318-22 Exhibit A-Coronis Health for Emergency Transport Third Party Billing - 2022.pdf

ice shall include the removal of staples, scanning and shredding of all documents after the prescribed time period as stipulated in the N.J. State Statues pertaining to Record Retention. 14

TOWNSHIP OF WEST ORANGE 6. The vendor shall deposit all payments received on behalf of the Township in an account designated by the Township within 48 hours of their receipt. a. The vendor shall provide to the Township Finance Department a copy of all deposit slips for patient payments within two working days of the deposit. TheTownship will accept either facsimile or by US Mail (to be postmarked within the two-day time period). On these deposit slips or on an accompanying statement, the vendor shall indicate the name of the original patient and the date the service was rendered. b. Vendor shall forward to the Township a monthly report listing all billings and collections. This report shall be due no later than 10 days after previous months end. Vendor shall supply a sample report for the Township’s approval. . 7. The vendor is to provide with each invoice, information on the collection process, on hardship waivers, and on the proper method of contacting the vendor to receive clarification of the billing process. The Township will prepare this information with the assistance of the selected vendor and the vendor shall be responsible for making copies of these documents for inclusion with their billing information. 8. The vendor shall provide either a local and or a toll-free telephone number to provide prompt responses to patients’ questions regarding services rendered and charges billed. Customer service personnel shall have quick access to patients’ records and qualified to perform these services. Vendor shall provide direct line access for the Township representatives. 9. The vendor shall be responsible for providing their own stationery, invoices, all office and normal expenses, postage, telephone cost, personnel expenses and standard operating expenses required to fulfill this contract. Vendor shall not identify the Township of West Orange or the Fire Department on its letterhead or any preprinted stationary. The only acceptable reference is in the description of services rendered by the Fire Department. 10. The vendor is to be paid a percentage of the collections received as determined in this proposal process. Consequently, it is in the vendor's best interest to expedite the

re Department. 10. The vendor is to be paid a percentage of the collections received as determined in this proposal process. Consequently, it is in the vendor's best interest to expedite the billing and collection process, and to take the necessary action to secure payment from those users who are capable of doing so. 11. The vendor is to respond with reasonably accurate information to all inquiries relating to the billing process, insurance coverage, and the hardship waiver process. All inquiries relating to the quality of the ambulance service provided are to be referred to the Fire Chief of the West Orange Fire Department. 12. The vendor shall negotiate Advanced Life Support (ALS) agreements for the Township subject to approval by the Township. 13. The vendor shall advise the Township Fire Department on any ambulance calls which they 15

TOWNSHIP OF WEST ORANGE believe will not be reimbursed by insurance companies or Medicare due to the fact that there were not deemed to be medically necessary or the incident reports are improperly completed. The vendor shall not bill the user for this ambulance call even though they believe the bill may not be paid. The information to be provided to the Fire Department is for information and education purposes only. 14. In addition to the insurance requirements provided in the General Conditions, the selected vendor must provide liability insurance or a surety bond for no less than $100,000 for employee dishonesty, forgery, and/or theft. 15. The vendor agrees to maintain all of its policies, procedures and practices in a manner consistent with all Medicare, State, and Federal regulations and requirements. It will hold the Township harmless from any liability due to changes in these regulations and procedures that relate to billing and collection processes. 16. The vendor shall provide at least a 30 day notice of any changes in its collection processes or the information provided to users or paying agents. The Township shall reserve the right to review and/or reject any changes proposed by the vendor. 17. To be considered for this contract, a vendor must provide references for EMS billing and collection services billing for at least three (3) governmental or non-profit agencies in the State of New Jersey for the past ten (10) years. In each of these cases the vendor must have supplied these services for at least five (5) years. As a part of the bid, the vendor shall provide the names and addresses of references from these three agencies. A summary of the billing and collection history for these agencies and include a copy of their standard invoice and explanatory information provided to the user. 18. The vendor shall be headquartered and operating in the State of New Jersey for at least ten years. The vendor shall provide information on the number of employees available for billing and follow up notices on behalf of the Township. 16

