Exhibit 10.27
DME SUPPLY AND RELATED SERVICES
AGREEMENT
THIS DME SUPPLY AND RELATED SERVICES
AGREEMENT (the “Agreement”) is made and entered into
effective as of the 5th day of July 2005 by and between Nassau
Orthopedic Surgeons, P.C. (“Provider”) and OrthoSupply
Management, LLC, a Massachusetts Limited Liability Company or its
designee (“OSMI”).
RECITALS
A. WHEREAS, Provider desires to
offer Provider patients requiring durable medical equipment and
orthotics (together referenced as “DME”) the option of
having such DME fitted and dispensed within its office suite (the
“Office”) in order to enhance the continuity,
convenience and quality of care provided to Provider
patients.
B. WHEREAS, OSMI supplies DME and
related services to physician groups and other health care
providers.
C. WHEREAS, Provider desires to
purchase DME and related services from OSMI to facilitate its
provision of DME to Provider patients.
D. WHEREAS, the parties desire to
enter into this Agreement in order to provide a full statement of
their respective responsibilities hereunder during the term of this
Agreement.
FOR AND IN CONSIDERATION of the
mutual covenants and agreements hereinafter contained, the parties
hereto hereby agree as follows:
OSMI shall have only the
responsibilities and authority delegated to it under this Agreement
or as delegated by Provider and accepted by OSMI from time to time.
Subject to the ultimate authority and control of the Provider, OSMI
shall have the following authorities and
responsibilities:
(a) Personal and Management
Services . OSMI shall provide the personal and management
services identified below in order to facilitate Provider’s
on-site provision of DME and related services to Provider
patients.
(1) Trained Consultant . OSMI
shall employ and provide to Provider on a leased employee basis one
(1) OSMI consultant, as follows:
A RehabPlus Manager trained in
insurance verification process and who shall each provide services
at the Office on a part-time basis, not less than twenty
(20) hours per week. The RehabPlus Manager shall assist
Provider in processing DME orders placed by Provider physicians,
providing insurance verifications, assuring proper inventorying and
storage of DME in the Office, proper fitting of DME, dispensing DME
to Provider patients who elect to order DME from Provider,
performing patient follow up to promote proper use and efficacy of
DME and record keeping related to the above duties, as reasonably
requested by Provider.
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Descriptions of the RehabPlus
Manager’s essential functions and qualifications are attached
as Exhibit A hereto. The RehabPlus Manager’s services
hereunder shall be subject to the control, supervision and
evaluation of Provider. Such employee also shall participate in
such periodic staff meetings and meetings with treating physicians
as the parties mutually agree are reasonably required for the
effective provision of DME and related services to Provider
patients.
Provider shall have the right to
approve the person designated by OSMI to serve as the RehabPlus
Manager, which approval shall not be unreasonably withheld or
delayed. Upon written request of Provider, OSMI shall remove the
person serving as the RehabPlus Manager from service under this
Agreement and, within a reasonable period of time thereafter,
replace such person with an individual approved by Provider in
accordance with this provision.
(2) Policy and Procedure
Manual . OSMI shall advise Provider regarding the compilation
of a policy and procedure manual (hereinafter referred to as the
“Manual”) for Provider’s review and approval,
which Manual shall include protocols, operating policies and
procedures and similar materials that are reasonably necessary for
the proper ordering, storage, fitting and dispensing of DME, as
well as proper documentation and patient follow up. OSMI may
recommend revisions to the Manual, as necessary, from time to time
and shall make such revisions as are necessary to tailor the Manual
to Provider needs.
(3) Educational Programs .
OSMI shall provide in-service training and educational programs for
Provider physicians and staff related to the proper fitting, use
and clinical benefits of DME.
(4) Quality Review Activities
. OSMI shall assist Provider in establishing a quality oversight
program and program evaluation standards to promote the efficacy of
DME and related services provided by the Provider.
(5) RehabPlus Solution . OSMI
shall provide RehabPlus Solution services as specified in Exhibit B
hereto. OSMI will provide over-sight and leadership management of
the Nassau Orthopedic Surgeons, P.C.’s RehabPlus Solution
(see exhibit A).
