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HomeMy WebLinkAbout2009-085 EMS - EMS Management and Consultants, Inc Billing Services Agreement~~~ir .aU,~dBs ~~ BILLING SERVICES AGREEMENT THIS BILLING SERVICES AGREEMENT (hereinafter "Agreement"), is entered into this _20_ day of October, 2009 between EMS MANAGEMENT & CONSULTANTS, INC. (hereinafter "EMS~MC") and the County of Orange. (hereinafter "Client"). WITNESSETH: WHEREAS, EMS~MC is an ambulance billing service company, and not a licensed collection agency, with experience in providing medical billing and collection services to medical transport providers, including fire and rescue and emergency medical service ("EMS") providers; and WHEREAS, Client is normally engaged in the business of providing emergency medical services (hereinafter "Services"), and billable medical transportation services (hereinafter "Transportation"); .and WHEREAS, Client wishes to retain EMS~MC to provide medical billing and collection services and EMS~MC wishes to provide those services to Client, as set forth in this Agreement. NOW, THEREFORE, in consideration of the mutual agreements described below and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows: 1. ENGAGEMENT. a. SERVICES -During the term of this Agreement, EMS~MC shall provide claims management and collect voluntary payments of Emergency Services routine billing, bill processing and fees required and customary for Service in accordance with Client's protocols billing and collection of funds. These services shall include, but are not limited to: (1) preparing and submitting initial and secondary claims and bills for Client to insurers and others responsible for payment; (2) performing reasonable and diligent routine efforts to collect and secure voluntary payments from primary and secondary payors and patients or other entities, (as EMS~MC deems appropriate); (3) issuing patient statements for all unpaid balances; (4) If EMS/MC has not filed patient insurance claim; established a voluntary payment plan, or an appeal of the insurance claim is not pending, within 120 days of receipt of account EMS/MC shall refer the account back to the Client for appropriate collection (EMS/MC will not receive any compensation for these accounts); (5) Billing accounts with outstanding balances to patients after the insurance and/or third party payor has determined benefits due; (6)Sending follow-up bills, except as to those accounts on which an insurance carrier or third-party payor has accepted responsibility to pay; and (7) Billing all uninsured patients directly, once Client has submitted all necessary information. b. MONTHLY REPORTS - EMS~MC will provide monthly financial deposit reports ("Report") to the Client within 10 business days of the last business day of the month. The Client will reconcile the daily ACH deposit reports with the monthly financial deposit reports to ensure funds are accurately collected and recorded. The REPORT will include both monthly and year-to-date billing and collection summary, check register report and deposit tickets. EMS/MC shall provide appropriate storage and data back-up for all records pertaining to Client's bills and collections hereunder, accessible to Client during reasonable business hours. EMS~MC will provide a weekly list along with proper documentation of accounts that require a refund. Client will ensure that all accounts requiring a refund receive a refund in a timely basis. c. RECORDS RETENTION - EMS~MC shall maintain records of all services performed and records of all financial transactions. EMS~MC shall retain all financial records not tendered or returned to Client on any termination hereof for at least ten (10) years, and retain all Medicare and Medicaid records for ten (10) 2 years. EMS~MC will comply with all applicable State and Federal regulations applicable to third party billers pertaining to the maintenance of patient files, financial records and related reports and documents, including but not limited to confidentiality of records. This undertaking will expressly survive the termination of this Agreement. If so requested by Client, EMS~MC shall provide Client with written guidelines or a policy and procedural manual specific to Client reflecting the current regulatory and procedural requirements applicable to Client as a service provider in the State of North Carolina providing services to Medicare, Medicaid and other government funded program patients. EMS/MC will provide any records requested by client within a timely manner. EMS~MC will work with the Client's designated management consultants to assist and support said consultants ("Consulting Services"). Under no circumstances will EMS~MC offer advice on any tax related or legal matters. d. PATIENT COMPLAINTS. (1) Patient Complaints. In accordance with Client's Emergency Management Policy, EMS~MC shall notify Client of all patient complaints about clinical services within two (2) business days of receipt and notify Client of all patient complaints about billing within two (2) days of receipt. When a patient complaint occurs EMS\MC will contact the liaison in the Clients Office, the account will be placed in suspension and referred back to the Client's Office for resolution. Patient complaints resolved by Client through Client's "Emergency Assistants Plan" or some other process will not result in payment to EMS/MC. (2) Inquiries. EMS~MC shall directly advise Client of any notices of audit, requests for medical records or other contacts or inquiries out of the normal course of business from representatives of Medicare, Medicaid or private payors, with which Client contracts ("Payor Inquiries"), and advise Client of any significant pattern of payor denials or downcodings for services billed by EMS~MC on Client's behalf ("Denial Patterns"). The Client will be notified of Payor Inquiries within ten (10) business days of EMS~MC's receipt of same. All other inquires concerning request for medical records or concerns of service are to be referred back to the Client. 