HomeMy WebLinkAbout22- Professional Services Agreement - Pintler Billing Services - EMS Billing Services
Professional Services Agreement for EMS Billing Services
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PROFESSIONAL SERVICES AGREEMENT
THIS AGREEMENT is made and entered into this _____ day of ____________, 202__
(“Effective Date”), by and between the CITY OF BOZEMAN, MONTANA, a self-governing
municipal corporation organized and existing under its Charter and the laws of the State of Montana,
121 North Rouse Street, Bozeman, Montana, with a mailing address of PO Box 1230, Bozeman, MT
59771, hereinafter referred to as “City,” and, PINTLER BILLING SERVICES, LLC, with an
address of P.O. Box 2458, Eureka, Montana, 59917, hereinafter referred to as “Contractor.” The City
and Contractor may be referred to individually as “Party” and collectively as “Parties.”
In consideration of the mutual covenants and agreements herein contained, the receipt and
sufficiency whereof being hereby acknowledged, the parties hereto agree as follows:
1. Purpose: City agrees to enter this Agreement with Contractor to perform for City
services described in the Scope of Services attached hereto as Exhibit A and by this reference made a
part hereof.
2. Term/Effective Date: This Agreement is valid for one year and will automatically
renew annually, unless either party requests a change in writing as detailed in paragraph 4(f) of this
Agreement. This Agreement is effective upon the Effective Date.
3. Scope of Services: Contractor will perform the work and provide the services in
accordance with the requirements of the Scope of Services. For conflicts between this Agreement and
the Scope of Services, unless specifically provided otherwise, the Agreement governs.
4. Payment:
a. General Charges and Payments. The City agrees to pay Contractor for services, as
set forth in the Scope of Services which is attached as Exhibit A.
b. Clearinghouse Subscription and Patient Statement Costs. The City will also be
responsible for the cost of the clearinghouse subscription and sending patient statements.
These charges may not exceed $33/month and $1.50 per patient statement per month
respectively.
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c. Start-up Fee. The City will be responsible for a one-time start-up fee of five hundred
dollars ($500.00) payable with payment of first invoice.
d. Monthly Statements of Transactions, Costs and Charges. Contractor will describe
the aforementioned costs, and any selected optional clients and their costs in a detailed
monthly statement identifying each transaction to allow for exact reconciliation. Costs may
not exceed reasonable and necessary costs for processing claims and procuring payment for
Client.
e. Suspension of Billing for Non-payment of Fees. The City agrees to pay Contractor
within ten (10) working days from date of invoice. Contractor reserves the right to suspend
billing for consistent non-payment or untimely payment by the City.
f. Changes to the Agreement. Contractor and the City shall retain the right to review
and possibly negotiate different terms of this Agreement as circumstances dictate. Any
changes to the rate of payment in paragraph 4a will be memorialized in an addendum to this
Agreement. The Parties reserve the right to re-negotiate the rate of payment prior to the
annual renewal of the contract.
5. City’s Representations:
a. The City will provide Contractor with all information and documents needed
by Contractor to make billing decisions and bill claims for the City. The City shall do this by
US mail, secure web portal, electronic PCR software, fax, or in person at least weekly unless
other arrangements have been made and both parties have agreed upon a change in delivery
arrangements. The City shall provide Contractor with true and accurate billing information,
including, but not limited to: patient demographic information, completed signature forms as
required by law, complete documentation of services provided, changes in crew members or
their licensure, payments and insurance remittance received, referral or authorization numbers
and/or documents, and/or other necessary medical documentation.
b. The City also agrees to provide Contractor with any new/updated information
within one week of receipt of such information. The City warrants that all information
provided to Contractor for billing purposes will be true and accurate to the best of its
knowledge. The City will keep original documents and provide Contractor with clear copies
in either paper or electronic form. All documents provided to Contractor will become the sole
property of Contractor except, upon termination of this Agreement, any protected health
information provided to Contractor by The City or created by Contractor on behalf of The
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City shall be handled as provided in the Business Associate Agreement between the parties.
c. The City agrees that the sole responsibility for maintenance of the relationship with
its ePCR vendor, including subscription, passwords, and administration, belongs to The City.
