AGREEMENT FOR PROFESSIONAL
FIRST RESPONSDER BILLING SERVICES
BETWEEN THE REDONDO BEACH FIRE DEPARTMENT
AND WITTMAN ENTERPRISES, LLC
This Agreement made and entered into this, 1st day of November 2023, by and between the Redondo Beach Fire Department, hereinafter referred to as “PROVIDER,” and Wittman Enterprises, LLC, hereinafter referred to as “CONTRACTOR.”
RECITALS
WHEREAS, PROVIDER desires to use the billing service offered by Wittman Enterprises, LLC an independent contractor, as its agent for the purpose of performing the services described in SECTION
2. SCOPE OF SERVICES.
WHEREAS, concurrently with entering into this Agreement that parties are also entering into the HIPAA Business Associate Agreement (“HIPAA Agreement”), attached hereto and incorporated by this reference as though fully set forth herein; and
WHEREAS, this Agreement is the “UNDERLYING Agreement” as defined by and reference in the HIPAA Agreement.
WITNESSETH: That the parties hereto have mutually covenanted and agreed, and by these presents do covenant and agree with each other as follows:
1. TERM: This Agreement shall commence on the date it is executed by CONTRACTOR and PROVIDER and it shall continue in full force and in effect until it is terminated by either party, giving ninety (90) days advance written notice to the other party.
2. SCOPE OF SERVICES: CONTRACTOR will perform services as set forth detailed in this section. PROVIDER understands, agrees to, and accepts that CONTRACTOR has no responsibility or obligation for determining the accuracy of any claims made to governmental agencies, and that CONTRACTOR relies on PROVIDER for making any such claims on documentation. All services provided pursuant to this Agreement shall also be subject to the terms and conditions of the HIPAA Agreement. To the extent there is any conflict between the provisions of this Agreement and the provisions of the HIPAA Agreement, the HIPAA Agreement will control, as set forth in Section 5.3 of the HIPAA Agreement.
2.1 Private Insurance Billing for First Response Calls
CONTRACTOR to prepare all insurance-request mailings. Correspondence to patients will be on 8 x 11 requests for insurance and will be placed in envelopes, sealed and mailed, postage prepaid. Initial mailing occurs within four (4) days of receipt of first responder ticket(s) from PROVIDER or their transporting agencies. A toll-free telephone number will be provided to patients. The standard schedule is as follows:
Private Insurance Schedule
1. Request for information to patient Immediately
2. Phone call to patient 15 days
3. Final request for information 30 days
2.2 Receipts Processing
CONTRACTOR will accept payments in the form of cash, check, money order, cashier’s check or credit card. All cash receipts will be deposited and posted within one (1) day of receipt of funds. All funds will be deposited into a PROVIDER-designated bank account.
Bank deposit receipts will be sent electronically to PROVIDER. CONTRACTOR shall have no access to the proceeds of the receipts. All funds are under the exclusive control of PROVIDER.
All credit card fees incurred through payment processing will be the responsibility of the PROVIDER. A credit card processor/merchant account will be designated and set up by PROVIDER.
2.3 Refunds
CONTRACTOR will research and verify all overpayments. If a refund is required, CONTRACTOR will submit electronically all supporting documentation to PROVIDER upon completion of research. PROVIDER will issue payment directly to specified party and will send an electronic copy to CONTRACTOR, to be posted to the Patient’s account within 24 hours.
2.4 Reports
Monthly, CONTRACTOR will perform accurate month end close procedures that will result in reports such as:
o Monthly Ticket Survey
o Monthly Sales Journal
o Monthly Cash Receipts Journal
o Monthly Receivables Aging
o Management A/R Analysis
o Statistical Reports customized to client needs
Such reports will be available to PROVIDER on the 15th day of the month following the date of service, or ten (10) business days after the final submission of patient care records from the previous month
2.5 Source Documents
CONTRACTOR will retain in electronic format all source documents including attachments for seven (7) years from the date of the reported incident. When service contracted is terminated, all source documents are returned to PROVIDER in an electronic format at PROVIDER’s expense.
3. COMPENSATION AND PAYMENT: CONTRACTOR will provide the billing services as stated for a fee as outlined in 3.1. CONTRACTOR will invoice Provider at the end of each month.
Invoices are payable upon receipt and shall be deemed late if not received by CONTRACTOR within thirty (30) calendar days of the invoice date.