3 e. AGENT - EMS~MC is appointed as the agent of Client under this Agreement solely for the express purposes of this Agreement relating to billing and receiving payments and mail, receiving and storing documents, and communicating with hospitals and other entities to facilitate its duties. EMS~MC will have no authority to pledge credit, contract, or otherwise act on behalf of Client except as expressly set forth herein. PAYMENTS FROM GOVERNMENT FUNDED PROGRAMS - As to all payments received from Medicare, Medicaid and other government funded programs, the parties specifically acknowledge that EMS~MC will only prepare claims for Client and will not negotiate checks payable or divert electronic fund transfers to Client from Medicare, Medicaid or any other government funded program. All Medicare, Medicaid and any other government funded program payments, including all electronic fund transfers, will be deposited directly into a bank account designated by Client to receive such payments and as to such account only Client, through its officers and directors, shall have access. 2. COMPENSATION OF EMS~MC. a. COMPENSATION -Client shall pay a fee for the services of EMS~MC hereunder, on a monthly basis, in an amount equal to six and three quarters percent (6.75%) of "Net Collections" as defined below (the "Compensation"). Net Collections shall mean all cash and check amounts including electronic fund transfers (EFT's) received by EMS~MC from payers, patients, attorney's offices, court settlements, collection agencies, government institutions, group health insurance plans, private payments, credit cards, healthcare facilities or any person or entity submitting funds on a patient's account, OR any amounts paid directly to the Client with or without the knowledge of EMS~MC that are paid, tendered, received or collected each month for Client's transports, less refunds processed or any other necessary adjustments to those amounts. EMS/MC will not be compensated for accounts referred back to and resolved by the Client; including, but not limited to customer complaints referred to client under 1(d)(1) and patients whose claims are processed under the Client's EMS Assistance Program. b. INVOICES - EMS~MC shall submit an invoice to Client by the 10th day of each month for the Compensation due to EMS~MC for the previous calendar month. The invoice shall accompany the Report provided by EMS~MC pursuant to 4 Section 1(b) of this Agreement. The Compensation amount reflected on the invoice shall be paid in full within 45 days from the date the invoice is first presented to Client and subject to approval by Client. All approved invoices are to be paid directly from the Client's banking institution to EMS~MC via paper check or direct deposit to EMS~MC's bank account. c. NONAPPROPRIATION - EMS~MC acknowledges that a "non- appropriation" may occur when Client is unable to secure or allocate sufficient funds in its operating budget to fulfill its financial obligations under the Agreement. If anon-appropriation occurs during the term of the Contract, Client may terminate the Agreement at the end of the then-current fiscal period ("Termination Date") without incurring any termination liability. 3. RESPONSIBILITIES OF CLIENT. a. PATIENT & BILLING INFORMATION - To the extent permitted by the federal and state law, Client will provide EMS~MC with complete demographic and charge information the minimum necessary for the processing of professional and/or technical component billing to third parties and/or patients, including the following: patient identification (name, address, phone number, birth date, gender); guarantor identification and address; insurance information; report of services; special claim forms; pre-authorization numbers; and such additional information as is requested by EMS~MC. b. PATIENT MEDICAL RECORDS -Client shall provide complete medical record documentation necessary to insure proper billing and secure claim payment; secure authorizations and signatures, including consent to treat, assignment of benefits and release of information, and physician certification statements (PCS) forms for all non-emergency transports. The client will report to EMS~MC within ten (10) business days, payments received directly by client; and promptly notify EMS~MC of any cases requiring special handling or billing. Client must provide Patient Care Reports (PCR) in a timely manner in order to achieve higher performance. Client wilt implement any reasonable changes that EMS~MC determines necessary for the accurate completion