Assignment to Contractor by The City within electronic PCR software shall constitute
delivery of information to Contractor. The City agrees to provide access to its ePCRs through
the electronic PCR software to Billing Company, and agrees that a lapse in the access or
subscription to the electronic PCR software shall void Contractor duties to retrieve billing
information. The City remains the custodian of the PCR and medical records, though
Contractor shall retain a copy for billing documentation and support. All requests by third
parties for medical records shall be directed to The City for fulfillment, with the exception
of records requests for purposes of treatment or payment by receiving hospitals and
responsible payers, including insurance companies, which may be handled by Contractor.
Routine records requests required to facilitate payment will be handled by Contractor.
6. Contractor’s Representations: To induce City to enter into this Agreement,
Contractor makes the following representations:
a. Contractor has familiarized itself with the nature and extent of this Agreement, the
Scope of Services, and with all local conditions and federal, state and local laws, ordinances, rules,
and regulations that in any manner may affect cost, progress or performance of the Scope of Services.
b. Contractor represents and warrants to City that it has the experience and ability to
perform the services required by this Agreement; that it will perform the services in a professional,
competent and timely manner and with diligence and skill; that it has the power to enter into and
perform this Agreement and grant the rights granted in it; and that its performance of this Agreement
shall not infringe upon or violate the rights of any third party, whether rights of copyright, trademark,
privacy, publicity, libel, slander or any other rights of any nature whatsoever, or violate any federal,
state and municipal laws. The City will not determine or exercise control as to general procedures or
formats necessary to have these services meet this warranty.
c. Contractor represents that it can integrate into the City’s electronic PCR software in
order to satisfy all of the duties and terms listed in this Agreement and the Scope of Services.
7. Independent Contractor Status/Labor Relations: The parties agree that Contractor
is an independent contractor for purposes of this Agreement and is not to be considered an employee
of the City for any purpose. Contractor is not subject to the terms and provisions of the City’s
personnel policies handbook and may not be considered a City employee for workers’ compensation
or any other purpose. Contractor is not authorized to represent the City or otherwise bind the City in
any dealings between Contractor and any third parties.
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Contractor shall comply with the applicable requirements of the Workers’ Compensation Act,
Title 39, Chapter 71, Montana Code Annotated (MCA), and the Occupational Disease Act of
Montana, Title 39, Chapter 71, MCA. Contractor shall maintain workers’ compensation coverage for
all members and employees of Contractor’s business, except for those members who are exempted
by law.
Contractor shall furnish the City with copies showing one of the following: (1) a binder for
workers’ compensation coverage by an insurer licensed and authorized to provide workers’
compensation insurance in the State of Montana; or (2) proof of exemption from workers’
compensation granted by law for independent contractors.
In the event that, during the term of this Agreement, any labor problems or disputes of any
type arise or materialize which in turn cause any services to cease for any period of time, Contractor
specifically agrees to take immediate steps, at its own expense and without expectation of
reimbursement from City, to alleviate or resolve all such labor problems or disputes. The specific
steps Contractor shall take shall be left to the discretion of Contractor; provided, however, that
Contractor shall bear all costs of any related legal action. Contractor shall provide immediate relief
to the City so as to permit the services to continue at no additional cost to City.
Contractor shall indemnify, defend, and hold the City harmless from any and all claims,
demands, costs, expenses, damages, and liabilities arising out of, resulting from, or occurring in
connection with any labor problems or disputes or any delays or stoppages of work associated with
such problems or disputes. There is no liability on the part of Contractor to any entity for any debts,
liabilities or obligations incurred by or on behalf of the City.
