RFP CONTRACT 200131 H.S MEDICAL BILLING.PDF
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Contract 200131
CONTRACT PURSUANT TO PH RFP 200131
This Contract is entered into this 8t h day of December, 2019 by and between Maricopa County ("County"), a
political subdivision of the State of Arizona, and H.S. Medical Billing Services dba PractiSynergy ("Contractor") for
the purchase of Medical Billing Outsourcing Services.
1.0 CONTRACT TERM:
1.1 This Contract is for a term of three (3) years, beginning on the Sth day of December, 2019 and ending
the 7th day of December, 2022.
1.2 The County may, at its option and with the agreement of the Contractor, renew the term of this
Contract for additional terms up to a maximum of three (3) additional years, (or at the County's sole
discretion, extend the contract on a month-to-month bases for a maximum of six (6) months after
expiration). The County shall notify the Contractor in writing of its intent to extend the Contract
term at least sixty (60) calendar days prior to the expiration of the original contract term, or any
additional term thereafter.
1.3 CONTRACT COMPLETION:
The Contractor shall make all reasonable efforts for an orderly transition of its duties and
responsibilities to another provider and/or to the County. This may include, but is not limited to the
preparation of a transition plan and cooperation with the County or other providers in the transition.
The transition includes the transfer of all records, and other data in the possession, custody or control
of Contractor required to be provided to the County either by the terms of this agreement or as a
matter of law. The provisions of this clause shall survive the expiration or termination of this
agreement.
2.0 PRICE ADJUSTMENTS:
Any requests for reasonable price adjustments must be submitted sixty (60) calendar days prior to the
Contract expiration date. Requests for adjustment in cost of labor and/or materials must be supported by
appropriate documentation. The reasonableness of the request will be determined by comparing the request
with the Consumer Price Index or by performing a market survey. If County agrees to the adjusted price
terms, County shall issue written approval of the change and provide an updated version of the Contract. The
new change shall not be in effect until the date stipulated on the Contract.
3.0 PAYMENTS:
3.1 As consideration for performance of the duties described herein, County shall pay Contractor the
sum(s) stated in Exhibit "A."
3.2 Payment shall be made upon the County's receipt of a properly completed invoice.
3.3 INVOICES:
3.3.1 The Contractor shall submit one (1) legible copy of their detailed invoice before payment(s)
will be made. Incomplete invoices will not be processed. At a minimum, the invoice must
provide the following information:
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Contract 200131
Company name, address and contact
County bill-to name and contact information
Contract Serial Number
County purchase order number
Project name and/or number
Invoice number and date
Payment terms
Date of service or delivery
Quantity (number of days or weeks)
Contract Item number(s)
Description of Purchase (product or services)
Pricing per unit of purchase
Total Amount Due
3.3.2 Problems regarding billing or invoicing shall be directed to the Department as listed on the
Purchase Order.
3.3.3 Payment shall only be made to the Contractor by Accounts Payable through the Maricopa
County Vendor Express Payment Program. This is an Electronic Funds Transfer (EFT)
process. After Contract Award the Contractor shall complete the Vendor Registration
Form located on the County Department of Finance Vendor Registration Web Site
(http;//www.maricopa.gov/922/Vendors).
3.3,4 Discounts offered in the contract shall be calculated based on the date a properly completed
invoice is received by the County.
3.3,5 EFT payments to the routing and account numbers designated by the Contractor will
include the details on the specific invoices that the payment covers. The Contractor is
required to discuss remittance delivery capabilities with their designated financial
institution for access to those details.
3.4 APPLICABLE TAXES:
3.4.1 Payment of Taxes: The Contractor shall pay all applicable taxes. With respect to any
installation labor on items that are not attached to real property performed by Contractor
under the terms of this Contract, the installation labor cost and the gross receipts for
materials provided shall be listed separately on the Contractor's invoices.
3.4.2 State and Local Transaction Privilege Taxes: To the extent any State and local transaction
privilege taxes apply to sales made under the terms of this Contract it is the responsibility
of the seller to collect and remit all applicable taxes to the proper taxing jurisdiction of
authority,
3.4.3 Tax Indemnification: Contractor and all subcontractors shall pay all Federal, State, and
local taxes applicable to its operation and any persons employed by the Contractor.
Contractor shall, and require all subcontractors to hold Maricopa County harmless from
any responsibility for taxes, damages and interest, if applicable, contributions required
under Federal, and/or State and local laws and regulations, and any other costs including;
transaction privilege taxes, unemployment compensation insurance, Social Security, and
Worker's Compensation.
3.5 TAX (SERVICES):
No tax shall be invoiced or paid against Contractor's labor. It is the responsibility of the Contractor
to determine any and all applicable taxes.
3,6 STRATEGIC ALLIANCE for VOLUME EXPENDITURES ($AVE):
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The County is a member of the SAVE cooperative purchasing group. SAVE includes the State of
Arizona, many Phoenix metropolitan area municipalities, and many K-12 unified school districts.
Under the SAVE Cooperative Purchasing Agreement, and with the concurrence of the successful
Respondent under this solicitation, a member of SAVE may access a contract resulting from a
solicitation issued by the County.
3.7 INTERGOVERNMENTAL COOPERATIVE PURCHASING AGREEMENTS (ICPA's):
County currently holds !CPA's with numerous governmental entities. These agreements allow
those entities, with the approval of the Contractor, to purchase their requirements under the terms
and conditions of the County Contract. It is the responsibility of the non-County government entity
to perform its own due diligence on the acceptability of the Contract under its procurement rules,
processes and procedures.
4.0 AVAILABILITY OF FUNDS:
4.1 The provisions of this Contract relating to payment for services shall become effective when funds
assigned for the purpose of compensating the Contractor as herein provided are actually available
to County for disbursement. The County shall be the sole judge and authority in determining the
availability of funds under this Contract. County shall keep the Contractor fully informed as to the
availability of funds.
4.2 If any action is taken by, any State agency, Federal department, or any other agency or
instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in connection with,
this Contract, County may amend, suspend, decrease, or terminate its obligations under, or in
connection with, this Contract. In the event of termination, County shall be liable for payment only
for services rendered prior to the effective date of the termination, provided that such services are
performed in accordance with the provisions of this Contract. County shall give written notice of
the effective date of any suspension, amendment, or termination under this Section, at least ten (10)
days in advance.
5.0 DUTIES:
5.1 The Contractor shall perform all duties stated in Exhibit "B", or as otherwise directed in writing by
the Procurement Officer.
6.0 TERMS AND CONDITIONS:
6.1 INDEMNIFICATION:
To the fullest extent permitted by law, and to the extent that claims, damages, losses or expenses are
not covered and paid by insurance purchased by the Contractor, the Contractor shall defend
indemnify and hold harmless the County (as Owner), its agents, representatives, agents, officers,
directors, officials, and employees from and against all claims, damages, losses, and expenses
(including, but not limited to attorneys' fees, court costs, expert witness fees, and the costs and
attorneys' fees for appellate proceedings) arising out of, or alleged to have resulted from the
negligent acts, errors, omissions, or mistakes relating to the performance of this Contract.
Contractor's duty to defend, indemnify, and hold harmless the County, its agents, representatives,
agents, officers, directors, officials, and employees shall arise in connection with any claim, damage,
loss, or expense that is attributable to bodily injury, sickness, disease, death or injury to, impairment
of, or destruction of tangible property, including loss of use resulting there from, caused by negligent
acts, errors, omissions, or mistakes in the performance of this Contract, but only to the extent caused
by the negligent acts or omissions of the Contractor, a subcontractor, any one directly or indirectly
employed by them, or anyone for whose acts they may be liable, regardless of whether or not such
claim, damage, loss, or expense is caused in part by a party indemnified hereunder.
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The amount and type of insurance coverage requirements set forth herein will in no way be construed
as limiting the scope of the indemnity in this paragraph.
The scope of this indemnification does not extend to the sole negligence of County.
6.2 INSURANCE:
6.2.1 Contractor, at Contractor's own expense, shall purchase and maintain the herein stipulated
minimum insurance from a company or companies duly licensed by the State of Arizona
and possessing a current A.M. Best, Inc. rating of B++. In lieu of State of Arizona licensing,
the stipulated insurance may be purchased from a company or companies, which are
authorized to do business in the State of Arizona, provided that said insurance companies
meet the approval of County. The form of any insurance policies and forms must be
acceptable to County.
6.2.2 All insurance required herein shall be maintained in full force and effect until all work or
service required to be performed under the terms of the Contract is satisfactorily completed
and formally accepted. Failure to do so may, at the sole discretion of County, constitute a
material breach of this Contract.
6.2.3 Contractor's insurance shall be primary insurance as respects County, and any insurance
or self-insurance maintained by County shall not contribute to it.
6.2.4 Any failure to comply with the claim reporting provisions of the insurance policies or any
breach of an insurance policy warranty shall not affect the County's right to coverage
afforded under the insurance policies.
6.2.5 The insurance policies may provide coverage that contains deductibles or self-insured
retentions. Such deductible and/or self-insured retentions shall not be applicable with
respect to the coverage provided to County under such policies. Contractor shall be solely
responsible for the deductible and/or self-insured retention and County, at its option, may
require Contractor to secure payment of such deductibles or self-insured retentions by a
surety bond or an irrevocable and unconditional letter of credit.
6.2.6 The insurance policies required by this Contract, except Workers' Compensation and
Errors and Omissions, shall name County, its agents, representatives, officers, directors,
officials and employees as Additional Insureds.
6.2.7 The policies required hereunder, except Workers' Compensation and Errors and
Omissions, shall contain a waiver of transfer of rights of recovery (subrogation) against
County, its agents, representatives, officers, directors, officials and employees for any
claims arising out of Contractor's work or service.
6.2.8 Commercial General Liability:
Commercial General Liability insurance and, if necessary, Commercial Umbrella
insurance with a limit of not less than $1,000,000 for each occurrence, $2,000,000
Products/Completed Operations Aggregate, and $2,000,000 General Aggregate Limit. The
policy shall include coverage for premises liability, bodily injury, broad form property
damage, personal injury, products and completed operations and blanket contractual
coverage, and shall not contain any provisions which would serve to limit third party action
over claims. There shall be no endorsement or modifications of the CGL limiting the scope
of coverage for liability arising from explosion, collapse, or underground property damage.
6.2.9 Automobile Liability:
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Commercial/Business Automobile Liability insurance and, if necessary, Commercial
Umbrella insurance with a combined single limit for bodily injury and property damage of
not less than $2,000,000 each occurrence with respect to any of the Contractor's owned,
hired, and non-owned vehicles assigned to or used in performance of the Contractor's work
or services or use or maintenance of the premises under this Contract.
6.2.10 Workers' Compensation:
Workers' Compensation insurance to cover obligations imposed by Federal and State
statutes having jurisdiction of Contractor's employees engaged in the performance of the
work or services under this Contract; and Employer's Liability insurance of not less than
$1,000,000 for each accident, $1,000,000 disease for each employee, and $1,000,000
disease policy limit.
Contractor, its contractors and its subcontractors waive all rights against Contract and its
agents, officers, directors and employees for recovery of damages to the extent these
damages are covered by the Workers' Compensation and Employer's Liability or
commercial umbrella liability insurance obtained by Contractor, its contractors and its
subcontractors pursuant to this Contract.
6.2.11 Errors and Omissions (Professional Liability) Insurance:
Errors and Omissions (Professional Liability) insurance and, if necessary, Commercial
Umbrella insurance, which will insure and provide coverage for errors or omissions or
professional liability of the Contractor, with limits of no less than $2,000,000 for each
claim.
6.2.12 Certificates of Insurance:
6.2.12.1 Prior to Contract award, Contractor shall furnish the County with valid and
complete certificates of insurance, or formal endorsements as required by the
Contract in the form provided by the County, issued by Contractor's insurer(s), as
evidence that policies providing the required coverage, conditions and limits
required by this Contract are in full force and effect. Such certificates shall
identify this contract number and title.