(b) Billing and Collection
Services . OSMI and Provider acknowledge that billing and
collection shall be the sole responsibility of OSMI. The RehabPlus
Manager, with assistance from and supervision by Provider, will
handle all patient and encounter information of Provider on
services rendered and enter said information into OSMI’s
billing & collection system. The following information
will be required by Provider to process customer
charges:
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Patient’s date of
birth
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Insurance information (copy of
face sheet)
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Front and back of insurance card
(copy)
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Office notes if billing an
unlisted procedure or billing a multiple procedure on the same
day
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Any additional information
required by OSMI for billing purposes
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Based upon the above information
received from Provider, OSMI shall provide the following billing
and account management services:
(1) Patient Services Billing
: Create claims or invoices, create patient bills, post payments,
perform collection follow-up.
(2) Reporting : A set of
monthly reports will be forwarded to Provider to detail the
activity of the month. Specific reports will be determined through
mutual consent of Provider and OSMI at the time of
start-up.
(3) Billing for Agreement
Services : For service described herein and in the RehabPlus
Service Agreement, OSMI will create a monthly bill for the cost of
goods purchased by Provider based on order information created from
OSMI’s billing software program, management fee and employee
lease(s) on a monthly basis no later than the 15th of the following
month.
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2.
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Obligations of Provider
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(a) Organization and
Operation . Provider shall retain ultimate legal responsibility
for the proper operation of the Provider. Provider, as a continuing
condition of OSMI’ s obligations under this Agreement, shall
at all times during the Term be and remain legally organized and
operated to provide physician services. Provider also will ensure
that it is organized as a “group practice” as that term
is defined in the Stark Act (42 U.S.C. § 1395nn(b)(2)) and
regulations promulgated pursuant thereto (42 C.F.R. §
411.355(b)), both as amended from time to time, including but not
limited to the “Special Rules for Profit Shares and
Productivity Bonuses” attached as Attachment A. Provider also
will be operated in a manner that qualifies Provider’s
provision of DME to Provider patients for the “in-office
ancillary services exception,” as defined by such
regulations.
(b) Provision of Physician
Services . The parties acknowledge and agree that Provider,
through its physicians, shall be responsible for and shall have
complete authority, responsibility, supervision and control over
the provision of all physician services rendered by the Provider,
and that all medical treatments and procedures related to the use
of DME shall be provided and performed exclusively by or under the
supervision of Provider physicians in such manner as Provider
physicians, in their sole discretion, deem appropriate. OSMI shall
have and exercise absolutely no control or supervision over the
provision of physician services.
(c) Engagement of Clinicians
. Provider shall be solely responsible for engaging all physician
and all non-physician personnel necessary to the proper operation
of Provider, other than the RehabPlus Manager provided by OSMI
pursuant to Section 1 above.
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(d) Quality Oversight Program
. Provider shall adopt a quality oversight program to monitor and
evaluate the quality and cost-effectiveness of DME and related
services provided at the Provider. Upon request of Provider, OSMI
shall provide administrative assistance to Provider in performing
its quality assurance/utilization review activities.
(e) Liaison . Provider and
OSMI shall agree upon one or more Provider representatives to serve
as liaison(s) for OSMI regarding RehabPlus billing and operational
matters.
(f) Direction and Supervision of
DME-Related Services . Provider shall be solely responsible for
identifying appropriate patients for DME and related services,
certifying the medical necessity of such DME and related services,
scheduling all Provider services (including DME fittings and follow
up appointments) and supervising the services of the RehabPlus
Manager. The degree of supervision required should be that which is
required to bill applicable payors for DME and related services and
to qualify for the “in-office ancillary services
exception” to the Stark Act identified above. Provider also
shall be responsible for reviewing and evaluating the performance
of the RehabPlus Manager, with a formal review to be conducted not
less than annually.