8. Indemnity/Waiver of Claims/Insurance: For other than professional services
rendered, to the fullest extent permitted by law, Contractor agrees to release, defend, indemnify, and
hold harmless the City, its agents, representatives, employees, and officers (collectively referred to
for purposes of this Section as the City) from and against any and all claims, demands, actions, fees
and costs (including attorney’s fees and the costs and fees of expert witness and consultants), losses,
expenses, liabilities (including liability where activity is inherently or intrinsically dangerous) or
damages of whatever kind or nature connected therewith and without limit and without regard to the
cause or causes thereof or the negligence of any party or parties that may be asserted against,
recovered from or suffered by the City occasioned by, growing or arising out of or resulting from or
in any way related to: (i) the negligent, reckless, or intentional misconduct of the Contractor; or (ii)
any negligent, reckless, or intentional misconduct of any of the Contractor’s agents.
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For the professional services rendered, to the fullest extent permitted by law, Contractor
agrees to indemnify and hold the City harmless against claims, demands, suits, damages, losses, and
expenses, including reasonable defense attorney fees, to the extent caused by the negligence or
intentional misconduct of the Contractor or Contractor’s agents or employees.
Such obligations shall not be construed to negate, abridge, or reduce other rights or obligations
of indemnity that would otherwise exist. The indemnification obligations of this Section must not be
construed to negate, abridge, or reduce any common-law or statutory rights of the City as
indemnitee(s) which would otherwise exist as to such indemnitee(s).
Contractor’s indemnity under this Section shall be without regard to and without any right to
contribution from any insurance maintained by City.
Should the City be required to bring an action against the Contractor to assert its right to
defense or indemnification under this Agreement or under the Contractor’s applicable insurance
policies required below, the City shall be entitled to recover reasonable costs and attorney fees
incurred in asserting its right to indemnification or defense but only if a court of competent
jurisdiction determines the Contractor was obligated to defend the claim(s) or was obligated to
indemnify the City for a claim(s) or any portion(s) thereof.
In the event of an action filed against the City resulting from the City’s performance under
this Agreement, the City may elect to represent itself and incur all costs and expenses of suit.
Contractor also waives any and all claims and recourse against the City, including the right of
contribution for loss or damage to person or property arising from, growing out of, or in any way
connected with or incident to the performance of this Agreement except “responsibility for [City’s]
own fraud, for willful injury to the person or property of another, or for violation of law, whether
willful or negligent” as per 28-2-702, MCA.
These obligations shall survive termination of this Agreement and the services performed
hereunder.
In addition to and independent from the above, Contractor shall at Contractor’s expense secure
insurance coverage through an insurance company or companies duly licensed and authorized to
conduct insurance business in Montana which insures the liabilities and obligations specifically
assumed by the Contractor in this Section. The insurance coverage shall not contain any exclusion
for liabilities specifically assumed by the Contractor in this Section.
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The insurance shall cover and apply to all claims, demands, suits, damages, losses, and
expenses that may be asserted or claimed against, recovered from, or suffered by the City without
limit and without regard to the cause therefore and which is acceptable to the City. Contractor shall
furnish to the City an accompanying certificate of insurance and accompanying endorsements in
amounts not less than as follows:
Workers’ Compensation – statutory;
Employers’ Liability - $1,000,000 per occurrence; $2,000,000 annual aggregate;
Commercial General Liability - $1,000,000 per occurrence; $2,000,000 annual
aggregate;
Automobile Liability - $1,000,000 property damage/bodily injury per accident; and
Professional Liability - $1,000,000 per claim; $2,000,000 annual aggregate.
The above amounts shall be exclusive of defense costs. The City shall be endorsed as an
additional or named insured on a primary non-contributory basis on the Commercial General,
Employer’s Liability, and Automobile Liability policies. The insurance and required endorsements
must be in a form suitable to City and shall include no less than a thirty (30) day notice of cancellation
or non-renewal. Contractor shall notify City within two (2) business days of Contractor’s receipt of
notice that any required insurance coverage will be terminated or Contractor’s decision to terminate
any required insurance coverage for any reason.
The City must approve all insurance coverage and endorsements prior to the Contractor
commencing work.
