive and professional
manner. Consultant shall follow the City's established policies / practices regarding the
direct billing of residents of the City.
B. Project organization:
The basic project organization shall be:
CONSULTANT PROJECT MANAGER, in cooperation with the CITY PROJECT
MANAGER, shall provide and oversee an integrated billing process for emergency
medical services within the City. Through the use of the Consultant's staff, Consultant
shall process the patient care report forms through a data processing system in order to
produce invoicing and corresponding reports. Through the use of Consultant's staff,
Consultant shall post all monies received by the City and produce the necessary
balance billing, account registers and accounting documents as outlined for the City.
The City will identify and maintain the 'lock box account' that the Consultant will post all
monies to.
C. ProLect staffing.
Staffing for the project shall be the responsibility of Consultant. The CITY shall provide
sufficient liaison personnel time to insure that report information is received by the
Consultant on a regular and timely basis.
D. Outline of authorized work:
Consulting Services Agreement between
City of South San Francisco and Wittman Enterprises, LLC — Exhibit A
21
Page 18 of 22
Contract - Exhibit C
Consultant shall produce invoicing (billing) for all qualified emergency medical
responses within the City, with corresponding completed report forms. Consultant shall
produce cumulative and detailed accounts receivable reports in generally accepted
accounting format. Invoicing and/or reports shall be produced on a monthly basis or in
such other time frame as mutually agreed. Consultant shall provide all necessary
personnel, equipment and products necessary for producing said invoicing and reports.
Consultant shall review and make recommendations, for change, if necessary, with
respect to current report forms content, data collection procedures therefore and billing
amounts for related services.
Consultant shall serve as the City representative in negotiation for payments with
various Health Maintenance Organizations, Preferred Provider Organizations, and
Medicare / Medi-Cal.
Consultant shall provide on-site training for the City personnel relating to proper billing
information procedures at City's request.
Consultant shall utilize proprietary software as a means to receive ambulance billing
information.
E. Deliverables:
Consultant shall produce and cause delivery of all invoices, statements and reports as
required. (See list of reports in Section F-4). In addition, Consultant shall provide City
with a report on its review of the report form, billing amounts and other items. This report
shall be provided to City no later than sixty (60) days after the commencement of the
contract. Consultant believes they will improve the billing process for service.
F Work Plan:
To accomplish the objective, authorized work, and deliverables of this Scope of Services
the following is agreed upon as the necessary action steps:
1. Action Steos
The following is an outline of steps to be taken by Consultant and City:
a) On a minimum time frame of twice per week, City will provide to the Consultant a
report of all calls that generated Ambulance Order numbers in the Data system
within the City.
b) On a minimum time frame of twice per week, Consultant will receive and screen
via proprietary software the Patient Care report forms for ambulance billing
information within City.
c) On a minimum time frame of twice per week, Consultant staff shall compare the
Ambulance Order report generated and provided by City with the information
received from proprietary software and report missing Patient Care Report
information to City.
........... ...... ....... ... __ ..... .........................
Consulting Services Agreement between
City of South San Francisco and Wittman Enterprises, LLC - Exhibit A Page 19 of 21
22
Contract - Exhibit C
d) Consultant staff shall input all pertinent data to Consultant data processing
system.
e) Consultant staff shall process the accounts and produce statements, invoices
and reports as required.
City shall receive all payments due and forward facsimiles (photocopies) of the
deposit information to Consultant staff on a routine basis.
g) Consultant shall post or credit the monies which City receives on accounts and
shall produce all corresponding reports and balance billing.
h) Consultant will meet at least monthly with CITY PROJECT MANAGER or
designee to discuss the project process and to review the projects reports.
2. Review Points
Consultant and City will review local demographic data and actual costs and
Consultant will make recommendations for change in billing procedures if necessary.
3. City Participation
City will provide a billing liaison person during normal business hours to Consultant.
Accounts Established Report: Commencing May 1, 2017, and thereafter by the 10th
of the month, City may request a report listing of all accounts established in the
system for the previous month or any specified period. This listing will include the
following:
• Alphabetized order by Patient name
• Account Number
• Date of Service
• Total Charges
Char Summary Report: Commencing May 1, 2017, and thereafter by the 10th of
the month a report listing of a summary of all charges by type of service for the
previous month will be delivered to the City.
Credit Summary Report: Commencing May 1, 2017, and thereafter by the 10th of the
month a report listing of a summary of all payments received by type of payer for the
previous month will be delivered to the City.
Char Ad*ustments Report Commencing May 1, 2017 and thereafter by the 10th of
I .......... _
the month a report listing of a summary of all charge adjustments made by type of
service for the previous month will be delivered to the City.
Credit Adustments Report. Commencing May 1, 2017 and thereafter by the 10th of
the month a report listing of a summary of all payment adjustments made by type of
payer for the previous month will be delivered to the City.
Consulting Services Agreement between
City of South San Francisco and Wittman Enterprises, LLC - Exhibit A
23
Page 20 of 21
Contract - Exhibit C
Closinq Balance Summary: Commencing May 1, 2017, and thereafter by the 10th of
the month a report listing the beginning balance, charges, credits, and adjustments,
and the ending balance for the previous month will be delivered to the City.
Paver Aging Report: Commencing July 1, 2017, and thereafter by the 10th of the
month a report listing each type of payer showing amounts owed by due date status.
The due dates should be in monthly increments for four months, followed by a two
month period, followed by accounts over 180 days will be delivered to the City. The
line item reserved for patients being billed should only include direct bill patients that
are actually billed based on City policies and practices.
Payer Summary Re art: Commencing July 1, 2017 for the period of April 1, 2017
through June 30, 2017 and thereafter by the 10th of the month following the end of a
calendar quarter a report summarizing the number of calls, charges, adjustments,
and payments by payer type will be delivered to the City
Non Active Accounts: Commencing August 1, 2017 and thereafter by the 10th of the
month a report detailing accounts that have had no activity or response for 120 days
will be identified and delivered to the City.
REMUNERATION PROVISIONS
A. CONSULTANT: CONSULTANT, commencing on May 1, 2017, will invoice City on a
Monthly basis on the 1st of the Month for payment as described in the Consulting
Services Agreement dated April 1, 2017.
B. CITY: City, commencing on May 1, 2017, will forward payments to the Consultant no
later than thirty (30) days after receipt of invoices for services.
2787642.1
Consulting Services Agreement between
City of South San Francisco and Wittman Enterprises, LLC - Exhibit A
24
Page 21 of 21
Attachment 3
COPY
Wittman enterprises
City of South San Francisco
Fire Department
RFP Contact:
Russ Harms, Director of Business DevelopmeAU
Phone: 916.669.4628 direct
,rhair,m.L,Ld-)webil LemL,,-r,.-cLrY-1. I
Wittman Enterprises, LLC 111093 Sun Center Drive, Rancho Cordova, CA 95670 1855.611.0056 ph 1916.381.5047 fax lv�n%rs otill:!bflleilrris.coin
M
CoverLetter ................................................................................................................................... 6
a. Full name, address, number and facsimile number nf the firm. Identify the local
office that will handle this service ........................................................................................................ O
Contractor Identification ................................................................................................................. 8
b Summary of the firm's general qualifications, background, number of employees, specialized
certifications of staff, office locations, etc .......................................................................................... O
Qualifications................................................................................................................................... O
Certified Ambulance Coders -------.---_....__..____._.._._....._...-------..8
EMSBilling Experience ..................................................................................................................... 9
CosEfhec1ivenessandtheApprophateChoice--------------------------9
CollectionRates ............................................................................................................................... g
Services Offered: Solutions ............................................................................................................ 1O
Ambulance Transport Billing and Collection ............................................................................. 1O
ePCRIntegration ........................................................................................................................ 1U
MembershipProgram Support .................................................................................................. 1U _-
Treat-No-Tra ns port Billing and Collection (aka Assessments): Optional Service ...................... 11
C. Name of the firm principals and adetailed summary of the team that will be used for these
services. An organization chart shall be included that clearly identifies each team member, the
responsibilities and nature of work each will perform . ..................................................................... 11
What Truly Makes Us Different: Lowest Oains-Per-Staff Ratio .................................................... 11
Company Governance and Organization ....................................................................................... 12
Contract Management Team ......................................................................................................... 1]
ProjectSupervision Team .............................................................................................................. 13
OperationsTeam ........................................................................................................................... 13
ClientLiaison Team ........................................................................................................................ 13
Pointof Contact ............................................................................................................................. 14
OrganizationChart ......................................................................................................................... 15
d. Describe the relevant experience of your firm with ambulance billing, collection reporting and
analytical services during the past five (S)years. Include ability to meet service deadline, extras
added after the contract, service size and list a reference name, address and phone number .......16
RelevantExperience ....................................................................................................................... 15
Billing Standards Compliance ......................................................................................................... 16
26
SelectReferences ........................................................................................................................... 17
2. Project Approach and Methodology
....'^'..^'..~~..~..~..~..^18
e. Describe the proposed billing and collection process to be accomplished per the scope of
services. Clearly delineate any modifications (additions or deletions) to the general scope of
BillingSystem .................................................................................................................................
1O
Billing Processes: Project Approach ...............................................................................................
18
Together VVe Achieve the Extraordinary ...................................................................................
18
Electronic Patient Care Records (ePCR) Interface .....................................................................
18
Billingto Payment Cycle ............................................................................................................
19
Billing and Collection Processes: Methodology -------------------------..2O
RecordoConfrmedandScreenedforCompleteness ---------------------.
20
Locating and Verifying Insurance ..............................................................................................
2O
Hospital Patient Records Systems .............................................................................................
2O
Follow-Up Protocols ..................................................................................................................
21
Assignment Authorization .........................................................................................................
21
PatientDatabase .......................................................................................................................
21
Identification of Payment Sources ............................................................................................
21
PatientPayment Options ...........................................................................................................
22
InstallmentPayments ................................................................................................................
22
Hardships, Discounts, and Reductions ......................................................................................
22
Denied or Disallowed Claims Protocols .....................................................................................
23
PrivatePay Accounts .................................................................................................................
24
Bill Schedule .-----........_..-------------.._._.......--.__------.25
Payment Processing .-----------.—.._..—....--.---------------.,25
Processing Funds: Live Cash Method .........................................................................................
26
CreditCard Payments ................................................................................................................
2G
Credit Card Payments Portal .....................................................................................................
26
Accounting of Payments Received ............................................................................................
26
Reporting Uncollected/Delinquent Accounts ............................................................................
27
PatientDisputes .........................................................................................................................
27
CollectionPractices ...................................................................................................................
27
27
t Identify sub-Consultants, if any, that will be used for this service. Outline what their
responsibilities will be and their qualifications ..................................................................................
2Q
Subcontracting Partners ................................................................................................................
JQ
8. Provide a list of the information you will routinely require for your work and the extent ofthe
assistance required from the City's support staff . .............................................................................
2O
ProviderResponsibilities ................................................................................................................
28
CitySupport Staff ...........................................................................................................................
2O
h. Detail compliance policies and procedures, as well as agency officer(s) and a statement of
their qualifications or experience to perform task ...........................................................................
2Q
Privacy and Security Statement .....................................................................................................
29
H|PAA Compliance .........................................................................................................................
29
H|PAA-Required Safeguards for Health Information .....................................................................
29
Exceeding H|PAA Safeguard Requirements ...................................................................................
29
Adherence to Privacy Laws ----.----..—._—.._..—.._.-----.—..—....—...----3O
Wittman Enterprises Privacy Policies ............................................................................................
3O
UkG Compliance Program Guidance ..............................................................................................
3l
Seven Key Elements ufOhG Compliance ....................................................................................
31
Wittman Enterprises Standards of Conduct ..................................................................................
]2
Access to Records Policy Summary ................................................................................................
33
InternalUse ............................................................................................................................... 33
Routine Disclosure to Third Parties ........................................................................................... 33
Non-Routine Disclosure to Third Parties ................................................................................... 33
Describe how the proposal differs from that of other processes used by similar firms . .......... 34
Electronic Communication and Access to Records ........................................................................ 34
ClientPortal ............................................................................................................................... S4
Patient Portal ----------.------------------------------.35
Collections Portal _.—......_..._.—._---------------.---_._....—.35
SecureEmail .............................................................................................................................. 35
File Transfer Protocol (FTP) ....................................................................................................... 36
i Describe how your firm will meet reporting requirements stated by the City and how this
information will beorganized. (ex. Payment type, outstanding amounts, reimbursements,
transporttype) . .................................................................................................................................. ]G
Clear and Concise Reporting .......................................................................................................... 36
Reportsand Records ...................................................................................................................... 37
k Include your firm's disaster recovery plan/system and retention policy .................................. 37
tu
�u ' arn 11 r
BusinessContinuity Plan ................................................................................... .............................38
1. Clearly identify the transition plan and timeline necessary to migrate all billing and collection
services from the City's current Consultant .......................................................... .............................38
Strategyand Implementation Plan ................................................................... .............................38
SecondaryTraining ....................................................................................... .............................50
Transition Timeline Estimated ...................................................................... .............................39
1001 Auditing and Training .......................................................................... .............................50
TransitionSchedule Estimated ..................................................................... .............................40
SpecialistProgram ...................................................................................... ...............................
m. Provide a detailed description of a transition plan for a future billing company that may be
Certified Ambulance Coders ......................................................................... .............................50
awarded a contract in the next RFP cycle. The plan should include a timeline as well as the lead
Training Program: Continuous Improvement ................................................... .............................50
time needed to close out specific City accounts ................................................... .............................40
TeamTraining ............................................................................................... .............................50
TransitionPlan .................................................................................................. .............................40
ContinuousEducation .................................................................................. .............................51
n. Detail analysis capabilities that show trending, program performance and other issues that
Appendix2: Key Personnel .............................................................................. .............................52
mayarise ............................................................................................................... .............................41
KeyPerformance Indicators .............................................................................. .............................41
CollectionsTimeline .......................................................................................... .............................42
Ambulance Revenue Analysis Report ............................................................... .............................43
QuarterlyClient Connect .................................................................................. .............................44
SECTIONC: Compensation Requirements ............................................................ .............................45
Competitor and Transition Performance Data ................................................. .............................45
SuperiorPerformance ....................................................................................... .............................45
MaximizingCollections ..................................................................................... .............................45
CostProposal .................................................................................................... .............................47
SECTIOND: Contract Exceptions .......................................................................... .............................48
3. Contract Exceptions ..................................................................................... .............................48
APPENDICES....................................................................................................... .............................49
Appendix1: Quality Assurance Programs ......................................................... .............................49
Auditing........................................................................................................... ...............................
49
TrainingProgram: New Hires ............................................................................ .............................49
InitialTraining ............................................................................................... .............................49
SecondaryTraining ....................................................................................... .............................50
1001 Auditing and Training .......................................................................... .............................50
SpecialistProgram ...................................................................................... ...............................
50
Certified Ambulance Coders ......................................................................... .............................50
Training Program: Continuous Improvement ................................................... .............................50
TeamTraining ............................................................................................... .............................50
ContinuousEducation .................................................................................. .............................51
Appendix2: Key Personnel .............................................................................. .............................52
Cft)l A Sooth San r n ,A4 ii':IR Me DelmstmenV /VP1b7u n N Nlhn1 ; "tier gcos 14
29
Appendix3: Sample Reporting ..................................................................................................... 54
Accounts Receivable Analysis (Payment Credits) ..........................................................................
54
ActivitySummary (by Code) ...........................................................................................................
55
Activity Summary (Detail byPuyor ----_..._._—.—.._.—.—.------------.._...56
Activity Summary (by Vehicle Month Destination) .......................................................................
S9
Activity Summary (with percentage) .............................................................................................
61
Aging bv Current Schedule (with percentage; by trip date) ..........................................................