6.4.23.1 In the event any insurance policy(ies) required by this Contract is(are) written on
a claims made basis, coverage shall extend for two years past completion and
acceptance of Contractor's work or services and as evidenced by annual
Certificates of Insurance.
6.4.23.2 If a policy does expire during the life of the Contract, a renewal certificate must
be sent to County fifteen (15) calendar days prior to the expiration date.
6.2.13 Cancellation and Expiration Notice:
Applicable to all insurance policies required within the Insurance Requirements of this
Contract, Contractor's insurance shall not be permitted to expire, be suspended, be
canceled, or be materially changed for any reason without thirty (30) days prior written
notice to Maricopa County. Contractor must provide to Maricopa County, within two (2)
business days of receipt, if they receive notice of a policy that has been or will be
suspended, canceled, materially changed for any reason, has expired, or will be
expiring. Such notice shall be sent directly to Maricopa County Office of Procurement
Services and shall be mailed or hand delivered to 320 West Lincoln Street, Phoenix, AZ
85003, or emailed to the Procurement Officer noted in the solicitation.
6.3 FORCE MAJEURE:
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6.3.1 Neither party shall be liable for failure of performance, nor incur any liability to the other
party on account of any loss or damage resulting from any delay or failure to perform all
or any part of this Contract if such delay or failure is caused by events, occurrences, or
causes beyond the reasonable control and without negligence of the parties. Such events,
occurrences, or causes will include Acts of God/Nature (including fire, flood, earthquake,
storm, hurricane or other natural disaster), war, invasion, act of foreign enemies, hostilities
(whether war is declared or not), civil war, riots, rebellion, revolution, insurrection, military
or usurped power or confiscation, terrorist activities, nationalization, government sanction,
lockout, blockage, embargo, labor dispute, strike, interruption or failure of electricity or
telecommunication service.
6.3.2 Each party, as applicable, shall give the other party notice of its inability to perform and
particulars in reasonable detail of the cause of the inability. Each party must use best
efforts to remedy the situation and remove, as soon as practicable, the cause of its inability
to perform or comply.
6.3.3 The party asserting Force Majeure as a cause for non-performance shall have the burden
of proving that reasonable steps were taken to minimize delay or damages caused by
foreseeable events, that all non-excused obligations were substantially fulfilled, and that
the other party was timely notified of the likelihood or actual occurrence which would
justify such an assertion, so that other prudent precautions could be contemplated.
6.4 WARRANTY OF SERVICES:
6.4.1 The Contractor warrants that all services provided hereunder will conform to the
requirements of the Contract, including all descriptions, specifications and attachments
made a part of this Contract. County's acceptance of services or goods provided by the
Contractor shall not relieve the Contractor from its obligations under this warranty.
6.4.2 In addition to its other remedies, County may, at the Contractor's expense, require prompt
correction of any services failing to meet the Contractor's warranty herein. Services
corrected by the Contractor shall be subject to all the provisions of this Contract in the
manner and to the same extent as services originally furnished hereunder.
6.5 INSPECTION OF SERVICES:
6.5.1 The Contractor shall provide and maintain an inspection system acceptable to County
covering the services under this Contract. Complete records of all inspection work
performed by the Contractor shall be maintained and made available to County during
Contract performance and for as long afterwards as the Contract requires.
6.5.2 County has the right to inspect and test all services called for by the Contract, to the extent
practicable at all times and places during the term of the Contract. County shall perform
inspections and tests in a manner that will not unduly delay the work.
6.5.3 If any of the services do not conform to Contract requirements, County may require the
Contractor to perform the services again in conformity with Contract requirements, at no
cost to the County. When the defects in services cannot be corrected by re-performance,
County may:
6.8.3.1 Require the Contractor to take necessary action to ensure that future performance
conforms to Contract requirements; and
6.8.3.2 Reduce the Contract price to reflect the reduced value of the services performed.
6.5.4 If the Contractor fails to promptly perform the services again or to take the necessary action
to ensure future performance in conformity with Contract requirements, County may:
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6.8.4.1 By Contract or otherwise, perform the services and charge to the Contractor,
through direct billing or through payment reduction, any cost incurred by County
that is directly related to the performance of such service; or
6.8.4.2 Terminate the Contract for default.
6.6 ORDERING AUTHORITY:
Any request for purchase shall be accompanied by a valid purchase order, issued by Office of
Procurement Services, a Purchase Order issued by the using Department or direction by a Certified
Agency Procurement Aid (CAPA) with a Purchase Card for payment.
6.7 PURCHASE ORDERS:
County reserves the right to cancel Purchase Orders within a reasonable period of time after
issuance. Should a Purchase Order be canceled, the County agrees to reimburse the Contractor for
actual and documentable costs incurred by the Contractor in response to the Purchase Order, The
County will not reimburse the Contractor for any costs incurred after receipt of County notice of
cancellation, or for lost profits, shipment of product prior to issuance of Purchase Order, etc.
6.8 SUSPENSION OF WORK:
The Procurement Officer may order the Contractor, in writing, to suspend, delay, or interrupt all or
any part of the work of this contract for the period of time that the Procurement Officer determines
appropriate for the convenience of the County. No adjustment shall be made under this clause for
any suspension, delay, or interruption to the extent that performance would have been so suspended,
delayed, or interrupted by any other cause, including the fault or negligence of the Contractor. No
request for adjustment under this clause shall be granted unless the claim, in an amount stated, is
asserted in writing as soon as practicable after the termination of the suspension, delay, or
interruption, but not later than the date of final payment under the Contract.
6.9 STOP WORK ORDER:
The Procurement Officer may, at any time, by written order to the Contractor, require the Contractor
to stop all, or any part, of the work called for by this contract for a period of ninety (90) calendar
days after the order is delivered to the Contractor, and for any further period to which the parties
may agree. The order shall be specifically identified as a stop work order issued under this clause.
Upon receipt of the order, the Contractor shall immediately comply with its terms and take all
reasonable steps to minimize the incurrence of costs allocable to the work covered by the order
during the period of work stoppage. Within a period of 90 calendar days after a stop-work is
delivered to the Contractor, or within any extension of that period to which the parties shall have
agreed, the Procurement Officer shall either:
6.9.1 Cancel the stop work order; or
6.9.2 Terminate the work covered by the order as provided in the Default, or the Tel initiation for
Convenience clause of this Contract.
6.9.3 The Procurement Officer may make an equitable adjustment in the delivery schedule
and/or Contract price, or otherwise, and the Contract shall be modified, in writing,
accordingly, if the Contractor demonstrates that the stop work order resulted in an increase
in costs to the Contractor.
6.10 TERMINATION FOR CONVENIENCE:
Maricopa County may terminate the Contract for convenience by providing sixty (60) calendar days
advance notice to the Contractor.
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6.11 TERMINATION FOR DEFAULT:
The County may, by written notice of default to the Contractor, terminate this Contract in whole or
in part if the Contractor fails to:
6.11.1 Deliver the supplies or to perform the services within the time specified in this Contract or
any extension;
6.11.2 Make progress, so as to endanger performance of this Contract; or
6.11.3 Perform any of the other provisions of this Contract.
The County's right to terminate this contract under these subparagraphs may be exercised if the
Contractor does not cure such failure within ten (10) business days (or more if authorized in writing
by the County) after receipt of the notice from the Procurement Officer specifying the failure.
6.12 STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST:
Notice is given that pursuant to A.R.S. § 38-511 the County may cancel any Contract without
penalty or further obligation within three years after execution of the Contract, if any person
significantly involved in initiating, negotiating, securing, drafting or creating the Contract on behalf
of the County is at any time while the Contract or any extension of the Contract is in effect, an
employee or agent of any other party to the Contract in any capacity or consultant to any other party
of the Contract with respect to the subject matter of the Contract. Additionally, pursuant to A.R.S
§ 38-511 the County may recoup any fee or commission paid or due to any person significantly
involved in initiating, negotiating, securing, drafting or creating the Contract on behalf of the County
from any other party to the Contract arising as the result of the Contract.
6.13 CONTRACTOR LICENSE REQUIREMENT:
6.13.1 The Contractor shall procure all permits, insurance, licenses and pay the charges and fees
necessary and incidental to the lawful conduct of his/her business, and as necessary
complete any required certification requirements, required by any and all governmental or
non-governmental entities as mandated to maintain compliance with and in good standing
for all permits and/or licenses. The Contractor shall keep fully informed of existing and
future trade or industry requirements, Federal, State and Local laws, ordinances, and
regulations which in any manner affect the fulfillment of a Contract and shall comply with
the same. Contractor shall immediately notify both Office of Procurement Services and the
Department of any and all changes concerning permits, insurance or licenses.
6.14 SUBCONTRACTING:
6.14.1 The Contractor may not assign to another contractor or subcontract to another party for
performance of the terms and conditions hereof without the written consent of the County.
All correspondence authorizing subcontracting must reference the Contract Number and
identify the job project.
6.14.2 The subcontractor's rate for the job shall not exceed that of the Prime Contractor's rate, as
bid in the pricing section, unless the Prime Contractor is willing to absorb any higher rates
or the County has approved the increase. The subcontractor's invoice shall be invoiced
directly to the Prime Contractor, who in turn shall pass-through the costs to the County,
without mark-up. A copy of the subcontractor's invoice must accompany the Prime
Contractor's invoice.
6.15 AMENDMENTS:
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All amendments to this Contract shall be in writing and approved/signed by both parties. The
designated Procurement Officer shall be responsible for approving all amendments for Maricopa
County.
6.16 ADDITIONS/DELETIONS OF REQUIREMENTS:
The County reserves the right to add and/or delete materials and services to a Contract. If a service
requirement is deleted, payment to the Contractor will be reduced proportionately, to the amount of
service reduced in accordance with the bid price. If additional materials or services are required
fi-om a Contract, prices for such additions will be negotiated between the Contractor and the County.
6.17 STRICT COMPLIANCE:
Acceptance by County of a performance that is not in strict compliance with the terms of the
Contract shall not be deemed to be a waiver of strict compliance with respect to all other terms of
the Contract.
6.18 VALIDITY:
The invalidity, in whole or in part, of any provision of this Contract shall not void or affect the
validity of any other provision of the Contract.
6.19 SEVERABILITY:
The removal, in whole or in part, of any provision of this Contract shall not void or affect the validity
of any other provision of this Contract.
6.20 RIGHTS IN DATA:
The County shall have the use of data and reports resulting from a Contract without additional cost
or other restriction except as may be established by law or applicable regulation. Each Party shall
supply to the other Party, upon request, any available information that is relevant to a Contract and
to the performance thereunder.
6.21 NON-DISCRIMINATION:
Contractor agrees to comply with all provisions and requirements of Arizona Executive Order 2009-
09 including flow down of all provisions and requirements to any subcontractors. Executive Order
2009-09 supersedes Executive order 99-4 and amends Executive order 75-5 and may be viewed and
downloaded at the Arizona State Library Research website
ttp://azinemory. azlibrary.gov/cdm/singl e itent/coIlection/execorders/id/680/rec/1) which is
hereby incorporated into this contract as if set forth in full herein. During the performance of this
Contract, Contractor shall not discriminate against any employee, client or any other individual in
any way because of that person's age, race, creed, color, religion, sex, disability or national origin.
6.22 CERTIFICATION REGARDING DEBARMENT AND SUSPENSION:
6.22.1 The undersigned (authorized official signing on behalf of the Contractor) certifies to the
best of his or her knowledge and belief that the Contractor, it's current officers and
directors;
6.211 are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from being awarded any contract or grant by
any United States Department or Agency or any state, or local jurisdiction;
6.22.2 have not within three (3) year period preceding this Contract;
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6.22.2.1.1 been convicted of fraud or any criminal offense in connection with
obtaining, attempting to obtain, or as the result of performing a
government entity (Federal, State or local) transaction or contract; and
6.22.2.1.2 been convicted of violation of any Federal or State antitrust statues or
conviction for embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen
property regarding a government entity transaction or contract;
6.22.2.1.3 are not presently indicted or criminally charged by a government
entity (Federal, State or local) with commission of any criminal
offenses in connection with obtaining, attempting to obtain, or as the
result of performing a government entity public (Federal, State or
local) transaction or contract; and are not presently facing any civil
charges from any governmental entity regarding obtaining, attempting
to obtain, or from performing any governmental entity contract or
other transaction; and have not within a three (3) year period preceding
this Contract had any public transaction (Federal, State or local)
terminated for cause or default.
