HomeMy WebLinkAboutUniversity Hospital
Augusta Richmond GA
DOCUMENT NAME: Un ,- v.e-vf "1; f/o 5/)/' b..../
DOCUMENT TYPE: 0.. 9 ye.f-i'r-U'l- f
YEAR: I ~ q t./
BOX NUMBER: '1
FILE NUMBER: ) 2- S-- Y3
NUMBER OF PAGES:
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AMENDMENT TO AGREEMENTS
This AMENDMENT to ~e Agreements (as hereinafter defined) is
entered into this /~- day of December, 1994, by and between
Richmond County (hereinafter referred to as the "County") and
University Health Services, Inc. d/b/a University Hospital
(hereinafter referred to as "University"), upon the terms and--
conditions set forth below.
.~'\. .
WIT N E SSE T H:
WHEREAS, County and University have previously entered into
those certain agreements dated February I, 1966, September 20,
1977, October I, 1977 and January 10, 1985 (hereinafter sometimes
collecti vely referred to as the "Agreements"),' each setting forth
the arrangement by which University will provide certain health
care services to the indigent residents of Richmond County; and
WHEREAS, County and University have previously entered into
that certain agreement dated September 23, 1971, setting forth
the arrangement by which University will provide ambulance
service to the indigent residents of Richmond County; and
WHEREAS, certain disputes have arisen between County and
University as to billing and other practices performed under the
Agreements; and
WHEREAS, County and University desire to amend the
Agreements;
NOW, THEREFORE, for and in consideration of the promises and
covenants contained herein, and for other good and valuable
consideration, the receipt and sufficiency of which is hereby
acknowledged, the parties hereto, intending to be legally bound,
do hereby agree as follows.
Section I. TERM OF AMENDMENT
This Amendment shall be for a term beginning January 1, 1995
and continuing until' the termination date provided by the
Agreements of January 31, 1996.
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.
Section II.
PRACTICES FOR CALENDAR YEAR 1994
Notwithstanding any provision(s) in the Agreements to the
contrary, County and University agree to the following terms and
conditions for the providing or cer~ain health care services to
the indigent residents of Richmond County by University for the
calendar year 1994:
A. provision of Services
University covenants and agrees that it has provided and
will continue to provide for the remainder of 1994, to the
cer~ified indigent residen~s or Richmond County, all health care
services usually and customarily provided by it, including
emergency room, outpatien~ clinic, inpatient and physician
services (so long as such services are covered by this Amendment
as outlined below), in a promp~ and proper manner consistent with
professional standards and all applicable laws and regulations.
University further covenants and agrees to provide said services
to said patients in the same manner and quality as provided to
other patients of University. It is understood that University
customarily provides physician services only in a limited number
of specialties, and only to a limited extent in those
specialities. Nothing in this Amendment is intended to or shall
have the effect of expanding University's obligation to provide
services to certified indigents beyond those services provided on
January 1, 1994.
B. Certification or Residency
County only agrees to pay for Covered Health Care Services
(as defined in Section III.D. below) provided to indigents who
are certified as residents of the County. University agrees to
provide to the County the names and addresses of all patients
treated as indigent residents of the County in the calendar year
of 1994. On a case by case basis, University will furnish the
County additional demographic data in University's possession to
permit the County to verify said patient's residency. County
shall not revoke a residency certification of any person who was
living in the County for six months or longer on the date of
service if such residence is confirmed by one of the methods set
forth at III.B.
C. Certification of Indiqency
County only agrees to pay for Covered Health Care Services
provided to residents of the County who are certified as
indigent. University agrees to certify to the County the
indigent status of all patients for whom payment from the County
under the Agreements and this Amendment is sought for the
calendar year 1994 (except as provided in Section I.D. below).
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1. As a preliminary matter, such certification shall
conr1rm that each said patient is with respect to the Covered
Health Care Service "self-pay", that is
a. does no~ have valid health 1nsurance and/or
medical payments coverage;
b. does not have Medicare or Medicaid 1nsurance
coverage; and
c. does not have worker's compensation coverage.
2. Such certification shall further state that each said
patient 1S "indigent" by virtue of being either:
a. a recipient or a minor child of a recipient
of food stamps in 1994 (as determined by records of the
Department of Family and Children Services ("DFACS") recipients
are deemed to be 100% indigent; or
b. a holder of valid and current clinic card
(issued by either University or DFACS) setting forth a level of
indigency qualification.