9. Termination for Contractor’s Fault:
a. If Contractor refuses or fails to timely do the work, or any part thereof, or fails
to perform any of its obligations under this Agreement, or otherwise breaches any terms or
conditions of this Agreement, the City may, by written notice, terminate this Agreement and
the Contractor’s right to proceed with all or any part of the work (“Termination Notice Due
to Contractor’s Fault”). The City may then take over the work and complete it, either with its
own resources or by re-letting the contract to any other third party.
b. In the event of a termination pursuant to this Section 8, Contractor shall be
entitled to payment only for those services Contractor actually rendered.
c. Any termination provided for by this Section 8 shall be in addition to any other
remedies to which the City may be entitled under the law or at equity.
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d. In the event of termination under this Section 8, Contractor shall, under no
circumstances, be entitled to claim or recover consequential, special, punitive, lost business
opportunity, lost productivity, field office overhead, general conditions costs, or lost profits
damages of any nature arising, or claimed to have arisen, as a result of the termination.
10. Termination for City’s Convenience:
a. Should conditions arise which, in the sole opinion and discretion of the City,
make it advisable to the City to cease performance under this Agreement, the City may
terminate this Agreement by written notice to Contractor (“Notice of Termination for City’s
Convenience”). The termination shall be effective in the manner specified in the Notice of
Termination for City’s Convenience and shall be without prejudice to any claims that the City
may otherwise have against Contractor.
b. Upon receipt of the Notice of Termination for City’s Convenience, unless
otherwise directed in the Notice, the Contractor shall immediately cease performance under
this Agreement and make every reasonable effort to refrain from continuing work, incurring
additional expenses or costs under this Agreement and shall immediately cancel all existing
orders or contracts upon terms satisfactory to the City. Contractor shall do only such work as
may be necessary to preserve, protect, and maintain work already completed or immediately
in progress.
c. In the event of a termination pursuant to this Section 9, Contractor is entitled
to payment only for those services Contractor actually rendered on or before the receipt of the
Notice of Termination for City’s Convenience.
d. The compensation described in Section 9(c) is the sole compensation due to
Contractor for its performance of this Agreement. Contractor shall, under no circumstances,
be entitled to claim or recover consequential, special, punitive, lost business opportunity, lost
productivity, field office overhead, general conditions costs, or lost profits damages of any
nature arising, or claimed to have arisen, as a result of the termination.
11. Limitation on Contractor’s Damages; Time for Asserting Claim:
a. In the event of a claim for damages by Contractor under this Agreement,
Contractor’s damages shall be limited to contract damages and Contractor hereby expressly
waives any right to claim or recover consequential, special, punitive, lost business
opportunity, lost productivity, field office overhead, general conditions costs, or lost profits
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damages of any nature or kind.
b. In the event Contractor wants to assert a claim for damages of any kind or
nature, Contractor shall provide City with written notice of its claim, the facts and
circumstances surrounding and giving rise to the claim, and the total amount of damages
sought by the claim, within thirty (30) days of the facts and circumstances giving rise to the
claim. In the event Contractor fails to provide such notice, Contractor shall waive all rights
to assert such claim.
12. Representatives and Notices:
a. City’s Representative: The City’s Representative for the purpose of this
Agreement shall be Josh Waldo or such other individual as City shall designate in writing.
Whenever approval or authorization from or communication or submission to City is required
by this Agreement, such communication or submission shall be directed to the City’s
Representative and approvals or authorizations shall be issued only by such Representative;
provided, however, that in exigent circumstances when City’s Representative is not available,
Contractor may direct its communication or submission to other designated City personnel or
agents as designated by the City in writing and may receive approvals or authorization from
such persons.
b. Contractor’s Representative: The Contractor’s Representative for the
purpose of this Agreement shall be Leslie Graves or such other individual as Contractor shall
designate in writing. Whenever direction to or communication with Contractor is required by
this Agreement, such direction or communication shall be directed to Contractor’s
Representative; provided, however, that in exigent circumstances when Contractor’s
Representative is not available, City may direct its direction or communication to other
designated Contractor personnel or agents.
c. Notices: All notices required by this Agreement shall be in writing and
shall be provided to the Representatives named in this Section. Notices shall be deemed given
when delivered, if delivered by courier to Party’s address shown above during normal business
hours of the recipient; or when sent, if sent by email or fax (with a successful transmission
report) to the email address or fax number provided by the Party’s Representative; or on the
fifth business day following mailing, if mailed by ordinary mail to the address shown above,
postage prepaid.