of billing forms and related documentation; execute all forms required by Medicare, Medicaid, GRAMPUS, 5 and any other payor or insurance carrier to allow EMS~MC to carry out its billing and other duties under this Agreement; and maintain client's own files with all original or source documents, as required by law. Client acknowledges that EMS~MC is not the agent of Client for storage of source documentation. Client will provide EMS~MC with a copy of any existing billing policy manuals, guidelines, or protocols, Medicare or Medicaid reports, or any other record or document related to services or billing of client accounts. c. In addition the Client shall provide EMS~MC with a copy of any existing medical records prepared by Client for each incident or patient service rendered for reimbursement [i.e. the Ambulance Call Report (ACR) or Patient Care Report (PCR)]. The PCR record shall comply with the Client's and any State and Federal guidelines for releasing such records. The Client attests, to the best of its knowledge, that the PCR and any and all associated Medical Records, forms and certification statements provided to EMS~MC are true and accurate; records of factual information observed and documented by the attending field technician during the course of the treatment and transport. d. The Client will obtain any and all additional patient documentation required by Centers for Medicare and Medicaid Services ("CMS") or any other governmental or commercial payer for reimbursement consideration, including but not limited to a Physician Certification Statements (PCS) or other similar medical necessity forms or prior authorization statements as deemed necessary by the payer. 4. TERM AND TERMINATION OF AGREEMENT. a. TERM OF AGREEMENT -This term of this Agreement shall be January 1, 2010 through December 31, 2010. .This Agreement shall automatically renew on the same terms and conditions as stated herein, for successive one (1) year terms, unless the Agreement is terminated as provided in 4b below. b. TERMINATION OF AGREEMENT - (i) Written Notice -Either party may provide 60 day written notice of its intent to terminate this Agreement by sending notice to the address provided below; or 6 (ii) Notice Not to Renew -The Client provides written notice of intent not to renew at least 60 days prior to expiration of any term; or (iii) , Termination for Cause - Notwithstanding paragraph 5(a), this Agreement may be terminated by either party at any time for cause based on a material breach of a term or condition hereof by the other party which is not remedied by the other party within thirty (30) days of written notice describing the breach in reasonable detail. "Cause" shall include the following: (1) Failure of Client to make timely payments due under this Agreement; (2) Any willful damage to property, business, reputation, or good will of the other party hereto; (3) Willful injury to any customer, independent contractor, employee or agent of the other party hereto; (4) Solicitation of business on behalf of a competitor or potential competitor of the other party hereto; (5) Harassment of any contractor or commitment of any act which otherwise creates an offensive work environment for contractors; (6) Inattention to or neglect of the duties to be performed by each party, which inattention or neglect is not the result of illness or accident; (7) Failure to practice in accordance with the appropriate policies, standards and procedures established by the respective parties; (8) Commitment of any unethical or immoral act which disparages the other party or could have the effect of disparaging the other party; or 7 (9) Any breach of any material provision of this Agreement. (10) Failure of EMS/MC to comply with the protocols set by the Client for Claims Management and the voluntary collection of accounts. 5. RESPONSIBILITIES UPON TERMINATION. a. INFORMATION REGARDING OPEN ACOUNTS - Provided Client has paid all amounts due and undisputed hereunder, upon any termination of this Agreement, and during the period of any notice of termination, EMS~MC will make available to Client or its authorized representatives, paper and electronic tape copies of information regarding open accounts, including accounts referred to an outside collection agency, and non-proprietary information concerning payors and claims processing, (all without additional charge except for the cost of blank electronic tape and reasonable copy charges), and will otherwise furnish reasonable cooperation and assistance in any transition to Client, or its successor billing agent. b. "WIND DOWN" -Following termination of this Agreement, for a period of ninety (90) days (the "Wind Down"), EMS~MC will continue its billing and collection efforts as to those accounts with dates of services prior to termination, subject to the terms and conditions of this Agreement, for the applicable fee set forth in paragraph 2(a). Client will continue to provide EMS~MC with copies of checks and payments on those accounts which were filed by EMS~MC under this agreement. EMS~MC shall have no further responsibilities as to such accounts after the Wind Down; however EMS~MC shall be entitled to compensation as provided in paragraph 2(a) for such amounts filed by EMS~MC, regardless of whether such amounts are collected by client during or after the Wind Down period. In the event Client has an outstanding balance owed to EMS~MC which is more than 45 days in arrears at the time of termination, EMS~MC shall have no obligation to provide any services after the date of termination. 