64
Aging Summary Detail -----------------------._.....----------66
AgingSummary ..............................................................................................................................
68
CashReceipts .................................................................................................................................
7O
Charge Type Detail -------------.._..—_—....--------------.._..-71
CollectionSummary .......................................................................................................................
72
DenialReport Detail (by Payor .....................................................................................................
T3
Denial Report Summary (by payor ...............................................................................................
75
GEMT Total Number ofMTS Transports ........................................................................................
76
K8ediCa| Fee for Service 6EK8T Transports and Detail ..................................................................
77
MediCu| HMO GEK4T TrnsportsandDetaiL --------------------------.AO
MonthlyPayment Listing ...............................................................................................................
U3
NSF.................................................................................................................................................
84
Ticket Survey (by |CD-9/1O) ...........................................................................................................
87
Ticket Survey Summary .----------..__..._.._.......--------------.-9O
TripCount (by call type) .................................................................................................................
91
TripCount (by diagnosis) ...............................................................................................................
82
TripCount (by Member) ................................................................................................................
93
Trips by Customer (frequent flyer) ................................................................................................
94
YTD (Management Summary Report) ............................................................................................
95
YTD—Revenue ...............................................................................................................................
9O
30
wthnal"I en o p r'Ise �
SECTION A.- Statement of Qualifications
,_ I M
Corinne Wittman-Wong, CEO
11093 Sun Center Drive
Rancho Cordova, CA 95670
owl'
City of South San Francisco Fire Department: Arnbulance BHHng Se Mmes 1 6
01
Your contract management team includes the following for the duration of the proposal evaluation and
throughout the life of the contract between us.
VValterhnboden Russ Harms StephanieCooper'Noe
President/CFO Director of Business Development Client Liaison
916.669.4602 direct 916.669.4628 direct 916.669.4607 direct
8SS.611.0056 toll free 8SS.611.0056 toll free OSS.61l.0OS6 toll free
City of Sotith SaiinFrandsmm Fire Department- Ambulance 0OUngSemi�s 17
CRI
1"Ortina n irn rii,, qn ir �c
Ti. Full name, address, telephone number andfacsimile number of the firm. identify the local office
that will handle this service.
Contractor identification
Wittman Ente p diQq1)
11093 Sun Center Drive
(855) 611-0056 (toll free)
(9 16) 381-5047 (main fax)
www.weUfflerris.ca,"n
Irt
Sacramento, California area. All production and patient service activities are conducted at 11093 Sun
Center Drive in Rancho Cordova, California.
b. Summary of the firm's general quacations, background, number of employees, specialized
certifications of staff, office locations, etc.
Certified Ambulance Coders
In addition to our internal training program, Wittman Enterprises is proud to offer staff members which
have been certified by the National Academy of Ambulance Coding, a nationally recognized leader in
Certified Ambulance Coding Training. Wittman Enterprises employs and provides regular training for
Certified Ambulance Coders ("CACs"). Wittman staff is continually trained under the same exacting
City of South San Francisco Hire Departnient: AnnbUlance BMing !,,,e (ices 18
33
Over23
yealsof
Ugwience
lechnMugy
Automation
'Talented fill,
PN.wp�e
Certified Ambulance Coders
In addition to our internal training program, Wittman Enterprises is proud to offer staff members which
have been certified by the National Academy of Ambulance Coding, a nationally recognized leader in
Certified Ambulance Coding Training. Wittman Enterprises employs and provides regular training for
Certified Ambulance Coders ("CACs"). Wittman staff is continually trained under the same exacting
City of South San Francisco Hire Departnient: AnnbUlance BMing !,,,e (ices 18
33
standards emphasized in the Coding Certifications. We budget funds annually to certify additional
Collection Rates
Through streamlined efficiency, talented staff, selective automation, and continuous improvement,
Wittman has a long track record of strong collection returns for our clients on billed charges. Wittman
Enterprises welcomes the opportunity to discuss differences in performance and how we generally
outperform our competitors by 10% to 20% in net collections for our EMS partners.
Wittman does not just pursue "the easy" claims processed by algorithmic programs. In addition to
collecting from Medicare, Medi-Cal, and private insurance, we aggressively appeal all denials, research
all private pays to find viable insurance, and we work with patients to arrange alternate methods of
repayment. Elements that can affect collection percentages include:
City of South San Francisco Fire Departiment: Airr�bUkHlCe Billing Services 19
34
a Inn 1l"'Jv
• Payer Mix: A higher percentage of private pay, for example, can lead to lower collections
percentages depending on your patients' ability to pay. Higher Medicare or Medi -Cal may result
in lower percentages because of the fixed reimbursement rates of each program.
• Incomplete PCR documentation: We may initially bill at a lower reimbursable rate due to a lack
of information available.
• Unclear or non - descriptive PCR narratives: Wittman Enterprises bills to the level of service based
on required documentation. If we are unable to accurately ascertain a level of service we might
bill at a lower reimbursable rate until required criteria are met.
• Missing, incomplete, or incorrect patient information on PCR: can delay timely reimbursement.
• Missing patient signatures on PCR: may delay and possibly impede our ability to bill Medicare or
Medi -Cal.
Many of these issues are identified during our billing process. We strive to provide ongoing feedback to
the EMS Department in order to improve the quality of documentation which in turn improves revenue
collected.
Services Offered: Solutions
Since 1991 Wittman Enterprises has provided products and services specifically designed to assure that
EMS transport and First Responder providers like the City of South San Francisco are reimbursed in a
timely manner for services they provide. We get our EMS partners their maximum reimbursement
available. Our services and proven performance include above - industry standards associated with
facilitating cost recovery for emergency and preventative services. Services include:
Ambulance Transtrort Billing and Collection
We provide our clients complete ambulance billing services in compliance with current local, state, and
federal laws and statutes. Wittman follows and exceeds currently accepted standards for accurate,
consistent, and best EMS billing practices while maximizing revenue: honoring your collection
philosophy and treating each of your patients, citizens, and visitors as our own.
ePCR Integration
We accept electronic files from most ePCR companies. At Wittman Enterprises we don't stop there. Our
EMS Partners receive a customized import mapping each field to ensure the most accurate import
possible from your ePCR provider.
Memberships Program gRRgTt
Wittman Enterprises can work with you on your membership administration and/or administer the
program for you. While many of our clients simply send us their updated Membership lists for billing
purposes only, several enjoy full - service administration of their programs which can include
membership renewals, membership billing and collection, and mailing campaigns to reach new
subscribers.
First Responder Billing and Collection: „p ,�_ ra 'al"' Service
In an effort to help recover the costs associated with deploying first responder personnel and
emergency vehicles, agencies more and more are exploring the option of charging a first responder fee
35
and recouping associated costs for the responses. We help you process, bill, and collect these
reimbursement costs.
Treat -No- Transport Billing and Collection (aka Assessments). Qp orm_1... y1
When patients refuses transport, or an ambulance crew determines that ambulance transportation is
not appropriate, many departments now employ treat -no- transport fees as a way to help offset
reasonable and associated costs for providing the service. Wittman works with you and/or your
ambulance provider to bill this fee for you if you retain your own NPI number.
Additional Services Available: Qp n lw Services
Wittman creates programs that meet your individual needs. We offer a variety of services that may be
stand alone or combined with our ambulance billing services. If you need a service that is not listed in
this response please contact us to discuss; because, our goal is always to provide you a suite of services
that truly meets the needs of the City. Other options include:
• Fire Inspection Billing
• False Alarm Billing
• Survey Letters
• HIPAA Notices of Privacy Practices
c. Name of the firm principals and a detailed summary of the team that will be used for these
services. An organization chart shall be included that clearly identifies each team member, the
responsibilities and nature of work each will perform.
What Truly Makes Us Different. Lowest Claims- Per -Staff Ratio
Through streamlined efficiency, talented staff, selective automation, and continuous improvement,
Wittman has a long record of strong collection returns for our clients on billed charges. Wittman
Enterprises generally outperforms our competitors by 10% to 20% in net collections for our EMS
partners.
Our EMS billing and collection success is tied directly to the ratio of PCRs to the number of quality
people assigned to your project. We believe that people are the key to our success.
City of Sotith San IllFrandsco Ffire BGDepartu ent: Arnbulance BilHing SeMces 1 11
al
10,000
7,500
5,000
2,500
Wittman PCRs per Staff Competitor PCRs per Staff
Company Governance and Organization
We are a limited Liability Company. Wittman Enterprises has 110 employees, 4 board members and 10
managers. Our Board of Directors is:
CEO
Corinne Wittman -Wong
President /CFO
Walter Imboden
Vice President
Kathryn Garcia
COO
David Wittman
Our staff is divided among four departments: Customer Service (68 employees); Cash Receipts (8
employees); Support Services /Electronic Billing (12 employees); Data Entry (22 employees). All
Oty of South San Fru nndsco Fire Department: nt: mbulan°nce MlHn°nt SeMces 1 12
37
1�1vittell'U'All 01 to," �'
Operations Team
• L-mi
11 years Wittmanlindustry experience
Rene Wittman, Cash Receipts Lead
20 years Wittmonlindustry experience
rvi L
0. 11 1
117 11 T • T - -- ' , AT - AT ` — , , I I I
with City and EMS personnel to discuss the goals of our business relationship, the services we provide,
d . Aji I
City of South San, Francisco Fire Departirnent- ArnbtAzince Bilfing Ser%kes 113
M.
should any issues arise. Please consider tom that Rues Harms (Director of Business Development),
Corinne Wittman-Wong (CEO), and Walter |mboden (President) are also available toyou at anytime.
We make ourselves accessible for meetings by teleconference, Skvpe, or in person as necessary. In
tandem with the Customer Service group and as part nf our comprehensive service the Client Liaison
team provides:
• Assistance in completing application forms required for maintenance of enrollment in Medicare
Port B and state K4edi'Ca| programs in the state where services are rendered, including the
establishment ofa National Provider Identifier (NP|)
• Assistance in maintaining and updating the local K8edi-Cal signature authorization forms for
billing paper claims
• Annual Medicare updates as required by the program
• Re-enrollment of Medicare and other third party payers required by Medicare or by the
respective third party payers
• EDI registration maintenance and updated application for local Medi-Cal and Medicare carriers.
• All required registration maintenance and updates of Wittman as South San Francisco's official
patient billing address
• Staff to obtain signatures, and provide mailing and follow-through on all enrollment forms and
all third party payers
• Specialized reporting
• Status and projections reporting
Point of Contact
Stephanie Cooper-Noe (CIVIC), Client Liaison
11O93 Sun Center Drive
Rancho Cordova, CA9SG7U
916.669.46O7 direct line
City of South SafvFrariciaco Fire DepartrrienVAmbu|anoeBiUing Semices 1 14
39
Organization Chart
Dona Wittman
Chairman of The Board
Joe Balkema
;utive Director of
Nicole Powers
Division Manager
Electronic Billing
Adifn rvsftafive
Assistant
wittmanenleyrises
Corinne Wittman -Wong
CEO
David Wittma Wter Imhoden
CIO I coo n III �1 Prealsident / CFO
Ingrid Jana Donna Bailey
Manager ofHR Director of Operations
Samantha Taylor Division niter Bump
Division Manager on Manage
'M—t F-1-1 S.1— Government Billin
Kathryn Wolf
Vice President
Russ Ha
Director of I=e-
Developernent
...... ........
I.nie Cooper Noe
Client Uaison
Judy Vang
cfieM suppod
servlces
1',ty cif ";outh Swi f'xnii!Jsc°o II due Depai UneM a Nir ,w ,mce Pi I H y, S- 15
40
H aff wir Montano
Haney
Wendy casuno
D vZ*n &qlewMarr
Division
01vision supelv[""t
PW—f
'rodul;UOV11BOng
PjrC,tjtqCtlCpn/B0Hng
C,,Wi Rec6pts
P��
See Yawl g
WsMca Ceccato
AngMas Thao
Rene Withwin
I
Dms Lead
DMSKal Levgj
�
Mvismn Lead
DMskn Lead
Dwision Lead
CIZ,,�Inl
E �eWllnk; Biflin
.1.M F--$ sell..
P
Quallty Assurance
PuoduefiarV80kin g
Cash Reccipts
1',ty cif ";outh Swi f'xnii!Jsc°o II due Depai UneM a Nir ,w ,mce Pi I H y, S- 15
40
W�I�Yi��O�ae°lia'Y ✓'F✓Y � � Jya °�
a Describe the relevant experience of y ur firma with ambulance billing, collection reporting arr
analytical services daring the post flue () years. include ability to t service deadline, extras
added after the contract, service size and list a reference name, address and phone number.
Relevant Experience
Billing Standards Compliance
Wittman observes all debtors' rights and .comph s with all appficable f der I and state kws, including by
way of example nd not as a limitation, applicable provisions of the federal Fair Debt Collections
Practices Act and the Consumer Credit protection Act.
Statement of Commitment
Wittman Enterprises, LLC doges riot have any commitments or potential commitments which will impact
our ability to continue performing inclustry- leading billing and coHectlartis for the oath San Francisco
Fire Department.
s;Atyof Sa:ou.afii S a n fnincjsco pure dl epraftrunerar: ar,ndiukroar, N1htg7 1 16
41
Y%iftftan rutt),Y) � I
Select References
Sacramento Metropolitan Fire District, CA
10545 Armstrong Avenue, Suite 200
Mather, CA 95655
Maurice Johnson, Assistant ChieflDirector of EMS
(916) 859-4135
"ClIpy
EMS Billing Partners since 2001
53,307 Billed Transports Annually
-7,508 Billed Assessments/First Responder Annually
City of Huntington Beach, CA
2000 Main Street
Huntington Beach, CA 92648
Jane Cameron, Fire Medical Director
(714) 375-5097
EMS Billing Partners since 1993
-10,373 Billed Transports Annually
273 Billed Assessments Annually
City of Pasadena, CA
100 North Garfield
Pasadena, CA 91109
Robert Ridley, Controller
(626) 744-7497
IYLM�L adena,,net
L,Adky.EL�. Jf
EMS Billing Partners since 2011
-10,224 Billed Transports Annually
-816 Billed Assessments Annually
San Ramon Valley Fire Protection District, CA
1500 Bollinger Canyon Road
San Ramon, CA 94583
Paige Meyer, Fire Chief
(925) 838-6601
pMtyg[2�Ef [,rE,c-a-,,g2y
EMS Billing Partners since 2000
-3,971 Billed Transports Annually
-1,299 Billed AssessmentslFirst Responder
City of South San Frandsr;o Fim Departinent- AmWance Uhng Sc? 'vices 1 17
42
vvillsma U4c , I x" I 'rpi (,W,
Billing Processes: Project Approach
Gt �, of South San 11�)andsco II ure Dell:'.ro wtmenv A, nbukmc�, N I hn', ".,efvk 18
EN
Wftfflan Irrj,
Personal: We expend great effort ensuring that every client feels taken care of and never as
though they are just one • many. We intend to continue that same level of service to the City
of South San Francisco. Remember, each client is a partner and our goal is to work together to
ITMIMMITTITM
L.eaders Our CEO, Corinne Wittman-Wong, is an involved member of the American Ambulance
Association, regularly presenting educational workshops for members, committees, and other
organizations on new developments to the Medicare Fee Schedule and associated issues.