13. Permits: Contractor shall provide all notices, comply with all applicable laws,
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ordinances, rules, and regulations, obtain all necessary permits, licenses, including a City of Bozeman
business license, and inspections from applicable governmental authorities, and pay all fees and
charges in connection therewith.
14. Laws and Regulations:
a. Contractor shall comply fully with all applicable state and federal laws, regulations,
and municipal ordinances including, but not limited to, all workers’ compensation laws, all
environmental laws including, but not limited to, the generation and disposal of hazardous waste, the
Occupational Safety and Health Act (OSHA), the safety rules, codes, and provisions of the Montana
Safety Act in Title 50, Chapter 71, MCA, all applicable City, County, and State building and electrical
codes, the Americans with Disabilities Act, and all non-discrimination, affirmative action, and
utilization of minority and small business statutes and regulations.
b. The Parties intend to comply fully with all applicable state and Federal laws and
regulations, including but not limited to the Balanced Budget Act of 1997, the Social Security Act,
the federal Anti-Kickback Statute, the federal False Claims Act, the Health Insurance Portability and
Accountability Act and all applicable state and federal fraud and abuse laws and rules. Contractor and
the City will each be responsible for monitoring and ensuring its own compliance with all applicable
state and Federal laws and regulations governing their respective activities pertinent to this
Agreement. The City accepts responsibility for knowledge of applicable regulations and laws, and
further warrants that patient care provided and activities performed by the City are compliant with all
applicable Federal and state laws and regulations. Contractor accepts only responsibility for
knowledge of regulations and applicable laws as they apply to Contractor activities, and assures the
City that Contractor will maintain the highest level of compliance possible through continued training
and education of its staff, and certification of at least one staff member as a Certified Ambulance
Compliance Officer (CACO) through the National Academy of Ambulance Compliance (NAAC).
Insofar as any terms or conditions of this Agreement are determined by any court or by the OIG to be
contrary to any such statutes or regulations, the parties will promptly and in good faith confer and
resolve any issues so as to make the performance of this Agreement consistent with all applicable
statutes and regulations.
c. If either Party becomes aware of any actual or potential violation by the other Party,
whether intentional or inadvertent, of any applicable state or Federal statute or regulation, it shall
promptly notify the other Party.
15. Nondiscrimination and Equal Pay: The Contractor agrees that all hiring by
Contractor of persons performing this Agreement shall be on the basis of merit and qualifications.
The Contractor will have a policy to provide equal employment opportunity in accordance with all
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applicable state and federal anti-discrimination laws, regulations, and contracts. The Contractor will
not refuse employment to a person, bar a person from employment, or discriminate against a person
in compensation or in a term, condition, or privilege of employment because of race, color, religion,
creed, political ideas, sex, age, marital status, national origin, actual or perceived sexual orientation,
gender identity, physical or mental disability, except when the reasonable demands of the position
require an age, physical or mental disability, marital status or sex distinction. The Contractor shall
be subject to and comply with Title VI of the Civil Rights Act of 1964; Section 140, Title 2, United
States Code, and all regulations promulgated thereunder.
Contractor represents it is, and for the term of this Agreement will be, in compliance with the
requirements of the Equal Pay Act of 1963 and Section 39-3-104, MCA (the Montana Equal Pay Act).
Contractor must report to the City any violations of the Montana Equal Pay Act that Contractor has
been found guilty of within 60 days of such finding for violations occurring during the term of this
Agreement.
Contractor shall require these nondiscrimination terms of its subcontractors providing services
under this Agreement.
