No preview available
HomeMy WebLinkAboutDocumentation_Regular_Tab 12I_4/10/1997 LcSSGi' tCf iad Memorandum • To: Thomas G. Bradford, Village1 .= I Ni From: James M. Weinand, Fire Chi.- Village Manager ; office Date: March 19, 1997 Subject: Agreement for Electronic Bi ng Attached hereto is an Agreement between the Village of Tequesta and Health Care Financing Administration (Medicare) for your consideration. Execution of this Agreement affords our billing agency the ability to forward Medicare Insurance claims via computer modem, to assure an accurate and more efficient processing time. This will expedite payment for services by approximately four weeks. This Agreement reduces the cost of insurance filing, which in return provides for a lower processing rate from our billing agency. This agreement has been forwarded to John C. Randolph, Village Attorney, for his approval concerning legal form and sufficiency, see attached correspondence. Mr. Randolph has made comment that the terms of the Agreement are quite specific • and involved, that we should be thoroughly aware of our responsibilities of such. It is my understanding that most of these responsibilities are upon this department regardless if we submit these claims electronically or by mail. The Medical Claims Processors Group Inc., who has been processing our claims, is fully aware of these responsibilities and has provided us guidance of such and will assure compliance with this Agreement. If you see fit, please execute the EDI Agreement so that electronic Medicare submissions may begin. If you have any questions or concerns, please do not hesitate to contact me. JMW/cm bradford\031997 RESOLUTION NO. 16-96/97 ' A RESOLUTION OF THE VILLAGE COUNCIL OF THE • VILLAGE OF TEQUESTA, PALM BEACH COUNTY, FLORIDA, APPROVING AN ELECTRONIC DATA • INTERCHANGE AGREEMENT BETWEEN THE VILLAGE OF TEQUESTA AND HEALTH CARE FINANCING ADMINISTRATION (MEDICARE) AND AUTHORIZING THE VILLAGE MANAGER TO EXECUTE THE SAME ON BEHALF OF THE VILLAGE. NOW, THEREFORE, BE IT RESOLVED BY THE VILLAGE COUNCIL OF THE VILLAGE OF TEQUESTA, PALM BEACH COUNTY, FLORIDA, AS FOLLOWS: Section 1. The Electronic Data Interchange Agreement between Health Care Financing Administration (Medicare) and the Village of Tequesta, attached hereto as Exhibit "A" and incorporated by reference as a part of this Resolution, is hereby approved and the Village Manager of the Village of Tequesta is authorized to execute the same on behalf of the Village of Tequesta. . THE FOREGOING RESOLUTION WAS OFFERED by Councilmember , who moved its adoption. The motion was seconded by Councilmember , and upon being put to a vote, the vote was as follows : 1 FOR ADOPTION AGAINST ADOPTION • The Mayor thereupon declared the Resolution duly passed and adopted this 10th day of April, A.D. , 1997 . MAYOR OF TEQUESTA • Ron T. Mackail ATTEST: • I1 � Joann Manganiello Village Clerk wp60\res\16-97 • FILE COPY JONES, FOSTER, JOHNSTON & STUBBS, P.A. ArroRNEt's AND COUNSELORS FLAULBR CENTER TOWER 505 SOUTH FLAOLER DRUM LARRY B.AtrxAmsa. MAxc D.IClmmvnnD ELEVEN/II FLOOR Firm P.J1mrrHAL CnRI nx�oPY MIOCKL T lUA,a WEST PALM BEACH,FLOATDA 33401 1902-19f0 M.T1.AucY 91Amarn lam B.MC(7,ACRIN CLAY C.BRocoatt Scan'L.McM=EQ Hury AEi.oa Johrolon Jo'c2A CONWAY DAvm PRATT P.O.Box3475 .1983 MA1a.wr L.Coora I C.R vmmnc R.Bn Hnc1 herie KB BvwA,DIAz STImo.J.R(,11 Av WBFI PALM BEACH,FL 33402.3473 :90 C. Wolre Ra+RmA 0 Douce PM&A.&Aaa (561)659-3D00 Paid 19 C.1991 awn:,It Dorm" D.C.e. BIM lII PAX:(561)832-1454 193.1.1991 C rcvsmc B.Dv i &rear A.tom II.ldrolAs.EAatsr AUJmeIL7bMIIiW Retired Wanes imrra.HARIC/MI JOHNB.TI Mom( DIRBCTLINB: 1YiJL,nAPoster Monaca;oa;M.Hm"(r Bums K Wawa PERI 9.Hciic, It Ammo MAWR OlCmaad HABi7AJu rorli IAAs.7m= lad[AP14eo March 3, 1997 VIA FAX: 575-6203 Tequesta Rug. James M. Weinand, Fire Chief Village of Tequesta WJ 8 1997 Department of Fire-Rescue Post Office Box 3273 Tequesta, Florida 33469 Fire Chlers Office RE: Village of Tequesta Electronic Data Interchange Agreement with Health Care Financing Administration Our File No. 13153.1 Dear Chief Weinand: I have reviewed the above referenced agreement which you forwarded to me under letter of February 26, 1997 . • The responsibilities of the Village of Tequesta Fire Rescue as "Provider" under the terms of this agreement are quite specific and . involved. You should make sure that the Village thoroughly understands its responsibilities under the terms of this agreement. As to paragraph 18, I believe that paragraph should be modified to . only hold HCFA harmless to the extent provided under Florida law. • Other than as mentioned above, I approve the agreement as to legal form and sufficiency. Sincerely, JONES, F•STER, JOHNSTON & STUBBS, P.A. 