Electronic Patient Care Records (ePCR) Interface
Wl&rM"-E I -r&l-
they correctly correspond to our billing system. There are no requirements or added costs for an
electronic interface. We work with each client to determine the most effective way to transfer the care
Oty of South Sari Frandsco Fire Department Ambdance Nfirig Sendces 1 19
44
CUMO-415trwim
1—j"-le a w'4 I'W.w
rpnctrav'Pc CWnui,
HIM.8
Ymmmi"Son 110, N'M_
Depart—t
W*
Claim l,q,y
d WQ(
GAMY
Dn l. All Paycees
Zmah Rneiptx
DAILY
kmd
I DO of
"ilpt
Oty of South Sari Frandsco Fire Department Ambdance Nfirig Sendces 1 19
44
Billing and Collection Processes: Methodology
Oty cJ South Sain ::raiu!Jm Fh,e Departivient: Arnbukinu, Ndfing 120
UO
• Contacting the patient cur family members rs for billing or insurance information
• Personal contact with the patient or patient's family via phone or email
0 Mailing inquiry forms to the patient
(Ay of" mo uh San 11I:i.anau ^ „u°:HweDq� �)artnu,FeW°AniI�uI�inc 3'iilIn",. "r�,�i,.� X21
46
For auto accounts, we determine from the patient whether they have med-pay through
their automobile insurance, we are billing a third party insurer, or if they have retained the services of
an attorney. Depending on the patient's response, we will either bill the patient's med-pay or private
health insurance, bill the responsible party urvxe will work with the patient's attorney toset up a lien
against their personal injury case. All appropriate follow-up on accounts occurs ne8u|oMy by specialized
personnel in our Customer Service Department.
Wittman Enterprises, LLC has also worked on several large insurance bankruptcies. These bankruptcies
have affected the revenue of our clients. Through our efforts, we have been able to obtain for our
clients up to 80Y6 of unsecured debt owed by several of these insurance companies. Most of our
competitors opt to forego this process osit can take years to settle these cases. It takes many hours of
correspondence and re-billing tothe bankruptcy courts to net our clients payments that otherwise
would have been written off.
Patient Pavment Options
Wittman Enterprises will affect positive collections for the City's financial requirements while providing
compassionate service to your patients—doing everything possible to attain reimbursement for your
daimon. With that goal, xve try to provide as many payment options as possible uothat patients have
choices of how best to make payments to their accounts. Whether they mail their check payment or
credit card billing information, provide their credit card information over the phone, set up a limited
installment payment plan, or prefer to access our Credit Card PAyp1gnLEqrt4I, we make it as simple as
possible for patients to submit their payments.
For patients unable to pay their full balance owed, Wittman follows your policies in regards to private
pay accounts. This could include minimum payments accepted and the duration of the private pay
contract. Based on our experience, we have found that limiting payback duration to one year usually
provides the best results for our clients. Patients have the option of making their monthly payments bv
check or credit card. They may also set up an AutoPay agreement with a signed authorization where
payment ia automatically withdrawn from their credit card each month.
Hardships, Discounts, and Reductions
in the course of providing our services, Wittman follows the City's policies. For example, you may waive
the ambulance fee if it is found that a patient does not have the financial resources to pay. We notify
your department in the case of any situation requiring modification of account balances, pay schedule,
referral to collections, or account write off. No adjustment is ever made without prior authorization
from you. All adjustments are clearly documented and identified in our regular reporting and
documentation. We customize policies at your direction regarding discounts and reductions to meet the
City's requirements. Some of these may include hardships, attorney requests, City employees, or small
balance write-offs. In aff cases, no discounting decisions or write offs are made without your advanced
approval.
47
Denied or Disallowed Claims Protocols
Wittman Enterprises pursues every claim and follows through with every denial so that all legitimate
revenue is collected on behalf of our clients. Denials are not accepted; in fact as a policy we appeal all
claims where the denial has appeal rights and we determine that an appeal is warranted. Additionally,
Wittman demands payment with the appropriate interest from non - compliant insurance companies.
l(Ti� T T-TTIRT-Arf . =..
Medicare may deny claims for any number of reasons such as a patient without Part B coverage on the
date of service, incorrect patient information on the claim, Medicare is a secondary payer, the patient
has a Medicare Advantage plan, and many others. Wittman Enterprises actively appeals and processes
all denials, making sure our clients get their maximum legal reimbursements. Our thorough process
starts with reviewing the denial code and includes:
• Identifying the course of action based on the denial code
• Further researching Medicare Eligibility
• Verifying payer primacy between patient insurance and Medicare coverage
• Locating Medicare Advantage plan coverage
• Reviewing modifiers and codes for accuracy
• Checking EOBs for reported non - covered services or for no Part B coverage
• Billing secondary payers such as insurance and Medi -Cal as necessary
• Correcting information requested on denial and resubmission to Medicare, supplemental
insurance, Medi -Cal, and the patient to reflect all necessary changes
• Scheduling a call -back date to follow up on resubmission
• Notating the account so that it reflects up -to- the - minute status of every claim
Medi -Cal Denial Protocols:
Not all Medi -Cal denials are provided to us in the same way. Most are received in traditional
Explanation of Benefit (EOB) format where codes are given and definitions for the codes are provided on
the EOB. Others are returned in letter format only without codes or any clear reason for the denial. Our
procedures for processing Medi -Cal denials include:
• Reviewing EOB /letter to verify if a payment was issued, and to identify the explanation for the
listed code. This primary step is key for determining the type of denial received and what
course of action to take for ultimate payment.
• Further investigating patient's Medi -Cal eligibility and modify claim data if necessary.
• Identifying hierarchy of payers. Assuming Medi -Cal is the primary; add appropriate denial
code along with any other necessary changes.
• Resubmitting claim to Medi -Cal.
• Scheduling a call -back date to follow up on resubmission.
• Notating the account so that it reflects up -to- the - minute status of every claim.
Insurance Denials Protocols:
Health Plans and Medical Groups issue denials when all or parts of a claim are not paid. There are
several types of denials. Some are issued correctly according to the patient's insurance policy and/or
m .,
,s�bV cif South San nwd.;mc�) hc� DeIImrmim: � Ni9i,r,p, S,;nr h:w; 123
W
'ililling guidelines others are incorrect due to an error by plan when processing
number We have a significant of #. d Operating Procedures (SOPs) covering numerous scenarios
for processing denials for Medicare, Medi-Cal, and Private Insurance. Our SOPs are also available to you
for i would like a more explanation of our # methods.
Private Pay Accounts
Surveys from r Collectors #c # # patients are more ^d to make
payment from f •repeated collection notices. by combining
through and collection notices, an agency can further increase the effectiveness. We have found this to be true
personal M to our # their patients.
Invoicing Calls to Patient Combination
Our first call to a private account occurs immediately after data entry of the incident into the system and
automated and /or manual searches for previous accounts for the same patient have been completed.
This verification call allow us to determine if the patient has insurance or any special circumstances that
will make it difficult to pay the bill in a reasonable amount of time. The early establishment of contact
with the patient is beneficial in establishing a working relationship with the patient on an individual
level. We believe our system of invoices, statements, delinquency notices, and individual letters, in
conjunction with telephone follow up, is an industry best practice producing results for your
organization.
City of ou'th Saiir Francisco Fire ifep artmcmt; Arrnbulaancr,., Uhng Serv'sces 1 24
49
iill Schedule
Wittman Enterprises customizes your private hill schedule to reflect the City's needs. These schedules
work in conjunction with our billing program, tracking accounts receivable and assigning therms to
customer service representatives for making follow -up ells. Following are two examples of customized
Private Payer — Example Schedule I
Patient I
"This timefrarne vales greatly depending on the information provided by the patient and the type of
connecUon available with the drop.-off hospital.
In the course of billing, patients without insurance are identified. if they are unable to make the
payment in Full, they are offered (payment arrangements that can Ibe made can a imonthly, bi- monthly, or
weekly schedule. Our customer service representative will set up the Time Pay within the system and
an initial letter is sent to the patient outlining the payment arrangements. There is no minimum
City of South !pan Ih�� :rauuu.iisco II he Il:mcll3artrnii:? nt;,Nr�ib�.,il ire „v l'�lHhn, -',, � v/k , 125
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Submission of Credit Card Information.
Accounting_2f Payments Received
On a monthly basis and by request Wittman Enterprises, LL[ accounts for all payments received and
provides financial reports of all billing and collection activity pursuant to GAAP.
51
`1�2'IYiL'�U`�'b 4Wfi'S %�' 7+ °� ✓'
Reporting Uncollected/Delinctuent Accounts
Monthly we provide the City with reports of uncollectable /delinquent patient accounts. They are
usually identified in the reports as "bad debt write off." Wittman Enterprises is not a collection agency
therefore we are not allowed to follow practices associated with collection agencies. Based upon your
policies, we will design a collection protocol that follows your philosophies and policies regarding the
collection of bad debt. With your authorization, we work directly with your identified staff on bad debt
write offs and/or directly with your chosen collection agency. No account will evi!�^r i� watten off as
.1 ton
�ua:�� m � � �u�:a�� t�a,�uam � uc�� ������.�' ^a��:i � unit ieu;!�uur i.µr�iaur u�r�o�t�rra t
Patient Disputes
We recognize that most patients are citizens of your community so our goal is to function as an
extension of the City of South San Francisco. We provide extensive training and look for individuals with
the ability to be compassionate and empathetic while efficiently resolving calls. There are managers and
directors available at all times to assist if customer issues cannot be resolved to the patients
expectations by our customer service department. All customer service staff is located in our
Sacramento facility.
Wittman Enterprises' goal is that each client and patient reaches a live person when they call into our
business office located near Sacramento, CA. If our EMS partners or their patients do not reach a live
person during regular business hours, they will be provided the option to leave a voicemail and offered
instructions on submitting an email inquiry. Wittman personnel will respond the same day during
normal operating hours or within 24 business hours when that is not possible.
If any complaint received by our customer service department involves care related concerns, Wittman
will contact the City and /or Fire Department directly for resolution.
Collection Practices
On average, we send less than 121 of all accounts billed for additional collection efforts. Wittman will
provide current reports identifying any non - collectable accounts to be released to your collection
agency. As part of our process, we work with your agency and provide them necessary documentation
regarding each account.
However, before an account is even considered for referral to collections, the following exhaustive
procedures will have been performed:
• Patients will have been cross- referenced by name, social security number, incident pickup or
residence address, and date(s) of service through a variety of resources including our
extensive patient database.
• The entire regular invoicing cycle will have been completed.
• We will have conducted all appropriate follow -up calls and letters.
• We have identified all available alternate patient contacts.
• We will have completed our skip- tracing processes to locate correct address and telephone
information with tools such as Accurint.com, The Haines Directory, MelissaData.com etc.
• Receiving hospitals will have been contacted for most accurate and current patient
demographic information.
Cftwyaaf Soii.ufilh'iSain Ilraaaadsco Ilium Delpi ullment� An L�udaieca fflh ^g'wr�via,,, 127
52
& A second verification of Medicare, Medi -Cal, and Primate Insurance eligibility is performed.
s provide a Cast of the information your will routinely require for your work and the extent of the
assistance required fr m the City's support staff.
Wittman Enterprises.
0 Obtain signature of patient or guardian.
* Provide patient's Social Security Number.
These are usually minimally time-consuming and can be typically accomplished via email our through our
secure FTP site at your convenience. We strive to provide the highest level of service possible and
minimizing your time commitments to the princess.
City Support Staff
Wittman Enterprises looks forward to regular contact with City staff for direction can specific accounts,
balance adjustments, and anther procedures requiring your authorization, On occasion, when we have
'qty cif Soullb S,ain Fm arudsrw;o Fite ejjoaftrr ent� Aink'ii.!I B'!IIirq � "Wrvi ;e ", 128
53
exhausted our resources and need help compl eting missing Mforimation, clarifying unclear or incomplete
narratives, we 111 request assistance fraarn our regular City contacts who are often able to acquire the
information from their resources. However, as your billing partner, Wittman generaUy does not require
regular tasks from City Staff as it is our yob to support your billing and reimbursement program.
hn Detail compliance policies and procedures, as well as agency officer(s) and a statement 9f their
qualifications r experience to perform tasty.
Exceeding HIPAA Safeguard Requirements
Wittman lEnterprises, LIC has developed a fraud and abuse compliance program to be a comprehensive
statement of the responsibilities and obligations of all employees regarding submissions for
Oty of Sou.uth S a n II'ua incisco p uu, R lepaltfrvueint� Ainb iIa m ce Pled ing S-,i c -, 129
54
reimbursement to Medicare, Medi -Cal, and other government payers for services rendered by clients of
iittrnan Enterprises, ILLC. We have established, and regularly maintain, control standards and
procedures to ensure that private Information remains secure.
Adherence to privacy Laws
consent of that patient.
M Medical Information Confidentiality - Civil Code sections _ 6- 56.37
condition and care provided.
Wittman Enterprises Privacy Policies
Responsibility of Managers: It is the responsibility of each manager to ensure that activities In his /her
area of responsibility are conducted in accordance with Wittm n °s compliance policies.
Employee E` uc tion: l ittim n Enterprises provides employees rigorous, initW and regular training
necessary and appropriate to ensure materiel compliance with applicable laws.
Monitoring and Auditing: Wittman Enterprises, LLC has adopted an audit policy to assist in Its efforts to
monitor the accuracy of claims and the security of IPHL We devote such resources as are reasonably
necessary to ensure that audits are (1) adequately staffed; (2) by persons with appropriate knowledge
and experience to conduct the audits; (3) utilizing audit tools and protocol which are periodically
Oy of Soutlln Sar, F)sunuu u:;O f uumw. Pail i, T, ,��. ",ia. _�,.�;' 30
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0 Bins are collected bi- weekly and the contents shredded per MPAA regulations.
Electronk Access and Storage Security:
0 Secure Server Room with Keypad Entry
0 Multi -Layer Hardware/Software Firewalls with Access Poles giving access to only the servers we
specify.
Corporate Anti-Virus.
• Corporate Web Filtering with Anti-Virus and Spain, which are logged and monitored.
• Server Monitoring roofs to manage Disk Capacity, Memory Utilization, and CPU Utilization.
• Email Archiver that stores and monitors all email traffic with a built in policy violation alerts.
Seven Key (Elements of OIG Comproance
Per the OIG, ittman`s polities and procedures include the following severe elements:
(1) Wittman Enterprises maintains written standards of conduct that have been developed for and
are continually updated to reflect clear compliance rules, expectations, training, monitoring, and
address potential fraud.
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Access to Records Policy Summary
Wittman Enterprises ensures that Its use, disclosure of and requests fear PHI are in accordance with the
Minimum (necessary requirements under HIP A. We make every reasonable effort to limit the amount
of PHI that we use, disclose, or request to the Minimum Necessary to accomplish the intended purpose
of the use, disclosure or request.
address the following:
0 The protocol must set forth the type of PHI that can be disclosed.
0 The protocol must identify the types or categories of persons to whom the PHI identified in -the
protocol can be disclosed.
The protocol must identify any applicable conditions to providing the disclosure.
individual review by the Privacy Officer;
Disclosures to a public official in accordance with applicable law, if the public official represents
that the information requested is the Minimum Necessary;
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• The information is requested by another Health Care Provider, Health Plan, or Health Care
Clearinghouse;
• The information is requested by a professional who is a member of Wittman's workforce or is a
Business Associate of Wittman Enterprises for the purpose of providing professional services to
the Organization, if the professional represents that the information requested is the Minimum
Necessary for the stated purpose(s); or
• A person is requesting PHI for research purposes and he or she has complied with the
Organization's policy on research and provides documentation to that effect.
In the event a workforce member believes that a request for a disclosure involving PHI from a person or
entity is not the Minimum Necessary, such workforce member must raise his or her concerns with the
Privacy Officer. The Officer is responsible for evaluating such requests for disclosure and determining
whether it is reasonable for Wittman Enterprises to rely on such request.
i. Describe how the proposal differs from that of other processes used by similar firms.
Electronic Communication and Access to Records
Client Portal
Client Portal
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Wittman Enterprises, LLC offers secured Internet access to our billing system via our Client Portal. No
additional software is required for the City of South San Francisco
to access the information through our secured website. It is
accessed through a secured login that is password protected.