6.22.2.2 If any of the above circumstances described in the paragraph are
applicable to the entity submitting a bid for this requirement, include
with your bid an explanation of the matter including any final
resolution.
6.22.3 The Contractor shall include, without modification, this clause in all lower tier
covered transactions (i.e. transactions with subcontractors) and in all solicitations
for lower tier covered transactions related to this Contract.
6.23 VERIFICATION REGARDING COMPLIANCE WITH A.R.S. §41-4401 AND FEDERAL
IMMIGRATION LAWS AND REGULATIONS:
6.23.1 By entering into the Contract, the Contractor warrants compliance with the
Immigration and Nationality Act (INA using e-verify) and all other Federal
immigration laws and regulations related to the immigration status of its employees
and A.R.S. §23-214(A). The Contractor shall obtain statements from its
subcontractors certifying compliance and shall furnish the statements to the
Procurement Officer upon request. These warranties shall remain in effect through
the term of the Contract. The Contractor and its subcontractors shall also maintain
Employment Eligibility Verification forms (1-9) as required by the Immigration
Reform and Control Act of 1986, as amended from time to time, for all employees
performing work under the Contract and verify employee compliance using the E-
verify system and shall keep a record of the verification for the duration of the
employee's employment or at least three (3) years, whichever is longer. 1-9 forms
are available for download at USCIS.GOV .
6.23.2 The County retains the legal right to inspect Contractor and subcontractor employee
documents performing work under this Contract to verify compliance with
paragraph 6.23.1 of this Section. Contractor and subcontractor shall be given
reasonable notice of the County's intent to inspect and shalt make the documents
available at the time and date specified. Should the County suspect or find that the
Contractor or any of its subcontractors are not in compliance, the County will
consider this a material breach of the Contract and may pursue any and all remedies
allowed by law, including, but not limited to; suspension of work, termination of
the Contract for .default, and suspension and/or debarment of the Contractor. All
costs necessary to verify compliance are the responsibility of the Contractor.
6.24 INFLUENCE:
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As prescribed in MCI-1203 of the Maricopa County Procurement Code, any effort to influence an
employee or agent to breach the Maricopa County Ethical Code of Conduct or any ethical conduct
may be grounds for Disbarment or Suspension under MC1-902.
An attempt to influence includes, but is not limited to:
6.24.1 A Person offering or providing a gratuity, gift, tip, present, donation, money,
entertainment or educational passes or tickets, or any type of valuable contribution
or subsidy,
6.24.2 That is offered or given with the intent to influence a decision, obtain a contract,
garner favorable treatment, or gain favorable consideration of any kind.
If a Person attempts to influence any employee or agent of Maricopa County, the Chief Procurement
Officer, or his designee, reserves the right to seek any remedy provided by the Maricopa County
Procurement Code, any remedy in equity or in the law, or any remedy provided by this contract.
6.25 CONTRACTOR EMPLOYEE WH1STLEBLOWER RIGHTS AND REQUIREMENT TO
INFORM EMPLOYEES OF WHISTLERBLOWER RIGHTS:
6.25.1 The Parties agree that this Contract and employees working on this Contract will
be subject to the whistleblower rights and remedies in the pilot program on
Contractor employee whistleblower protections established at 41 U.S.C. § 4712
by section 828 of the National Defense Authorization Act for Fiscal Year 2013
(Pub. L. 112-239) and section 3.908 of the Federal Acquisition Regulation;
6.25.2 Contractor shall inform its employees in writing, in the predominant language of
the workforce, of employee whistleblower rights and protections under 41 U.S.C.
§ 4712, as described in section 3.908 of the Federal Acquisition Regulation.
Documentation of such employee notification must be kept on file by Contractor
and copies provided to County upon request.
6.25.3 Contractor shall insert the substance of this clause, including this paragraph, in all
subcontracts over the simplified acquisition threshold ($150,000 as of September
2013).
6.26 UNIFORM ADMINISTRATIVE REQUIREMENTS:
By entering into this Contract the Contractor agrees to comply with all applicable provisions of Title
2, Subtitle A, Chapter II, PART 200—UNIFORM ADMINISTRATIVE REQUIREMENTS,
COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL AWARDS contained in
Title 2 C.F.R. § 200 et seq.
6.27 ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR
OTHER REVIEW:
6.27.1 In accordance with section MCI 371 of the Maricopa County Procurement Code
the Contractor agrees to retain (physical or digital copies of) all books, records,
accounts, statements, reports, files, and other records and back-up documentation
relevant to this Contract for six (6) years after final payment or until after the
resolution of any audit questions which could be more than six (6) years,
whichever is latest. The County, Federal or State auditors and any other persons
duly authorized by the Department shall have full access to, and the right to
examine, copy and make use of, any and all said materials.
6.27.2 If the Contractor's books, records, accounts, statements, reports, files, and other
records and back-up documentation relevant to this Contract are not sufficient to
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Contract 200131
support and document that requested services were provided, the Contractor shall
reimburse Maricopa County for the services not so adequately supported and
documented.
628 AUDIT DISALLOWANCES:
If at any time it is determined by the County that a cost for which payment has been made is a
disallowed cost, the County shall notify the Contractor in writing of the disallowance. The course
of action to address the disallowance shall be at sole discretion of the County, and may include
either an adjustment to future invoices, request for credit, request for a check or a deduction from
current invoices submitted by the Contractor equal to the amount of the disallowance, or to require
reimbursement forthwith of the disallowed amount by the Contractor by issuing a check payable to
Maricopa County.
6.29 OFFSET FOR DAMAGES:
In addition to all other remedies at Law or Equity, the County may offset from any money due to
the Contractor any amounts Contractor owes to the County for damages resulting from breach or
deficiencies in performance of the Contract.
6.30 CONFIDENTIAL INFORMATION:
Any information obtained in the course of performing this Contract may include information that is
proprietary or confidential to the County. This provision establishes the Contractor's obligation
regarding such information.
The Contractor shall establish and maintain procedures and controls that are adequate to assure that
no information contained in its records and/or obtained from the County or from others in carrying
out its functions (services) under the Contract shall be used by or disclosed by it, its agents, officers,
or employees, except as required to efficiently perform duties under the Contract. The Contractor's
procedures and controls at a minimum must be the same procedures and controls it uses to protect
its own proprietary or confidential information. If, at any time during the duration of the Contract,
the County determines that the procedures and controls in place are not adequate, the Contractor
shall institute any new and/or additional measures requested by the County within fifteen (15)
calendar days of the written request to do so.
Any requests to the Contractor for County proprietary or confidential information s shall be referred
to the County for review and approval, prior to any dissemination.
6.31 PUBLIC RECORDS:
Under Arizona law, all Offers submitted and opened are public records and must be retained by the
Records Manager at the Office of Procurement Services. Offers shall be open to public inspection
and copying after Contract award and execution, except for such Offers or sections thereof
determined to contain proprietary or confidential information by the Office of Procurement Services.
If an Offeror believes that information in its Offer or any resulting Contract should not be released
in response to a public record request under Arizona law, the Offeror shall indicate the specific
information deemed confidential or proprietary and submit a statement with its offer detailing the
reasons that the information should not be disclosed. Such reasons shall include the specific harm
or prejudice which may arise from disclosure. The Records Manager of the Office of Procurement
Services shall determine whether the identified information is confidential pursuant to the Maricopa
County Procurement Code.
6.32 PRICES:
Contractor warrants that prices extended to County under this Contract are no higher than those paid
by any other customer for these or similar services.
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6.33 INTEGRATION:
This Contract represents the entire and integrated agreement between the parties and supersedes all
prior negotiations, proposals, communications, understandings, representations, or agreements,
whether oral or written, express or implied.
6.34 RELATIONSHIPS:
6.34.1 In the performance of the services described herein, the Contractor shall act solely
as an independent contractor, and nothing herein or implied herein shall at any
time be construed as to create the relationship of employer and employee, co-
employee, partnership, principal and agent, or joint venture between the County
and the Contractor.
6.34.2 The County reserves the right of final approval on proposed staff for all Task
Orders. Also, upon request by the County, the Contractor will be required to
remove any employees working on County projects and substitute personnel
based on the discretion of the County within two (2) business days, unless
previously approved by the County.
6.35 GOVERNING LAW:
This Contract shall be governed by the laws of the State of Arizona. Venue for any actions or
lawsuits involving this Contract will be in Maricopa County Superior Court, Phoenix, Arizona.
6.36 ORDER OF PRECEDENCE:
In the event of a conflict in the provisions of this Contract and Contractor's license agreement, if
applicable, the terms of this Contract shall prevail.
6.37 INCORPORATION OF DOCUMENTS:
The following are to be attached to and made part of this Contract:
6.37.1 Exhibit A, Pricing;
6.37.2 Exhibit B, Scope of Work;
6.37.3 Exhibit C, Office of Procurement Services Contractor Travel and Per Diem
Policy.
6.37.4 Exhibit D, Business Associate Agreement
NOTICES:
All notices given pursuant to the terms of this Contract shall be addressed to:
For County:
Maricopa County Public Health
ATTN: Cheryl Bucalo
4041 N. Central Avenue, #1400
Phoenix, AZ 85012
(602) 506-6886
Cheryl.Bucalo@Maricopa.gov
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For Contractor:
H.S. Medical Billing Services, dba PractiSynergy
Katie Fergus, President, CEO
500 E. Court Avenue, Suite 305
Des Moines, IA 50309
(515) 237-3974 ext. 204
katie@practisynergy.corn
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IN WITNESS WHEREOF, this Contract is executed on the date set forth above.
CONTRACTOR
AUTHORIZED SIGNATURE
PRINTED NAME AND TITLE
ADDRESS
DATE
MARICOPA COUNTY
CHAIRMAN, BOARD OF SUPERVISORS DATE
ATTESTED:
CLERK OF THE BOARD DATE
APPROVED AS TO FORM:
DEPUTY COUNTY ATTORNEY DATE
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Contract 200131
EXHIBIT A
BIDDER NAME: PractiSynerzY (legal name H.S. Medical Billing Services)
VENDOR ft:
BIDDER ADDRESS: 500€ Court Ave., Ste 305 Des Moines IA 50309
P.O. ADDRESS:
BIDDER PHONE fr. (515) 237-3974 ext. 204
BIDDER FAX ff: (515) 883-2692
COMPANY WEB SITE: htlps://practisynergy.com/
COMPANY CONTACT (REP): Katie Fergus President CEO
E-MAIL ADDRESS (REP): katiepractisynergy.com and iratre rfinansynergy.com
PAYMENT TERMS: Net 30
COMPENSATION/FEES: RATES
MEDICAL BILLING OUTSOURCING -% 7.0:€ of monies collected 57.0% of $500,000 = $35,000 (approximate per year)
MEDICAL BILLING OUTSOURCING — OTHER FEES (Describe) $ 2,520 (approximate per year for 2 visits for 2 people)
Travel for 2 semi-annual face-to-face meetings with NICDPH staff per 16Iaricopa County Procurement Department Travel Policy.
Estimated Costs:
Flights DSM PHX approximately 5400 round trip per trip x 2 people x 2 times per year = 51,600.00
Hotel per diem (per GSA website): $146 x 2 people x 2 times per year = $584.00 — 1 overnight per trip
Ni&IE per diem (per GSA website): $42 x 4 (2 people, 2 times per year, 2 partial days per trip). $336.00
(As defined herein) (Please fill in)
Respondent's signature below indicates understanding and agreement to perform the services outlined in the Request for Proposal
indicated above for the total amount they have listed above.