3.1 Fees
A. Contract Year 1 $15.00 per imported incident
B. Contract Year 2 $16.00 per imported incident
C. Contract Year 3 $17.00 per imported incident
4. FINANCE CHARGE: Contractor invoices unpaid by more than forty-five (45) days are subject to a monthly interest charge of 1 1/2% unless in dispute.
5. AGENCY RELATIONSHIP: CONTRACTOR is an independent billing service contractor and PROVIDER specifically designates CONTRACTOR as its agent for the purpose of performing the services described in Section 11 of this Agreement.
5.1 Liaison: PROVIDER shall assign a liaison for conference and communication of any matters subject to the services provided by the contract.
5.2 Coordination of Services: The CONTRACTOR and PROVIDER mutually agree that person(s) who have knowledge of this agreement and the legal capacity to comply with this agreement shall be available for conference at all regular business hours (PST). Each party agrees that during a time that this agreement is in effect, the responsible contact person(s) will be available at all regular business hours (PST) for communication or other matters of this agreement. The current contact information as of the signing of this agreement is:
Primary Contact for CONTRACTOR Primary Contact for PROVIDER Judy Vang, Client Liaison Issac Yang, Division Chief
11093 Sun Center Drive
Rancho Cordova, CA 95670
401 South Broadway
Redondo Beach, CA 90277
916-669-4613
Email [email protected]
310-318-0663
Email [email protected]
6. PERFORMANCE MONITORING: CONTRACTOR agrees to allow PROVIDER, or any agent or Consultant as they deem so qualified, to monitor audit, review, examine, or study the methods, procedures and results of the billing and collection methods used.
7. COMPLYING WITH THE LAW: CONTRACTOR shall adhere to all applicable state and federal laws and regulations in effect during the term of this Agreement.
8. INSURANCE: CONTRACTOR will maintain in force throughout the term of this Agreement the following insurance:
A) General Liability Insurance, 3,000,000 aggregate,
B) Professional Liability Insurance, 1,000,000
C) Workers Compensation Insurance, 1,000,000.
9. INDEMNIFICATION AND HOLD HARMLESS: CONTRACTOR hereby agrees to indemnify, defend, and save harmless PROVIDER, its officers and employees from all liability, including any claim of liability and any losses or costs (including reasonable attorneys’ fees) arising out of the negligent or intentional act, recklessness or gross negligence of CONTRACTOR its officers, or employees.
PROVIDER agrees to defend, indemnify and hold CONTRACTOR and its officers, and employees harmless from and against any and all claim, actions, damages, expenses (including reasonable attorney’s fees), losses or liabilities incurred by or asserted against CONTRACTOR its officer or employees as a result of this Agreement; provided, however, that such duty to defend, indemnify and hold harmless shall not apply to any claim or liability to the extent caused by the negligent or intentional act, recklessness or gross negligence of CONTRACTOR its officers, or employees.
10. CONTRACTOR LIMITED LIABILITY: CONTRACTOR shall use due care in processing the claims of the PROVIDER, but CONTRACTOR will be responsible only to the extent of correcting any errors which occur within CONTRACTOR's reasonable control; such errors will be corrected at no additional charge to PROVIDER. This liability of CONTRACTOR with respect to this Paragraph shall in any event be limited to the total compensation for the services provided under this Agreement and shall not include any contingent liability, regardless of the form of action.
11. CONTRACTOR SERVICES AND RESPONSIBILITIES: CONTRACTOR shall perform the following services for PROVIDER.
a) screen, prepare, and submit claims to any and all payors including but not necessarily limited to insurance carriers, and any other source of pay for first responder incidents. b) track and trace all claims submitted,
c) retain all source documents for 72 months,
d) provide adequate precautions to protect confidentiality of patient records in accordance with applicable state and federal law.
e) timely submit claims, predicated upon normal working conditions and subject to adjustment at any time in the event of any cause or causes beyond the control of CONTRACTOR f) conduct all contact and correspondence with beneficiaries or responsible parties.
12. PROVIDER RESPONSIBILITIES: Provider shall have the following responsibilities to CONTRACTOR
a) Provide CONTRACTOR with the proper documentation necessary to prepare claims and reach final adjudication, including any and all PCRs for each incident. b) Provide CONTRACTOR with any correspondence from the fiscal intermediaries, insurance, attorneys, patients in order for CONTRACTOR to perform proper follow up of outstanding billings and proper posting and tracking of accounts receivable.