Information accessed from the Portal is in real time, allowing
authorized City or Fire personnel to view each claim wherever it
is in the billing and collection process. This real time access to
the Wittman billing system will allow the City to view all accounts
and any transactions performed as they occur providing South
San Francisco with the most up -to -date information on any
account.
Access to the Client Portal is granted only to pre- authorized City
and EMS personnel with permission to view such information and
Client Portal
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City of youth Sans Francisco Fire E)ellpar'trirnerW ArnbUlance Ui'ing Serving's 134
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Client Portal
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MOW Number
Run Number
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Patient Portal
For many years Wittman has provided patients with Portal access as well. Each invoice, statement, anii
"I'll r --YLt aw f Iff rimv
make a payment, or simply inquire about their bill. This site is available 24 hours a day, 7 days a week.
Collections Portal
In addition to our client and ;catient i, we have created a Portal for the most commonh� re�#-.uestecl
items from collection agencies based on input from our clients. This portal provides the commonly
requested collection agency information, but limits access to only these items for security and HIPAA
Review accounts electronically
Print invoices
Print Patient Care Reports
Print 1500 billing forms.
is fullv secure -14 VAI Led fr*'tt vou. Ajjl%jorlm� 9 - v
,qgLC,jM *,ti-L
and network levels. MailGate SC simplifies
management with one comprehensive secure
itmail solution for inbound, outbound and
it of South San Frandsco F ire Department- Amb.flance Nifing Services 1 35
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City of South San Francisco Fire Department Ambulance Billing Services 136
61
Reports and Records
The City of South San Francisco will have access to our ��0�����a and dientnepo�inBsystem aUowinO
authohzedOtyand Rmepemnnne|to obtain invoice4acnountbalances, billing reports, and other hands-
on accountmana8ementtoo|u. Daily, monthly, quarterly,
annual, and special reporting can beprovided
in PM�� and ExceY format Our reporting system allows
interface with CirystmU nepori ft are. For
examp|e,SouthSanFrancisco^scustumizedreportin8pno8rammiQhtindudespuci� u has:
"'g-Number of Reports
Numb�r8i||�dandReneived yp e
Calls Not Billed
Gross Charges
Contributions Allowed or Write Down
Net Charges
Adjustments
�
Payments
Refunds
Balance Owed
\ ' Number of Bills and Amounts Sent toCollections
Pending Claims atCollections
Write Offs
Aging Reports
k. include yourfirm's disaster recovery plan1system and retention policy.
Computer Operating System
All employee computers run Windows 7 and our network is run through Windows 2012 servers,
Windows 2012B2, and our 2012 SQL server. We currently have no plans to modify our network except
for following our regular maintenance and equipment replacement schedules.. Wittman Enterprises
utilizes dual layer protection for both software and hardware. The selected tools include:
° ANSAnbvirus Business Edition software
° AVG RrevvaU Security blocks hackers attempting to access data stored on your
endpoints and business network. Stops ma|wane taking over your computers urlaptops.
Works unwired and wireless networks.
• Keeps our identity safe from the Spyware and Adware that tracks personal information
• Detects and removes dangerous rootkits that hide malicious software that attempts to
take control of the computer.
• Protects from nnakware and helps stops anything that b already infected.
• Virus Definition Updates are performed hourly.
*
Barracuda Spam Virus F/onwo0Appliance
• Manages all inbound and outbound email traffic to protect organizations from email-
borne threats and data leaks.
• With the Barracuda Spam Firewall, protecting against inbound malware, spam, phishing,
and Denial of Service attacks ensures that business productivity isn't impacted by
attacks through the email system.
• Customizable policies enable further enforcement of detailed requirements that govern
inbound email messages.
• Virus Definition Updates are performed hourly.
City of Somilb San Francisco Fire Delpmrtmmem%:Anbu|anoeHHng Services 137
Z-4
Utilizing software, our electronic computing and storage capabilities are backed up
redundantly by a Dell Power Vault 124T with 24 terabytes of storage capacity. Wittman's network
consists of a redundant Raid Ten Array Network Attached Storage, running on two Dell R720 Dual
Processor eight core servers on Windows 2012 Server in an active/passive cluster mode. Wittman uses
Rescue Net Billing by ZOLL Data Systems.
1. Clearly identify the transition plan and timeline necessary to migrate all billing and collection
servicesfrom the City's current Consultant.
If we are fortunate enough to earn your EMS partnership, your transition plan will be customized to
meet and exceeded your needs and expectations as our experience has shown that no two transitions
are the same. Our transition process is built around five key steps that will be facilitated by your Client
Liaison, Stephanie Cooper-Noe, and the entire Wittman Project Management Team. It is designed to
City of South San Francisco Rre DepartmenV Ambulance WHing Services 138
RK
ihqttnIw'�'r'n
As a result of our business model, you will find that many of our processes are customizable to the
needs to the City. Through our 24 years of experience, we have learned that each EMS organization
functions differently and has unique expectations and needs. We have elected to not advise you how
your billing program to meet your requirements and expectations.
Transition Timeline Estimated
Our billing system is easily customized and we are able to complete set procedures within 48 hours of
award of contract. Wittman Enterprises has significant experience in working out old work from
numerous billing systems. We are capable of taking on this task immediately upon award and execution
of a contract. Billing private insurance and private pay claims starts immediately and we vigorously
attempt to collect on all aging account receivables turned over to us. As part of our regular processes
we maintain complete account receivables, payment collection, and balance records on each
patient. The countdown to "flipping on the billing switch" is completed in the few milestone steps
shown below.
Step I Step 2 Step 3 Step 5
wrframel�farrjwoye CPCR Intedoce Ramping UP Step 4 Anolysis
comptetJow 30 day.s completion: 15 completion: 160-Live 6 months
days 3.5 days
City of South San Francisco Fire [)epartimeint: Arnbull a nce IHhrug SeMces 139
64
Transition Schedule Estimated
Step 1- 30 days
•
Award of contract
• Welcome
.
Kickoff meeting and introductions
• Gather
.
Fully- executed Contract and Business Associates Agreement (BAA)
Information
.
Gathering of Company Specifics, demographic information, pay -to address
• Procurement
requirements, etc.
• Transition
.
Begin transition billing immediately
Billing
.
Completion of transfer documents with Medicare, Medi -Cal, and other
insurance
•
Assembling of the City's policies: add to Wittman department procedures
•
Wittman department manager and customer service briefings on the
City's policies & procedures
•
Client and vendor ramp -up meetings as needed
Step 2 -15 days
•
Mapping and interfacing of ePCR and billing systems
• ePCR Interface
•
Attain necessary logins, passwords, credentials, permissions
• Reporting
•
Testing ePCR interfaces for the System's EMS billing program
Program
.
Client, vendor, and ePCR ramp -up meetings as needed
•
Customize the City's Reporting Program
Step 3 - 15 Days
•
Complete overlapping and remaining tasks from Step 1 and Step 2
• Ramping Up
.
Gather banking information and materials and make necessary transfers
of information
Y
Set up the City's personnel on Client Portal, FTP site, etc.
•
Client and vendor ramp -up meetings as needed
Step 4
•
Accept live data via ePCR interface
■ Go -Live
.
Transmit electronic claims to Medicare, Medi -Cal, etc.
•
Client and vendor ramp -up meetings as needed
Step 5 - 6 months
•
Conduct comprehensive process, compliance, and documentation
■ Analysis
analyses
•
As needed, provide the City's EMS personnel comprehensive billing
compliance and documentation training
m. Provide a detailed description of a transition plan for a future billing company that maybe
awarded a contract in the next RFP cycle. The plan should include a timeline as well as the lead
time needed to close out specific City accounts.
Transition Plan
Because most of our clients have remained with us for years it is unlikely that we will need to transition
our services to an alternate billing firm. Our services are tailored and monitored constantly to meet and
exceed your expectations regularly. However, in the event of the end of a contract, Wittman
Enterprises is committed to serving your needs at the highest level possible and would continue to
perform our responsibilities professionally and helpfully to ensure a smooth transition. Wittman has
only transitioned a small number of clients from our billing program so instead of offering a formal
process, we commit to working with the City and your new billing agency throughout the transition
process to provide any information that you or your new billing company may require, including reports,
Ct y of SciuutIli San Franc !Iscx f aua: De;iu «nu f:men Y\rribiuILmc v Bil I in,� 140
9�
documentation, etc. We will also work to define a wind-down period that is acceptable to both parties.
The industry standard is 90 days, but we can negotiate that timeframe based on your situation.
n. Detail analysis capabilities that show trending, program performance and other issues that m
�
Getting the Average Charge per Day last 3 months charges divided by the number Vfdays in
those 3 months; and
° Dividing the A/R Balance by the Average Daily Charge, giving us how many days of charges are
When the work is being managed appropriately your outstanding A/R should not usually be more than
three months of charges. Much of this key information will be provided in your Year-to-Date Revenue
Report along with several other Key Performance Indicators (KPIs).
In addition to DSO review, our operations director uses department KP|s to analyze trends,
performance, and to address any anomalies before they become issues.
Billing Department
• Trending ofTransports
• Month-End Report Comparisons and Reconciliations
Customer Service Department Workflow Timeliness
• Hospital Data Exchange
• Mail Returns/Missing or incorrect phone numbers
• Private Mail
• Medicare Signatures
City mfSouth Sari Francisco fire Departmerrt:Ambu|ance8UUng Services 141
66
Cash Receipts Department
• Payments monitored for timeliness and unusual trends
• Refunds Trending
Collections Timeline
Taking into account that Medicare payments are received after 14 days (at the earliest) and based upon
typical collection rates, the graph below represents how accounts are collected on average by month for
our clients; on average 74% of revenue will be collected within 60 days of service. The remaining
approximately 11% is reserved for possible referral to collection agencies, for appeals, payment
arrangements, litigation holds, and other usual and customary adjustments to dollars billed.
60
50
40
30
20
10%
0%
Collection Receipt Percentage by Month
.-i N M d Ln lD I, 00 0) O r14
L t L t t L t L t
Y Y Y Y Y Y Y Y Y L L
c C C Y Y Y
cO CC0 c0O ccO CCO ccO CCO ccO 0
C Cc c ci
G G G G G G G G G G G G
Wittman Enterprises is generally able to assume all aged accounts receivable work for the same or
similar fee to new work; however, the final price would be negotiated at the time of transition and is
based on the age, quantity and quality of remaining work after the incumbent's wind -down period.
This aged work is addressed on a case -by -case basis and added to our billing system to reflect all
activities prior to Wittman assuming the account. One each account is added, we then superimpose our
billing process in an attempt to capture any revenue available for the account. Billing and collections for
these accounts must be treated as urgent due to timely filing restrictions; however, results and
timeframes will vary based on the quality of information provided.
u;ity of c,ili.ut San Francisco plrc De�paftruenU Arnbi l n� a IE',illin ,, Sei,via, :� 142
67
Ambulance Revenue Analysis Report
Ambulance Revenue for FY
Top date IS EFTWEEN 071010014 AND 0613612015
!er NGV- Rep.11,Gg
Page I
CRY (�Iif Soi,Wlh sair, 1::11'an(J!'wv 11:111%, 143
68
Date of Service
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Page I
CRY (�Iif Soi,Wlh sair, 1::11'an(J!'wv 11:111%, 143
68
Quarterly Client Connect
In 2015 we started our Quarterly Client Connect program which provides a program check -up,
opportunities to discuss industry trends and standards, address agency questions and concerns, and
review performance trends and reporting. Visits are conducted via conference call, Go -to-
Meeting/Skype conferences, and in- person visits with Finance and Fire personnel. Analytical content at
these meetings usually include some or all of the following:
• Payer Mix Analysis
• Collection Rate Analysis
• Year -to -Date Revenue Report
• Management Summary Report
• Ticket Survey Report
• Ambulance Revenue for Fiscal Year Report
Cary cif Sot, Oh San V rnmnds:o Ffi,c Delp artriinent: A rl:mdanr, r, flhn ^ uon l .o, 144
69
iowittmairu
SEcnaN C: Compensation Requirements
Competitor and Transition Performance Data
We believe that it is important to demonstrate our superior performance over our competitors on
behalf of our clients and potential clients and' when necessary, provide specific information regarding
vendors with inconsistent performance history. For examp|e, using average revenue collected per
transport, the chart below shows the significant improvement achieved based on simple revenue per
transport dollars for clients who have transitioned from your current vendor to Wittman Enterprises.
Burney Fire Protection District
vz
Carson City Fire Department
Cosumnes Community Service District F
CSA 69 (Heartland)
North'Eounly Fire Protection District
North Richland Hills
North Tahoe Fire Protection District
Through streamlined efficiency, talented staff, automation, and continuous improvement, Wittman has
a long track record of strong revenue returns for our clients. We consider the net percentage collected
,!firom the amount billed to be the ultimate standard bN, whichNour ambulance billirqV, comXonN- "huld be
evaluated. Net collections are those dollars eligible for collection after taking into account Medicare
and Medi-Cal contractual write downs.
Other agencies may offer at a lower fee; however, we ask that you evaluate the net revenue received
and consider how our personal attention to your account considerably increases revenues to your
bottom line. For example, two of our long-term clients contracted with a national competitor to
City of South San Francisco Fire Department: AmbuWnce8iU|n0 Services 145
70
wittinan
Wittman Enterprises (for "a lower fee") and experienced not only a significant drop in the level of
response and service but a substantial decrease in net revenue collected. The following tables detail the
annual overall drop in revenue for those clients referenced above who left Wittman Enterprises for a
perceived drop in program cost.
CLIENT #1
COMPETITOR
DIFFERENCE
RATECHARGEDTO CLIENT
$ 17.25 PER TICKET
$12.75 PER TICKET
$4.50 peir I (1kill.t_-]
REVENUE COLLECTED
$37,030,484
$34,056,482
COST IN FEES TO CLIENT
$1,242,000
NET REVENUE TO CLIENT
$35,788,484
$360,000 Saving by Selecting
the Low Cost Vendor
$2,614,002 Loss in Net
Revenue Due to the Vendor
Under Performing
This client also experienced similar results by selecting a vendor that bid a slightly lower rate. Rate is an
important factor however it should be coupled with overall vendor performance to realize the net
savings or in this case loss to the agency.
Wittman bases its fees on a number of factors including information on the types of transports you have
(ALS versus BLS), your average transport distance and the demographics of your area (Medicare, K4edi'
Ca|,|nourancee|igib|eindividua|sveousself-fundedpatientsvvithnoinsurance).
The City ofSouth San Francisco can court on Wittman Enterprises to conduct diligent, regular, and
uninterrupted billing and collection services in o professional businesslike manner with superior
City mfSouth San Framdsco Fire Department Ambu|anceBUDngSend�� 146
71
vOttrill"WAn c'na')
performance. We believe our personal approach and higher levels of service greatly exceed industry
standards. Your expectations and overall satisfaction are attained through ongoing and regular training,
Cost Proposal
Per the RFP instructions, the Cost Proposal for Ambulance Billing Services has been submitted under
separate cover. We are a full service billing agency from the point of data entry to the last cent
collected. Our fees contain the full range of EMS billing services including:
Immediate availability to patients
✓
No-cost reporting
Ad Hoc reporting for no additional fee
✓
Instantaneous response to reporting needs
✓
Technological automation
✓
✓
Patient Database (since 1991)
✓
Hospital connectivity
Single location with tight HIPAA and compliance controls
✓
Lowest claim to staff ratio
✓
Full reconciliation and discrepancy research
✓
Medicare Revaliclations
Membership program support
✓
Special account handling (employee, time pay, indigent program)
Patient Satisfaction Survey Management
✓
Reliable Internet-based Portal System:
• Client Portal
✓
• Patient Portal
• Collection Agency Portal
Dedicated Client Liaison and Division Manager to your account
✓
City of South San Francisco
Ffire Department. AmbLflar)U? BflHng
Se'rvices 47
72
vvit,,tli ✓ aV c I(r ('c,,+t
3. Contract Exceptions
We have reviewed the RFP, proposed contract, and Business Associate agreement and the scope of
services. At this time we do not have any exceptions or requested changes that reflect variations from,
or exceptions to, the conditions and specifications of this proposal (with the exception of any bullet -
pointed content below). We respectfully request the option to address any questions that may arise
during contract negotiations.