16. Intoxicants; DOT Drug and Alcohol Regulations/Safety and Training: Contractor
shall not permit or suffer the introduction or use of any intoxicants, including alcohol or illegal drugs,
by any employee or agent engaged in services to the City under this Agreement while on City property
or in the performance of any activities under this Agreement. Contractor acknowledges it is aware of
and shall comply with its responsibilities and obligations under the U.S. Department of Transportation
(DOT) regulations governing anti-drug and alcohol misuse prevention plans and related testing. City
shall have the right to request proof of such compliance and Contractor shall be obligated to furnish
such proof.
The Contractor shall be responsible for instructing and training the Contractor's employees
and agents in proper and specified work methods and procedures. The Contractor shall provide
continuous inspection and supervision of the work performed. The Contractor is responsible for
instructing its employees and agents in safe work practices.
17. Modification and Assignability: This Agreement may not be enlarged, modified or
altered except by written agreement signed by both parties hereto. The Contractor may not
subcontract or assign Contractor’s rights, including the right to compensation or duties arising
hereunder, without the prior written consent of the City. Any subcontractor or assignee will be bound
by all of the terms and conditions of this Agreement.
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18. Reports/Accountability/Public Information: Contractor agrees to develop and/or
provide documentation as requested by the City demonstrating Contractor’s compliance with the
requirements of this Agreement. Contractor shall allow the City, its auditors, and other persons
authorized by the City to inspect and copy its books and records for the purpose of verifying that the
reimbursement of monies distributed to Contractor pursuant to this Agreement was used in
compliance with this Agreement and all applicable provisions of federal, state, and local law. The
Contractor shall not issue any statements, releases or information for public dissemination without
prior approval of the City.
19. Confidentiality: Neither Contractor nor the City shall, during the term of this
Agreement or any extension hereof, for any reason, disclose to any third party any proprietary
information regarding the other party unless required to do so by law, regulation or subpoena. For
purposes of this Agreement, “proprietary information” shall include, but not be limited to audit
requests, audit results, billing processes, and subscriber lists.
20. HIPAA Business Associate Agreement: The Business Associate Agreement
between the City and Contractor applicable to the parties under this Agreement is attached hereto as
Attachment A. This Agreement is the Underlying Agreement referred to therein.
21. Non-Waiver: A waiver by either party of any default or breach by the other party of
any terms or conditions of this Agreement does not limit the other party’s right to enforce such term
or conditions or to pursue any available legal or equitable rights in the event of any subsequent default
or breach.
22. Attorney’s Fees and Costs: In the event it becomes necessary for either Party to retain
an attorney to enforce any of the terms or conditions of this Agreement or to give any notice required
herein, then the prevailing Party or the Party giving notice shall be entitled to reasonable attorney's
fees and costs, including fees, salary, and costs of in-house counsel including the City Attorney’s
Office staff.
23. Taxes: Contractor is obligated to pay all taxes of any kind or nature and make all
appropriate employee withholdings.
24. Dispute Resolution:
a. Any claim, controversy, or dispute between the parties, their agents, employees, or
representatives shall be resolved first by negotiation between senior-level personnel from each
party duly authorized to execute settlement agreements. Upon mutual agreement of the
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parties, the parties may invite an independent, disinterested mediator to assist in the negotiated
settlement discussions.
b. If the parties are unable to resolve the dispute within thirty (30) days from the date the
dispute was first raised, then such dispute may only be resolved in a court of competent
jurisdiction in compliance with the Applicable Law provisions of this Agreement.
25. Survival: Contractor’s indemnification shall survive the termination or expiration of
this Agreement for the maximum period allowed under applicable law.
26. Headings: The headings used in this Agreement are for convenience only and are not
be construed as a part of the Agreement or as a limitation on the scope of the particular paragraphs to
which they refer.