3. Patients who are "self-pay indigents" as provided
herein and are certified as residents of Richmond County shall be
deemed "certified" for.purposes of this Section II.
D. Payment by County
County shall be responsible for payment within thirty days
of receipt of a bill for Covered Health Care Services provided by
University pursuant to the Agreements and this Amendment as
follows:
1. Emergency Room
a. For all "certified" indigent residents,
County agrees to pay the "cost" for all Covered Health Care
Services provided in University's emergency Room, including
services provided by physicians either salaried by or under
contract with University, less, where applicable, the amount of
patient payment required by the patient's indigency level
classification whether or not the patient makes the payment. As
to Covered Health Care Services including physician services,
"cost" means the product of charges for such services multiplied
by the 1993 Medicare cost-to-charge ratio.
b. Realizing that this certification
process set forth in Section II.C. above is being applied
retroactively, County agrees to pay the portion of costs (costs,
for the purposes of this subsection, equalling the charges by
University multiplied by the Medicare cost-to-charge ratio) for
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all non-certified "self-pay" residents, proven uncollectible (as
of November 27, 1994) through normal collection processes from
non-certified "self-pay" residents who received Emergency Room
care during the period from March 21 to May 15, 1994.
2. Outoatient Clinic
a. cor all "certified" indigent residents,
County agrees to pay the "cost" for all Covered Health Care
Services provided in University's Outpatient Clinics, including
services provided by physicians either salaried by or under
contract with Universlty, less, where applicable, the amount of
patient payment required by the patient's clinic card
classification whether or not the patient makes the payment. As
to Covered Health Care Services, "cost" means the product of
charges for such services including physician services multiplied
by the 1993 Medicare cost-~o-charge ratio.
b. Realizing that this certification
process set forth in Section II.C. above is being applied
retroactively, County agrees to pay the portion of costs (costs,
for the purposes of this subsection, equalling the charges by
University multiplied by the Medicare cost-to-charge ratio) for
all non-certified "self-pay" residents, proven uncollectible (as
of November 27, 1994) through normal collection processes from
non-certified 'self-pay" residents who received Outpatient Clinic
care during the period from March 21 to May 15, 1994.
3. Inpatient
a. For all "certified" indigent residents,
County agrees to pay "charges" for services provided to such
patients as provided for in the September 20, 1977 Agreement;
provided, however, that any inpatient procedure for which the
County has previously refused payment as non-covered may be
reevaluated according to the guidelines for covered and non-
covered services set forth in Section 111.0. hereof. In.~
addition, 23-hour observation admissions, ambulatory and minor
surgery admissions and physicians' fees (for physicians either
salaried by or under contract with University, and calculated..in
accordance with CPT-4 Billing Codes) shall be considered covered
services.
b. Realizing that this certification
process set forth in Section II,C. above is being applied
retroactively, County agrees to pay the portion of charges for
all non-certified "self-pay" residents proven uncollectible (as
of November 27, 1994) through normal collection processes from
"self-pay" residents who received inpatient care during the
period from March 21 to May 15, 1994,
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4. Cap on Payments
Regardless of actual costs and/or charges incurred and
billed under this Section II" in no event and under no
circumstances shall County payor be required to pay in excess of
$3.5 million (hereinafter refer=ed to as the "Cap") for Covered
Health Care Services rendered pursuant to the Agreements and this
Amendment for the calendar year 1994 for either emergency room,
outpatient clinic, and/or inpatient care. The parties recognize
and agree that County has as or ~he date of this Amendment paid
University $716,443 of the Cap.
E. Review or 1994 Billinqs
The parties agree that County (or its designated agent)
shall be allowed to review all billings by University to the
County for the calendar year 1994 and that University shall
furnish to County (or its designated agent) all documents and
materials necessary for County to complete said review. Unless
County requests in writing additional specific documents, County
shall be deemed to have received all necessary documents and
materials thirty days after receipt of the bill for December,
1994 services. County shall have 90 days from the later of the
receipt of the bill for December, 1994 services or its receipt of
specifically requested additional billings, documents and
materials to complete its review, After said 90 day period, all
such bills shall be final and uncontestable, except as limited by
the Cap. The payment of bills shall not be delayed by review
under this section.