'ohn Randolph JCR\ssm • • ELECTRONIC DATA INTERCHANGE AGREEMENT This Agreement between VILLAGE OF TEQUESTA FIRE RESCUE (herein called "provider") and the Health Care Financing Administration , (herein called "HCFA"), is made as of , 19 , and shall remain in effect until terminated. ("Provider" means a hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, hospice, physician, or supplier as defined in 42 C.F.R. s400.202 or physician as defined in s1861(r) of the Act.) The provider and HCFA desire to facilitate, through the use of electronic formats, claims submission and payment by electronically transmitting and receiving data that are in specific machine readable formats. HCFA and the provider intend such transactions to be legally valid and enforceable. A. The Provider Agrees: • 1. That it shall be liable for any and all breaches of this Agreement that may be committed by any partner, director, officer, employee, servant, agent, or subcontractor of the provider.. The provider agrees further that the terms "agent" and "subcontractor" include, but are not limited to, a billing service or data transmission service that the provider uses, employs, or contracts with. The provider agrees further that it shall be liable for any and all breaches of this Agreement that may be committed by an organizational component to which a Medicare provider number, supplier number, UPIN, or billing number has been assigned, irrespective of whether such component has, itself, separately executed an EDI agreement. 2. Not to disclose any information concerning a Medicare patient to any other person or organization, except HCFA and/or its contractor, without the express written permission of the Medicare patient or his/her parent or legal guardian or as required by State or Federal law. 3. To ensure that Medicare patient eligibility data are used only for the purpose of,preparing and filing accurate Medicare claims. 4. To submit claims only on behalf of those Medicare patients who have given their written authorization to do so, and to certify that required patient signatures, or legally authorized signatures —on behalf of patients, are on file. 5. To ensure that every electronic entry can be readily associated and identified with an original source document. Each source document must reflect the following information: o Patient's name, o Patient's health insurance claim number, o Date(s) of service, • a Diagnosis/nature of illness, and 0 Procedure/service performed. • 6. That the Secretary of Health and Human Services or his/her designe and/or the contractor has the right to audit and confirm information submitted by the provider and shall have access to all original source documents and medical records related to the provider's submissions, including the patient's authorization and signature. All incorrect payments that are discovered as a result of such an audit shall be adjusted according to the applicable provisions of the Social Security Act, Federal regulations, and HCFA guidelines. EDI 2/25/94 • 7. To certify that all claims for Medicare primary payment have been developed for other insurance involvement and that medicare is the primary payer. 8. To guarantee the accuracy, completeness,and truthfulness of all claims submitted to the contractor. 9. To retain all original source documents and medical records pertaining to any such particular medicare claim for a period of at least 6 years, 3 months after the bill is paid. 10. To prevent unauthorized users from submitting claims or committing other data security • violations. 11. To affix the Medicare-assigned number of the provider on each claim electronically transmitted to the contractor. 12. That the Medicare-assigned number constitutes the provider's legal electronic signature and constitutes an assurance by the provider that services were performed as billed. 13. To provide and maintain the equipment, software, services and testing necessary to effectively and reliably transmit claims,and to use other available data services required by HCFA, such as receipt of remittance advice. • 14. To use sufficient security procedures to ensure that all transmissions of documents are authorized and protect all patient-specific data from improper access. 