September 15 2019
Signature (REQUIRED) Date
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Contract 200131
EXHIBIT B
SCOPE OF WORK
Orizinal Scope of Work:
1.0 INTENT:
The Maricopa County Department of Public Health, hereinafter referred to as the "MCDPH", is seeking
proposals from qualified firms, hereinafter referred to as the "Contractor", to provide billing services for
MCDPH in accordance with the terms, conditions, and specifications contained in this Request for Proposal
(RFP). It is the intent of the MCDPH to establish a contract with an established billing services provider
for the purpose of collecting fees from patient insurance carriers for medical services provided by MCDPH.
This RFP is intended to cover all points of a contract from the reporting by the MCDPH of the service to the
satisfaction of the receivable. It is expected that the Contractor shall charge MCDPH a percentage of the
monies collected.
MCDPH currently provides primary care services and other specialty medical treatment to the citizens
and visitors of Maricopa County. MCDPH is seeking to obtain the services of a qualified service
provider for the actual billing of funds due and accounts receivable posting of funds received by the
MCDPH for these services.
MCDPH estimates billing patient insurance carriers (primarily AHCCCS) for approximately $500,000
annually for its specialty clinics. MCDPH clinics are using an electronic medical record, eChnicalWorks,
for patient charting and creation of claims. There are no delinquent accounts and there is no requirement
for collection of payments from a patient.
Maricopa County reserves the right to award this contract to multiple vendors. The County reserves the
right to award in whole or in part, by section or geographic area, or make multiple awards, where such
action serves the County's best interest.
Other governmental entities under agreement with the County may have access to services provided
hereunder (see also Section 3.9 and 3.10 below).
2.0 SCOPE OF WORK:
2.1 The successful Contractor, under this contract, shall provide all services necessary to collect
revenues from insurance carriers for patients seen at MCDPH clinics. These services shall
include but not be limited to:
2.1.1 Receipt of the patient information necessary for billing. This information will come
from the electronic medical record used by MCDPH, eClinicalWorks. The Contractor
will be furnished limited access to the electronic medical record system in order to
obtain the necessary information to create a claim. If the Contractor desires, the
Contractor may obtain (at their own expense) any other software or system interface
that will allow compatibility with eClinical Works for furnishing or converting data
into their own billing system.
2.1.2 Contractor shall be responsible for reviewing each patient claim created for content to
accomplish the following: (a) To check for discrepancies between services provided
and billing codes populated into the claim; (b) to ensure the number of patients seen in
a day match the number of claims generated; (c) ensure that the appropriate claim
forms are completed and the documentation to support the charge is present in the
medical record; and (d) that appropriate billing codes have been assigned to services
based on the documentation, treatment, and chief complaint of the patient.
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Contract 200131
2.1.3 To the extent possible, Contractor shall provide electronic claims processing and paper
filings to insurance companies. The first invoice will be dated no later than fifteen (15)
days after the date of service (DOS).
2.1.4 The Contractor shall be responsible for the initial collection, generation of any and all
insurance forms, filings, and record maintenance.
2.1.5 Provision of all monthly finance, billing, receivable, and aging reports as stated herein:
2.1.5.1 Collections profiles for each month, dating back to the beginning of said
contract;
2.1.5.2 Status of all claims for the current month and total in system;
2.1,5.3 Aging Report;
2.1.5.4 Month end information for Finance;
2.1.5.5 Daily Payment logs;
2.1.5.6 Month end payment logs;
2.1.5.7 Any additional reports that MCDPH may need or request will automatically be
formatted to their requirements and sent to the department.
2.1.6 Contractor shall comply with the policies and procedures developed and implemented
by MCDPH in response to the improvement of the department and the privacy act of
HIPAA. The agency will enter into a Business Associates Agreement (Attachment D)
with MCDPH to insure all HIPAA policies are adhered to. Any violations of HIPAA
by the contracted billing company will be grounds to terminate all contractual
agreements.
2.1.7 Contractor shall comply with HIPAA regarding protected health information (PHI) and
guardian of all record sets and will maintain any and all documentation, records, and
patient information in a safe and secure manner allowing for inspection and/or audit by
the County.
2.1.8 Contractor s h a 11 store all record sets for a minimum of thirty-six (36) months and
then turn them over to MCDPH for permanent storage.
2.1.9 Contractor shall be in compliance with the Final Security Rule of HIPAA and remain
under a business associates agreement during the duration of the contract.
2.1.10 Contractor shall provide sufficient customer service representative(s) to in all billing
inquiries in a timely manner, not to exceed three (3) business days.
2.1.11 Contractor shall conduct any follow-up required to obtain necessary insurance
information for payment processing.
2.1.12 All payments will be received by MCDPH and copies will be forwarded to Contractor
for posting to patient accounts. Payments will be posted to patient accounts within
three (3) business days of receipt of information from MCDPH. Records of posted
payments will be provided to MCDPH on a daily basis.
2.1.13 Contractor shall be responsible for the posting of payments to the appropriate patient
account, updating insurance information on individual patient accounts, insurance
claim processing and general patient account notations. The Contractor shall be
responsible for all inquiries and resolution of insurance denials and rejections. The
Contractor shall contact the appropriate insurance carrier for the resolution, correction
and re-submission of any patient billing. If corrected information is received, the
billing record will be updated and submitted for payment to the appropriate insurance
carrier.
2.1.14 In the event a billing is denied for any reason except failure to bill in a timely fashion,
and the Contractor is unable to correct and resubmit the claim, the Contractor will
notify MCDPH. If the claim is denied due to failure to bill in a timely fashion, the
Contractor will accept all financial responsibility for administrative costs concerning
the patient's account.
2.1.15 Contractor shall be responsible to follow-up on each medical claim for services
rejected by an insurance provider. The Contractor shall contact insurance providers by
telephone, mail or FAX in order to resolve each rejected claim. The Contractor shall be
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Contract 200131
responsible to furnish insurance providers with all requested patient information,
medical information and documentation, including the re-submission of the rejected
claim. The Contractor shall, on a weekly basis, prepare and deliver a written report for
all rejected claims detailing the reason for rejection and provide documentation on
each claim resubmitted.
2.1.16 Contractor shall provide initial training for medical provider staff and training for new
medical provider staff in coding and billing in a primary care setting. The Contractor
shall also provide training for medical provider personnel on changes in coding of
services or new requirements for coding as they occur and as they relate to services
provided by medical providers. Training may be onsite, classroom style training, or
may be available to staff online or via the web.
2.1.17 The Contractor shall agree to
2.1.17.1 Provide follow up on electronically submitted claims for which payment has
not been received between 30 and 45 days following initial submittal. Follow-
up shall be accomplished on all unpaid paper claims between 45 & 60 days
after initial submittal. Follow-up efforts and results must be documented and
available to the County. Follow-up efforts subsequent to the initial effort must
also be documented and retrievable.
2.1.17.2 Provide MCDPH, after receiving reasonable notification, with all financial
records pertaining to the billing and collection for MCDPH for auditing
purposes.
2.1.17.3 Receive and keep on file all documents associated with the billing process,
including but not limited to, documentation for Medicare, Medicaid, and all
other insurance providers.
2.2 ELIGIBILITY:
2.2.1 To be eligible to respond to this RFP, the proposing firm must demonstrate that they,
or the principals assigned to the project, have successfully completed services, similar
to those specified in the Scope of Services section of this RFP and are licensed,
insured, bondable, and HIPAA compliant in the State of Arizona. The proposal should
demonstrate at least three years of documented, successful experience with and cuiTent
knowledge of primary care services billing. Experience must include filing claims with
government programs such as Medicare and Medicaid, as well as commercial health
insurance programs (HMO's and PPG's) and the processing of at least 10,000 visits
per year.
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Contractor's Response:
Executive Summary
PractiSynergy (legal name H.S. Medical Billing Services, Inc.) has a full understanding of the commitment needed to
fulfill the services requested by the Maricopa County Department of Public Health (MCDPH) in the Medical Billing
Outsourcing Services Request for Proposals {RFP). The following proposal spells out the qualifications, capability,
methodology and design for an effective and efficient outsourced medical billing process. We are presently
providing these services for the Polk County (Iowa) Health Department and the Pottawattamie County (Iowa)
Public Health Department and look forward to the opportunity to provide these services to MCDPH in the future.
We will call upon our experienced staff to apply our proven billing methodology to MCDPH to increase the amount
collected. The core values of the PractiSynergy team include:
• COLLASORATIOU - providing a collaborative environment with our clients throughout our relationship
• GROWTH - equipping our clients with the best opportunities for growth by partnering to establish sound
financial decisions
• INTEGRITY - operating under ethical business practices an remain impartial in decision making with our
clients to maintain health client relationships
PractiSynergy employees maintain these values as a result of more than three decades in the industry providing
excellent service to our clients. We have continuously witnessed positive financial outcomes resulting from our
services and have seen how it positively affected the economy, communities, and patient lives. PractiSynergy has
solid longstanding experience in the public sector creating a deep knowledgebase within our existing staff.
PractiSynergy has comprehensive experience billing for public health and family practice clinical services in the
private-sector and non.profit as well as the publicisector.
Qualifications to Serve as the MCDPH Contractor for the Project
PractiSynergy is an experienced leader in providing Medical Billing Services to several state and county public
health departments private-sector and non-profit medical clinics. PractiSynergy has over 30 years of experience
with the medical billing solutions we provide.
Our expertise and applications include:
• Certified Coders to review procedure and diagnostic coding
• Electronic interface with eClinkal Worts and other practice management systems
• Reporting to verify claims submitted compared to scheduled/confirmed appointments
• Real-time eligibility verification
• Integrated claim scrubbing software to detect errors prior to submission
• Cloud based medical claims submission
• Denial management and reporting tools
• Robust reporting systems for our clients - Including standard and ad hoc reporting
The work methodology and design of PractiSynergy's system provide a solid foundation to support the full scope of
work requested in the published REP.. PractiSynergy workflow is adaptable to the required work to furnish NICOPH
with a complete, comprehensive and accurate billing services and reporting. Our integrated solution is made up of
many component parts and we have the expertise and experience to effectively understand the details of how
each component supports the overall goals of maximizing reimbursement, improving quality of care and
controlling the costs of the Maricopa County Department of Public Health.
Posed on our review of the AFP requirements ProchSycergy rveve,n we are the most suitable car; clidate for
Site following reasons.
PractiSynergy has successfully provided medical billing services requested in this RFP since 1986
We have a proven track of designing and implementing effective billing solutions that provide our public
sector clients reimbursement to cover the costs of their services since 2008
Advanced technology used to scrub data to ensure clean claims are sent and payment Is received quickly
4. Our processes are tailored to each individual client for the most efficient methodology for reirnburiernent
5. We provide value-based billing services for public and private sector and nonprofit clients
In closing, PractiSynergy's service performance in public health as demonstrated with the Iowa Department of
Public Health and Iowa counties of Polk and Pottawattamie is unparalleled. As reimbursements remain steady or
shrink and commercial payers seemingly deny more claims each year, PractiSynergy has a systematic approach to
initial claim subntission and claim denial management that is proven to work. In summary, PractiSy-nergy will carry
out all contract responsibilities for MCDPH in the same highly professional, successful manner to which all our
clients have become accustomed. We will develop successful working relationships to deliver the County the same
unparalleled service and support. We offer the MCDPH a truly best•in•class solution designed to meet your needs
now and into the future. Our team is ready to assist you with technical innovation and unsurpassed customer
service for your patients and providers.
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Contract 200131
Proposal Narrative
Qualifications and Capability
Corporate Background
PractiSynergy (legal name HS Medical Billing Services Inc.) has been in business since 1986 providing revenue cycle
management services for over thirty-three years. PractiSynergy core services are Medical Billing and Coding
Accounts Receivable Follow-Up, Credentialing, and Third-Party Claim Processing. The business took on a re-branding
project and as of January 1, 2018 the new brand name is PractiSynergy. This change will allow the business to
broaden the lines of business beyond medical billing and be a resource to medical practices in other ways. The vision
for excellence for existing customers and growth into new markets led to the addition of Kevin Babb in 2019 as a
partner and Chief Operating Officer to oversee daily processes to maximize efficiency for PractiSynergy and the
clients we serve. Our core business will remain medical billing, but we now have the resources and connections to
offer services beyond the traditional scope of medical billing. With a solid reputation of INTEGRITY, COLLABORATION,
and GROWTH, we provide services to our clients to strive for the possibilities beyond today.
