This Revenue Cycle Management Services Addendum (this "RCM Addendum") applies to any Revenue Cycle Management Services ("RCM Services") designated in a current Order between Customer and Golden Hour. Capitalized terms not defined below but used herein will have the same meaning as in the Master Software, SaaS and Services Agreement.
- General. As further described in this RCM Addendum, Golden Hour will provide RCM Services in accordance with Golden Hour's established policies, procedures and workflows designed to create, submit, collect and maximize reimbursement of medical claims associated with emergency medical transports by Customer.
- Allocation. Customer will transmit all Claims to Golden Hour as soon as reasonably practical and no later than three (3) days after they arise. Customer's engagement of Golden Hour is exclusive with respect to the RCM Services. Customer will not engage any other person or entity to perform services that are the same as, or similar in nature and scope to, the RCM Services.
- Demographics. Within thirty (30) days of the Effective Date, Customer will provide Golden Hour with information reasonably necessary for Golden Hour to provide the RCM Services, including the information requested in the implementation plan to be sent to Customer.
- Transports. Customer will provide the following to Golden Hour concurrently with the transmission of the Claims to which they relate:
- Complete transport record;
- Digital attachments of all data ancillary to such record including, but not limited to: (a) Assignment of Benefits; (b) Advance Beneficiary Notice; (c) Certificate of Medical Necessity; (d) copies of all signed documents related to ambulance transport (including, but not limited to, the memorandum of transfer forms, letters of agreement, guarantees of payment and authorizations from insurers and other entities); and (e) any additional attachments or records that support the use of the particular type of transport of a patient and that patient's condition (including, but not limited to, electrocardiogram readings, discharge summaries, hospital medical records and specialized hospital transport teams involved with the care during the transport);
- Patient loaded miles;
- Facility demographics detail;
- Copy of all correspondence associated with a Claim;
- Complete payment information related to any reimbursement or payment accepted prior to, or at the time of, transport including, but not limited to, any down payment; and
- Other transport Claim information as may be reasonably requested by Golden Hour from Customer for the purpose of the RCM Services.
RCM Services expressly exclude, and additional fees for Professional Services will be due and payable for, any review of a patient's insurance coverage or policy requirements, commonly known as benefits checks, prior to transport of such patient. Golden Hour is not responsible for any errors or omissions caused by inaccurate information provided by Customer.
- Liaison. Upon Golden Hour's request, Customer will assist and facilitate in data acquisition, data verification, local legal issues and insurance appeals process in support of the RCM Services. This assistance and facilitation may require, without limitation the gathering and coordination of information and supporting documentation to process, code, file and collect upon Claims.
- Coding. Based upon the information provided by Customer, including, but not limited to, scope of practice, medical crews' clinical impressions, medical records and related documentation, and regulations published by applicable third-party payors, for each Claim, Golden Hour will (I) perform coding; (II) verify the correct billing code; and (III) verify and assign the correct billing modifiers. Customer will promptly notify Golden Hour of any material changes to information previously provided to Golden Hour that would impact coding.
- Payors. Golden Hour will collaborate in good faith with Customer to obtain insurance verification and other information necessary to provide the RCM Services, including: (I) confirming insurance coverage for transports; (II) exercising due diligence in obtaining information needed to process Claims; and (III) identifying primary, secondary and tertiary payors in material compliance with applicable federal and state laws. RCM Services expressly exclude, and additional fees for Professional Services will be due and payable for, payor enrollment and management services, including, but not limited to, license updates, pay-to information, vehicle additions and board member or ownership changes.
- Processing. Golden Hour will implement and maintain a system for processing Claims that (I) submits Claims in electronic and paper format to payors and (II) provides to payors with such Claims all necessary patient insurance forms, electronic claim data and supplemental statements. If Golden Hour is provided with all information necessary to submit a Claim, Golden Hour will submit such Claim in accordance with the timetables set for in applicable law.
- Transports. Golden Hour will make reasonable efforts to collect payments due to Customer for Claims based upon the billing protocols established by Customer and Golden Hour. Specifically, Golden Hour will perform the following tasks with respect to Claims:
- Implement and maintain a charge recovery and cash receipt control system;
- Maintain Customer account records for Claims, including posting daily remittances, updating patient records, calculating contractual disallowances and reclassifying accounts once payments have been made;
- Perform account follow-up, including monitoring payors' responses to Claims, balance due collections from patients, and secondary insurance submissions;
- Generate daily cash deposit updates in accordance with generally accepted internal control standards; and
- Make reasonable efforts to resolve any remittance advice exceptions.
The efforts described in this section do not guarantee payment. Payments of benefits are subject to all terms, conditions, limitations and exclusions of a patient's contract at the time of service. Additionally, a patient's health insurance company will only pay for services it deems to be "reasonable and necessary." Thus, a patient's health insurance company could deny coverage, even after benefits or eligibility are verified.
- Lockbox. Customer will establish a lockbox (the "Lockbox") with a banking institution ("Bank") for payments related to the Claims (the "Payments"), which will be Customer's sole property. Customer will authorize Bank to provide Golden Hour with read-only access to the Lockbox.