6. EXCLUSIVITY AND MISCELLANEOUS BILLING POLICIES. a. EXCLUSIVITY -This Agreement for the management of claims to provide billing and collection services is made with EMS~MC as Client's exclusive provider 8 for all dates of service during the term hereof. The Client may not directly file, submit or invoice for any Services rendered while this Agreement is in effect b. CLIENT COLLECTION ACTIVITY - In addition, Client agrees not to collect or accept payment for services from any patient unless the service requested does not meet coverage requirements under any insurance program in which the patient is enrolled, or the patient is uninsured; or the patient's record is returned to Client in accordance with section 1.a(4) and 1.d(1) of this Agreement. All other payments received directly by Client, other than those mentioned above, for these services must be reported to EMS~MC as provided in paragraph 3(b) and shall be treated as Net Collections for purposes of paragraph 2(a). c. CLIENT SERVICE RATES - In compliance with CMS regulations, Medicare patients will not be charged by Client a higher rate or amount for identical covered services charged to other insurers or patients. Accordingly, only one fee schedule shall exist and be used in determining charges for all patients regardless of insurance coverage. d. INCOMPLETE OR INACCURATE RECORDS - EMS~MC reserves the right not to submit a claim for reimbursement on any patient in which the PCR and/or associated medical records are incomplete or appear to be inaccurate or do not contain enough information to substantiate or justify reimbursement. This includes missing patient demographic information, insurance information, physician certification statements (PCS) or any required crew and/or patient signatures, or otherwise contradictory medical information. EMS~MC shall notify Client in writing within ten (10) days of determining that the PCR and/or associated medical records are incomplete or appear to be inaccurate or do not contain enough information to substantiate or justify reimbursement. The notice shall specify the records required for submission of a claim for reimbursement. In the event the records are unavailable, Client shall instruct EMS~MC how to proceed. e. CLIENT COMPLIANCE PLAN (1) The Client shall implement and maintain a working compliance plan ("Compliance Plan") in accordance with the most current guidelines of the U.S. Department of Health and Human Services ("HHS"). The Compliance Plan must include, but not limited to, formal written policies and procedures 9 and standards of conduct, designation of a compliance officer, quality assurance policy and effective training and education programs. (2) In accordance with the HHS Office of Inspector General ("OIG") Compliance Program Guidance for Third-Party Medical Billing Companies, EMS~MC is obligated to report misconduct to the government, if the billing company discovers credible evidence of the provider's continued misconduct or flagrant, fraudulent or abusive conduct. In the event of such evidence, EMS~MC has the right to refrain from (a) submitting any false or inappropriate claims, (b) terminate the contract and/or (c) report the misconduct to the appropriate authorities. 7. PRIVACY. a. CONFIDENTIALITY-All data and information furnished to EMS~MC by Client shall be regarded as confidential, shall remain the sole property of Client and shall be held in confidence and safekeeping by EMS~MC for the sole use of the parties and EMS~MC under the terms of this Agreement. EMS~MC agrees that except as provided otherwise herein, its officers, employees and agents will not disclose to any person, firm or entity other than Client or Client's designated legal counsel, accountants or practice management consultants any information about Client, its practice or billing, or any of the patients of Client unless required to do so by Federal, State or local law enforcement authorities within jurisdiction and/or acting under the law and/or under court orders. The Client and EMS/MC will enter into a Business Associate Agreement as provided by Public Law 104- 191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F -Administrative Simplification, Sections 261, et seq., as amended ("HIPAA"), which is hereby incorporated into this Agreement and attached as Exhibit A. 8. GENERAL. a. STATUS OF THE PARTIES -Nothing contained in this Agreement shall be construed as establishing a partnership or joint venture relationship between EMS~MC and Client. EMS~MC and its employees and representatives shall be independent contractors, solely responsible for its performance under this agreement. 