• On page 4 of the RFP it states, "The successful Consultant shall be required to appear as a
witness on behalf of the City ... " Wittman Enterprises has no exception to the request;
however, we reserve the right to charge on an individual basis for travel expenses of the
witness(es) including time, transportation, meals, and lodging as required based upon the
particular case in question.
(,Vt�"y cJ So 4.Nt:h SrrYIIIYI H "aV"cls F' F!II 11.)qI3aftim H"YIV nIku mcr 5111hrr, 1 48
73
APPENEACES
request for information.
Training Program: New Hires
Our comprehensive and ongoing training program allows us to continuously improve the way we
conduct our clients' business and get you your maximum legal reimbursement available, The new-hire
training program is divided into four parts:
C !I ty of Sot thi San R a ndsco, Fht:: Dcjj�) art rriont� Ainhu I m ic; ! I I I! np ':I' i:,o %iii 149
74
Training Program: Continuous Improvement
a New Client Transition
• First Responder Clients
• Industry/Job Training and Updates
• CMS Updates Updates
Is Noridian, Pooh as Updates
CAY cif So uth San Fi a mJsco 11::hu IDeloat tin enV At rb�flancv Bfflhtt, 150
75
• [oding/CD-10 Training
• Errors and Exceptions Reporting
Continuous Education
Wittman Enterprises requires employees to not only stay current on industry and individual job
requirements but to continue to push their learning curve through continuing education and bring our
clients the best qualified staff in our industry. For in-house training, attendance io taken and individual
HR files are updated to maintain a list of continuing education projects each employee has undertaken.
Additionally, outside-house training is documented via program participation and/or CEU certification.
In-Huse Continuous Education
• Telephone Doctor: Continuous Customer Service Training
• Business Communications
• The 7 Habits of Highly Effective Managers
Outside Continuous Education Examples:
0 Certified Ambulance Coders (CAC) Continuing Education
• New Manager Training
• Project Manager Training
• H|PAA Officer Training
• Medicare and K8edi[a|/Medi-[a|Billing
76
Appendix 2; Key Personnel
Corinne Wittman-Wong, Chief Executive Of rcer
Corinne has been with Mittman Enterprises, LLC for more than 20 years. As CEO she is responsible for
the strategic planning and vision of the company. Her strong knowledge of the industry integrates
completely with her experience of working In all departments of the company and provides her with a
unique perspective on our company's philosophy and goals. She administers the supervision of our
clients' accounts, and the adherence of policies and procedures set forth by the company, while
facilitating and encouraging leadership qualities, irunovativeness, and direction of our employees,
Walter Irn oden, Presi erut /CF0
For 23 years falter has worked in the EMS billing industry. He oversees all aspects of the day -to -day
production and operations of the company, monitoring both production and personnel. He directs the
blifing and collection processes ensuring adherence to our clients' contract requirements. He develops
office procedures that are designed to enhance and expedite workflow. Over the years while working in
every department at Dittman Enterprises, EI..0 Walter has developed strategic, tactical, and short -term
operations that enable him to provide invaluable guidance and training to our department managers.
Kathryn Garcia, Vice President
in her 20 years with Wittman, Kathryn has worked and managed all departments. This provides her the
perspective and experience to help the City with any special requests or circumstances. Kathryn
oversees the blllin team and the cash receipts team. She provides the City with special reports to aid
the balancing process for trips, refunds, and deposits. She also creates, reviews and distributes all client
month -end reports.
by 30% in heir first year with Wittman.
Joe Balkerna, Executive Director® IT
Joe brims 21 years of programming experience with C#, VB, ASP, JavaScript, and BB X, along with moire
than 12 years of SQL knowledge and reporting design. He has installed more than 30 billing systems
nationwide. At Mittman he designs multiple client-focused programs and reporting mechanisms, and
streamlined our working environment by designing a document management system to go paperless:
scanning over 3,000 documents daily.
Stephanie Cooper-Noe, Client Liaison
For more than 12 years Stephanie has provided ambulance billing leadership and customer service to
our clients. She develops our Compliance and Documentation Webinars, trains employees and monitors
their compliance with the company's MPAA program, designs client-specific reports, oversees Medicare
Reval"udatiions, and provides the conduit between client finance departments, fire departments, and
Wittman Enterprises, I_EC„ Certifications: Certified Medical Billing Associate.
h�;y of Sol uth Sahli Ur allId.aco Nriil. �.�� ��. &W 4mttrirw�pu9, rttnh' ,lk, I1 e BiiIIln�, k- 4 152
Iffi
Russ Harms, Director mfBusiness Development
Russ brings 24 years of management leadership, direction of progressive operations, and the building of
strong client partnerships to Wittman Enterprises and our clients. He specializes in organizational
development and management, strategic planning, performance management, continuous
improvement business development, leadership development, and change management. Education:
Master of Arts, English; Bachelor nf Arts, English.
Jennifer Gentry, Client Support Servicms(ePCR Interface)
Jennifer has been with Wittman Enterprises for over 16 years. She facilitates the integration ofePCR
systems with our ZJLL billing system. Jennifer works with each client to ensure that we have the most
effective information import possible through a customized mapping process. Jennifer is also the co-
moderator of our Medicare Compliance Committee and works on our Medicare documentation training
program for staff and clients. Certifications: Certified Ambulance Coder.
Jennifer Bump, Division Manager (Customer Coordination)
For more than 1O years Jennifer has been with Wittman Enterprises. She began in Customer Service,
working on private insurance accounts as a specialist, working incoming and outgoing calls, and
ultimately as the lead over the revenue assurance team. Later she took over as manager of our
Customer Service Division. Currently she is a division manager for Customer Service, directing the
specialist team working on all governmental payers. She oversees the Quality Assurance Department
over cash receipts and all of the Customer Service Department, and coordinates the company training
Samantha Taylor, Division Manager (Customer Services)
Following 8years as o successful business owner, 10 years in medical and insurance administration,
Samantha joined Wittman Enterprises 4 years ago. She brings extensive experience in medical billing
and coding, and significant knowledge of and experience with medical insurance billing, legal policies,
appeals, and follow-ups. At Stanford University Hospital she created a 30-person team to handle
incoming correspondence, insurance authorization, and other requirements for hospital stays.
Nicole Powers, Division Manager Billing)
Nicole has been with Wittman for over 12years. She oversees the receiving and importing of all Patient
[any Reports (P[Rn), document scanning, and claim submissions (electronic billing) via paper and
electronic means to all payers. Nicole continuously streamlines electronic processes and updates
automation to ensure appropriate timelines are met to ensure the most timely and efficient
reimbursement for our clients.
78
wittina mon), erp,, ia(s
Appendix 3: Sample Reporting
Accounts Receivable Analysis (Payment Credits)
Ambulance Revenue for FY
Up'lefie IS BF`l 1,N OG"ID WD 14 AND X6,^: 51j G
Date of Service
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Page 1
City of Sot,ith San Francisco Fire Department: Ambulance Uhng Services 1 54
79
wift"ITI an 4v I I
Activity Summary (by Code)
Activity Summary
TnP Data IS BETWEEN 0110W015 AND 1213112015.
29.,4
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4,349,310,60
2,042225.28
2,307,086,32
$39.01
1�222,72774
6,743.70
907,18928
604.97
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Activity Summary (Detail by Payor)
Activity Summary
T11P date IS OE EN 0IMI12015 AND 0113,12015
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City of South San Francisco FJre Department- An)bdance Bflkng!Servuces 1 56
81
,AAM,nan e,nt I tl'� riw�
Activity Summary
T,,p dot, IS BETWEEN 0110112015 AND 010112015,
Elm o 21 1cm 9MECUMU 94ALMIM we4 GhaeOey at A" E&I ML-M
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City of South San Francisco Fire Department. Ambulance BiMng Services 157
82
Activity Summary
Trip dat. !S BETWEEN 01/0112015 AND 0 113 112 0 9 5
ftm KgLTM QM OMM L-MCMM ftl-¢ Romatlj Eavmmex MLIt;gjj$
Grand Tools; 4 539,;ZM% 270,351:17 SE2t25 too lk& tmss ? SOM41 43$.60 24,262.55 61805
Resa�eNet'" Reryxvrp
Page 3
Aty of South Sari Frandsco Fire Department ArnbluVance BiMng Services 158
83
liyiftiirilaflra slls
Activity Summary (by Vehicle Month Destination)
Activity Summary
Tnp Date IS BETWEEN 0110 112 01 5 AND 0110212015
City of Sotifli San Rrandsco Hre 1)epatrtmwft Ambtflance UHing Services 159
84
eoa
000
Qeo
0.0
5,03,21
0100
0.0
5,03.27
am
Date of Service: 112015
1 OW
000
0.00
000
5 W3 2?
000
Qua
590327
000
Facility: <None>
I D(,1
0 GO
D flu
000
590327
000
000
.590327
000
MEDI 12 12900.0
7,39179
5.608.61
am
4,47642
000
0.0
1,033.19
45905
Date of Service: 112015
➢2 129040
739179
5 W 0
000
147512
0W
000
1.033{4
45905
Facility: Lutheran Medical Center
' 2.24 50
183550
1.3(50 00
000
1 malm
ON)
0 00
1013 19
46U 05
Facility: North Suburban Medical Center
I 'woo
27560
82500
am
132500
am
am
1033 19
45905
Facility: Saint Anthony North Hospital
0 857,590
5 261 29
3 NA 61
000
2 261 42
000
0 W
1 033 19
45905
ME02 7 7.55050
4,506.21
2.954,29
0.00
2,168.48
300'00
0,00
05.81
422
Date of Service: 112015
7 7 550 50
459621
2 954 29
W
2, 16818
300 00
000
185 0,
12204
Facility: Saint Anthony North Hospital
653300
M 21
193679
000
1 354 4B
im 00
000
ImOl
42204
Facility: Saint Anthony North Medical Pavillion
1 1017M
0W
1 017 m
000
@,4OU
000
000
16.5.04
42204
MED3 6 6.51726
4,41661
200
OM
2.15343 13
573,50
OM
952.19
318 .74
Date of Service: 112016
651,20
14% Ol
2000"
000
215143
a73 50
000
65249
341,74
Facility: Good Samaritan Medical Center
1205w
104928
"3 77
000
00D
DW
OOD
6520
340 74
Facility: Lutheran Medical Center
1 111400
ON 59
11415
0011
11415
000
000
05249
:118 74
Facility: Northwest ER
2 2 203 "A
673 Oki
t 33D.12
am
7% 92
573 50
0 W
65249
346 74
Facility: Saint Anthony North Hospital
R-NK
RVw,rig
Page I
City of Sotifli San Rrandsco Hre 1)epatrtmwft Ambtflance UHing Services 159
84
vivittinan oaopvrkg IS
Activity Summary
UP Di,to IS BETWEEN OV01/20S AND 0110212015, AND Company IS City of VVSuuuinsuer Fire Depaft,,terit, AND Status IS A-0-d OR Diked OR Crosse! OR C—olete OR NeTcaauut N" Coil OR NMI
rransit w
11WRItA Loitu 2MUSILIM r.O.ILA NILQUAU Bt, adi IA VOIL-Qu 911WWA
2 1.99475
1 502 90
01 85
000
128806,
000
000
65219
US 74
MED4 6 28,166.05
3.!62.36
6.23670
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5.267.20
000
0.00
M.0
692"
Date of Service: 112015
9 10,19805
396235
623570
000
5.28720
0 (X)
000
06050
50206
Facility: Good Samaritan Medical Center
2 249670
701 4B
173522
000
2.73522
000
0W
96850
69205
Facility: North Suburban Medical Center
1 "01800
G1642
40958
OW
40956
Goo
OW
maw
542.86
Facility: Northwest ER
3 3 12250
000
3 12250
coo
2 154 so
000
000
9" 50
692 N
Facility: Saint Anthony North Hospital
3 3620&5
264,45
97640
000
97040
000
000
QS8 50
09286
MED6 a 8.490.60
4,6%.57
3,8N,03
om
2.57123
4,122,60
0.00
200.30
4515,75
Date of Service: 112015
fi 6-u060
4 W6 57
360403
a C.D
257123
112250
000
20030
4%75
Facility: North Suburban Medical Center
203 0
8215,
38210
0 W
38210
000
000
20030
48675
Facility; Northwest ER
07015
666 72
30343
0(X)
30343
000
000
20010
40675
Facility: Saint Anthony North Hospital
2 2A0030
13mm
813 So
000
65166
000
000
2030
46675
Facility: SaintAnthony North Medical Pavillion
4 4 126W
117166
2 354 M
000
1032N
1 122 so
000
20030
46075
Grand Totals i 43 45,656,90
24�443.73
20A73,07
al
I. 22,545,03
1'996.on
-311116,70 i
40."
R.pruriq
P.ga 2
City of South San Francisco Fire Department ArrflbWance BiMng Services 1 60
85
%rd'ittllIp a III ell I I I P17 W"�
Activity Summary (with percentage)
Activity Summary with Averages
Tnpda�o IS BE MCUN I I "19Q0Q, AND U I 01,1201b
Paga I W
City of South San Frafidsco Fire Department: ArrflbWarrce BfflirWg SeMces 161
86
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City of South San Frafidsco Fire Department: ArrflbWarrce BfflirWg SeMces 161
86
Witi'marl entepp'i'-r �
Activity Summary with Averages
Tq, dv 15 RE 'WEEN 01,101005 AND 1) 1131,'20 CIS
it of South Sari Francisco Hre Depairtment: Airrb,flance BflHng Sery ces 1 62
87
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I
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100%
it of South Sari Francisco Hre Depairtment: Airrb,flance BflHng Sery ces 1 62
87
Activity Summary with Averages
Tr,p date IS BETWEEN 0110112015 AND 0113112015
.... ........
6yg Ngg &U %-&Kg-q-hn
PIM UU&I 2mnsuflqu 99athil M Piet slmu Rty AO.1 Eaments 0411? 9 912ad
Grand Totals of 09,214,15 270,351.17, 268J863.11 0.00 400,$87.68 24,202.69 516.05 366,39 71o1%
Rest eNerl R.p.,b,,g
Page 3 of 3
My of South San Francisco We Departrrent: Arnbu ance WMing Services 163
88
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$229 55
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Billing Schedule
2-Da S
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§ 1:D s
91 -120 Days
121 180 Days
Over Days
Total Balance
of Total
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$0,00
$000
$0.00
$0 DO
$000
$900 00
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372%
Bill Patient for Auto Info CC
$000
$000
$0.00
$000
$000
$0.00
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$0,00
$000
$0.00
$000
$000
$2,03550
$2,035.50
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$0.00
$000
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MOO
$000
$3,234.21
$3.23421
1336%
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$000
$000
S0.00
$0.00
$000
$43439
$43439
1.791/.