F. Credits to COUnty
With respect to any particular 1994 account upon which
the County made a payment, County shall be entitled to a credit,
to the extent of its payment on a particular patient account, on
its next billing, for the following:
1. to the extent of University's recovery under
any lien imposed under Georgia law;
revoked. -
2. to the extent any indigent certification lS
Credits under this section shall not reduce the Cap.
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Section III.
PRACTICES FROM JANUARY 1, 1995 TO JANUARY 31,
1996
Notwithstanding any provision(s) In the Agreements to the
contrary, County and University agree to the following terms and
conditions for the providing of certain Covered Health Care
Services to the indigent residents of Richmond County beginning
January 1, 1995 and continuing until January 31, 1996:
A. provision of Services
University covenants and agrees to provide to the certified
indigent residents of Richmond County all Covered Health Care
Services (as defined in Section III.D. below) usually and
customarily provided by it, including emergency room, outpatient
clinic, inpatient and physician services, in a prompt and proper
manner consistent with professional standards and all applicable
laws and regulations. University further covenants and agrees to
provide said services to said patients in the same manner and
quality as provided to other patients of University. It is
understood that University customarily provides physician
services only in a limited number of specialties, and only to a
limited extent in those specialities. Nothing in this Amendment
is intended to or shall have the effect of expanding University'S
obligation to provide services to certified indigents beyond
those services provided on January 1, 1994.
University reserves the right to deny services to any
patient who engages in dangerous or disruptive behavior.
B. Certification of Residencv
In order to receive Covered Health Care Services (as
hereinafter defined), a patient or responsible household member
must have been a resident of Richmond County for at least six (6)
consecutive months prior to the date Covered Covered Health Care
Services are sought. Responsible household members are persons
legally married (whether by ceremony or common-law) or living in
a domestic relationship, and the legally responsible parents or
guardians of children under the age of 18. If there is doubt as
to who are the legally responsible parents of children under the
age of 18, a copy of the child's birth certificate shall be
required to verify parentage.
Residency must be confirmed by at least one (1) of the
following:
1. rent receipts for a period of six (6)
consecutive months, a lease, or a statement by a rental agency or
established real estate business that the patient has resided in
the County for at least 6 months;
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2. a valid Georgia driver's license showing an
examination date at least 6 months old and a Richmond County
address;
3. employment check stubs showing the patient's
(or a responsible household member's) address during the
preceding 6-month period, or a statement from the patient's (or a
responsible household member's) employer attesting to residence
in Richmond County;
4. utility bills or payment stubs (at least one
of which is current and at least one of which is between 6 and 12
months old) In the patient or a responsible household member's
name;
5. a telephone book or city directly listing
showing the patient's or responsible household member's name;
6. a voter registration card issued at least 6
months before and showing a Richmond County polling place;
7.. attestations of residency (in the form of
affidavits) for at least 6 months from the patient and two other
people, one of whom must be a minister with a Richmond County
congregation or the director of a private relief organization
such as the Salvation Army;
8. a letter from DFACS verifying receipt of food
stamps from Richmond County DFACS; or
9. a currently valid University certification
card issued under Section B.S. below.
No bill for a patient whose residency cannot be certified
according to the above requirements shall be submitted to, or
paid by, the County. University agrees to notify the County
immedia~ely should it receive information that any certification
is in error, or that any patient is attempting to certify
residency falsely.
C. Certification of Indiqencv
In order to receive Covered Health Care Services (as
hereinafter defined) each patient must be certified as indigent
according to this Amendment. As a preliminary matter, such
certification shall confirm that each said patient is with
respect to the Covered Health Care Service "self-pay", that lS
a. does not have valid health insurance and/or
medical payments coverage;
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b. does not have Medicare or Medicaid lnsurance
coverage; and
c, does not have worker's compensation coverage.
Unless otherwise disqualified, a patient will be certified
as indigent under this Amendment if the sum of his/her gross
income plus other responsible household members' gross income(s),
is equal to or less than that listed in the attached income scale
(based upon the Federal Poverty Guidelines) for the applicable
household size. The attached income scale shall be amended
January 1 of each calendar year in order to correspond with the
then current Federal Poverty Guidelines.
For purposes of this section, responsible household members'
gross income includes the gross income of any dependent children.