10 b. INDEMNITY - EMS~MC agrees to indemnify and hold harmless Client and any of its officers, agents and employees, from any claims of third parties arising out or any act or omission of EMS~MC in connection with the performance of this contract. c. ASSIGNMENT -Neither this Agreement nor any rights or obligations hereunder shall be assigned by either party without prior written consent of the other party, except that this Agreement may be assigned without consent to the survivor in any merger or other business combination including either party, or to the purchaser of all or substantially all of the assets of either party. d. BINDING EFFECT. This Agreement shall inure to the benefit of and be binding upon the parties hereto and their respective heirs, successors, assigns, and legal representatives. e. NOTICE -Any notice or other communication required or permitted under this Agreement shall be in writing and shall be deemed to have been given on the date delivered personally or deposited in the United States Postal Service, certified mail, return receipt requested, with adequate postage affixed, addressed as follows: Client: Orange County Revenue Collector Post Office Box 8181 Hillsborough, North Carolina 27278 EMS~MC: EMS Management & Consultants, Inc. 4731 Commercial Park Ct., Ste. B. Clemmons, NC 27006 With Copy to: Karen M. Wilson Robinson & Lawing, LLP 101 N Cherry Street, Suite 720 Winston Salem, NC 27101 11 Either party may change its address for notices under this Agreement by giving written notice of such change to the other party in accordance with the terms of this paragraph. f. GOVERNING LAW -This Agreement and the rights and obligations to the parties thereunder shall be construed and governed by the laws of the State of North Carolina and venue for any proceedings arising here under shall be in said state. g. INTEGRATION OF TERMS -This instrument constitutes the entire agreement between the parties, and supersedes all prior negotiations, commitments, representations and undertakings of the parties with respect to its subject matter. h. AMENDMENT AND WAIVER -This Agreement may be amended or modified only by an instrument signed by all of the parties. A waiver of any provision of this Agreement must be in writing, designated as such, and signed by the party against whom enforcement of the waiver is sought. The waiver of a breach of any provision of this Agreement shall not operate or be construed as a waiver of any subsequent or other breach thereof. IN WITNESS WHEREOF, the undersigned have caused this Agreement to be duly executed on the later of the dates set forth below. EMS~MC: EMS Management & Consultants, Inc ~~ By CLIENT: Orange Co~"u~n~ty l ~. ,! :~ Valerie P. Foushee, Chair Title: ~ ~p Date: l U - z~-~ ~ Orange County Board of Commissioners Date: ~ ~ This instrument has been preaudited in the manner required by the Local Government Budget and Fiscal Control Act. 12 Gary Humph~inance Director Approved as ical c ntent: Jo berson, epartment Director Approv s to and legal sufficiency: Annette M. Moor ,Staff Attorney Date: ~ 2 d Date: ~~ ~/U ~ Date: ~ 1 b 13 Business Associate Agreement This Agreement between the County of Orange ("CLIENT"), Transport and EMS Management & Consultants, LLC ("BILLING COMPANY") is executed for the purpose of ensuring that BILLING COMPANY carries out its obligations to CLIENT in compliance with the privacy and security regulations pursuant to Public Law 104-191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F -Administrative Simplification, Sections 261, et seq., as amended ("HIPAA"). This Agreement encompasses BILLING COMPANY'S assurance to protect the confidentiality, integrity, and security of any personally identifiable protected health information ("PHI") that is collected, processed or learned as a result of the services provided to CLIENT by BILLING COMPANY, including any such information stored and transmitted electronically, referred to as electronic protected health information ("e-PHI") A. BILLING COMPANY agrees that it will: 1. Not use or further disclose PHI except as permitted under this Agreement or required by law; 2. Use appropriate and commercially reasonable safeguards to prevent use or disclosure of PHI except as permitted by this Agreement; 3. Work to mitigate, to the extent practicable, any harmful effect that is known to BILLING COMPANY of a use or disclosure of PHI by the BILLING COMPANY in violation of the requirements of this Agreement. 4. Report to CLIENT any use or disclosure of PHI not provided for by this Agreement of which BILLING COMPANY becomes aware; 5. Require that any agents or subcontractors to whom BILLING COMPANY provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to BILLING COMPANY with respect to such PHI; 6. Make PHI available to CLIENT and to the individual who has a right of access as required under HIPAA within 30 days of the request by Client to the individual; 14 7. Incorporate any amendments to PHI when notified to do so by CLIENT; 8. Provide an accounting of all uses or disclosures of PHI made by BILLING COMPANY as required under the HIPAA privacy rule within 60 days; 9. Make its internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining BILLING COMPANY'S and CLIENT'S compliance with HIPAA; 10. At the termination of this Agreement, return or destroy all PHI received from, or created or received by BILLING COMPANY on behalf of CLIENT, and if return or destruction is not feasible, the protections of this agreement will continue to extend to such PHI. B. The specific uses and disclosures of PHI that may be made by BILLING COMPANY on behalf of CLIENT include: 1. The preparation of invoices to patients, carriers, insurers and others responsible for payment or reimbursement of the services provided by CLIENT to its patients; 2. The preparation of reminder notices and documents pertaining to collections of overdue accounts; 3. The submission of supporting documentation to carriers, insurers and other payers to substantiate the health care services provided by CLIENT to its patients or to appeal denials of payment for same. 4. The uses required for the proper management of the BILLING COMPANY as a business associate. 