13. DISPUTES: Any controversy or claim arising out of or relating to this Agreement, or the breach thereof, shall be settled by arbitration administered by the American Arbitration Association in accordance with its Commercial Arbitration rules and judgment upon the award rendered by the arbitrator may be entered in any court having jurisdiction thereof. Civil Code of Procedure 1283.05 is incorporated into the discovery provisions of CCP §1283 in all issues arising out of or relating to this Agreement, or the breach thereof.
14. EXCUSE OF NON-PERFORMANCE: Neither party shall be liable for damages to the other party for failure of performance under the terms of this Agreement in the event that party's performance is prevented or made unreasonably difficult or costly by any labor dispute beyond control of the party, war, governmental action, looting, vandalism, earthquake, fire, flood, or any other natural occurrence.
15. DISENGAGEMENT AGREEMENT: Upon termination of the contract, CONTRACTOR will continue to perform billing services to the date agreed upon as the termination date.
CONTRACTOR will return to PROVIDER all previously retained source documents, along with a full accounting of outstanding accounts receivable in an electronic format at the PROVIDER’s expense.
16. NOTICE: Any notice given hereunder shall be deemed served immediately if hand-delivered in writing to an officer or other duly appointed representative of the Party to whom the notice is directed, or if transmitted by electronic format to the email address contained in this Agreement or listed below.
Notices shall also be deemed served five business days after transmittal by registered, certified, express, or regular mail or by Federal Express to the business address identified in this Agreement.
CONTRACTOR: PROVIDER:
Corinne Wittman-Wong, CEO Patrick Butler, Fire Chief
11093 Sun Center Drive
Rancho Cordova, CA 95670
401 South Broadway
Redondo Beach, CA 90277
Email [email protected] Email [email protected]
17. ENTIRETY: Any of the terms or conditions of this Agreement may be waived at any time by the party entitled to the benefit thereof, but no such waiver shall affect or impair the rights of the waiving party to require observance, performance or satisfaction either of that term or condition as its applies on the subsequent occasion or of any other term or condition hereof.
Nothing in this Agreement, whether express or implied is intended to confer any rights or remedies under or by reason of this Agreement on any persons other than the parties to it and their respective successors and assigns, nor is anything in this Agreement intended to relieve or discharge the obligation or liability of any third persons to any party to this Agreement nor shall any provision give any third persons any rights of subrogation or action over against any party to this Agreement This Agreement sets forth the entire understanding of the parties with respect to the subject matter herein. There are no other understandings, terms or other Agreements expressed or implied, oral or written, except as set forth herein.
IN WITNESS WHEREOF the parties hereto have executed this Agreement the day and year first herein above written.
WITTMAN ENTERPRISES, LLC REDONDO BEACH FIRE DEPARTMENT
By: By:
Corinne Wittman-Wong, CEO Patrick Butler, Fire Chief
________________________________ ___________________________________ (Signature) (Date) (Signature) (Date)
Wittman Enterprises, LLC
Business Associate Agreement
Between Wittman Enterprises, LLC and the Redondo Beach Fire Department This Business Associate Agreement (“Agreement”) between the Redondo Beach Fire Department (Covered Entity) and Wittman Enterprises, LLC (Business Associate) is executed to ensure that Wittman Enterprises, LLC will appropriately safeguard protected health information (“PHI”) that is created, received, maintained, or transmitted on behalf of the Redondo Beach Fire Department in compliance with the applicable provisions of Public Law 104-191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F – Administrative Simplification, Sections 261, et seq., as amended ("HIPAA"), and with Public Law 111-5 of February 17, 2009, known as the American Recovery and Reinvestment Act of 2009, Title XII, Subtitle D – Privacy, Sections 13400, et seq., the Health Information Technology and Clinical Health Act, as amended (the “HITECH Act”).
A. General Provisions
1. Meaning of Terms. The terms used in this Agreement shall have the same meaning as those terms defined in HIPAA.
2. Regulatory References. Any reference in this Agreement to a regulatory section means the section currently in effect or as amended.
3. Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with HIPAA.