For purposes of this section, any child (regardless of age) who
is or could be claimed as a dependent on his/her parent's income
tax return will be considered for indigency certification
according to his/her parent's gross income (with respect to a
minor with an absent parent who is not providing support to that
minor, the minor shall not be considered as having income from
that absent parent),
1. Determination of Gross Income
For purposes of this section, gross income means any and all
income before deductions, and includes the following:
a. wages and salaries before any deductions;
b. recelpts from self-employment before any
deductions, or from an owned farm or business after farm and
business deductions;
c. public assistance in any form;
d. social security payments;
e. supplemental security income (881);
f. unemployment compensation;
g. worker$' compensation payments;
h. veterans's benefits;
l. training stipends;
J. alimony payments;
k. child support payments;
1. military family allotments;
m. regular support from absent family members or
persons not living in the household;
n. government employee pensions;
o. private pensions;
p. insurance benefits paid on a regular,
annuity-like basis;
q,
r.
lncome form estates
annuity payments;
dividends, interests,
and trusts;
rents, royalties,
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s.
t.
disposable spending
living expenses),
unlon payments or assistance of any kind; and
any other form of income which results in
ability (such as student loans used for
""I
L. .
Verification of Gross Income
Gross lncome shall be verified as follows:
a. Possession of a currently valid Outpatient
Clinic card issued under Section a,5 below; or
b, For food stamp recipients, gross income shall
be determined from -DFACS records (unless such records are more
thgn 12 months old); or
c. For other than food stamp recipients (or for
those whose DFACS records are more than 12 months old), gross
income shall be determined from federal and/or state income tax
returns for the immediately preceding year for the patient and
all responsible household members and with all children (except
those born after the end of the last tax year) accounted for as
dependents, with adjustments made to bring figures current; or
d. Where income tax returns are not available,
the patient and all responsible household members shall be
required to disclose under oath all income (as defined in this
Section III.C.) received in the last 8 weeks from all sources.
University shall require patients to authorize DFACS to
access their income records from the computer records of the
Georgia Department of Labor. Any patient refusing to provide
such a~thorization shall not be certified as indigent. Within
seven days of its receipt of the authorization, DFACS will notify
University if the DOL income exceeds the patient's certified
indigency level.
3. Resources
Once a patient's income is determined, DFACS shall determine the
resources of that patient. Any patient whose total resources
exceed $1,500.00 shall not be certified as indigent; provided,
however, that in the event said patient's resources later fall
below $1,500.00, said patient may reapply for indigent
certification, and said patient will be allowed to pay toward
his/her billings from University for Covered Health Care Services
until the $1,500.00 figure is reached. For purposes of this
section, "resources" include the following:
1. real estate;
2. ,cash reserves (except that cash reserves of
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$800.00 or less are not counted as resources);
3. automobiles (except that up to two automobiles
used by the patient and/or household members for transportation
to and from work will not be counted as resources); and
4. life insurance (except that the first
$3,000.00 of cash value for life insurance for the patient and
each responsible household member shall not be counted as
resources).
4, Other Requirements and Standards for Patients
a. Medicaid/SSI
Unless excused in writing by DFACS, within 60 days of the
issuance of a certification card as a Richmond County indigent, a
patient must make a formal application through DFACS for Medicaid
coverage. If a patient refuses to make such application, or if
Medicaid coverage is denied due to an excess in resources, the
patient's indigent certification will be retroactively revoked.
If determined by DFACS to be SSI eligible, within 30 days of
notification fromDFACS a patient must make a formal application
through.DFACS for SSI coverage. If a patient refuses to make
such application, or if SSI coverage is denied due to an excess
in resources, the patient's indigent certification will be
revoked retroactive to the date of notification to apply for SSI.