Mcaid Out of State Electronic
$0,00
$0.00
$0.00
$0,00
$000
$149.79
$14919
0,62%
Medicare - Secondary Colorado
$0.00
$000
MOO
$0.00
KOO
$0.00
$0.00
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Mcaid Colorado Paper
$000
$000
$0.00
$0.00
$0.00
$70473
$704.73
291%
Ins Dir Pay to Pt Paper CC
$0,00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
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$0.00
$000
$0.00
$0.00
S0.00
$0,00
$0.00
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$0.00
$000
$0,00
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$0.00
$24,202.69
$24.202.69
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RescueNetl- Printed Om 101512015 at 10 14:38AM
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$24,202.69
Page 2
( Ay siiwnAh San, F�i'and�:,co II he 165
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121-180
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1.298 50
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1 03450
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49724
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121-180
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1 29850
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1 20500
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1.26800
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1 13300
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1,06700
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1,03450
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1.17950
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9,365.00
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1,13900
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1,139.00
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1.205 00
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0.00
0.00
1,205,00
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Page 1
'it y of South San Francisco Fire Department. Arnbulance BflHng Services 1 66
91
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Aging Detail Report by Current Payor (Trip Date)
Aging as of 9/3012015. and
FIRE DEPARTMENT
fill--La
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3114,811
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0.00
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0.00
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43790
437.90
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000
000
0.00
96850
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0.00
0.00
0.00
0,00
968.60
0160
000
0100
000
0180
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RescueNet- Printed On 10612015 at 1023 OOAM
ItW,IK12MFM21\ RESCUENEnREPORTS3"ILLINGtAGINGIAGING DETAIL. BY GURREW
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City of South San Francisco Hire Department: Ambulance Bilfing Services 167
92
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Aging Summary
Aging Summary Report by Current Payor (Aging Date)
Aging as of 9730/2015, and
FIRE DEPARTMENT
99MIgIl-puatr
990:0
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<Nonea
0100
moo
0,00
(too
0100
0.00
0100
AARP/740819
0.00
0.00
0.00
040
MOO
040
(Loo
Aetna11,4079
0.00
0100
0100
0100
0.00
040
0100
MG Travel Assistance/8003
040
0.00
0.00
MOO
0.00
0.00
0100
American Family Ina/600 Amer
0100
040
040
0,00
0.00
0,00
0.00
Bankers Life and Casualty/1935
0100
0.00
MOO
MOO
Moo
040
0X00
BC SS of Colorado FEP/I 05657
Call
0.00
0100
0100
040
0100
MOO
BCBS of Colomd*15747
0100
0,00
0100
COO
MOO
0100
040
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7,435,68
3,896,96
3,44160
40180
0,00
0100
15,150.04
Chi 1182223
95240
0.00
MOO
0100
0.00
0,00
952,00
Clanallowel
0.00
MAO
0.00
0.00
0.00
0100
968.60
Equitable Life & Casualty ina124
040
0.00
0.00
0100
0100
oleo
0.00
Farmers Auto Ina,1268994
0.00
229.56
0.00
0,00
0.00
Coll
229,55
GEHA14665
0.00
0.00
0.00
040
Moo
040
0.00
GEICO Auto InsuranceIS09105
0,00
0,00
0.00
0.00
0.00
040
0.00
Great West Healthcarefil)00
0.00
0.00
0.00
0100
040
0.00
4.00
Kaiser Claims E 1185391
1,169m
0.00
0100
Cog
0.00
0.00
i'lwoo
Liberty Mutual Work Comp,11682
0100
0.00
0.00
0100
0100
0100
0.00
Mcald HMO Denver Health Choi,
040
040
0100
132.62
040
0.00
13152
Mcald HMO Total Longterm Can
0.00
0.00
0.00
0.00
0,00
591.43
691.43
Mears, HMO Humans ImU14601
0.00
0,00
0.00
0100
4SC96
0.00
451.96
Moore HMO Innovage/0950 E Lo
0100
0100
0.00
0,00
040
0100
040
Meare HMO Kaiser EM9653916
0100
0100
0100
040
496,55
0.00
495,65
Moore HMO Socum Horizons Dh
386,15
0.00
0.00
(soo
0100
0.00
386.16
Moore HMO Secure Horizons of
0.00
802.83
0.00
040
0.00
CAB
882-83
Mcare HMO United Health Core
0.00
0.00
0.00
0.00
0100
241.19
24119
Modica finsurance130990
040
0100
0100
0100
0.00
0.00
troo
Madficald Colorado
995,00
0.00
149.78
9140
040
0.00
1,236.09
Medicare Colorado
434.39
0100
0.00
-409.36
442,12
8100
46715
Membership Colorado
0.00
040
MOO
0100
0.00
040
100
Membership Westminster
MOD
0.00
MOD
0.00
0100
0.00
0100
Hameln Health Ins127267
1,083.50
040
0.00
0.00
0.00
MOD
1,08150
Mutual Of Omaha/ Mutual of Om;
0.00
0.00
MOD
0100
0.00
0.00
0.00
Opt heal 30757
0100
040
0.00
040
0.00
0.00
Moo
Physicians Mutual Life Inal2018
Moo
040
0.00
0.00
040
040
0.00
Pipeline Industry Benefit Fundif
0100
0100
040
0.00
040
0.00
0.00
Pomco InsuranceIG329
0100
040
0.00
1100
0.00
0.00
0,00
Progressive Auto Ins17604 Tech
040
0.00
0100
0.00
0100
0.00
MOD
Rescuel,let'-
Printed On. 1015/2015atI016.63AM
Page I
kiVU2K12MEM2MESCUENEMEPORTS32'ZILLINGAGINGAGING SUMMARY BY CURR
City of South San Francisco Fire Department, ArnbLdance Niing Services 168
93
Aging Summary Report by Current Payor (Aging Date)
Aging as of 9130/2015- and
FIRE DEPARTMENT
Currant Pavor
Cwnm
21M
61'94
91 -12e
1 - D
2Y21-10
Tgtal
Pyramid Life Ins/12922
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Rocky Mountain Health Plan110(
0.00
0.00
0.00
0.00
0.00
0.00
0100
State Farm Atuo Ins/52282
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Travelers Work Comp /173762
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Tricare for Life lnst7890
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Tricare West UHCf7064
1,212.50
0.00
0.00
0.00
0.00
0.00
1,212.50
UMR/30541
0100
0.00
0.00
0.00
0.00
0.00
0.00
UNAPPLIED CASH PAYOR
- 5,903.27
0.00
0.00
0.00
0.00
0.00
- 5,903.27
United Health Care West/30968
1,083.50
0.00
0.00
0.00
0.00
0.00
1,083.50
United Health Care/30555
0100
0.00
0.00
0.00
0.00
0.00
0.00
USAA Auto Ins/5000
0.00
0.00
0.00
0.00
0,00
0.00
0.00
Veterans Admin Rocky Mountail
%8.50
0.00
1,268.00
0.00
0.00
1,106.00
3,342.50
Payors Balances
9,810.8
5,47',9
4 „5L 1.3
215.2
1 389.8
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RescueNetTM Printed On: 1015/2015 at 10 18:53AM
1\1M1N12MEM21lRESCUENETIREPOR TS37.leILLiNGIAGINGWC,ING SUMMARY 9Y CURR
Page 2
City of youth yarn Francisco Fire I)ellp rtmeil1V ,irnN.lianc'e Billing Services 169
94
Cash Receipts
Cash Receipts Summary by Deposit Date for: FIRE DEPARTMENT
Totals:- $165,18 x. .8 $4,743.701 $15.
RescueNet -
UWKI 2MLM2 IkRESCUENETkREPORI S32 lCUST0MkCREDIT TYPE RETAIL BY PRIMARY PAYORI I RPT
Printed On, 1015)2015 at 10:44:28AM
Page 1
City of South Sari Frandsco Fire Derwirtment: Arnbu�lance BdIfing Services 1 70
95
Contractual
Re.cnnc
Akl- -a
0901115
$1.939.47
56.888-52
80.60
5-3�782.70
0902'15
S3A89 92
55.708,58
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$0.00
0903115
$357.57
S8.794i6
$f 1,041
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10,593.26
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$87,101
$(uw
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$2.99649
$5.25827
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SI.UU
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(I') (w 15
$19.384.79
$5.70939
S0011
$f).of)
$1)9)
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$791 cry
$962,88
SAW
$o'(w
50-00
IN 11W
812.918,01
$5M3-49
$090
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(1914'15
$2.460.05
$6. 639.10
$006
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$0.00
(19 15 11
$2.88 5507
5 -265
$0.01)
S 150)
(19 =46'15
$31.12877
$1.192.5.1
$16(X}
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S-39731
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$(),w)
(x).18 %15
$7203.61
$661.45
$AUX)
50.01)
$l)jIl)
0921115
$3,423.48
5 -4.08
$(),Rf)
5 -995,W
s(.ot)
0!) -22'15
S3.803.66
1-3809
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(X)23145
819.497,10
5-15488
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523.14
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$0.00
1 MUNI
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09'30'15
S 18.444.06
5419.38
50 '(H)
S-8760)
3001
Totals:- $165,18 x. .8 $4,743.701 $15.
RescueNet -
UWKI 2MLM2 IkRESCUENETkREPORI S32 lCUST0MkCREDIT TYPE RETAIL BY PRIMARY PAYORI I RPT
Printed On, 1015)2015 at 10:44:28AM
Page 1
City of South Sari Frandsco Fire Derwirtment: Arnbu�lance BdIfing Services 1 70
95
Charge Type Detail
Charge Type by Billing Zone
FIRE DEPARTMENT
Charge Type
Count
Dollars
Base Rate
INLSI
300
$269.280,00
ALS2
5
$4.675.00
Assessment at Scene
4
$660.00
BI.SI'I
174
$138.852.00
Mcnibership hu-ni1%
12
$660,00
Memher,hip Indi% idual
19
$665.00
MiSC. SUDI)IieS
DiSI'mabic Supplic,
488
$59,048.00
Spinal Immobili/alion
21
$1.617.00
mileaee
KIII 1:1 Wc,tminwr
2.414
$39.835.95
IV sunrilies
IV I herap,
208
$14.976.00
Oxygen
Oxygen
142
$8,946.00
Total for <None> 3,793 S 539,214.95
Grand Total for FIRE DEPARTMENT
3�791
10 5`2015
Cfty of South San Francisco J:h'e Departmemu Aimbulanu.,, BflHng ServWces 1 71
96
Collection Summary
Collection List - Summary
FIRE DEPARTMENT
Poletand-99—M
ifiPpa
&A—#
LngNIOLN
Balance
Jones, Louis
11112015
1648
12345678
$0,00
Jones, Louis
'1110015
1652
1234Y 78
$0,00
Jones, Louis
11112015
1659
12345678
$0,00
Jones, Louis
1/112015
1650
12.345678
$0,00
Jones, Louis
I61 /2015
16947
12345678
$0.00
Jones, Louis
11112015
1644
12345678
-$796.21
Jones, Louis
111120,15
1660
12345678
$01,00
Jones, Louis
111120I5
1657
12345678
$0.00
Jones, Louis
U112015
1645
12345678
$149.79
Jones, Louis
11112015
1661
12345678
$0.00
Jones, Louis
11112015
1655
12345678
$0.00
Jones, i ouis
11142015
1656
12345678
$0.00
Jones, Louis
11142015
'1658
12345678
WOO
Jones, Louis
11112015
1654
12345678
$0.00
Jones, Louis
11112015
1646
1234,%78
$0,00
Jones, Louis
11112015
317811
12345678
-$5,90327
Jones, Louis
11142015
1653
12345676
$0,00
Jones, Louis
I61/2015
1649
12345678
$0,00
Jones, Louis
1111'2015
1661
12345678
$0,00
Totats for FIRE DEPAITIVENT
Trip Count,, 19
RaWncw .$6549,69
Department.
Pinpoint Technologies, Inc Printed on: 10/5/2015 at 2.02 29PM
NXVV2Kl2MEM21\RESCUENETAREPORTS32IRFPLIST11 RPT
City of South San Francisco Fire Departirrient: Ainbdanu', Biding Services 1 72
97
Vintu'lli'la llrntcrPriw' '
Denial Report Detail (by Payor)
Denial Reason Detail by Payor
City of Westminster Fire Department
Medicaid Colorado
Date ff.—n# P48-9 §LN R2 LICI gftaigl Raas� eglanCq
0.00
Previously paid Payment for
this claim/service may have
been provided in a previous
payment.
Previously paid, Payment for
this claim/service may have
been provided in a previous
payment.
0,00
Claim/service lacks
information which is needed
for adjudication Additional
information is supplied using
remittance advice remarks
codes whenever appropriate.
This change to be effective
4/1/2007: At least one Remark
Code must he provided.
Claim/service lacks
information which is needed
for adjudication. Additional
information is supplied using
remittance advice remarks
codes whenever appropriate.
This change to be effective
41M007: At least one Remark
Code must be provided.
N/A
Payment adjusted due to the
impact of priGi, payer(s)
adjudication including
payments and/or adjustments
RescueNet'- Reporting Printed on 1016/2015 at 9:46 48AM Page I
V�W2K12MEM2"RE5CUENET REPORTS32U3lLt.lNGIC,OLLECTIONSMENIALDETA{t BYPAYOR RPT
City of South San Francisco Fire Department. Ambulance BjIling Services 173
98
w&ln a ii,il r, fit nI � h, Pij,O
Denial Reason Detail by Payor
City of Westminster Fire Department
Payment adjusted due to the
impact of prior payer(s)
adjudication including
payments and/or adjustments
Previously paid. Payment for
this claim/service may have
been provided in a previous
payment
Previously paid Payment for
this claim/service may have
been provided in a previous
payment.
Total Denied Claims: 4
Total Divirried Ct#Jmfv,, I
Grand Tolsil; 4
Rescuel,letlm Reporting Printed on 1 01612 01 5 at 9 46.48AM
VtW2Kl2ME.M2lkRESCt]ENET%REPOP,TS32tBILLINGICOLLECTIONS%DFNIALDFTAILBYr'AYOR RPT
iU# (
Total Balance : 0.00
Total Company SAIance : 4R,"
Grano UArf.,j.,,ND
City of South Both Francisco Fire Departrneint�m Arnbulance Uhng Seiwices 1 74
99
Page 2
Denial Report Summary (by payor)
Denial Reason Summary by Payor City of Westminster Fire Department
Company IS City of Westminster Fire Department; AND Trip Date IS BETWEEN 01/0112015 AND 01/0112015; AND Status IS Assigned OR Silted OR Closed OR
Complete OR Net Transit New Call OR NetTransit New Will Call OR NetTranQ Review OR NetTransit W
P"or
Medicaid Colorado
t� of Mutate RLWAPIM! QuWanding Balam;q
Previously paid Payment for this
claim/service may have been
provided in a previous payment.
Previously paid. Payment for this
claim/service may have been
provided in a previous payment.
Payment adjusted due to the
impact of prior payer(s)
adjudication including payments
and/or adjustments
Payment adjusted due to the
impact of prior payer(s)
adjudication including payments
and/or adjustments
Previously paid. Payment for this
claim/service may have been
provided in a previous payment.
Previously paid. Payment for this
dairntservice may have been
provided in a previous payment
%kVWK12MEM21%RESCUENETIREPORTS$2$ILLINGkCOLLECTIONSWENIALSUMMARYBYPAYOR RPT
Printed . 105(2015 W 9,4813AM
RescwNet- Reporting
City of South San Francisco Fire EXpartmeft ArnbWarice Uhng Service s 175
100
wittmanen o,,rpi
GEMT Total Number of MTS Transports
GEMT Total Number of MTS Transports
RescueNetlm Reporting
Page I of I
Oty of' South San, Francisco Fire Department: Ambulance Bilfing SerOces 1 76
101
tt of trine
MENT
Fiscal Year:
(2014,2015)
3,296
icluiftierf, i
,
(ID710112014-OW201,4)
'i74
1
MaRAgAd C..
93
F.. F. S.,I,.
14
Medi-Madi
58
Other
W9
Quarter, 2
(IMII;014.1213112014)
761
Managed C—
89
F- F- S—k.
24
M.d[-M.dJ
65
583
3
869
M-&O.d C4.