27. Severability: In the event that any one or more of the provisions contained in this
Agreement shall, for any reason, held by any court or by the Office of Inspector General of the United
States Department of Health and Human Clients to be invalid, illegal, void, or unenforceable in any
respect, such invalidity, illegality, voidability, or unenforceability shall not affect any other provisions
and the Agreement shall be construed as if such invalid, illegal, or unenforceable provision had never
been contained in it.
28. Applicable Law: The parties agree that this Agreement is governed in all respects by
the laws of the State of Montana.
29. Binding Effect: This Agreement is binding upon and inures to the benefit of the heirs,
legal representatives, successors, and assigns of the parties.
30. No Third-Party Beneficiary: This Agreement is for the exclusive benefit of the
parties, does not constitute a third-party beneficiary agreement, and may not be relied upon or
enforced by a third party. There is no intent by either Party to create or establish a third-party
beneficiary or status or rights in any patient, subscriber or other person or entity.
31. Counterparts: This Agreement may be executed in counterparts, which together
constitute one instrument.
32. Integration: This Agreement and all Exhibits attached hereto constitute the entire
agreement of the parties. Covenants or representations not contained herein or made a part thereof
by reference, are not binding upon the parties. There are no understandings between the parties other
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than as set forth in this Agreement. All communications, either verbal or written, made prior to the
date of this Agreement are hereby abrogated and withdrawn unless specifically made a part of this
Agreement by reference.
33. Consent to Electronic Signatures: The Parties have consented to execute this
Agreement electronically in conformance with the Montana Uniform Electronic Transactions Act,
Title 30, Chapter 18, Part 1, MCA.
**** END OF AGREEMENT EXCEPT FOR SIGNATURES ****
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and
year first above written or as recorded in an electronic signature.
CITY OF BOZEMAN, MONTANA ____________________________________
CONTRACTOR
By________________________________ By__________________________________
Jeff Mihelich, City Manager
Print Name: ___________________________
Print Title: ____________________________
APPROVED AS TO FORM:
By_______________________________
Greg Sullivan, Bozeman City Attorney
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Pintler Billing Services, LLC
President
Leslie Graves
-1-
Ex. A: Scope of Services Agreement
EXHIBIT A: SCOPE OF SERVICE AGREEMENT
CLIENT CONTACT: CONTRACTOR CONTACT:
City of Bozeman
121 N. Rouse Ave.
Bozeman, Montana 59715
Pintler Billing Services, LLC
P.O. Box 2458
Eureka, Montana 59917
Primary Contact: Josh Waldo
406-582-2351
jwaldo@bozeman.net
Primary Contact: Leslie Graves
406-297-1627
leslie@pintlerbillingservices.com
Term:
_____________, 2022 to ____________, 2022
Project Overview:
The City of Bozeman operates transporting ambulances on a backup basis within the city
limits of Bozeman when the primary transporting service is unavailable. The City of
Bozeman is looking for a third party vendor to provide ambulance and response billing,
collection, financial reporting and analytical services.
Service Details:
1. Claims Processing and Follow-up. Contractor will process Client’s trip reports and submit
insurance claims, electronically or on paper (as required by payer), to insurance carriers as
soon as possible upon receipt of billing information but never more than five (5) days after
billing information is received by Contractor from Client, provided the billing information is
complete upon receipt as detailed above and is received from Client on a regular schedule of
at least weekly. Contractor will bill patients monthly for co-payments or private payments
due to Client. Contractor will track claims submitted and any delinquent claims will be
pursued by Contractor. Contractor will generate aging reports monthly and will investigate
past due claims and patient account issues. Payment plans for patients, if established by
Client policy, will be tracked by Contractor and delinquent patient accounts will be
presented in report form to Client for consideration of referral to an outside agency for
collection action. At the direction of Client, Contractor will negotiate payment plans with
patients and/or supply patients with a financial hardship waiver request form. Past due
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December 31
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Ex. A: Scope of Services Agreement
accounts will be sent by Contractor to Centron Services, a Montana collections agency (or
agency selected by Client), at the direction of Client.