In the event an application for either Medicaid or SSI
coverage is denied due to procedural grounds (including, but not
limited to the patient's failure to cooperate in the application
process), the patient's indigent certification will be
retroactively revoked.
b. Unemployment
Any patient or responsible household member claiming to be
unemployed must produce evidence of disability or verification
from the Georgia Department of Labor that he/she has registered
with them and has received an Employment Application Card and is
active in the "Peach Program~; provided, however, that this
subsection does not apply to adults legally responsible for the
care of young children or a disabled individual.
c. Food Stamps
If determined by DFACS to be eligible for food stamps,
within 30 days of notification from DFACS, a patient must make a
formal application through DFACS for food stamps. If a patient
refuses to make such application, or if food stamp eligibility lS
denied due to an excess in resources, the patient's indigent
certification will be revoked. Further, if an application for
food stamps is denied due to procedural grounds (including, but
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not limited to the patient's failure to cooperate in the
application process), the patient's indigent certification will
be revoked retroactive to the date of notification to apply for
food stamps.
d. Records
Unless a lOllger period is specified, patients must provide
any information requested in connection with the certification
and billing process within ten (10) business days of request.
Failure to do so shall result in a denial of indigent
certification or revocation retroactive to the date of the
request.
5. Certification Process
All certification cards are to be issued by DFACS. Cards
are valid for any covered service event ending 60 days
immediately preceding issuance and for the 12 month period after
issuance, Cards must be reissued at least every 12 months.
DFACS shall make all efforts to process certifications
within 30 days from its receipt of a request for certification.
DFACS shall station at least one employee to accept Medicaid
applications at University's outpatient clinics during clinic
hours. This processing time shall b~ tolled during any period
within which the DFACS worker is waiting for information from the
patient; provided, however, that if such information is not
forthcoming in the time period specified in Section III.D. above,
certification shall be denied. In the event DFACS does not
process certifications in the time specified above, the patient
shall be provisionally certified as 100% indigent. In the event
the patient is later determined by either DFACS or the County to
be less than 100% indigent, the provisional certification shall
be revoked and the County shall receive a credit in accordance
with Section III.H.3. below.
The application for indigency shall not require more than a
sixth grade education to complete, and shall not be longer than 1
page in length.
DFACS shall keep University apprised of the name, address
and telephone number provided by each patient seeking
certification as indigent. University reserves the right to
assist patients in the certification process when deemed
necessary. DFACS shall notify University when an applicant has
only 3 business days remaining before possible denial of
certification under Section III.C. 4 above.
6. Appeals Process
Patients denied indigent certification, who seek a higher
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certification level, or whose indigent certification is revoked,
may appeal such determinations to the Director of DFACS. Such
appeal must be in writing and submitted to said Director no more
than 30 days after the date of denial or revocation. The
Director shall make his determination on the issue and submit it
to the Appeals Board for final approval or disapproval. If the
denial, lower certification level, or revocation is overturned,
all Covered Covered Health Care Services from 60 days prior to
the submission of the original request for certification shall be
covered under the indigent certification.
D. Non-Covered Health Care Services
Only those Covered Health Care Services which are medically
necessary are to be provided to certified indigent residents of
Richmond County pursuant to the Agreements and this Amendment.
The following Covered Health Care Services are not covered and
shall not be paid for by the County:
1. Inpatient and outpatient services and/or procedures
not covered by the Georgia Medicaid program or the federal
Medicaid program; provided, however, that outpatient prescription
medicines dispensed by University'S pharmacy are covered.
? Services provided on an inpatient basis which are
routinely provided on an outpatient basis; provided, however,
that inpatient diagnostic procedures will be covered when
performed in conjunction with treatment requiring an inpatient
admission or a 23-hour observation admission.
3. Cosmetic surgery; provided, however, that
reconstructive surgery is a covered service.
4. Physician fees; provided, however, that the fees of
physicians who are salaried by or under contract with university
are covered.
5. Ambulance and other transport serVlces.
6. Abortions; provided, however, that an abortion
performed when the mother's life is in danger is covered.
7. Home Health Care Services; provided, however, that
when a physician states in writing that the providing of Home
.Health Care Services are necessary to avoid an inpatient
admission or to avoid extending an inpatient admission, those
services will be covered.
8. Any serVlce rendered more than 6 months' prlor to a
patient's initial request for certification.
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E. Non-Covered Patients
The individuals listed below are not eligible for indigent
care payments by the County:
1. Any person receiving Cancer State Aid except
when program runds are exhausted as to that person.
2. Any veteran eligible for Veterans'
Administration assistance; provided, however, that DFACS must
establish non-eligibility Hith some evidence beyond veteran
status and a disability pension of 50% or less.
3. Any member of the military or any military
member's dependent(s).