101
F- F., S—ice
20
M.d4A.di
89
Other
659
Quaker:: 4
f,WO112015-06WI20�5)
892
M.—q.d C..
104
P.. F., S.M e
24
MirdiW.d,
Or
Other
683
RescueNetlm Reporting
Page I of I
Oty of' South San, Francisco Fire Department: Ambulance Bilfing SerOces 1 76
101
Medi-Cal Fee for Service GEMT Transports and Detail
Medi-Cal Fee For Service GEMT Transports
RUE PM #ofr6ris Paments
Fiscal Year: (2014-2015) 82 10,169.64
00 , Art 14
M.d,C.ICWO... 14 1,97826
Quarter: 2 1,10/0112014-1213112014) 24 2,977,43
Medical CWmia 24 2,977,43
Quartet: 3 (0110IM015-0/31,2016) 20 2,486-92
Med�CW Caftlerrim 20 2,486M
Medical caftml. 24 2,727.03
RescueNet'" Reporting
City of South an Frandsco Fire Department. Ambulance MUng Servkes 177
102
wft'tiina n en te)p h Js,:,�,,
Medi-Cal Fee For Service GEIVIT Transports Detail
eaff 20 MT-qu
fimus-hAmn 9mIxAftQW
HN G-homn
Rgy 69
PaYmarNa
FIRE DEPARTMENT
Fiscal Year: (2014-2015) 82
103,131.97 92,694.75
10,437.22
0.00
10,169.64
Quarter,; ' 1 (07MII2014-OM1*!4) 14
Customer Name migAl I
21,4011
0.00
OiOOIS
7113/2014
$1,552.71
$1,415.08
$137.63
712112014
$1,312.67
$1,184.62
$128.05
712412014
$1,464,68
$1,339.83
$124.85
712912014
$2,113.29
$1,927.73
$185,56
7/2712014
$1,328.10
$1,209.64
$118,46
8/8/2014
$1,684.69
$1,537.47
$147.22
818/2014
$1,239.08
$1,123,12
$115.96
8/13=14
$2,610.67
$2,418.72
$191-95
8/11/2014
$826.73
$713.96
$112.77
8/30/2014
$1,336.83
$1,208.09
$128.74
915/2014
$1,790X
$1,611,20
$17917
911012014
$1,135.92
$1,019,96
$115,96
9/1712014
$1,144.01
$1.031.24
$11217
9/2112014
$1,950.36
$1,771.19
$179.17
Quarter: 2 (IM142014-12131/2014) 24
29,422,34
2,077,43
0,00
2,977.,43
QHFJqMLr JIM
9jWSLftDft
2r2UShMW
92DUAlIM
EMMA
10/412014
$1,122.72
$1,006.76
$115.96
104/2014
$1,339.59
$1,223.63
$115,96
1011;2014
$2,303.41
$2,062,60
$240.81
1011712014
$1,085.03
$972.26
$112.77
1012212014
$1,247.37
$1,12152
$124,85
1012212014
$1,405.70
$1,280.85
$124.85
1012612014
$1,205.56
$1,089,60
$116.96
10/2712014
$1,296.79
$1,178.33
$118.46
10127/2014
$1,209.81
$1,084.96
$124.85
10127/2014
$831.26
$718.49
$112.77
1112/2014
$1,134.59
$1,025.02
$109.57
11/2112014
$1,243.36
$1,130,59
$112.77
1112912014
$1,746.30
$1,582.41
$163.89
12/=014
$1,321.40
$1202.24
$119.16
121912014
$1,301.84
$1,183.38
$118.46
12/16/2014
$1,425.97
$1,246.80
$179.17
12/2212014
$1,236.66
$1,123.89
$112.77
12123/2014
$824.52
$711,75
$112.77
12124=14
$1,336.81
$1,16913
$16708
12/2712014
$1,245,39
$1,123.73
$12166
12/28Q014
$1,410.94
$1,292.48
$118.46
12/30/2014
$1J9310
$1,071.44
$121,66
12/2812014
$954.22
$841,45
$112.77
,Quarter: 3 (01,01)2015-0313"2016) 20 24,000.187 21,513.95 2,4e692 OM 2,4�6;92
RescueNetl- Reporting
City of South San f�randsco Fire Department: AMb,flance Hling Senficc.,�s 1 78
103
v,/, ''U'll"HWI I "WIC)
Medi-Cal Fee For Service GEMT Transports Detail
DO
# of Trim
r5rm qhamo Contr Allow
N§1 CN,.mts
R Ad j
ftyMgnq
I-IRE DEPARTMENT
QuarE 4
41 �4 .
AI
... ...
CUS4omer Nama
MrtdiCal W#
Date of Serylcq
r2rp$s Charg".
Conti Allow
Payments
6/27/2015
$675.53
$553.87
$121.66
6125/2015
$1,127.96
$1,018.39
$109.57
RescueNet- Reporting
4
City of South San Francisco Hre Departiment, Arnbu ance BiHing Serv�ces 179
104
Medi-Cal HMO GEMT Transports and Detail
Medi-Cal HMO GEMT Transports
fox
of TriDS
Pamente
PRE DEPARTMENT
.w
Fiscal Year: (2014. 2015)
343
43,211.03
Quad:, 1
1 83
11,176.77
McaI HMO lE[*' Wand Empire Heath PI-14349
1
115%
mcat HMO Partnership Health Plan ScgannJI366
2
32027
MG I HMO Pannerrglip H-ffli Plan S-030
1
132.40
McaI HMO Pao—hip Hoahh PI&VI368
N
10,60814
Quador: 2 ('101011201442131(20,14)
78
10,394.92
MW HMO 81ne C-16W07
1
13873
M.1 HMO Health R.n W S.. J..qi1839
1
11847
McaI HMO Partnership Health Plan Napa/1368
$
13294
M.1 HMO ftd—h,p Heath Plan Sonnn-MWO
2
254,33
M.1 HMO Paft—hp H- h PIWI368
73
9.75045
,Qtjafter 3 (0110,112OU-03MI2016)
90
11,234,86
MwI HMO CA Health a W V*11 mMWO
1
12885
M.1 HMO LA Can,181 1 5W
1
13382
McaI HMO Partnership Health Plan SoaomWI368
I
120 .52
M.1 HMO patneshp Heah PW03"
fMi
10,722.82
M.1 14MO S.. F—.— He.1th PIn,V201 3,d
1
12885
sn"'t
Quafter, 4 (,04M112,016-06rW2014)
92
10,494,48
Mc I HMO W. C'.wG0M67
1
12530
M.1 HMO C.1 V— H-nW14598
1
109.56
M.) HMO Padn—h,p H-Ii4 PIW1368
89
10.04075
MWI 4MO S. F,.,,.— I te.11tt Plan=l 3,0
1
128.85
Sn-:
RescueNetn' Reporting
C'i ty of South an Francisco Fire Dejjpartmerft mbUance Bfflir�g Services 180
105
m��alCmm�mm�rmscc� ri /���p°�'r /�tim
Medi -Cal HMO GEMT Transports Detail
Pavor go of Trios Szs4m4.. kAfift NA: cnarn+3a Rev AW Pmvm t
Fiscal Year: (2014 -2015) 343 397,469.13 348,563.97
48,905.16
0.00
43,211.03
Q QSi24A4) " " 87 842;40 ". 118 ` =/+1,88 "; _
Customar Hama Me919,11- )ti RauLboft
' N a 51,2
fi1 nsAllmes
Contr Atiow
11,1""7 "
Pavmems
81312014
$1,353.29
$1,237.33
$115.96
7!2012014
$1,817.12
$1,627.15
$189.97
8/11/2014
$1,262.55
$1,132.25
$130.30
9/28/2014
$1,220.10
$1,087.70
$132.40
7/3/2014
$1,617.91
$1,445.49
$172.42
7/5/2014
$1,023.79
$899.76
$124.03
7/2/2014
$975.37
$844.32
$131.05
7/3/2014
$802.17
$678.14
$124.03
714/2014
$1,202.08
$1,064.76
$13732
7/7/2014
$852,82
$725.28
$127.54
7/1012014
$1,281.17
$1,117.19
$16198
7/6/2014
$2,193.81
$1,968.74
$225.07
7/6/2014
$1,596.70
$1,40122
$193.48
7/8/2014
$992.52
$851.69
$140.83
7/11/2014
$1,090.69
$963.15
$127.54
7114/2014
$1,131.07
$1,003.53
$127.54
7/14/2014
$2,326.59
$2,072.26
$25433
7/14/2014
$96156
$825.24
$137.32
7/1 912 01 4
$1,339.59
$1,212.05
$127.54
7/17/2014
$82442
$700.49
$124.03
7/19/2014
$1,793,30
$1,592.05
$201.25
7/24/2014
$1,11927
$995.24
$124.03
7/24/2014
$841.64
$717.61
$124,03
7/20/2014
$1,405.70
$1,268.38
$137.32
7/24/2014
$1,119.27
$995.24
$124,03
7/21/2014
$1,074.12
$946.58
$127.54
7120/1014
$1,279.73
$1,142.41
$13732
8/2/2014
$1,084.06
$956,52
$127,54
7/31/2014
$1,098.53
$970.99
$127.54
7/31/1014
$1,189,90
$1,056.09
$133.81
8/112014
$1,627,40
$896.35
$131.05
7/27/2014
$1,452.15
$1,261,43
$190.72
8/2/2014
$934.20
$813.68
$120.52
8/9/2014
$1,286.02
$1,148.70
$137.32
817/2014
$1,231.83
$1,098.02
$133.81
816/2014
$1,071.77
$947,74
$124.03
8/5/2014
$984.68
$832.57
$152.11
8/6/2014
$1,750,76
$1,550.26
$200.50
8/15/2014
$824,52
$700.49
$124.03
8/13/2014
$1,129.97
$1,002.43
$127.54
8113/2014
$1,38527
$1,251.46
$133.81
8/11/2014
$844.54
$717.00
$127.54
RescueNel'" Reportmg
2
City of South San Fra dsco Fire Department. ai.tmm nt. A msbulance Uhng Services 181
106
11,10*fman rnretpisv 1,
Medi-Cal HMO GEMT Transports Detail
m ULTdo 910a 2hBrh€a g2nkasl w
Shna
.
ftvAdl
. ......... ............ . ... . .... -
Eumsaft
IRE DEPAR TIVIIENT
1,10 1'43
0., 0-6
0,4044 8
0. Amly.,q
ftnsbmm
ContrAllow
511912015
$864,56
$733.51
$131.05
5/2012015
$1,927.35
$1,675.78
$251,57
5119/2015
$1,314,75
$1,19072
$124.03
5/18!2015
$974.24
$846.70
$127,54
6/19/2015
$844.54
$720.61
$124,03
5/=015
$1,435.93
$1,30212
$133.81
5)3012015
$841.09
$717.06
$124,03
5)3012015
$954.22
$830.19
$124.03
5125/2015
$864.56
$733,51
$131.05
5126/2015
$1,088.34
$964.31
$124.03
61412015
$1,121.61
$994.07
$127,54
61112015
$884,58
$732.06
$0.00
6/112015
$1,128,38
$997.33
$131M
6/812015
$1,139.29
$1,011.75
$127,54
61712015
$1,097.59
$977.07
$120.52
611012015
$1,389.09
$1,070.56
$0.00
6110/2015
$2,207.90
$2,067.07
$140.83
6/17/2015
$1,154.61
$1,030.58
$124.03
6117/2015
$1220.72
$1,003.80
$0.00
6117/2016
$84937
$725.34
$124.03
6117/2015
$1,115.55
$991.52
$124.03
6114/2015
$1,209.81
$1,072,49
$137.32
6120/2015
$822.17
$701.65
$120.52
6114t2015
$1,290.16
$1,119.97
MOO
6/20/2015
$1,085.16
$922.07
$0.00
612212015
$1,277.46
$1,147,16
$130,30
6/21/2015
$1,250.12
$1,122.58
$127.54
6/24/2015
$1,116A0
$99137
$124.03
6/26/2015
$1.074.12
$946.58
$127.54
6r2712015
$1,224.42
$1,090.61
$133.81
6/24/2015
$1,114.45
$905,60
$000
6121/2015
$1,262.55
$987.33
$0,00
6/25/2015
$819,41
$666,18
$0,00
6/2312015
$862.82
$725,28
$127.54
6128/2015
$1,082.82
$958.79
$124.03
6/30/2015
$1,165.49
$1,003.80
$0,00
6/27/2015
$1.262.39
$1,133.54
$128.85
RMUeNet" Reporting
9
City of South San Francisco Fire Departmeivit: AirribUlance Bifflng Services 182
107
IVMIII�Iila 111,111 ell firl�� RIJ
Monthly Payment Listing
Activity Summary
01W*015
I W 0"'d-0 rd.—
1 114 N,
996X51,
1"45
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174111
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611010015
1652 Me6,— CQ .do
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6,649,69
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Page I
City of South San F rancisco Fire Department: Annb�.,dance Bffling Services 183
108
NSF
Credit As Type Detail by Credit Payor
Post Date IS BETWEEN 0110112013 AND 12131r2013;
FIRE DEPARTMENT
Payor/Credit Type Count Dollars
Payor BC of CA/60007
Revenue Adjustments
Trip Date pe'r Do. Vp.sft Do. rnp W. R— Numb., Check Number
201Z090i 2013-06,25 2013-05-04 Returned Chea Bank Fees 2 0.00
Totals For Type Returned Check Bank Fees 2 $0.00
Totals For BC of CA/60007 2 $0.00
Payor Bill Patient
Revenue Adjustments
Trip Date
Past mi.
Deposit two
Trip M:
Ran N—b.,
Check Number
2009-02-18
2013-11-08
2013-10-28
Returned Check Bank Fr—.,
1 -2500
Trip Date
P-1 Dr.
DeposIt Date
Trip 4:
Ran Number
ch.* N—bar
201912-10
201306-13
2013-05.31
Rtn—d Check Bunk Fees
1 -25.00
Trip Date
Post Date
Dep-if D.A,
Trip
Run Number
Check Numbs,
2012-10-09
2013-04-09
2013 -03 -01
Returned CheO Bank Fees
1 -25,00
THP D.I.
Past Dar.
VWVt D.P.
WF N.
R- Number
Check Numbs,
2013-10D9
2013-12r26
2013,12-13
Reh,,.rO Clkeck Bank Fees
1 -25 DO
Totals For Type
Returned Check Bank Fees
—4 4100-00
Totals For Bill
Patient
4 —00
Printed On 111512014 at 10,49.16AM
Page I
%1VV2K3MEM6'.RESCUENEMEPORTS321CUSTOMkCRMT TYPE DETAIL CUSTOM RPT
City of South San Francisco Fire Delpartimeft Ambulance BiHing Se vices 184
109
1104ttmain r,+ "11,11 "01WiSCS
Credit As Type Detail by Credit Payor
Post Date IS BETWEEN 01/0112013 AND 12(31/2013: AND Company IS City of Oceanside Fire Department, AND Status IS Assigned OR Billed OR Closed OR
Complete OR NetTransit New Call OR NetTransit New Will Call OR NetTransit Review OR NetTransit Wil...
................. . ..... . ... . . ............. . . .. . . ... . .. . . . ..... . . . . . . . . . . . . . . . ............. . . . . .............. . .. ........ .. ............ -'.— .. . . . . ..........