15. To acknowledge that all claims will be paid from Federal funds, that the submission of such claims is a claim for payment under the medicare program, and that anyone who misrepresents or falsifies or causes to be misrepresented or falsified any record or other information relating to that claim that is required pursuant to this Agreement may, upon conviction, be subject to a fine and/or imprisonment under applicable Federal law. 16. If the provider has executed a Medicare provider agreement, or accepted assignment of the beneficiary's claim, the provider agrees to accept the amount approved by Medicare as full payment for services on the claim and to bill the patient only for deductible, coinsurance, and noncovered services to the extent permitted by the Medicare program. If the claim is not accepted on an assignment-related basis by a provider who is a physician or supplier, but such provider submits the claim electronically on the beneficiary's behalf,then such provider agrees to limit charges to the beneficiary, with respect to the item or service furnished to the beneficiary, to a percentage established by HCFA of the Medicare payment established by HCFA for such item or service. 17. To establish and maintain procedures and controls so that information concerning Medicare patients,.or any information obtained from HCFA or its contractor, shall not be used by agents, officers, or employees of the billing service excepts as provided by the contractor (in accordance with 1106 (a) of the Act). 18. To research and correct any and all claim discrepancies and to hold the contractor and HCFA harmless from any claims, cost, or damages incurred as a result of such discrepancies. EDT 2/25/94 • B. The Health Care Financing Administration Agrees: 1 . To transmit to the provider an acknowledgement of claim receipt. 2. To affix the intermediary/carrier number, as its electronic signature, on each remittance advice sent to the provider. 3. To ensure that payments to providers are timely in accordance with HCFA's policies. 4. That no contractor may require the provider to purchase any or all electronic services from the contractor or from any subsidiary of the contractor or from any company for which the contractor has an interest. The contractor will make alternative means available to any electronic biller to obtain such services. 5. To keep providers apprised at all times of HCFA's regulations and guidelines pertinent to EMC. All submitters must receive the information in an equally timely manner. 6. To ensure that all Medicare electronic billets have equal access to any services HCFA requires Medicare contractors to make available to providers or their billing services, regardless of the electronic billing technique or service they choose. Equal access will be granted to any services the contractor sells directly, indirectly, or by arrangement. C. The Parties Mutually Aaree That: If any transmitted data are received in an unintelligible or garbled form,the receiving party, if feasible, shall notify the originating party within 2\business days. This Agreement shall become effective when executed by both of the parties.The responsibilities and obligations contained in this document will remain in effect as long as medicare claims are submitted to the contractor. Either party may terminate the Agreement by giving the other party thirty (30)days written notice of its intent to terminate. Written notice will be deemed received on the date it is handed to the other party or the date it is postmarked if the mail is used. • • EDI 2/25/94 • D. Signatures: I am authorized to enter into this Agreement on behalf of the indicated party and I have read and agree to the foregoing provisions and acknowledge same by signing below. Provider's Name For HCFA: VILLAGE OF TEQUESTA FIRE RESCUE Scott A. Masters Manager - EMC/ACS Suwon 357 TEQUESTA2 eTitle DRIVE (P.O.(P.0. BOX #3273) Riverside Avenue - 5C Address Address TEQUESTA, FL 33469-0273 Jacksonville, Florida 32202-491 S City/State/Zip City/State/Zip • By By THOMAS G. BRADFORD Title VILLAGE MANAGER Title Date Date • PLEASE PROVIDE THE FOLLOWING MEDICARE INFORMATION Physician/Supplier/PA Group Signature Current Sender Number: K 17 9 2 physician, supplier, PA group previously filed electronically;-please indicate sender number which is/was used: N/A Type of Claim: ❑ Medicare Part A ® Medicare Part B Medicare B Physician/Supplier/PA Group Provider Number: A0704 Medicare A 4 digit Provider Number: 10 PA Groups should complete the reverse side. • EDI 2/25/94 For PA Groups Only: To expedite the processing of your agreement, please provide the name, signature, provider number, and date of all physicians billing under this PA Group. Physician's Provider Name (Sicnature) Name (Printed) Number Date N/tq • • • • EDI 2/25/94