4. Any person not a resident or Richmond CountYi
provided, however, that the coverage of a person while a resident
who later moves away, is not affected by this provision.
5. Any person who, within the last 3 years, was
convicted of welfare fraud, entered into a disqualification
consent agreement, was determined at an administrative hearing to
have committed an intentional welfare program violation, or who
waived a disqualification hearing with respect to a charge of
welfare fraud or intentional program violation.
6. Any college student who is covered under
his/her parent's insurance coverage;
7. Any transient worker, such as a construction
or agricultural worker, who is domiciled outside of Richmond
County.
8. Any resident of a public institution.
9. Any individual domiciled outside Richmond
Count who is present in Richmond County due to participation in a
halfway house program or other rehabilitation program.
10. Any illegal alien or illegal immigrant.
11. Any patient who initiates a lawsuit to
establish SSI disability; provided, however, that the initiation
of such a lawsuit only suspends coverage as an indigent until
resolution of the lawsuit, at which time those services not
6therwise paid for by Medicare or Medicaid may be paid for by the
County.
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F, Payments by Patient
A certified indigent resident or Richmond County is required
so make payments toward his/her bill in accordance with the
provisions of the September 20, 1977 Agreement; however, a
failure to make payments will not disqualify the resident. After
the Cap for, as applicable, 1995 or 1996 is reached, University
shall have the right to pursue collection from the patients of
the account balance without regard to any write down of charges
to costs.
G. Payments by County
County shall not be responsible ror the payment of any costs
and/or charges for any person not certified as an indigent
resident of Richmond County in accordance with the Agreements and
this Amendment.
For all "cer-tified", indigent residents of Richmond County,
County shall be responsible for payment within thirty days of
receipt of a bill for Covered Health Care Services provided by
University pursuant to the Agreements and this Amendment as
follows:
1. Emergency Room
For all certified indigent residents, County agrees to pay
the "cost" for all Covered Health Care Services provided in
University's Emergency Room, including services provided by
physicians either salaried by or under contract with University,
less, where applicable, the amount of patient payment required by
the patient's certification level whether or not the patient
makes the payment. As to Covered Health Care Services, "cost"
means the product of charges for such services multiplied by the
1994 Medicare cost-to-charge ratio, or until it is available, the
1993 Medicare cost-to-charge ratio. As to physicians' services,
"cost" means the physicians' fees as determined by CPT-4 billing
codes and Medicaid fee schedule.
2. Outpatient Clinic
For all certified_indigent residents, County agrees to pay
the "cost" for all Cov~red Health Care Services provided in
University's Outpatient Clinics, including services provided by
physicians either salaried by or under contract with University,
less, where applicable, the amount of patient payment required by
the patient's certification level whether or not the patient
makes the payment. As to Covered Health Care Services, "cost"
means the product of charges for such services multiplied by the
1994 Medicare cost-to-charge ratio, or until it is available, the
1993 Medicare cost-to-charge ratio. As to physicians' services,
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"cost" means the physicians' fees as determined by CPT-4 billing
codes and Medicaid fee schedule.
3. Inpatient
For all certified indigent residents, County agrees to pay
"charges" for Covered Health Care Services provided on an
inpatient basis, including services provided by physicians either
salaried by or under contract with University, less, where
applicable, the amount of patient payment required by the
patient's clinic card classification whether or not the patient
makes any payment. For purposes of this section, "charges" means
the normal and customary charges imposed by University for such
services, without the application of a cost-to-charge ratio.
4, Cap on Payments
Regardless of actual costs and/or charges incurred and
billed under this Section III" unless subsequently modified by
the County, County shall not payor be required to pay in excess
of $2.5 million (hereinafter referred to as the "Cap") for
Covered Health Care Services rendered pursuant to the Agreements
and this Amendment for the calendar year 1995, or in excess of
$208,333 for January, 1996 services, either for emergency room,
outpatient, and/or inpatient care.
H. Credits to County
University agrees to continue its collection efforts on all
unpaid bills for which the County is entitled to a credit under
the Agreements and this Amendment. County is entitled to a
credit, to the extent of its payment on a particular patient
account, on its next billing, as follows:
1. to the extent of University's recovery under
any lien imposed under Georgia law;
2. to the extent any indigent certification is
revoked for any reason, or is denied after Covered Health Care
Services are provided; and
3. to the extent University collects more from a
certified patient than that patient's liability under the
patient's certification level.