B. Obligations of Business Associate
Wittman Enterprises, LLC agrees that it will:
1. Not use or further disclose PHI other than as permitted or required by this Agreement or as required by law;
2. Use appropriate safeguards and comply, where applicable, with the HIPAA Security Rule with respect to electronic protected health information (“e-PHI”) and implement appropriate physical, technical and administrative safeguards to prevent use or disclosure of PHI other than as provided for by this Agreement;
3. Report to the Department any use or disclosure of PHI 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 by 45 CFR §164.410. Breaches of unsecured PHI shall be reported to the Redondo Beach 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 Enterprises, LLC agree to the same restrictions, conditions, and requirements that apply to Wittman Enterprises, LLC with respect to such information;
5. Make PHI in a designated record set available to the Redondo Beach Fire Department and to an individual who has a right of access in a manner that satisfies the Department’s obligations to provide access to PHI in accordance with 45 CFR §164.524 within 30 days of a request;
6. Make any amendment(s) to PHI in a designated record set as directed by the Redondo Beach Fire Department, or take other measures necessary to satisfy the Department’s obligations under 45 CFR §164.526;
7. Maintain and make available information required to provide an accounting of disclosures to the Department or an individual who has a right to an accounting within 60 days and as necessary to satisfy the Redondo Beach Fire Department’s obligations under 45 CFR §164.528;
8. To the extent that Wittman Enterprises, LLC is to carry out any of the Redondo Beach Fire Department’s obligations under the HIPAA Privacy Rule, Wittman Enterprises, LLC shall comply with the requirements of the Privacy Rule that apply to the Department when it carries out that obligation;
9. Make its internal practices, books, and records relating to the use and disclosure of PHI received from, or created or received by Wittman Enterprises, LLC on behalf of the Redondo Beach Fire Department, available to the Secretary of the Department of Health and Human Services for purposes of determining Wittman Enterprises, LLC and the Department’s compliance with HIPAA and the HITECH Act;
10. Restrict the use or disclosure of PHI if the REDONDO BEACH Fire Department notifies Wittman Enterprises, LLC of any restriction on the use or disclosure of PHI that the Department has agreed to or is required to abide by under 45 CFR §164.522; and
11. If the Department is subject to the Red Flags Rule (found at 16 CFR §681.1 et seq.), Wittman Enterprises, LLC agrees to assist the Redondo Beach Fire Department in complying with its Red Flags Rule obligations by: (a) implementing policies and procedures to detect relevant Red Flags (as defined under 16 C.F.R. §681.2); (b) taking all steps necessary to comply with the policies and procedures of the Department’s Identity Theft Prevention Program; (c) ensuring that any agent or third party who performs services on its behalf in connection with covered accounts of the Department agrees to implement reasonable policies and procedures designed to detect, prevent, and mitigate the risk of identity theft; and (d) alerting the Department of any Red Flag incident (as defined by the Red Flag Rules) of which it becomes aware, the steps it has taken to mitigate any potential harm that may have occurred, and provide a report to the Department of any threat of identity theft as a result of the incident.
C. Permitted Uses and Disclosures by Business Associate The specific uses and disclosures of PHI that may be made by Wittman Enterprises, LLC on behalf of the Redondo Beach Fire Department include:
1. The preparation of invoices to patients, carriers, insurers and others responsible for payment or reimbursement of the services provided by the Redondo Beach Fire Department to its patients;
2. Preparation of reminder notices and documents pertaining to collections of overdue accounts;
3. The submission of supporting documentation to carriers, insurers and other payers to substantiate the healthcare services provided by the Department to its patients or to appeal denials of payment for the same; and
4. Other uses or disclosures of PHI as permitted by HIPAA necessary to perform the services that Wittman Enterprises, LLC has been engaged to perform on behalf of the Department.
D. Termination
1. The Redondo Beach Fire Department may terminate this Agreement if the Department determines that Wittman Enterprises, LLC has violated a material term of the Agreement.
2. If either party knows of a pattern 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 shall take reasonable steps to cure the breach or end the violation, as applicable, and, if such steps are unsuccessful, terminate the Agreement if feasible.
3. Upon termination of this Agreement for any reason, Wittman Enterprises, LLC shall return to the Department or destroy all PHI received from the Department, or created, maintained, or received by Wittman Enterprises, LLC on behalf of the Department that Wittman Enterprises, LLC still maintains in any form. Wittman Enterprises, LLC shall retain no copies of the PHI. If return or destruction is infeasible, the protections of this Agreement will extend to such PHI.
AGREED TO THIS FIRST DAY OF JULY, 2021
WITTMAN ENTERPRISES, LLC REDONDO BEACH FIRE DEPARTMENT
By: By:
Corinne Wittman-Wong, CEO Patrick Butler, Fire Chief
________________________________ ___________________________________ (Signature) (Date) (Signature) (Date)