City of Oceanside Fire Department
Paver /Credit Type
Payer Mcare HMO Greater Tri-City IPAt5059
Revenue Adjustments
EDMEAD, FRANK
THP 0M. P-f ot. DeP..ft Dale Trip 0: F?- Number Check Number
2013-05-15 2013-OMI 201307-17 0350 A 11904 R.W—d Check Ba.I, Fees
Totals For Typo Retumed Chock Bank Fees
Totals For Mcare HMO Greater Tri-City 115
Company Totals
RescueNetl- Printed On. I11512014at104916AM
kIV4K3MEM8 RESCUFNET\REIIORTS325CUSTOMIGREDIT TYPE DETAIL CUSTOM RPT
Count Dollars
-25.00
1 -$2500
-$ MOO
125.0
City of South San Francisco f1re Department: AmbWance IBMin g SeMces 185
110
Page 2
MhUnvan irwerp,114'WIV
Credit As Type Detail by Credit Payor
Pcesl Date IS BETWEEN 0IV/2013 AND 1 2/3 112 01 3
Grand Totals
71 M jo 126
Pr,al*dOn 11152014a1I0 A916AM Page 3
NMv WLCUSIOMIRM
City of South San Francisco Fire Departrnent: AmWance ffiMing, Ser0ces 186
in
-vi, 0
v, k nw�
Ticket Survey (by ICD-9110)
Ticket Survey Summary Report
by Diagnoses
Trip Date IS BETWEEN 08/01/2015 AND 08/31/2015,
lla or Number of Trips
% ()fr Frip%
N of A1114, Ace.
1('1)9
<None>
1
0.38%
0
Adverse Drug Effect
2
0,77%
0
99520
Allergic Reaction-Unspecified
I
O-M%
0
9953
Aloc-Alteration Of Awareness
28
10.77%
0
78002
Altered Mental Status
1
(138%
0
78097
Amputation-Finger Complete
1
0.38%
0
8860
Anxiety State-Unspcfd
5
1,92%
0
30000
Aphasia
1
0.39%
a
7843
Cardiorespiratory Arrest
4
1-54%
0
4275
Chest Pain
8
3.08%
0
78650
Comp-Mech Vascular Device
3
1115%
0
9961
Comp-Urethral Indwelling Catl
1
0.38%
0
9%31
Confused State-Unspfd
8
3.08%
0
2930
Cramps-Upper/Lower Extreml
1
0.38%
0
72982
Death-Unattended
1
038%
0
7989
Dehydration
1
0.38%
0
27651
Diaphoretic
1
0.38%
0
7808
Diarrhea
2
0.77%
0
78791
Disorder-Behavioral/Conduct
1
(11.38%
0
3129
Disturbance of Salivary Secre
I
O-M%
0
5277
Dizzy/Vertigo/Giddiness
2
0.77%
0
7804
Eating Disorders -Other
1
11.38%
0
30759
Facial Droopffacial weakness
1
038%
0
78194
Failure To Thrive-Adult
2
0.77%
0
7837
Fatigue
1
0J8%
0
78079
Fever-Unspfd
3
1.15%
0
78060
Fracture-Arm/Closed
1
0.38%
1
8180
RescueNet" Printed On'. 10112/2015 at 4; 1 3:20PM Page I
AW2K12MEM21\RESCUENE'RREPORTS32\CUSTOM\COPY OF CHARGE DETAIL TRIP DATE1112.RPT
11'.0 of"loiAh Saiii FnhmJs1i:iD Fh e Dii�!jjmii trnent. BiMi ir, 87
112
vvit"t,xn. a f "7:',, t ; (,, v
Ticket Survey Summary Report
by Diagnoses
Trip Date IS BETWEEN 08101/2015 AND 08/31/2015;
Pacor Number of*frips
% of Trips
Hof Aulo Acc.
W09
Fracture-PaleflalMsed Unspi
9
8220
Fracture,-ROx
1
0J8%
0
80700
Fractave-Wrist and Hand Clos,
1
0.38%
0
8170
Fracture-Wrist and tiand Oper
1
0138%
1
8171
Gaft.-Maxic
1
0,38%
0
7812
Herniplegia
2
0,77%
0
342W)
firrat
1
038%
0
5789
Ingestion-MeifickW Substwo;
1
038%
0
9779
Injur3a4he0t Wall
3
6.15%
2
95911
Injury-Elbow
2
MM
0
9593
Injury-Eye
1
038'%
0
9219
Injury-Face
9
3,46%
4
95W9
Injury-FInger
1
40,39%
0
9595
Injury-Head
7
20M
3
95901
Injury-Hip
5
11,92%
0
9596
Inpiry-Lower leg
11
413%
4
0597
Injury-ShoiddedUplPer Amn
4
L54%
1
9592
injury-Trunk Urspefil Me
5
L92%
2
Injury-Unspefd Vto
3
LVM
1
9599
Intoxication-AlcobW Acute
2
0,77%
0
303(V
Uceradw7 .kye Unspoeffied
2
0177%
0
8714
Larprabon-ilead WiNo loss of
x
310%
0
$5100
Nausea-Mone
1
0138%,
0
78702
Pain-Abdominal Corkerahzed
7
169%
0
78907
Pain-Abdoadnal L,LQr
2
0177%
0
78904
PaIn-Abdominal Um, pfd She
1
41138%
0
789W
Pain-Anklell'oot
2
107%
0
71947
RescueNet' Printed OR 10/12/2015 at 4.13 20PM Page 2
k1 W2Kl2MEM211 RESCUENE'nREPORTS32\CtJSTOMlCOPY OF CHARGE DETAIL TRIP DATE1112 RPT
My of South Sari Ft anidsii'x) Fhe Del�,9artrn,,M Nnl,)ubn(i- Bi in- ', oi vlfle, 188
113
vvittjvian rn,rerp rhe.�
Ticket Survey Summary Report
by Diagnoses
Trip Date IS BETWEEN 08/01/2015 AND 08/3112015;
"UnIber OVIrips % of Trips Nut Auf,)Acc• WD9
Wound-Lower Limb 1 0.38% 1 8940
Grand l'otalpicket Count 260
Grand Total Charges S .3-It 1 1101" .",
RescueNet' Printed On 10112/2015 at 4:13:20PM Page 4
\kW2K12MEM211RESCUENEI)REPORTS321CUSTOMICOPY OF CHARGE DETAH- rRIP DATE1112 RPT
City of South an Francisco Fire Departinent. Ambulance BMing Sery ces 189
114
VAtIrnan pnkrp risn
Ticket Survey Summary
Ticket Survey Summary Report
by Payor
Trip Date IS BETWEEN 01/01/2015 AND 01/31/2015;
Payer
Number of Trips
% ofTrips
IbtalCharges
% of ('ha rges
<none>
3
0.58%
S 3-35 6.50
0.62%
Auto Insurance
8
1.54%
S8,482.00
1.57%
Insurance
29
5.57%
S 32,031.00
6.05%
Insurance Electronic
30
5.76%
S33,757.50
6.26%
Kaiser
25
4.80%
S 29,651.50
5.50%
Kmistr- Medicare
60
11.52%
S69,246.00
12.84%
M('aI/,%K'sdd
129
24.76%
S 138,474.50
25.68%
Mcal/Alcaid IUNIO
1
0.19%
S1,089.50
0,211%
Medicare
86
16.51%
S94,403.15
17.51%
Medicare IM10
60
11.52%
S66,471.80
12-33%
Membership
31
5.95%
S 1.32501
0,25%
Private Pay
57
10.94%
S 58,279.5,11,
10.81%
Workers ('0MIre.11sation
2
0.38%
S2,047.00
0.38%
Grand Total Ticket Count $21
Grand'Votal Charges $ $39,214.95
RescueNet I- Printed On: 10/6/2015 at 2:44:20PM
k\W2Kl2MEM21XRESCUENEnREPORTS321CUSTOMICOPY OF CHARGE DETAIL TRIP DATEI 11 RPT
Page I
Cky of South San Francisco Fire Department: Ambulance BiHing Servtices 1 90
115
Mlt'LmAn P 11 "? I
Trip Count (by call type)
DM. IS BETMEN 07I1U2014 AND OWWO IS
Female
male
Unknown
T.W
A Sl Ad,,t r U1.
112
127
Trip Count of Call Type by Patient Age
2Q
ALS1 CWe 3
1,932
1,742
1
3,675
ALS2 Cxdt, 3
28
45
0. 17 113 W 30 31 to 40
73
41 1, 50 51 (1 W
24
6t 1170
? 1 11, 60
at to 16
91 v—, v
D M
TM,
VM" Y..'.
2
Y— Y—
954
Y-"
V—
Y—
ddxl
Red ol
ALS1 Ad,axw Lot, S.pW 0 0
3
3
5
39
82
M
20
5
240
ALS1 G.M1 3 177 499
w
413
Ns
03
493
563
205
9
3,675
AL52 C -113 4 6
4
11
a
11
14
10
3
2
73
A--t 3 N- 1, 2 1
3
6
7
6
13
1
0
0
Is
R 5F Cd. 2 0 0
0
0
0
0
1
1
0
0
2
BLSF CdI 3 IN 314
M
222
2"
179
155
239
W
2
1.am
Wd-1 F,e..1- 0 0
a
0
0
0
2
0
0
0
2
M—t-'o'p 0 0
a
2
7
25
d4
51
B
I
IN
T',t,ti 332 022
WD
667
737
762
204
951
336
19
Can
Trip Count of Call Type by Patient Sex
M21( 2MEM?IMESCUENETARFPORTS321CUSTOM'AGCCTCNTII RPT
P'.. o,� 1N 15 927 Ulm
City of South San Francisco Fire Department: AnnbLdace BdHing Services 1 91
116
Female
male
Unknown
T.W
A Sl Ad,,t r U1.
112
127
1
2Q
ALS1 CWe 3
1,932
1,742
1
3,675
ALS2 Cxdt, 3
28
45
0
73
ft--� Code 3 No,
24
21
0
45
&SE CMo 2
1
1
0
2
USE C.6t, A
954
899
1
1.854
M21( 2MEM?IMESCUENETARFPORTS321CUSTOM'AGCCTCNTII RPT
P'.. o,� 1N 15 927 Ulm
City of South San Francisco Fire Department: AnnbLdace BdHing Services 1 91
116
Trip Count (by diagnosis)
Trip Count by Diagnosis
Trip Date IS BETWEEN 01!0112015 AND 01/3112015,
Total
99
\\W2K1 2MEM21\RESCUENERREPORTS32\CUSTOM\DIAGTYPEI .RPT
Printed on 10/61201 5, S 32 46AM
ReacueNet- Reporting
Oty of Swith Sarw Fraticisco Fire Deparbnent: Arnbtflairlce Bfflirqp, Services 192
117
Wittman clat, rpriie ".
Trip Count (by Member)
Trip Count by Members by Call Type
Profit Center: KNone>
Date of Service Run Number Customer Name
Primary Payor
Cali Type
Patients Age at
time of DOS
01/18/15
Membership Colorado
ALS1 Code 3
83
01/10115
Mutual Of Omaha/Mutual of Omaha Plaza
ALS1 Code 3
78
01/03/15
Membership Westminster
ALS1 Code 3
88
01/27/15
Membership Colorado
ALS1 Code 3
93
01/07/15
Membership Colorado
ALS1 Code 3
88
01/12/15
BCBS of Colorado FEP/105557
ALS1 Code 3
88
OV05/15
Membership Colorado
ALS1 Code 3
81
01/28/15
Membership Colorado
ALS1 Code 3
72
01/17/15
Mcare HMO Kaiser EMI/853915
BLSE Code 3
68
01/17/15
Mcare HMO Kaiser EMI/853915
BLSE Code 3
68
01108/15
Membership Colorado
ALS1 Code 3
61
01/11/15
Bill Patient
ALS1 Code 3
87
01/23/15
Membership Colorado
BLSE Code 3
82
01/23115
Medicare Colorado
BLSE Code 3
86
01/30115
Bill Patient
ALS1 Code 3
86
01/24/15
Pipeline Industry Benefit Fund/ 470950
BLSE Code 3
100
01/21/15
Membership Colorado
ALS1 Cade 3
70
01/06/15
Membership Colorado
ALS1 Code 3
90
01115/15
Membership Colorado
ALS1 Code 3
90
01/11/15
Bill Patient
ALS1 Code 3
84
Total 0 of Transports: 19
Profit Center: Membership
lWV2K12MEM211RESCUENET \REPORTS32tCUSTOMOPCTCNT1111 RPT
P-ted w+ 10!512015 12.2242PM
R—NMI Repo nq
Pegs 1
City of South pan Francisco Hire Depa rtryi .ant: Arribi. ki rot:: Bifl a tp Senfices 193
118
witt"wan rwemid- t5(,,'
Trips by Customer (frequent flyer)
01118/2015 BLSE Code 3
Gross Charges: $1,033.15
Payments: $833.15
01/24/2015 ALS1 Code 3
Gross Charges: $1,052.15
Payments: $852.16
01/30/2015 ALS1 Code 3
Gross Charges: $1,130.00
Payments: $685.07
01/31/2015 ALS1 Code 3
Gross Charges: $1,050.50
Payments: $612.60
Total trips, 5 Gross charges: 6,237,60
Gross Payments. 3,764,77
6\ff2Kl2MEM21\RESCUENET)REPORTS32kCUSTOM\CUSTTRIP112 RPT
PnntefJ on 101612015, 9 40 15AM
Res ueNet' Reporting
Page I
City of Smith San Francisto Fire Departrnent. Arnbi,flance Bflkng Services 194
119
wittrn a n ente�p
YTD (Management Summary Report)
Management Summary Report
Monthly and Fiscal Year to Date
FIRE DEPARTMENT
August 2016
Financial Class
Numberof
Percentof
Yearto Date
Percentof
Charges
Percentof
Yearto Date
Percentof
Payments
Percentof
Yearto Date
Percentof
... ...... . .....
LLinl
o!!�Sst!l
i�
...............
L0L L-
a s
!?!�L M
2t
1--j
!�VnL n .-
Total
12!=
Medicare
38
10.61%
86
12.67%
$40,70433
10.67%
$89,924.14
12.72%
$19,514.39
18.91%
$53,414.94
2242%
Medicare HMO
34
9150%
60
8.84%
$34,903.89
9.15%
$60,527.59
8.56%
$26,743.33
25.92%
$58,053,87
24.91%
Medi-Cal
2
0.56%
5
0.74%
$1,73162
0.45%
$4,680,51
0.66%
$1,626.25
1.58%
$1,626.25
0.70'A
meoi-Cal HMO
39
10.89%
83
12.22%
$39,263,68
10.29%
$80,362.59
11.37%
$9,326.84
9.04%
$19,664.07
8.44%
Insurance
11
3.07%
17
2,S0%
$12,717.82
3.33%
$18,815,02
2.66%
$33,813.97
32.77%
$76,210.02
32.70%
Private Pay
210
58.66%
372
54.79%
$222,297.82
58.25%
$381,316.60
53.96%
W-,16-9.53-
11.79%
$24,087,07
1034%
Kaiser
0
0.00%
0
0.00%
$0.00
0,00%
$6.,00
0.00%
$0.00
0,00%
$0,00
0.00%
Other-
24
6,70%
56
8.25%
$28,1C0.43
7,38%
$60,869.79
8.60%
$ODO
0.00%
$0.00
obo%
Prior Sales
$1,843.00
0.48%-
$10,20.9.17
1.45%
sub Total
358
100.
679
100-00%
$381,643.99
100,00%
$706,685.41
100.00%
$103,194.31
10D.00%
$233,056,22
100.00%
00%
0
0.00%
$0.00
0.00%
50.00
0.00%
$00
0,00
U0%
'000
0.00
0,00%
0(,0%
Total
358
100,00%
679
100.00%
7= 5381 643.99
100.00 b
5706 685.41
_1109.
194.31
100.00%
$233,056.22
100.00
it of Sotith Sain Franclscc Fire Department: ArnbWance Uling Services 195
120
v%rTTU,r�,,a jrV t,,, ri., 4"',
YTD —Revenue
Oty (ff South S a i F umJsco Fhe De i a ribrieriM Ninbu I aiv,,, BlHlq_� 196
121