I. Billinqs to County
1. University's billings to the County shall contain
the following information:
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a. Name of patient; address of each patient;
date of each service; CPT code for each
outpatient service or the ICD-9 code for
inpatient service; the charge for each
service; and, the County liability for each
serVlce
b. A summary by area (ER, Clinic, inpatient or
outpatient) which includes total charges,
total County liability, applicable cost to
charge ratio, credits by type, and errors or
omissions discovered during the billing
period related to prior bills
c. A list of the current certified indigent care
card holders
d. A statement signed by University's CFO and
Administrator that the billings comply with
the Agreements and Amendment and that for
1994 billings only include "self-pay"
patients and for 1995 and 1996 billings only
include individuals certified by DFACS
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University shall provide County the following:
a. University's Medicare Cost Report as of
January 1, 1994 and all subsequent changes
thereto
b. Upon request, University will provide access
to its charge master as of January 1, 1994
and all subsequent changes thereto. The
County shall hold the charge master in strict
confidence and will not redisclose charge
master information
3. University shall provide County within a
reasonable time after a request for a specific
account information, the payment detail of any
account upon which County made a payment during
1994, 1995 or 1996
J. Review of 1995 and Januarv, 1996 Billinqs
The parties agree that County (or its designated agent)
shall be allowed to review all billings by University to the
County for the calendar year 1995 and January, 1996 and that
University shall furnish to County (or its designated agent) all
documents and materials necessary for County to complete said
review. Unless County requests in writing additional specific
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documents, County shall be deemed to have received all necessary
documents and materials thirty days after receipt of each bill.
County shall have 90 days from the later of the receipt of each
bill or its receipt of specifically requested additional
billings, documents and materials to complete its review. After
said 90 day period, the bills shall be final and uncontestable,
except as limited by the Cap. The payment of bills shall not be
delayed by review under this section.
IV. AMBULANCE SERVICES
No charges shall be made by university to the County under
the Agreements or this Amendment with regard to ambulance serVlce
provided by University to certified indigent residents of
Richmond County. All aspects of such ambulance services shall be
covered by and under the Agreement for ambulance services dated
September 23, 1971.
VI. MISCELLANEOUS PROVISIONS
A. Amendment
The Agreements and this Amendment may be amended only by the
express written consent and agreement of both parties hereto.
B. Sole Aqreement
The Agreements and this Amendment represent the entire
agreement between the parties hereto and supersedes any and all
previous written and/or oral agreements or understandings. In
the case of conflicts between this Amendment and the Agreements,
this Amendment shall control.
C. Governino Law
This Agreement shall be governed by and construed In
accordance with the laws of the State of Georgia.
D. Severability
In the event any provision of this Agreement is rendered
invalid or unenforceable under any law or regulation, or declared
null and void by any court of competent jurisdiction, the
remainder of the provisions of this Agreement shall, subject to
this paragraph, remain in full force and effect.
E. Waiver
Waiver of a breach of any provision of this Agreement shall
not be deemed a waiver of any other breach of the same or
different provisions.
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F. Notices
Any notice to be given hereunder by one party to the other
shall be effected in writing and may be delivered either by
certified U.S. mail with return receipt requested, by regular
U.S. mail, properly addressed and postage prepaid, by overnight
mail or by hand-delivery to the addresses listed below. Any
party may change its address below by written notice given in
accordance with this Section. Notices delivered personally shall
be deemed received upon actual receipt. Notices mailed shall be
deemed received no later than two (2) united States Postal
Service business days after the date of such mailing.
To University:
University Health Services, Inc.
Vice President for Finance
John G. Calhoun
1350 Walton Way
Augusta, Georgia 30901-2629
To County:
Richmond County Board of Commissioners
c/o James B. Wall, County Attorney
Post Office Box 2125
Augusta, Georgia 30901
IN WITNESS WHEREOF, the parties hereto have set their hands
and seals as of the day first above written.
RICHMOND COUNTY BOARD OF
COMMISSIONER
~
By:
Title:
UNIVERSITY HEALTH SERVICES, INC.
d/b/a UNIVERSITY HOSPITAL
. By: ~~
A Donald C. Bray ~
j . ~ Title: president
~~
tJ1TlVr:i.SS
~ (j).
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