PractiSynergy currently has thirty-five active clients varying in size from solo medical practices to a practice with
thirty physicians. Each medical practice, county health department, or other special project is unique, and workflows
are designed for client to be the most efficient and effective to ensure prompt reimbursement for clinical
procedures. Medical specialties served over the past three decades include public health agencies, family
medicine/primary care. Solid relationships with public health agencies have been formed over the past ten years
with tightening budgets PractiSynergy has been an integral partner in the changing landscape of public health
funding. Description of 5er/ices provided to the State of Iowa's Department of Public Health and Iowa's largest
County Public Health Department is described in the "Relevant Experience' section of this proposal.
PractiSynergy has approximately twenty full-time staff and additional contracted employees each serving a vital
role in the management of our clients' revenue cycle. We have strategically divided our group into 5 teams:
Administrative Services, Coding Team (Certified Coders), Demographic and Data Entry Team, Payment Posting
Team, and our follow-Up Team. Each team has a team-lead who keeps the workflow going each day to avoid
bottlenecks. Members in the team are cross trained on client accounts to avoid potential issues during absences.
This team structure allows our staff to focus on their key portion of the entire revenue cycle while maintaining
internal controls and the ability to monitor and control the quality of work being performed. The duties and
functions of these teams and how they relate to Maricopa County Department of Public Health (MC OPH) are
defined in the Scope of Work/Work Methodology.
Relevant Experience
PractiSynergy is skilled at billing and claini follow-up for government clients as well as for-profit clients.
Attachment C lists references. PractiSynergy began its service to public health entities in 2008 when it contracted
to provide billing services to Iowa's Polk County Department of Public Health (hereafter Polk County) continuing to
provide these services today. Under the contract for Polk County approximately 8,000 claims for 5760,000 are
submitted annually for primary care and flu vaccinations — most claims being for flu vaccinations. All claims are
based on standing orders front the County Medical Director, but there are regularly two nurse practitioners
rendering care as well. Polk County is Iowa's largest county in population with approximately 480,000 people, it
has one central public health clinic but has nearly 100 satellite clinics throughout the county during peak times
such as flu shot season. The payer mix for Polk County is approximately 6556 government sources (Medicare,
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Contract 200131
Medicaid, and TriCare) with commercial and patient-pay making up the remainder. We continue to maintain a
strong working relationship with Polk County and have assisted them to successfully cover their costs for flu
vaccines, travel vaccines and other necessary medical care (Scope of Work 2.2.1).
In 2010, PractiSynergy was awarded the contract for the Centers for Disease Control (CDC) supported Local Public
Health Agency Immunization Service Billing Program grant, RFP-58820034, This grant was renewed and continued
through July 201. The outcome of the grant was a Local Public Health .Agency Billing Toolkit that was supported
with state-wide training throughout Iowa delivered by PractiSynergy staff members. As a result, many local public
health agencies began billing for their services to generate revenue. F'ractiSynergy and the Iowa Department of
Public Health received national recognition from CDC for this program. In addition, F .ractiSynergy sub-contracted
with the states of Indiana and Illinois to successfully deliver similar programs.
In 2017 PractiSynergy was awarded the contract to process claims for chronic disease programs in the State of
Iowa, RFP — 5888111898 which is an on-going award through June 2023. These claims are for select procedure codes
with a narrow set of diagnoses and is part of the Federal National Breast and Cervical Cancer Early Detection
Program, the federal WISEWOMAN program, State of Iowa Colorectal "Get Screened" program, and the State of
Iowa Cervical Cancer screen programs. PractiSynergy processes and pays over $660,000 per year for over 12,000
claims on average per year for these programs. Utilizing a similar process of medical billing, the process includes
scanning any paper claims received, entering claim data into the claim processing system, the computer program
matches several data points to determine if the claim is payment eligible and then the claims are paid or denied
with explanations of benefits and payment being sent electronically to the participating providers.
In late 2018 PractiSynergy was contracted with Pottawattamie County Iowa Health Department to perform
medical billing services for primary care and flu vaccinations. The anticipated annual volumes for the
Pottawattamie County Health Department is approximately 2,000 claims per year for about $200,000 per year.
Pottawattamie County does not have an electronic health records system at this time —therefore information is
gathered through a secure file sharing program for scanned documents of demographic forms and medical
supetbills (charge sheets). PractiSynergy's teams perform data entry, payment posting functions, and claim denial
management.
PractiSynergy also performs medical billing services for non-governmental practices. Metro Geriatric Services
(client since 2014), based in Clive, IA is one of the highest volume clients who bills primary care-type services as
well as vaccinations. Approximately 12,000 claims are submitted annually for Metro Geriatric Services. Having a
geriatric practice requires nearly all claims to initially be sent to Medicare or a Medicare Advantage program along
with any applicable secondary insurance commercial or governmental. Additionally, PractiSynergy provides billing
services for Performance Rehabilitation in Oelwein, IA is a physical therapy and occupational therapy clinic sending
approximately 11,000 claims annually. Performance Rehab has approximately 1/3 of its annual payments coming
from Medicare as primary insurance for their patients. Additionally, Medicare secondary claims and Medicaid
secondary claims account for another approximately 1/4 of the payment mix.
Staff Experience
Practi-Synergy has three members on its leadership team, Katie Fergus, President/CEO, Kevin Babb, COO, and Katie
Frost, Director of Revenue Cycle Katie Fergus, President, has over 15 years of experience in health care. As a CPA
her career in health care started as an accountant which led to becoming the Medical Billing Manager of one of the
largest (non-hospital) non-profit organization in the State of Iowa. Kevin Babb, COO, has over twenty-five years of
experience in health care. Kevin is an RN who worked as a surgical nurse at the beginning of his career then
becoming the owner of a large case management company and claim processing company for workers
compensation claims. After selling the case management company. Kevin became an administrator for several
small medical practices stream-lining operations within the medical practices. Katie Frost is a Certified Professional
Coder who has been in the health care industry for over twenty years doing medical coding, billing, and collections
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Contract 200131
work. Katie Frost understands the entire revenue cycle inside and out and trains staff how to get the appropriate
resources needed to get medical claims paid. Katie Frost will be the main contact for any specific questions from
MCPHD daily. The resumes of the leadership team members are included in Attachment E at the end of this
proposal.
PractiSynergy core group of 4 employees will be assigned to the MCPHD billing project. Resumes of staff are
included where noted. A coder will be assigned to review the procedure code and the diagnoses assigned to the
patient encounter (staff not identified yet). The data entry staff member will enter demographic and insurance
information obtained from eCW creating and submitting the electronic claim with a 98;4 accuracy rate (staff
member Savannah Ingraham identified — resume included). Savannah has been with PractiSynergy since November
2018 and was hired specifically to work on the Polk County Health Department flu clinic claim entry. Savannah
under the supervision of Katie Frost, Director of Revenue Cycle, has one of the highest accuracy rates in the
department and can quickly get through high volumes with few errors.
The payment posting team lead, Angela Snyder (resume in Attachment EL is the most senior member of the team
with more than 13 years with the company, will be applying payments, notating denials, and reporting the
payments daily to tviCPHD. Angela has continuously worked with Polk County Health Department since they
became a client in 2008 and has a thorough understanding of billing and collections for public health services.
Angela has billed government and commercial insurance (HMOs and PPOs) for Polk County Health Department's
flu shot clinics, family practice clinic, screening services, and many other medical procedures. PractiSynergy
restructured its billing department and appointed Angela as the team lead of the payment posting area since this
requires a comprehensive understanding of identifying correct payments and recording incorrect payments, non-
payments or denials.
David Stone (resume in Attachment t) on the follow-up team will be assigned to review the claim queue for any
zero paid claims, rejections and ciaim denials daily. Follow-up methods include contacting appropriate third-party
payers to research denials by telephone, email, mail or fax to resolve each claim. David notates all actions on each
encounter worked for a client providing a description of the reason for the zero-paid claim, denial or rejection,
what information was needed to get the claim paid, and the timeline of when the claim was re-submitted.
Specifically, David has worked on claim denials and pended claims for the Polk County Health Department and the
Pottawattarnie Public Health Department. His attention to detail and communication of common errors has ted to
improved claim processing on the initial claim submissions.
Scope of Work/Work Methodology
The Administrative Services team retrieves patient information required for billing from client electronic medical
records (EMR) or paper copies provided by client (if the client does not have an MR). PractiSynergy staff are fully
trained on ErviRs including eClinicalWorks, Kareo, NextGen, Cerner, and others. With access to client EMR systems,
PractiSynergy staff can obtain all the demographic and payer information necessary to create an electronic claim.
Any paper documents are received, the administrative staff scans into the billing software PractiSynergy uses
(Scope of Work 2.1.1).
Using certified coders, the coding team ensures documentation is present in the patient medical records to
support the charge and that appropriate billing codes have been assigned to services based on the documentation,
treatment, and chief complaint of the patient. The data entry team is responsible for entering demographic and
insurance information for each patient as furnished by the client. The team checks for any discrepancies between
services provided and the appended billing codes. A cross-check is performed between the schedule/the number
of patients seen in a day and the number of claims that are queued up for submission (Scope of Work 2.1.2). The
data entry team enters claim data within forty-eight hours of the date of service and submits claims nightly
electronically through the claim's clearinghouse contracted with PractiSynergy (Scope of Work 2.1.3). For clients,
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Contract 200131
PractiSynergy has the responsibility to collect initial information, generate all Claims telectronic and paper), keep a
record of claims filings, and maintain patient and provider records (Scope of Work 2.1.4).
PractiSynergy's payment team gathers payment copies and related information from MCDPH. Payments are
posted within seventy-two hours or three business days of receipt. Daily reporting of payment applications will be
provided to MCDPH (Scope of Work 2.1.12). Payments will be posted and applied to the appropriate patient
• accounts. Insurance information on patient accounts, insurance claim processing, and other genera/ patient
account notations will be made by PractiSynergy. The payment team will post insurance claim denials to patient
accounts and assign to the follow-up team for resolution, correction, and re-submission (Scope of Work 2.1.13).
PractiSynergy's follow-up team is available during office hours to provide responses to all billing inquiries. If an
answer is not immediately available or requires further research, a response will be provided within no longer than
three (3) business days (Scope of Work 2.1.10). The follow-up team consistently works rejected and denied
accounts obtaining any missing or corrected information to successfully obtain claim payment (Scope of Work
2.1.11). If a claim denies and due diligence by the follow-up team does not result in the appropriate information
required to re-submit claim for payment, the follow-up team will notify MCDPH in a timely manner. PractiSynergy
will assume financial responsibility for costs concerning a patient account which denied as a result of not
submitting the claims timely - unless previous communication with MCDPH on the account had been made (Scope
of Work 2.1.14). Claim rejections and denials will be worked by the follow-up by contacting third party payers by
telephone, mail, email, or fax in or order to resolve each claim. Any information requested by payers will be
submitted by the follow-up team within the tirneframe requested by the payer. A weekly report will be generated
of all rejected claims detailing the reason for rejection or denial and the documentation that was provided on each
re-submission (Scope of Work 2.1.15).