TOWNSHIP OF WEST ORANGE Questions that have been asked in the past  Anticipated contract start date: 60 days from receipt of bids.  Maximum number of renewal options by policy or statute? 5 year maximum  Current contract has gone full term.  All options to extend the current contract been exercised.  Estimated or actual dollars were paid last year, last month, or last quarter to any incumbent(s): $100,314.94 paid for 2021  Proposals will be evaluated and how the selected vendor(s) will be chosen by: Competitive Contracting Ranking Method: Management, Technology & Cost  Level of satisfaction with your current vendor(s), if applicable. Satisfactory  Annual total adjustments for last year or for the last 12 months: N/A  Annual contractual allowance write offs for last year or for the last 12 months: N/A  Annual gross collections last year or for the last 12 months: $1,184,690.89  Per-mile ground transport charges: $15.00  Advanced life support emergency level 1 charges: $1,900.00  Advanced life support emergency level 2 charges: $2,450.00  Basic life support charges: BLS 1 - $800.00  Basic life support emergency charges: N/A  Specialty care transport charges: N/A  Treatment without transport charges: N/A  Average per-trip charge: $950.00  Last changes to your transport rates, and are you considering raising any of the rates currently charged: 2013 and we may consider changing if market allows  Percentage of patients are residents versus non-residents, and do you charge the two groups differently: N/A and Residents without insurance are not billed.  We do not operate any shared services agreements with any other municipal or county governments in the region.  Transports per year for basic life support for last year or for the last 12 months: 2021 = 3,355 12 months = 3,173  Transports per year for advanced life support emergency level 1 for last year or for the last 12 months: 2021 = 227 12 months = 212  Transports per year for advanced life support emergency level 2 for last year or for the last 12 months: 2021 = 4 12 months = 0  Transports per year for specialty care transport for last year or for the last 12 months: N/A  Transports per year for treatment without transport for

2 months: 2021 = 4 12 months = 0  Transports per year for specialty care transport for last year or for the last 12 months: N/A  Transports per year for treatment without transport for last year or for the last 12 months: N/A  Payer mix expressed as percentages of 100% billed: Medicaid 3%, Medicare 59%, Self Pay 3%, Commercial Ins 35%  Payer remit mix expressed as percentages of 100% of what you typically receive: Medicaid 14%, Medicare 54%, Self Pay 18%, Commercial Ins 14%  Total transport vehicles do you now operate: 4  Average loaded miles per trip: 5  Average revenue per call: $350.28  We do not have a lockbox provider.  EPCR provider: EMS Charts 17

TOWNSHIP OF WEST ORANGE  Current collection agency provider: Coronis Health, Morganville, NJ  Facility typically receiving most of our patients: St. Barnabas, Livingston, NJ 18

TOWNSHIP OF WEST ORANGE BIDDER’S CHECK LIST Mandatory Items  Completed Bid Proposal Form ________  Business Registration Certification ________  Public Works’ Contractors Certification (if applicable) ________  Stockholders Disclosure Statement ________  Affirmative Action Compliance Notice ________  Bid Deposit ________  Surety for Performance Bond ________ (If applicable)  Iranian Disclosure Form _________  Acknowledgement of Addenda _________  Township Political Contribution Statement _________ Please provide two (2) additional copies of entire bid package, one of which can be on a flash drive. Please review your proposal carefully before submitting. 19

TOWNSHIP OF WEST ORANGE THIRD PARTY BILLING FOR EMERGENCY AMBULANCE SERVICES PROPOSAL FORM The Township of West Orange is seeking an incentive based scale to maximize the collection of the billable ambulance services. An example is provided below. Example: Percentage Range of Collections by Vendor 5 % $0 to $100,000.00 10 % $101,000.00 to $200,000.00 Percentage increases to be paid by the Township would be based on total collections over a 12 month period. The undersigned hereby agrees to furnish all services, labor, materials, supervision, equipment, and other means as necessary to perform all the work in accordance with these specifications. _______ % $ 0 to 750,000.00 _______ % $ 751,000.00 to 1,000,000.00 _______ % $ 1,000,001.00 to 1,500,000.00 _______ % $ 1,551,000.00 and above ________________________________ ________________________________ Authorized Signature Print Name & Title ______________________________________ ______________________________________ Company Name Address ______________________________________ ______________________________________ Date City, State, Zip ______________________________________ Telephone Number ______________________________________ 20

TOWNSHIP OF WEST ORANGE Email Address Business Registration Certification Effective September 1, 2004, the State has expanded its Contractor Registration Program to local Government contracts, P.L. 2004, c57. All business organizations that do business with a local government agency are required to be registered with the State. The business must provide proof of that registration to the local government agency before that local government agency can enter into a contract with the business. A copy of the Business Registration Certificate shall be provided at the time any bid or RFP is submitted; failure to do so is a fatal defect that cannot be cured. A copy of the Business Registration Certificate must also be on file before any purchase order/voucher or other contracting document can be issued. Contractors are responsible for notifying subcontractors. Further information and registration can be obtained online from the NJ Treasury, Division of Revenue or by calling (609) 292-1730. ************************ P.L. 1999 Chapter 238. The Public Works Contractor Registration Act specifies that no contractor or subcontractor shall bid on or engage in any contract (or part thereof) for public work which is subject to the provisions of the “New Jersey Prevailing Wage Act”, P.L. 1963 C. 150 (c. 34:11-56.25 et seq.) for the construction, reconstruction, demolition, alteration, repair, or maintenance of a public building regularly open to and used by the general public or public institution, and includes any subcontractor or lower tier subcontractor of a contractor unless they are registered with the Commissioner of Labor. 21