5. Other uses or disclosures of PHI as permitted by HIPAA Privacy Rule. C. BILLING COMPANY agrees to assume the following obligations regarding electronic Protected Health Information (e-PHI): 15 1. BILLING COMPANY agrees to implement commercially reasonable administrative, physical and technical safeguards designed to protect the confidentiality, integrity and availability of the a-PHI that it creates, receives, maintains or transmits on behalf of CLIENT. 2. BILLING COMPANY will require that any agent, including a subcontractor, to whom to it provides a-PHI that was created, received, maintained or transmitted on behalf of CLIENT agrees to implement commercially reasonable administrative, physical and technical safeguards designed to protect the confidentiality, integrity and availability of such a-PHI. 3. BILLING COMPANY agrees to alert CLIENT of any security incident (as defined by the HIPAA Security Rule) which it becomes aware, and the steps it has taken to mitigate any potential security compromise that may have occurred, and provide a report to CLIENT of any loss of data or other information system compromise as a result of the incident. 4. BILLING COMPANY agrees to indemnify and hold harmless CLIENT and any of its officers, agents and employees, from any claims of third parties arising out or any act or omission of BILLING COMPANY in connection with the performance of this Agreement. D. Term and Termination 1. Term. The Term of this Agreement shall be effective as of January 1, 2010, and shall terminate when all of the Protected Health Information provided by CLIENT to BILLING COMPANY, or created or received by BILLING COMPANY on behalf of CLEINT, is destroyed or returned to CLIENT or, if it is infeasible to return or destroy Protected Health Information, protections are extended to such information, in accordance with the termination provisions in this Section. 2. Notwithstanding any other provisions of this Agreement, this Agreement may be terminated by CLIENT, in its sole discretion, if CLIENT determines that BILLING COMPANY has violated a material term or provision of this Agreement pertaining to CLIENT'S obligations under the HIPAA privacy or security rules, or if BILLING COMPANY engages in conduct which would, if committed by CLIENT, would result in a material violation of the HIPAA privacy or security rules by CLIENT. a. Effect of Termination. 16 (1) Except as provided in paragraph (2) of this section, upon termination of this Agreement, for any reason, BILLING COMPANY shall return or destroy all Protected Health Information received from CLIENT, or created or received by BILLING COMPANY on behalf of CLIENT. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of BILLING COMPANY. BILLING COMPANY shall retain no copies of the Protected Health Information. (2) In the event that BILLING COMPANY determines that returning or destroying the Protected Health Information is infeasible, BILLING COMPANY shall provide to CLIENT notification of the conditions that make return or destruction infeasible. Upon [Insert negotiated terms] that return or destruction of Protected Health Information is infeasible, BILLING COMPANY shall extend the protections of this Agreement to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as BILLING COMPANY maintains such Protected Health Information. E. General Provisions. 1. Regulatory References. A reference in this Agreement to a section in the Privacy Rule means the section as in effect or as amended. 2. Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191 (HIPPA). 3. Survival. The respective rights and obligations of BILLING COMPANY under Section D "Effect of Termination" of this Agreement shall survive the termination of this Agreement. 4. _Interpretation. Any ambiguity in this Agreement shall be resolved to permit Covered Entity to comply with the HIPPA Privacy Rule. Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in the HIPPA Privacy Rule. 5. The Client shall not reauest BILLING COMPANY to use of disclose PHI in any manner that wouln not be permissible under the HIPPA Privac r~ if done by the Client, except if the BILLING COMPANY uses or discloses PHI for, and in the manner provided herein for the management and administration of the services provided to the Client 6. Governing Law -This Agreement and the rights and obligations to the parties thereunder shall be construed and governed by the laws of the State of North Carolina and venue for any proceedings arising here under shall be in said state. 17 tN WITNESS WHEREOF, the undersigned have caused this Agreement to be duly executed on the later of the dates set forth below. EMS~MC: EMS Management & Consultants, Inc. ~ ~ By: -~ Title: C FU Date: ~G - z~-~ CLIENT: Orange Coun ~/ ay: ~ Title: (~ C.~ Date: ~ U c~ 18