Monthly, PractiSynergy generates reports for all clients to review all the activity throughout the month. The
following reports will be provided to MCDPH as specified in the Request for Proposal (Scope of Work 2.15.1-7):
1. Collections profiles for each month, dating back to the beginning of said contract
2. Status of all claims for the current month and total in system
3. Aging Report
4. Month end information for Finance
S. Daily Payment logs
6. Month end payment logs
7. Any additional reports that MCDPH may need or request will automatically be formatted to their
requirements and sent to the department
PractiSynergy agrees to perform our duties in a legal and compliant manner, consistent with currently published and
applicable federal, state and local laws, rules and regulations. In support of that commitment, PractiSynergy asserts
the following:
• PractiSynergy shall comply with the policies and procedures developed and implemented by MCDPH in
response to the improvement of the department and the privacy act of HIPAA (Scope of Work 2.1.6)
• PractiSynergy will enter into a Business Associates Agreement (Attachment D) with fv1CDPI-1 to ensure all
HIPAA policies are adhered to (Scope of Work 2.1.6)
• Any violations of HIPAA by the PractiSynergy will be grounds to terminate all contractual agreements (Scope
of Work 2.1.6)
• PractiSynergy will comply with HIPAA regarding protected health information (PHI) and guardian of all
record sets maintaining any and all documentation records, and patient information in a safe and secure
manner (Scope of Work 2.1.7)
• MCDPH to review our Compliance Program upon request (Scope of Work 2.1.7)
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Contract 200131
PractiSynergy will conduct its own periodic risk assessment and advise MCDPH of any findings that may
affect MCDPH's compliance or performance
PractiSynergy will take reasonable steps to ensure that each business partner complies with all
requirements of HIPAA
• PractiSynergy agrees to conduct appropriate background checks on all employees, contractors, agents and
vendors to assure that all services are provided by individuals who have not been excluded by any
government authority. Employees are required to sign a workplace confidentiality agreement which is kept
on file
• PractiSynergy agrees to maintain appropriate compliance records and assure their completeness, security
and safety
• PractiSynergy will store all record sets for a minimum of thirty-six (36) months and then turn them over to
MCDPH for permanent storage (Scope of Work 2.1.8)
• PractiSynergy be in compliance with the Final Security Rule of 111PAA and remain under a Business
Associates Agreement for the duration of the contract (Scope of Work 2.1.9)
PractiSynergy agrees to the following assertions for MCDPH:
Provide follow up on electronically submitted claims for which payment has not been received between
30 and 45 days following initial submittal. Follow-up shall be accomplished on all unpaid paper claims
between 45 & 60 days after initial submittal. Follow-up efforts and results must be documented and
available to the County. Follow-up efforts subsequent to the initial effort must also be documented and
retrievable (Scope of Work 2.1.17.1)
• Provide MCDPH, after receiving reasonable notification, with all financial records pertaining to the
billing and collection for MCDPH for auditing purposes (Scope of Work 2.1.17.2)
• Receive and keep on file all documents associated with the billing process, including but not limited to,
documentation for Medicare, Medicaid, and all other insurance providers (Scope of Work 2.1.17.3)
System Design
PractiSynergy utilized a standard Active Directory and domain controlled internal system with multiple collocations
and backups. In a typical scenario we would utilize our VPN software or that of the MCDPH to initiate a secure
portal. We currently operate in the eClinical Works system with other customers utilizing the same process of
VPN/clirect login to their system to generate the charges each date of service. The information is imported (as
much as possible) into PractiSynergy's billing platform. Any information not imported will be manually keyed in.
Claims are submitted through the integrated claim clearinghouse Trizetto which has an electronic data interfaces
(EDI) to the payers allowing a crosswalk of data to occur between what is sent from the original file into the
receiver's system.
Updates for CPT are performed quarterly within the software and include updates to codes, claim and payment
posting formats, and software updates from the vendor. Additionally, our IT staff is on hand to fix or create reports
to meet the needs of MCDPH. Updates to payers are typically done individually by the Director of Revenue Cycle to
avoid billers getting into configuration screens, but these updates can be done immediately to avoid delays in
billing.
The COO maintains the security system for the computers located on-site and remote locations. A firewall is
utilized to provide a barrier between the data we are working on and "cybercriminals." A firewall is also installed
on the home network of remote employees. PractiSynergy maintains IT security policies and protocols that are
reviewed annually. Education to staff is provided about security protocols particularly around password practices.
Regular backs are done throughout the day and a full off-site back-up is kept as part of the disaster recovery plan.
Only the CEO and the COO have access to the off-site back-up. Anti-virus and malware are installed on each
workstation and server on the network to protect against phishing, ransomware, trojan horses, and other viruses.
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Contract 200131
Pricing/Fees
Pricing fees are quoted in Attachment A. The percentage of collections was based on cost estimates for staff,
software, supplies, and necessary overhead required to perform the duties necessary to bill and collect medical
claims for the benefit of Maricopa County. Based on existing expertise — no/limited training will be required for
PractiSynergy staff to step into the outsourced billing role. it is best practice to meet face-to-face and we have
included costs for 2 meetings per year as additional costs to the billing project. These meetings would be attended
by President Katie Fergus and the Director of Revenue Cycle Katie Frost.
Training
PractiSynergy has a philosophy of continuous improvement to best support its clients. On a regular basis,
PractiSynergy will conduct weekly or monthly phone conferences (as needed) to summarize any overarching issues
that have come up throughout the week/month. We will be logging all questions in a central document shared
between PractiSynergy and the MCDPH for all necessary people to have access for questions and answers at any
given time to refer to. This is especially useful during weekly phone conferences.
PractiSynergy will provide initial training for medical provider staff and any new medical provider staff in coding
and billing for the primary care setting (Scope of Work 2.1.16). Coding updates are typically done annually, but
some changes are made quarterly. Training will be provided for medical personnel on changes in coding of
services/procedures or any new requirements for coding as the occur and as they relate to services provided by
the medical providers. PractiSynergy will provide this information to MCDPH in a few different ways. At the weekly
calls there will be a standing agenda item for any new coding or billing requirements. The Director of Revenue
Cycle will review these with those on the call. An email will also be sent with a summary of the changes and if it
will affect MCDPH. Finally, if there are any webinars by the payers, we will provide information to MCDPH staff
would like to attend.
PractiSynergy will meet with the MCDPH semi-annually either at its location to provide information regarding
coding and billing requirement updates as well as a face-to-face opportunity to communicate successes and
concerns. Typically, the most significant changes are effective at the beginning of the calendar year so training
would be most appropriate during the month of December. However, depending on the payers such as Arizona
Medicaid or other commercial insurances, training may be critical during another time of year as well.
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Contract 200131
EXHIBIT C
OFFICE OF PROCUREMENT SERVICES CONTRACTOR TRAVEL AND PER DIEM POLICY
1.0 All contract-related travel plans and arrangements shall be prior-approved by the County Contract
Administrator.
2.0 Lodging, per diem and incidental expenses incurred in performance of Maricopa County/Special District
(County) contracts shall be reimbursed based on current U.S. General Services Administration (GSA)
domestic per diem rates for Phoenix, Arizona. Contractors must access the following internet site to
determine rates (no exceptions): (www.gsa.gov ).
2.1 Additional incidental expenses (i.e., telephone, fax, internet and copying charges) shall not be
reimbursed. They should be included in the contractor's hourly rate as an overhead charge.
2.2 The County will not (under no circumstances) reimburse for Contractor guest lodging, per diem or
incidentals.
3.0 Commercial air travel shall be reimbursed as follows:
3.1 Coach airfare will be reimbursed by the County. Business class airfare may be allowed only when
preapproved in writing by the County Contract Administrator as a result of the business need of the
County when there is no lower fare available.
3.2 The lowest direct flight airfare rate from the Contractors assigned duty post (pre-defined at the time
of contract signing) will be reimbursed. Under no circumstances will the County reimburse for
airfares related to transportation to or from an alternate site.
3.3 The County will not (under no circumstances) reimburse for Contractor guest commercial air travel.
4.0 Rental vehicles may only be used if such use would result in an overall reduction in the total cost of the trip,
not for the personal convenience of the traveler. Multiple vehicles for the same set of travelers for the same
travel period will not be permitted without prior written approval by the County Contract Administrator.
4.1 Purchase of comprehensive and collision liability insurance shall be at the expense of the contractor.
The County will not reimburse contractor if the contractor chooses to purchase this coverage.
4.2 Rental vehicles are restricted to sub-compact, compact or mid-size sedans unless a larger vehicle is
necessary for cost efficiency due to the number of travelers. (NOTE: contractors shall obtain pre-
approval in writing from the County Contract Administrator prior to rental of a larger vehicle.)
4.3 County will reimburse for parking expenses if free, public parking is not available within a
reasonable distance of the place of County business. All opportunities must be exhausted prior to
securing parking that incurs costs for the County. Opportunities to be reviewed are the DASH;
shuttles, etc. that can transport the contractor to and from County buildings with minimal costs.
4.4 County will reimburse for the lowest rate, long-term uncovered (e.g. covered or enclosed parking
will not be reimbursed) airport parking only if it is less expensive than shuttle service to and from
the airport.
4.5 The County will not (under no circumstances) reimburse the Contractor for guest vehicle rental(s)
or other any transportation costs.
5.0 Contractor is responsible for all costs not directly related to the travel except those that have been pre-
approved by the County Contract Administrator. These costs include (but not limited to) the following: in-
room movies, valet service, valet parking, laundry service, costs associated with storing luggage at a hotel,
fuel costs associated with non-County activities, tips that exceed the per diem allowance, health club fees,
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Contract 200131
and entertainment costs. Claims for unauthorized travel expenses will not be honored and are not
reimbursable.
6.0 Travel and per diem expenses shall be capped at 15% of project price unless otherwise specified in individual
contracts.
7.0 Contractor shall provide, (upon request) with their invoice(s), copies of receipts supporting travel and per
diem expenses, and if applicable with a copy of the written consent issued by the Contract Administrator. No
travel and per diem expenses shall be paid by County without copies of the written consent as described in
this policy and copies of all receipts.
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Contract 200131
EXHIBIT D
MARICOPA COUNTY
By and Through its
Department of Public Health (MCDPH),
Clinical Services
Business Associate Agreement
This Agreement sets out the responsibilities and obligations of H.S. Medical Billing Services
dba PractiSynergy, (-Business Associate" or "Associate") as a business associate of the
MAR1COPA COUNTY, a covered entity, under the Health Insurance Portability and Accountability
Act (-HIPAA"), the Health Infomiation Technology for Economic and Clinical Health ("HITECH")
Act, and pursuant to the Contract or Engagement Letter between Associate and MARICOPA
COUNTY.
MARICOPA COUNTY may make available and/or transfer to Associate Protected Health
Information ("PH r ) of individuals in conjunction with Services, which Associate will use or disclose
only in accordance With this Agreement. Associate and MARICOPA COUNTY agree to the terms
and conditions of this Agreement in order to comply with the use and handling of PHI under the
HIPAA Standards for Privacy of Individually Identifiable Health Infomiation, 45 C.F.R. Part 160
and Part 164, Subpart E ('Privacy Standards') and the HIPAA Security Standards, 45 C.F.R. Part
160 and Part 164, Subpart C ("Security Standards"), both as amended from time to time. Unless
otherwise provided, all capitalized terms in this Agreement will have the same meaning as
provided under the Privacy Standards and Security Standards. Associate and MARICOPA
COUNTY will comply with the temis of this Agreement for the duration of the Contract or
Engagement Letter and for such other continuing periods as provided in this Agreement. Upon
the compliance date of any final regulation or amendment to final regulation promulgated by the
Secretary of Health and Human Services that affects Associate's use or disclosure of PHI, the
parties agree to take such reasonable action as is necessary to amend this Agreement in order
for MARICOPA COUNTY to comply with such final regulation or amendment to final regulation.
Defuution fol terns in ihi Agieement:
I. Business Associate or Associate means an entity that perfomis or assists in the
performance of a function on behalf of a Covered Entity, which involves the use, or
disclosure of Individually Identifiable Health Information as defined in 45 C.F.R. § 160.103.
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Contract 200131
In addition, an Associate can be an entity that provides data transmission services to a
Covered Entity, is more than a mere conduit of information, and allows a Covered Entity
to access the maintained information in a manner beyond a random or infrequent basis.
The terms "Business Associate', "Associate" and 'Contractor' are synonymous.