(g) Documentation . Provider
shall be solely responsible for providing appropriate medical
documentation, as necessary to satisfy all applicable legal
requirements, professional standards and billing requirements,
including but not limited to letters of medical necessity and
signed orders. Provider shall place all orders for DME from OSMI
using order forms provided by OSMI and shall be responsible for
selecting principal diagnosis and procedure codes based on Medicare
and other applicable payor standards and guidelines. Provider
agrees to comply with all DME order entry procedures specified by
OSMI. Provider shall maintain a separate accounting of all
collections it receives from DME and related services provided
pursuant to this Agreement. Provider shall deposit any such
collections into the Bank Account within three (3) calendar
days of receipt by Provider. Provider shall weekly forward copies
of Explanations of Benefits forms and/or receipts of payment in
order to enable proper updating of patient accounts receivable
ledgers and accounting for total collections.
(h) Licenses, Permits and
Certifications . Provider shall be responsible for obtaining
and maintaining any licenses, permits, certifications and provider
numbers necessary for the Provider to dispense DME within the
Office and bill payors for DME and related services.
(i) Financial
Responsibilities . Provider shall, at its sole
expense:
(1) Provide all necessary Office
space (by lease or otherwise), receptionist services, security
services and utilities as may be required for operation of the
Provider, including the storage, fitting and dispensing of
DME.
(2) Equip and furnish the Office
space within which DME may be stored, fitted and
dispensed.
(3) Arrange any modifications,
maintenance and repairs to the Provider premises, furnishings or
equipment necessary to maintain the Provider in good condition and
in compliance with all applicable legal requirements.
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(4) Pay all physician and other
Provider employee salaries and benefits, as well as compensation to
independent contractors engaged directly by Provider.
(j) Charges . Provider shall
determine the charges for all DME and related services provided to
Provider patients.
(k) Compliance with Law and
Professional Standards . All of Provider’s duties and
responsibilities shall be conducted in accordance with all
applicable federal, state and municipal laws, rules, regulations,
ordinances and orders, professional standards and the ethical
standards and standard of care of the medical community wherein the
Office is located.
(l) Collection Responsibility and
Payment to OSMI . Provider shall be responsible for:
(1) Collecting, receiving and
administering, in Provider’s name and Provider’s
account, for deposit into a bank account held in the name of
Provider (the “Bank Account”), all accounts receivable
attributable to DME and related services provided to Provider
patients in the Office in accordance with collections procedures
approved by Provider. Such accounts receivable shall be owned by
Provider and shall constitute revenue to the Provider.
(2) Maintaining files containing
documentation to support claims filed by Provider.
(3) Forward all RehabPlus related
Explanation of Benefits (EOB) to OSMI weekly from date of
receipt.
(m) Compliance with Law . All
of OSMI ’s duties and responsibilities shall be
conducted in accordance with all applicable federal, state and
local statutes, rules and regulations.
(n) Software . OSMI may
provide Provider with the right to use OSMI’s intranet-based
data collection system under the terms of OSMI’s standard
license agreement. Provider shall license to OSMI all software
systems that may be required to facilitate the functionalities of
OSMI’s software system,
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Compensation for OSMI Services
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In consideration for the items and
services provided by OSMI pursuant to this Agreement, OSMI shall be
compensated as follows:
(a) Personnel Services . See
Exhibit A.
(b) Billing & Collection
Services – Flat Fee . OSMI will provide the
billing & collection for the Provider’s Rehab Plus
Solution. The fee for such services will be $3,500 per month and
payable on the fifteenth (15) of every month; except that OSMI
shall accrue the billing fee for the first two (2) months (for
a total accrual of $7,000), and then such fee will be
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billed over the remaining ten (10) months
of the Agreement (at $4,200 per month). By way of example, in
months three (3) through twelve (12) of this Agreement
the amount due from Provider for billing and collecting shall be
$4,200 per month.
(c) DME . As compensation for
the DME supplied to Provider by OSMI pursuant to Section 1(c),
OSMI shall be paid in accordance with the fee schedule attached as
Exhibit C.
(d) Invoicing . During the
first one hundred twenty (120) days that this Agreement is in
effect, Provider shall be invoiced on the basis of the cost of
goods dispensed (or utilized) by Provider. Thereafter, Provider
shall be invoiced on the basis of the costs of goods ordered by
Provider. OSMI shall not issue its initial invoice to Provider (for
goods and services delivered during the first month that this
Agreement is in effect) until at least thirty (30) days after
the commencement date of this Agreement and such invoice shall not
be due and payable until thirty (30) days after such issuance.