- Posting. All billing instructions issued by Golden Hour for Claims will direct the payor to remit Payments to the Lockbox. Payments collected by Golden Hour on behalf of Customer will be deposited into the Lockbox. Customer will notify Golden Hour within thirty (30) days of any direct or separate remittance with respect to any Claim made directly to Customer. If Golden Hour receives confirmation that Payment, offset or recoupment of a Claim has been applied by the applicable payor but Customer has not reported such Payment, offset or recoupment within one hundred twenty (120) days of Golden Hour receiving such confirmation, then Golden Hour may apply such Payment, offset or recoupment to Customer's account.
- Payments. Golden Hour will undertake reasonable efforts to assign each Payment to the correct Claim. Without limiting Section 3 of this RCM Addendum:
- If Golden Hour receives a payment from Customer that does not relate to a Claim ("Non-GH Payment"), then Golden Hour will: (a) notify Customer of such Non-GH Payment; (b) attempt to return it to Customer; and (c) post it as a Non-GH Payment until Customer accepts such return.
- If Golden Hour receives a payment without remittance information reasonably sufficient for Golden Hour to identify the Claim to which such payment pertains (an "Unidentified Payment"), then Golden Hour will: (a) notify Customer of such Unidentified Payment; (b) request that Customer provide information reasonably sufficient to identify the Claim to which the Unidentified Payment pertains; and (c) post it as an Unidentified Payment until Customer provides such information.
- If Golden Hour receives a payment from Customer's designated third-party collections agent relating to a Claim (a "Collections Agent Payment"), then: (a) Golden Hour will post such Collections Agent Payment to that Claim; and (b) Collection Fees (as defined in the Agreement) will be due and payable hereunder with respect to such Collections Agent Payment.
- If Golden Hour receives a refund request or overpayment notice relating to a Payment, or if Golden Hour identifies that Customer has received a payment in excess of the amount of a Claim (in each case, a "Payment Inquiry") then: (a) Golden Hour will promptly notify Customer of such Payment Inquiry; (b) Customer will promptly respond to such Payment Inquiry, including providing a refund to the payor, if necessary; and (c) post a refund, overpayment or recoupment, as required.
- In consideration of the time and effort required by Golden Hour concerning Claims even where a refund is requested or overpayment or recoupment occurs, Customer will not be entitled to recoupment, offset or reimbursement of Collection Fees paid to Golden Hour for the Claim that is the subject of a Refund or Overpayment.
- Reporting. On a monthly basis, Golden Hour will provide Customer with a report to allow Customer to track each Claim, which report will indicate amounts billed, collections received, adjustments made, write-offs applied and other demographics and actions resulting from the RCM Services. Concurrently with the delivery of the foregoing report, Golden Hour also will provide Customer with a summary report that indicates total cash collected, allowances made, adjustments applied and other items required for financial reporting.
- General. Unless otherwise expressly provided hereunder, in no event will one party be liable to the other party for such other party's non-compliance with applicable laws including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 (P.L. 104 191), 42 U.S.C. Section 1320d, et. seq., and regulations promulgated thereunder, as amended from time to time (such statute and regulations collectively referred to as "HIPAA") or rules and regulations of the Center for Medicare and Medicaid Services.
- Compliant Transports. Customer specifically represents, warrants and agrees that all transports performed by Customer are valid medical transports that comply with all applicable federal and state laws and regulations and other applicable requirements for payment including, but not limited to, any requirements for crew member credentials, certifications or licensure ("Compliant Transports"). Without limiting Golden Hour's other rights and remedies, for any transport that is not a Compliant Transport (a "Non-Compliant Transport"), Golden Hour will: (a) if a Claim was submitted for such Non-Compliant Transport, collaborate with Customer or payor, or both, with respect to the refund of any payment received by Customer and cancellation of such Claim; (b) return any Claim for such Non-Compliant Transport and corresponding documentation to Customer; and (c) have no further obligation to perform RCM Services related to such Non-Compliant Transport. In consideration of the time and effort required by Golden Hour concerning the Claims described in this Section 3.B, Customer will pay Collection Fees for such Claims as if Customer received Payment for such Claims.
- Compliance Program. Each party will maintain a compliance program in accordance with applicable laws and regulations. Additionally, Golden Hour will adhere to Customer's commercially reasonable policy with respect to accounts receivable delivered to Golden Hour at least ninety (90) days in advance of required compliance, including with respect to write-offs, bad-debt, contractual adjustments and other adjustments of accounts receivable balances; provided that if a material conflict exists between such policy and Golden Hour's accounts receivable policy, Golden Hour and Customer will cooperate in good faith to develop a mutually agreeable policy with respect to accounts receivable for the RCM Services.
- Non-Solicitation. Customer will not solicit or hire Golden Hour's employees, either during this Agreement or for a period of one (1) year after the expiration of this Agreement, without the prior written consent of Golden Hour.
- Insurance. Golden Hour, at its own cost and expense, will obtain and maintain, during the Term of the Agreement, insurance policies in adequate amounts to support Golden Hour's obligations and operations. Such insurance coverage shall include Worker's Compensation Insurance, General Liability Insurance, Professional Liability Insurance, and Automobile Liability Insurance.