EXHIBIT 10.25
DME SUPPLY AND RELATED SERVICES
AGREEMENT
THIS DME SUPPLY AND RELATED SERVICES
AGREEMENT (the “Agreement”) is made and entered into
effective as of the 1st day of February, 2005 by and between Denver
Sports Performance Enhancement Center Professional, LLC d/b/a
Steadman Hawkins Clinic - Denver (“Provider”) and Ortho
Supply Management, Inc. a Massachusetts corporation 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:
1. Obligations of OSMI .
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 or as indicated personnel may be provided by
Denver Sports Performance Enhancement Center
Professional.
(1) Trained DME Consultants .
Denver Sports Performance Enhancement Center Professional shall
provide one (1) RehabPlus Manager trained in insurance
verification process and who shall each provide services at the
Office on a full-time basis, not less than [forty (40)] hours per
week. DME Consultants shall assist Provider in processing DME
orders placed by Provider physicians, assuring proper inventorying
and storage of DME in the Office, proper fitting of DME, dispensing
of DME and record keeping related to the above duties, as
reasonably requested by Provider. Descriptions of each DME
Consultant’s essential
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functions and qualifications are
attached as Exhibit A hereto. The DME Consultant’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 may elect to utilize a current clinic employee
to provide the service of the RehabPlus Manager.
Based upon mutual consent a
Certified Motion Specialist Consultant may be hired as determined
upon the service needs of the program
(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,
insurance verifications, billing & collecting, 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 Program .
OSMI shall provide RehabPlus Services as specified in
Exhibit B hereto.
(6) OSMI will provide
over-sight and leadership management of the Provider RehabPlus
program (see exhibit A).
(7) DME Supply . OSMI
shall ship to Provider all DME ordered by Provider in accordance
with Section 2(g) below.
Provider acknowledges that
OSMI is legally authorized to supply continuous passive
motion (CPM) equipment and related supplies and other DME typically
dispensed in a hospital or home setting. OSMI may offer
Provider certain DME product bundles, such as those shown in
Exhibit C hereto and may develop additional DME product bundles
tailored to Provider’s protocols. Provider may (but is not
required to) recommend OSMI to patients who require such DME
but in so doing shall provide patients with the names of at least
two alternate recommended DME suppliers from whom they may order
such DME. Provider acknowledges that any DME supplied by
OSMI to patients that is dispensed outside the Office shall
be
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documented on OSMI paperwork
and billed directly by OSMI under OSMI ’s name
and billing identification number and that all receipts associated
with such DME shall be the sole property of OSMI
.
a. Billing and Collection
Services . OSMI and Provider acknowledge that billing
and collection shall be the sole responsibility of OSMI .
Billing and collection will be the responsibility of OSMI .
The RehabPlus Manager will handle all patient and encounter
information of Provider on services rendered and enter said
information into designated software system provided by OSMI
. 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:
Patient Services
Billing : Create claims or invoices, create patient bills,
post payments, perform collection follow-up.
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.
Billing for Agreement
Services : For
service described herein and in the Rehab Plus Service Agreement,
OSMI will create a monthly bill for the cost of goods
utilized based on order information created from OrthoRehab’s
billing software program, Management fee and employee lease(s) on a
monthly basis no later than the 15th of the following
month.
2. Obligations of Provider
.
(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. §
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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 DME Consultant provided by OSMI
pursuant to Section 1 (a)(1) above.
(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.
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.
(e) 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 DME
Consultant. 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 DME Consultant, with a formal review to be conducted not
less than annually.
(f) 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
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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.
(g) 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.
(h) 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.
(i) Charges . Provider shall
determine the charges for all DME and related services provided to
Provider patients.
(j) 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.
(k) 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 non-governmental
accounts receivable attributable to DME and related services
provided to Provider patients in the Office in accordance with
collections procedures approved by Provider. Such non-governmental
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.
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(3) Forward all RehabPlus related
Explanation of Benefits (EOB) to OrthoRehab weekly from date of
receipt.
(l) 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.
(m) OrthoRehab’s
Software . OSMI shall provide Provider with the right to
use, OSMI ’s intranet-based data collection system and
Inventory Control 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 OrthoNet.
3. Compensation for OSMI
Services . 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 &
Collections Services . Provided by OSMI pursuant to
Section 1(a), OSMI shall be paid on a monthly basis and
the fee will be 7% of the monthly collected payments.
(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 . 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.
4. Reasonable Value . 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.
5. Term . The term of this
Agreement shall commence on Feb. 1, 2005 (“Commencement
Date”) and shall remain in full force and effect for a period
of one (1) year
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(the “Initial Term”) and SHALL BE
AUTOMATICALLY RENEWED FOR ADDITIONAL ONE (1) YEAR PERIODS (THE
“RENEWAL TERMS”) THEREAFTER UNLESS EITHER PARTY GIVES
THE OTHER PARTY NOTICE OF ITS INTENT NOT TO RENEW AT LEAST SIXTY
(60) CALENDAR DAYS PRIOR TO THE EXPIRATION OF THE INITIAL TERM
OR ANY RENEWAL TERM.
6. Termination . 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. Notwithstanding 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 such breach, the canceling party
shall have the right to terminate this Agreement by sending written
notice of final cancellation to the breaching party, which final
termination shall be effective upon the expiration of ten (
10 ) 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. In the event that this
Agreement is terminated for cause under this Section during the
Initial Term, the parties shall not enter into any other agreement
for DME or related services during what would have been the
remainder of the Initial Term.
(c) Termination Without Cause
. Either party may terminate this Agreement without cause at any
time following the Initial Term by providing prior written notice
to the other party, which fina