Thereafter, OSMI shall invoice Provider for all fees due under
Section 3(a & b) hereunder on a monthly basis.
Provider shall be invoiced for fees due under Section 3(c) the
following month after initially dispensed to the patient. If any
amount so invoiced or automatically payable is not paid on or
within forty-five (45) calendar days after the invoice is
received or fees are automatically payable, the outstanding balance
shall bear simple interest from the date of said invoice or payment
date at a rate of one percent (1%) per month until such amount
is paid in full. Any payments made thereafter received by OSMI
shall be applied first to interest accrued but unpaid and then to
the oldest unpaid payable/invoice. In addition, the parties agree
that a failure by Provider to pay any such invoice or amount
automatically payable within forty-five (45) calendar days of
the date the invoice is received or the payment date (as the case
may be) shall be a material breach of this Agreement, subject to
cure provisions of Section 6(b). Any such termination of this
Agreement by OSMI shall not affect Provider’s obligation to
pay amounts due to OSMI under this Agreement, but no such payment
after the cure period shall affect the effectiveness of such
termination.
Payment of the compensation due to
OSMI is not intended to be and shall not be interpreted or applied
as permitting OSMI to share in Provider’s fees for physician
services or any other services, but is acknowledged as the
parties’ negotiated agreement as to the reasonable fair
market value of the items and services furnished by OSMI pursuant
to this Agreement.
The term of this Agreement shall
commence on August 1, 2005 (“Commencement Date”)
and shall remain in full force and effect for a period of one
(1) year (the “Initial Term”) and SHALL BE
AUTOMATICALLY RENEWED FOR AN ADDITIONAL ONE (1) YEAR PERIOD
(THE “RENEWAL TERMS”) THEREAFTER UNLESS EITHER PARTY
GIVES THE OTHER PARTY NOTICE OF ITS INTENT NOT TO RENEW AT LEAST
THIRTY (30) CALENDAR DAYS PRIOR TO THE EXPIRATION OF THE
INITIAL TERM OR ANY RENEWAL TERM .
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The provisions of Section 5 of
this Agreement notwithstanding, this Agreement may be terminated
prior to the expiration of its Initial Term or any Renewal Term as
follows:
(a) Termination for
Insolvency . If either party shall apply for or consent to the
appointment of a receiver, trustee or liquidator of itself or of
all or a substantial part of its assets, file a voluntary petition
in bankruptcy, or admit in writing its inability to pay its debts
as they become due, make a general assignment for the benefit of
creditors, file a petition or an answer seeking reorganization or
arrangement with creditors or take advantage of any insolvency law,
or if an order, judgment or decree shall be entered by a court of
competent jurisdiction, on the application of a creditor,
adjudicating such party a bankrupt or insolvent or approving a
petition seeking reorganization of. such party or appointing a
receiver, trustee or liquidator of such party or of all or a
substantial part of its assets, and such order, judgment or decree
shall continue unstayed and in effect for any period of thirty
(30) consecutive calendar days, the other party may terminate
this Agreement by giving such party notice of termination which
shall be effective on the date set forth therein.
(b) Cancellation for Breach .
In the event of a material breach of this Agreement by either
party, the other party may cancel this Agreement by giving written
notice of cancellation to the breaching party, setting forth the
reasons therefor, which cancellation shall be effective and final
upon the expiration of twenty ( 20 ) calendar days
after delivery in accordance with Section 14(f) hereof or at
such later date and time as may otherwise be specified in such
notice. Not withstanding the above, if the nature of the breach is
such that it can reasonably be cured and if the breaching party
commences such cure in good faith and, within ten ( 10
) calendar days after delivery of the aforesaid notice of
cancellation, gives written notice to the canceling party of the
action being taken to effect such cure, then this Agreement shall
not be canceled because of such breach, unless the breaching party
thereafter fails to pursue such cure diligently and in good faith
to completion within a reasonable period of time, but in no event
more than twenty ( 20 ) calendar days after giving
notice of such cure to the canceling party. However, if the
breaching party fails to so cure