2. Monthly Reports. Contractor will generate monthly reports detailing activity related to
claims and patient billing, including: aging, total revenue, total charges, patients receiving
statements, and any other matters agreed upon between Client and Contractor.
3. Patient and Client Staff Questions. Contractor will provide a telephone number for
questions and inquiries from patients and staff of Client. All questions from patients and
staff of Client will be answered by Contractor immediately when possible, but never longer
than one business day after receipt. If a transition from a prior Contractor is involved,
Contractor will provide unlimited assistance via email or phone to Client crew and managers
regarding completion of transition from previous Contractor, specific trip report
documentation and completion questions, and general questions regarding any aspect of
Contractor services for Client. One live (on-site or virtual) documentation training per year
for Client’s crews and other designated staff is included at no additional charge.
4. Patient Benefits, Prior Authorization and Referrals. Contractor will perform verification
of patient benefits for Client upon receipt of complete patient insurance and demographic
information. Client will be responsible for prior authorizations and/or referral procurement
where required prior to transport, although Contractor shall inform and educate Client of
requirements for authorizations and referrals whenever possible. Contractor is not
responsible for denied claims, including but not limited to any denials due to policy
exclusions, benefit limits, or insurance company decisions.
5. Refund Requests and Refunds. Contractor will investigate and, as necessary, dispute any
refund requests by insurance companies made to Client. In the event that a refund is due,
Client agrees to pay the refund amount to the insurance company, patient, or other party to
whom the refund is due within the time frame required by law. If there is a refund paid by
Client, Contractor will then refund to Client the amount corresponding to the percentage
billed by Contractor of the amount collected by Client that it subsequently refunded.
6. Processing and Reporting of Claim Payments. Contractor will provide a PO Box as a
payment address for remittance of physical payments. Contractor will collect mail from the
PO Box daily and payments received for Client will be deposited in Client’s account
biweekly. Client will provide deposit slips and a deposit stamp to Contractor, and Contractor
will deposit payments physically or via US Mail depending on bank location of Client. A
detailed report of all deposit items will be sent via secure web portal by Contractor to the
Client office for reference and archival purposes. At the request of Client, a separate
notification will be sent by Contractor to any County Treasurer’s office, bookkeeper’s
office, or other individual or entity designated by Client.
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Ex. A: Scope of Services Agreement
7. Assistance in Updating Enrollment Information and Address Changes. Contractor will
provide assistance to Client in updating enrollment information pertaining to Contractor with
Medicare, Medicaid, BlueCross BlueShield, and other major insurance carriers. Contractor
will also notify payers of address changes as necessary. Contractor will also provide
assistance with enrollment in EFT (and associated ERA) processes with payers as available.
8. Back-up Procedures. Contractor will maintain electronic copies of all software, billing
programs, and billing records offsite in a HIPAA-compliant manner. Contractor will contract
with a third-party storage company or companies to use state-of-the-art systems for data
preservation and, if necessary, restoration of systems.
Payment:
The City agrees to pay Contractor for services, at a rate of 8% of the amount received by
The City from all revenue it receives as a result of Contractor efforts. Contractor will
provide The City with a monthly statement and monthly reports detailing all transactions
that occurred during the previous month. Contractor will invoice The City at the beginning
of each month for claim payments received during the previous month. Payment will be due
within ten (10) days of The City’s receipt of the invoice
Additional Services: N/A
The scope of services set forth above are a binding agreement between the City of Bozeman and
Pintler Billing Services, LLC. This Scope of Service Agreement is incorporated into the Parties’
Professional Services Agreement. By signing below, each Party agrees to comply with the terms
and conditions set forth in this Scope of Service Agreement.
City of Bozeman Pintler Billing Services
Signature: __________________________ Signature: _________________________
Printed: __________________________ Printed: _________________________
Title: __________________________ Title: _________________________
Date: __________________________ Date: _________________________
DocuSign Envelope ID: 2B19CB10-FA79-40CC-9877-E52C5FA48BE8
Leslie Graves
President
4/20/2022
City Manager
4/20/2022
Jeff Mihelich