Notwithstanding this definition, if Contractor does not have access to or create Protected
Health Information under this Contract, Contractor is not an Associate, and the terms of
this Agreement do not apply to Contractor.
2. Contractors of Business Associate means a person or an entity to whom an Associate
delegates a function, activity, or service that the Associate has agreed to perform for a
Covered Entity. A contractor of an Associate which creates, receives, maintains, or
transmits personal health information on behalf of the business associate is itself a
Business Associate and therefore will comply with the terms of this Agreement. For
purposes of this Agreement the term "Contractor" includes the Contractor, its employees,
its subcontractors and its agents.
3. Protected Health Information ("PHI") means the health infonriation that is created or
received by a Covered Entity; and relates to the physical condition, mental health or other
health condition of an Individual, or to the provision of health care to the Individual
(including but not limited to the payment for such health care); and identifies or can be
used to identify the Individual as defined in 45 C.F.R. § 160.103.
4. Individual shall have the meaning set forth in 45 CFR § -160.103, including a person who is
the subject of the Protected Health Information, and shall include an individual or entity
who qualifies as a personal, legal representative of the person, as the context requires.
5. Privacy Rule shall mean the Standards for Privacy of Individually Identifiable Health
Information at 45 CFR Parts 160 and 164, Subparts A and E, as may be amended,
modified or superseded, from time to time.
6. Security Rule shall mean the Standards for Security of Individually Identifiable Electronic
Health Information at 45 CFR Parts 160 and 164, Subparts A, C and E, as may be
amended, modified or superseded, from time to time.
7. Breach shall mean the acquisition, access, use or disclosure of Protected Health Information
in a manner not permitted by the HIPAA Privacy Rule, that compromises the security or
privacy of the Protected Health Information as defined, and subject to the exception given
to such term in 45 C.F.R. § 164.402.
8. Breach Notification Rule shall mean the interim final rule related to breach notification for
unsecured protected health information at 45 C.F.R. Parts 160 and -164.
9. Covered Entity shall have the meaning given to such term in 45 C.F.R. § 160.103.
10. Designated Record Set shall have the meaning given to such term under the Privacy Rule
at 45 C.F.R. § 164.501.
11. Security Incident shall have the meaning given to such phrase under the Security Rule at
45 C.F.R. § 164.304.
12. Unsecured PHI shall have the meaning given to such phrase under the Breach Notification
Rule at 45 C.F.R. § 164.402.
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Contract 200131
13. Electronic Protected Health Information or ePHI shall have the same meaning given to
such term under the Security Rule, including, but not limited to, 45 C.F.R. § 160.103.
14. Electronic Media shall have the same meaning given to such term in 45 C.F.R. § -160.103.
15. Health Information Technology for Economic and Clinical Health (HITECH) Act, as
codified at 42 U.S.C. §§ 17921-17954.
16. Secretary shall mean the Secretary of the Department of Health and Human Services or his
or her designee.
It is agreed by and between the parties that:
1. Uses and Disclosures of Protected Health Information. Associate will use and disclose
PHI only for those purposes necessary to perfoml its duties, obligations and functions under
the Contract, or as othemise expressly permitted in this Agreement or as required by other
law.
a. Associate will not use or further disclose any PHI in violation of this Agreement.
b. Associate may use PHI to perform data aggregation services as permitted by 45 C.F.
R. § 164.504(e) (2) (i) (B).
c. Associate agrees that anytime it provides PHI received from MARICOPA COUNTY to
a Contractor, its employees, subcontractor, or agent to perform Services for
h4ARICOPA COUNTY, Associate first will enter into a contract with such Contractor,
employees, subcontractor or agent that contains the same terms, conditions, and
restrictions on the use and disclosure of PHI as contained in this Agreement.
d. If Associate maintains a Designated Record Set, MARICOPA COUNTY will provide
Associate with copies of applicable policies and procedures, which the Associate will
comply with as related to an individual's right to access PHI; request an amendment to
PHI; request confidential communications of PHI; or request an accounting of
disclosures of PHI.
2. Associate Use or Disclosure of Protected Health Information for its Own Purposes.
Associate may use or disclose PHI received from MARICOPA COUNTY for Associate's
management and administration, or to carry out Associate's legal and contractual
responsibilities. Associate may disclose PHI received from tvlARICOPA COUNTY to a third
party for such purposes only if:
a. The disclosure is required by law; or
b. Associate secures written assurance from the receiving party that the receiving party
will: (i) hold the PHI confidentially; (ii) use or disclose the PHI only as required by law
or for the purposes for which it was disclosed to the recipient; and (iii) notify the
Associate of any breaches in the confidentiality of the PHI.
c. Associate may use and disclose de-identified health infomiation, if (i) the use is
disclosed to MARICOPA COUNTY and permitted by MARICOPA COUNTY in its sole
discretion, (ii) that the de-identification is in compliance with 45 C.F.R. § 164.502(d),
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Contract 200131
and (iii) the de-identified health information meets the standard and implementation
specifications for de-identification under 45 C.F.R. § 164.514(a) and (b).
d. Associate shall use and disclose PHI only to the extent reasonably necessary to
accomplish the intended purpose of such PHI.
3. Safeguards. Associate will implement and maintain appropriate safeguards to prevent any
use or disclosure of PHI not othemise permitted in this Agreement.
a. Associate also will implement administrative, physical and technical safeguards to
protect the confidentiality, integrity, and availability of any electronic protected health
information ("e-PHr), if any, that Associate creates, receives, maintains, and transmits
on behalf of MARICOPA COUNTY.
b. Upon request of MARICOPA COUNTY, Associate will provide evidence to MARICOPA
COUNTY that these safeguards are in place and are properly managed.
4. Reports of Improper Use or Disclosure of Secure or Unsecure Protected Health
Information and of Security Incidents and Breaches. Associate will report in writing to
MARICOPA COUNTY any use or disclosure of PHI, including any breach, not permitted by
the contract between Associate and MARICOPA COUNTY within five (5) days of Associate's
learning of such use, disclosure or breach or within five (5) days following the exercise of
reasonable diligence vvould have known of the improper use, disclosure, or breach.
5. Mitigation of potential harmful effects. Associate shall mitigate all potential harmful effects
of a use or disclosure of Protected Health Information by Business Associate in violation of
the requirements of this Agreement. Immediately following the Associate's discovery of a
Breach (or upon the Associate's reasonable belief that a Breach has occurred), Associate
shall provide MARICOPA COUNTY with sufficient information to permit MARICOPA
COUNTY to comply with the Breach notification requirements set forth at 45 C.F.R. § -I 64.400
et seq.
a. Specifically, if the following information is known to (or can be reasonably obtained by)
the Associate. Associate will provide to MARICOPA COUNTY all available infomiation
that MARICOPA COUNTY is required to include in its notification to the individual
pursuant to the Breach Notification Rule, including but not limited to:
i. contact information for individuals who were or who may have been impacted by
the Breach (e.g., first and last name, mailing address, street address, phone
number, email address);
ii. a brief description of the circumstances of the Breach, including the date of the
Breach, the date of discovery of the Breach, and the identity of who accessed and
received the Unsecured PHI;
iii. a description of the types of unsecured PHI involved in the Breach (e.g., names,
social security number, date of birth, address(s), account numbers of any type,
disability codes, diagnostic and/or billing codes and similar information);
iv. a brief description of what the Associate has done or is doing to investigate the
Breach, mitigate harm to the individual impacted by the Breach, and protect
against future Breaches; and
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Contract 200131
v. contact information bra liaison appointed by the Associate with whom MARICOPA
COUNTY may ask questions and learn additional information concerning the
Breach.
b. Following a Breach, Associate will have a continuing duty to inform MARICOPA
COUNTY of new infomiation learned by Associate regarding the Breach, including but
not limited to the information described in items (I) through (5), above.
c. Associate also will report in writing to MARICOPA COUNTY any Security Incident
(successful or unsuccessful) of which Associate becomes aware within five (5)
business days of Associate learning of such use or disclosure.
Specifically, Associate will report to MAR ICOPA COUNTY any unauthorized access, use,
disclosure, modification, or destruction of e-PHI or interference with system operations in
an information system containing e-PHI of which Associate becomes aware, provided that:
i. such reports will be provided only as frequently as the parties mutually agree, but
no more than once per month; and
ii. if the definition of 'Security Incident" under the Security Standards is amended to
remove the requirement for reporting "unsuccessful - attempts to use, disclose,
modify or destroy e-PHI, the portion of this Section 5 addressing the reporting of
unsuccessful, unauthorized attempts will no longer apply as of the effective date
of such amendment.
6. Obligations Regarding Associate Personnel. Associate will appropriately inform all of its
employees, agents, representatives, members of its workforce, and Contractors, its
employees, subcontractors, or agents of Associate ("Associate Personnel"), whose services
may be used to satisfy Associate's obligations under the Contract and this Agreement of the
terms of this Agreement. Associate represents and warrants that the Associate Personnel
are under legal obligation to Associate, by contract or otherwise, sufficient to enable
Associate to fully comply with the provisions of this Agreement. Associate will maintain a
system of sanction for any Associate Personnel who violates this Agreement.
7. Access to Protected Health Information.
a. MARICOPA COUNTY Access, Within five (5) business days of a request by
MARICOPA COUNTY for access to PHI received from MARICOPA COUNTY,
Associate will make requested PHI available to MARICOPA COUNTY.
b. Patient Access. If a Patient requests access to PHI directty from Associate, Associate
will within five (5) business days fonvard such request in writing to MARICOPA
COUNTY. MARICOPA COUNTY will be responsible for making all determinations
regarding the grant or denial of a Patient's request for PHI and Associate will make no
such determinations. Only MARICOPA COUNTY will release PHI to the Patient
pursuant to such a request.
8. Amendment of Protected Health Information.
a. MARICOPA COUNTY Request. Within five (5) business days of receiving a request
from MARICOPA COUNTY to amend an individual's PHI received from WRICOPA
COUNTY, Associate will provide such information to MARICOPA COUNTY for
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Contract 200131
amendment. Alternatively, if MARICOPA COUNTY request includes specific
information to be included in the PHI as an amendment, Associate will incorporate such
amendment within five (5) business days of receipt of the MAR1COPA COUNTY
request.
b. Individual Request. If an individual makes a request for amendment directly to
Associate, Associate will forward within five business days such request in writing to
MARICOPA COUNTY. MARICOPA COUNTY will be responsible for making all
determinations regarding amendments to PHI and Associate will make no such
determinations.
9. Accounting of Disclosures; Requests for Disclosure.
a Disclosure Records. Associate will keep a record of any disclosure of PHI received
from MARICOPA COUNTY that Associate makes to its employees, subcontractors,
and agents, or other third parties other than:
(1) Disclosures to health care providers to assist in the treatment of patients;
(2) Disclosures to others to assist MAFtICOPA COUNTY in paying claims;
(3) Disclosures to others to assist MARICOPA COUNTY in conducting its health care
operations, as defined in 45 C.F.R. § 164.501; or
(4) Disclosures made pursuant to an individual's Authorization.
Associate will maintain this disclosure record for six (6) years from the termination of this
Agreement.
Associate also agrees to maintain necessary and sufficient documentation of Disclosures of
Protected Health Information as would be required for MARICOPA COUNTY to respond to a
request by an individual for an accounting of Disclosures, in accordance with 45 CFR 164.528.
b. Data Regarding Disclosures. For each disclosure for which it is required to keep a
record under paragraph 8(a), Associate will record and maintain the following
information:
(1) The date of disclosure;
(2) The name of the entity or person who received the PHI, and, the address of such
entity or person, if known,
(3) A description of the PHI disclosed; and
(4) A brief statement of the purpose of the disclosure.
c. Provision to MARICOPA COUNTY. Associate will provide to MARICOPA COUNTY
its record of disclosures under paragraph 8(a), if any, within thirty days of each
disclosure. Within five business days of receiving a notice from MAR ICOPA COUNTY
of an individual's request for an accounting. Associate also will provide to MARICOPA
COUNTY its disclosure record.
d. Patient Request to Associate. If a Patient requests and accounting of disclosures
directly from Associate, Associate will forward the request to MAR1COPA COUNTY
within five (5) business days of Associate's receipt of the request, and will make its
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Contract 200131
records of disclosures available to MARICOPA COUNTY as otherwise provided in this
Section. MAR1COPA COUNTY will be responsible to prepare and for delivery of the
records of disclosure to the Patient. Associate will not provide an accounting of its
disclosure directly to the Individual.
