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2009-085 EMS - EMS Management and Consultants, Inc Billing Services Agreement
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2009-085 EMS - EMS Management and Consultants, Inc Billing Services Agreement
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Last modified
11/18/2009 10:54:31 AM
Creation date
11/16/2009 10:35:42 AM
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BOCC
Date
10/20/2009
Meeting Type
Regular Meeting
Document Type
Agreement
Agenda Item
6f
Document Relationships
Agenda - 10-20-2009 - 6f
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\Board of County Commissioners\BOCC Agendas\2000's\2009\Agenda - 10-20-2009
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and any other payor or insurance carrier to allow EMS~MC to carry out its billing <br />and other duties under this Agreement; and maintain client's own files with all <br />original or source documents, as required by law. Client acknowledges that <br />EMS~MC is not the agent of Client for storage of source documentation. Client will <br />provide EMS~MC with a copy of any existing billing policy manuals, guidelines, or <br />protocols, Medicare or Medicaid reports, or any other record or document related <br />to services or billing of client accounts. <br />c. In addition the Client shall provide EMS~MC with a copy of any existing <br />medical records prepared by Client for each incident or patient service rendered <br />for reimbursement [i.e. the Ambulance Call Report (ACR) or Patient Care Report <br />(PCR)]. The PCR record shall comply with the Client's and any State and Federal <br />guidelines for releasing such records. The Client attests, to the best of its <br />knowledge, that the PCR and any and all associated Medical Records, forms and <br />certification statements provided to EMS~MC are true and accurate; records of <br />factual information observed and documented by the attending field technician <br />during the course of the treatment and transport. <br />d. The Client will obtain any and all additional patient documentation required <br />by Centers for Medicare and Medicaid Services ("CMS") or any other <br />governmental or commercial payer for reimbursement consideration, including but <br />not limited to a Physician Certification Statements (PCS) or other similar medical <br />necessity forms or prior authorization statements as deemed necessary by the <br />payer. <br />4. TERM AND TERMINATION OF AGREEMENT. <br />a. TERM OF AGREEMENT -This term of this Agreement shall be January 1, <br />2010 through December 31, 2010. .This Agreement shall automatically renew on <br />the same terms and conditions as stated herein, for successive one (1) year <br />terms, unless the Agreement is terminated as provided in 4b below. <br />b. TERMINATION OF AGREEMENT - <br />(i) Written Notice -Either party may provide 60 day written notice of its <br />intent to terminate this Agreement by sending notice to the address <br />provided below; or <br />6 <br />
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