10. Notice of Privacy Practices. MAR1COPA COUNTY shall provide Associate a copy of its
Notice of Privacy Practices ("Notice') in accordance with 45 C.F.R. § '164.520 as well as any
changes to the Notice. If MAR1COPA COUNTY Notice specifically affects Associate's use
or disclosure of PHI, MARICOPA COUNTY shall inform Associate of the specific limitations.
Associate shall abide by the limitations of MARICOPA COUNTY' Notice that affects its use
or disclosure of PHI of which it has been specifically informed. Any use or disclosure
permitted by this Agreement may be amended by changes to MAR1COPA COUNTY' Notice
if MARICOPA COUNTY specifically informs Associate of the amendment provided, however,
that the amended Notice shall not affect permitted uses and disclosures on which Associate
relied prior to receiving notice of such amended Notice.
11. Access to Books and Records.
a. MARICOPA COUNTY Access. Associate will, within five (5) business days of
MARICOPA COUNTY written request, make available during normal business hours
at Associate's offices, all records, books, agreements, policies and procedures relating
to the use or disclosure of PHI received from MARICOPA COUNTY for the purpose of
allowing MARICOPA COUNTY or its agents or auditors to determine Associate's
compliance with this Agreement.
b. Government Access. Associate will make its internal practices, books, and records
relating to the use and disclosure of PHI received from, or created or received by
Associate on behalf of, MAR1COPA COUNTY available to the Secretary of the
Department of Health and Human Services to the extent required for detemiining
compliance with the Privacy Standards. Notwithstanding this provision, no attorney-
client, accountant-client or other legal privilege will be deemed waived by Associate or
MARICOPA COUNTY as a result of this Section.
12. Termination. MAR1COPA COUNTY may immediately terminate the Contract, if any and this
Agreement upon written notice to Associate if MAR1COPA COUNTY determines that the
Associate or subcontractor(s) or agent(s) of Associate has breached a material term of this
Agreement. Alternatively, MARICOPA COUNTY may elect to provide Associate with written
notice of Associate's or subcontractor(s)' or agent(s)' of Associate breach of any term or
condition of this Agreement and afford Associate the opportunity to cure the breach to the
satisfaction of MARICOPA COUNTY within thirty (30) days of the date of such notice. If
Associate fails to timely cure the breach, as detemiined by MAR1COPA COUNTY at its sole
discretion, MARICOPA COUNTY may terminate the Contract and this Agreement.
13. Return or Destruction of Protect Health Information.
a. Return of PHI; Destruction. Within thirty (30) clays of termination of the Contract or
this Agreement. Associate will return to MAR1COPA COUNTY all PHI received from
MARICOPA COUNTY or created or received by Associate on behalf of MAR1COPA
COUNTY that Associate maintains in any form or format. Associate will not maintain or
keep in any form or format any portion of such PHI. Alternatively, Associate may, upon
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Contract 200131
IviARICOPA COUNTY written consent, destroy all such PHI and provide written
documentation of such destruction. The requirement to return or destroy such PHI will
apply to all agents or subcontractors of Associate. Associate will be responsible for
recovering any PHI from such agents or subcontractors. If Associate cannot obtain the
PHI from any agent or subcontractor, Associate will so notify MARICOPA COUNTY
and will require that such agents or subcontractors directly return PHI to MAR1COPA
COUNTY or otherwise destroy such PHI, subject to the terms of this Section.
b. Alternative Measures. If Associate believes that returning or destroying PHI at the
termination of the Contract or this Agreement is infeasible, it will provide written notice
to MARICOPA COUNTY within five (5) business days of the effective date of
termination of this Agreement. Such notice will set forth the circumstances that
Associate believes makes the return or destruction of PHI infeasible and the alternative
measures that Associate recommends for assuring the continued confidentiality and
security of the PHI. MARICOPA COUNTY promptly will notify Associate of whether it
agrees that the return or destruction of PHI is infeasible. If MAR1COPA COUNTY
agrees that return or destruction of PHI is infeasible, Associate agrees to extend all
protections, limitations and restrictions of this Agreement to Associate's use or
disclosure of PHI retained after termination of this Agreement and to limit further uses
or disclosures to those purposes that make the return or destruction of the PHI
infeasible. Any such extended protections, limitations and restrictions will apply to any
agents or subcontractors of Associate for whom return or destruction of PHI is
determined by MARICOPA COUNTY to be infeasible. If MARICOPA COUNTY does
not agree that the return or destruction of PHI from Associate or its agents or
subcontractors is infeasible, MARICOPA COUNTY will provide Associate with written
notice of its decision, and Associate, its agents and subcontractors will proceed with
the return or destruction of the PHI pursuant to the temis of this Section within fifteen
(15) days of the date of MAR ICOPA COUNTY notice.
14. Restrictions on Use or Disclosure of Protected Health Information. If MARICOPA
COUNTY advises Associate of any changes in, or restrictions to, the permitted use or
disclosure of PHI received from MARICOPA COUNTY, Associate will restrict the use or
disclosure of such PHI consistent with the MARICOPA COUNTY instructions.
15. Mitigation Procedures. Associate agrees to have procedures in place for mitigating, to the
maximum extent practicable, any deleterious effect from the use or disclosure of PHI received
from MARICOPA COUNTY in a manner contrary to this Agreement or the Privacy Standards.
16. Compliance with the HITECH Act. Associate will comply with the requirements of Title XII,
Subtitle D of the Health Infomiation Technology for Economic and Clinical Health (HITECH)
Act, codified at 42 U.S.C. §§ 17921-17954, which are applicable to Associates, and will
comply with all regulations issued by the Department of Health and Human Services (HHS)
to implement these referenced statutes, as of the date by which Associates are required to
comply with such referenced statutes and HHS regulations.
a. Associate will also comply with Section 13402 of the HITECH Act, codified at 42 U.S.C.
§ 17932, and with all regulations issued by HHS to implement this statute, as of the
date by which Associates are required to comply with such referenced statutes and
HHS regulations. Associate will make a report to the MARICOPA COUNTY of any
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Contract 200131
breach of unsecured protected health information, as required by 42 U.S.C. § 17932(b),
within five (5) business days of Associate's discovery of the breach. Associate will
indemnify MARICOPA COUNTY for any reasonable expenses MARICOPA COUNTY
incurs in notifying individuals of a breach caused by Associate Of its subcontractors or
agents.
17. Miscellaneous.
a. Compliance with Laws. The Parties acknowledge that state and federal laws relating
to electronic data security and privacy are rapidly evolving and that amendment of this
Agreement may be required to ensure compliance with such developments. Should
such developments occur, and upon either Party's good faith request, the other Party
agrees to enter good faith negotiations concerning the terms of an amendment to this
Agreement.
b. Construction of Terms. The terms of this Agreement will be construed in light of any
applicable interpretation or guidance on the Privacy Standards and Security Standards
issued by the Department of Health and Human Services and other applicable state or
federal laws, rules and regulations as amended from time to time.
c. No Third Party Beneficiaries. Nothing in this Agreement will confer upon any person
other than the parties and their respective successors or assigns, any rights, remedies,
obligations, or liabilities, whatsoever,
d. Assignment of Rights and Delegation of Duties. This Agreement is binding upon
and inures to the benefit of the Parties hereto and their respective successors and
permitted assigns. However, neither Party may assign any of its rights or delegate any
of its obligations under this Agreement without prior written consent of the other Party,
which consent shall not be unreasonable withheld or delayed. Notwithstanding any
provisions to the contrary, however, MARICOPA COUNTY retains the right to assign
or delegate any of its rights and obligations hereunder to any of its wholly owned
subsidiaries, affiliates or successor companies. Assignments made in violation of this
provision are null and void.
e. No Waiver. Failure or delay on the part of either Party to exercise any right, power,
privilege or remedy hereunder shall not constitute a waiver thereof. No provision of
this Agreement may be waiver by either Party except by a writing signed by an
authorized representative of the Party making the waiver.
f. Severability. The provisions of this Agreement shall be severable, and if any provision
of this Agreement shall be held or declared to be illegal, invalid or unenforceable, the
remainder of this Agreement shall continue in full force and effect as though such
illegal, invalid or unenforceable provision had not been contained herein.
g. Entire Agreement. This Agreement constitutes the entire agreement between the
parties with regard to the Privacy Standards and Security Standards, there are no
understandings or agreements relating to this Agreement that are not fully expressed
in this Agreement and no change, waiver or discharge of obligations arising under this
Agreement will be valid unless in writing and executed by the party against whom such
change, waiver or discharge is sought to be enforced.
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Contract 200131
h. Written Agreement. This Agreement is considered as an integral part of the
underlying Contract, and is incorporated as though fully set forth within the Contract.
This Agreement will govern in the event of conflict or inconsistency with any provision
of Contract
i. Choice of Law. This Agreement and the rights and obligations of the parties hereunder
shall be governed by and construed under the laws of the State of Arizona, without
regard to applicable conflict of law principles.
Counterparts. This Agreement may be executed in two or more counterparts, each of
which shall be deemed an original and when taken together shall constitute one
agreement.
k. Facsimile and Electronic Signatures. Facsimile and electronic signatures shall be
deemed to be original signatures for all purposes of this Agreement.
I. Notices. Any notices required under this Agreement will be sent to the parties at the
following address by first class mail, fax or hand delivery:
For County: For Associate: Contact and Notice Info
MARICOPA COUNTY PractiSynergy
BOARD OF SUPERVISORS Attn: Katie Fergus
301 W. Jefferson Street, tOln Floor 500 E. Court Ave , Ste 305
Phoenix, AZ 85003 Des Moines, IA 50309
(602) 506-3416 (515)237-3974
Agreed to by MARICOPA COUNTY and Associate by
MARICOPA COUNTY ASSOCIATE
circ-l-53 4-12-- September 15. 2019
SIGttAILME DATE SIGIIATURE DATE
Katrin S Fergus President CEO
pwriTliew SNP liTLk PRAM /COLE AND MU
ATTEST
CLERK OF THE BOARD DATE
APPROVE AS TO FORM:
Attorney for Matioopa Cowity Date
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Contract 200131
BUSINESS ASSOCIATE AGREEMENT
FOR RELEASE OF INFORMATION TO THIRD PARTIES
1 (*Associate") is a business associate of MARICOPA COUNTY, pursuant to the
Agreement between Associate and MARICOPA COUNTY dated September 15, 2019
(*Agreement"). Pursuant to that Agreement, Associate is required to comply with the requirements
for the use and handling of Protected Health Information (PHI') from MARICOPA COUNTY as
set forth in the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R.
164.501 et. seq. as amended from time to time (Privacy Standards").
2. Associate is permitted to disclose PHI to (-Recipient") for the necessary
management and administration of Associate and to carry out the legal responsibilities of the
Associate, provided that Recipient provides Associate with the following assurances for
Recipient's use and disclosure of PHI.
3. Associate seeks to disclose PHI to Recipient for the following management, administration or legal
responsibilities of Associate:
4. The disclosure of PHI to Recipient is conditioned upon Recipient's assurance that, and Recipient
agrees that it will:
a. Hold the PHI confidentially and make no re-disclosure to any third party without Associate's
express advance written consent;
I). Use or disclose the PHI only as required by law or for the purposes set forth above; and
c. Notify Associate in writing of any breaches in tile confidentiality of the PHI within three days of
discovery of any such breach.
ASSOCIATE RECIPIENT
SIGNATURE DATE SIGNATURE DATE
PRINT NAME =IND TITLE PRINT NAME AND TITLE
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