Exhibit “A” In consideration of the payments set forth in Exhibit “B”, Contractor shall provide the following services: 1. Contractor shall provide orthopedic specialty services in the Division of Medical Specialty, Department of Medicine, including inpatient, outpatient, and emergency care. 2. Contractor shall participate in such scheduled coverage of service as is mutually arranged and agreed upon by members of the Department of Surgery under the supervision of the Chief of Surgery. 3. Contractor is to hold one (1), half day clinic per week and rotate one (1) half day surgery per week. 4. Contractor shall develop a schedule for "On Call," and/or "Emergency Call" status during all other times on Monday through Friday and for twenty-four (24) hours each Saturday, Sunday, or holiday. "On Call" and "Emergency Call" are defined as being available by telephone or pager to the hospital medical staff, nursing supervisor, and administrator on-call as needed. In addition, Contractor must adhere to the guidelines of the San Mateo County Trauma System by being immediately available by phone and must make every reasonable effort to be present at the hospital at the time of the patient's arrival. 5. It is expressly understood that Contractor and subcontractors for Medical Specialty services, are subject to these conditions, that all will accept equal scheduling for "On Call" status and that each will be responsible for his/her portion of "On Call" time. All physicians who take calls for Medical Specialty must have SMMC hospital privileges 6. Scheduled surgery hours shall be Monday through Friday, 0730 through 1500 hours. Add-on cases during the afternoon, nights, and weekends should be truly urgent or emergent. Any elective add-on cases need prior administrative approval. 7. Contractor shall participate in such teaching and/or training programs as are, or may be, established by the medical staff at San Mateo County General Hospital. Each individual's participation in continuing education is documented and considered at the time of reappointment to the medical staff and/or renewal or revision of individual clinical privileges. 8. Contractor shall fulfill those requirements for active staff membership set forth in Articles 3 and 4.2 of the SMMC Medical Staff Bylaws, and maintain such active staff status as a condition of the Agreement. 9. Contractor shall attend regularly and serve without additional compensation on committees responsible for Peer Review activities, Quality Assurance, Utilization Review as outlined in the Medical Staff Bylaws, Rules and Regulations. 10. Contractor shall provide Medical Staff administrative support to hospital and nursing in meeting surgical and anesthesia standards as defined by Joint Commission, Title 22, and other applicable standards. |
Exhibit “B” |
In consideration of the services provided by Contractor in Exhibit “A”, County shall pay Contractor based on the following fee schedule: |
1. Contractor shall be paid at the rates set forth below, to include the complete professional component associated with orthopedic services. 2. The source of orthopedic base units is the current Medicare Resource-Based Relative Value Scale (RBRVS) Relative Value Work Units (RVUs.) 3. Contractor compensation for orthopedists by the County will be based on an RVU base work unit value of $49.16 in year one (I) and $50.88 in year two (II). 4. Contract shall be paid monthly. Such payments will be 1/3 of the quarterly floor, and shall be paid no later than the 30th day of the following month. Quarterly and pro-rated quarterly payments will be made no later than the 30th day of the month following the close of the quarter 5. Contractor’s quarterly compensation will be no less than a minimum amount specified below: Year I (Monthly = $9,979) April 1, 2007 through June 30, 2007: $29,938 July1, 2007 through September 30, 2007: $29,938 October 1, 2007 through December 31, 2007: $29,938 January 1, 2008 through March 31, 2008: $29,938 Year II (Monthly = $10,329) April 1, 2008 through June 30, 2008: $30,986 July1, 2008 through September 30, 2008: $30,986 October 1, 2008 through December 31, 2008: $30,986 January 1, 2009 through March 31, 2009: $30,986 6. In year one (I),if the quarterly total of RVU’s performed multiplied by the unit value of $49.16 for any quarter result in an amount greater than the quarterly floor amount for that quarter, the County will pay Contractor the difference. 7. In year two (II),If the quarterly total of RVU’s performed multiplied by the unit value of $50.88 for any quarter result in an amount greater than the quarterly floor amount for that quarter, the County will pay Contractor the difference. 8. If total units performed for any quarter result in an amount less than an average of 183 units per month, which is 10% below minimum, Contractor agrees to meet with the Medical Director, or his designee, to determine the source of low productivity no later than 30 days from the end of the preceding quarter. 9. Compensation for partial quarters shall be on a pro-rata basis, using the same methodology as set forth in this Agreement. 10. Contractor shall submit the quarterly invoice no later than the 5th day of the month, following the close of the quarter. County shall generate and provide to contractor a verification report for RVU unit reconciliation on the 10th of every month. Any discrepancies between Contractor quarterly invoice and County verification report(s) should be resolved by the 15th of the month, following the close of the quarter. Contractor will make best effort to reconcile encounters monthly. County will reimburse Contractor for all RVU units supported by encounter forms submitted up to and including the 10th of the month, following the close of the quarter. Any outstanding RVU unit encounter forms submitted after the 10th of the month following the close of the quarter will be reimbursed at the following quarter's settlement. 11. Total payment for services under this agreement will not exceed TWO HUNDRED AND NINETY THREE THOUSAND SIX HUNDRED AND NINETY SEVEN DOLLARS, ($293,697.) |
Exhibit “C” Billing and Invoicing Requirements All Contractors shall be obligated to comply with the following billing and invoicing provisions: A. OUTPATIENT Contractor shall submit to County complete, accurate and timely encounter forms here to support invoicing for services rendered. Invoices should be submitted no later than the 10th of the following month: |
Complete” shall mean: -- All procedure and diagnosis codes shall be present on form in CPT format -- Contractor’s signature, date and title is present on form and accompanying invoice -- Referral Authorization Form (RAF) is completed by Contractor as required by MediCal or HPSM regulations “Accurate” shall mean: -- E & M CPT codes must be consistent with level of care -- Other procedures codes must be consistent with diagnosis -- Procedures must be consistent with Medicare and MediCal guidelines for medical necessity -- All Contractor services must be supported by documentation in inpatient Chart “Timely” shall mean: -- Submission of encounter forms to County within three calendar days from date of service |
The SMMC will provide physician encounter forms appropriate to specialties covered under this agreement. The SMMC will also provide, at time of service, encounter forms will be embossed or have a sticker applied with the following information: |
-- Medical Record number -- Patient Name -- Date of Birth -- Date of Service -- Patient Number -- Financial Class SMMC will attach a RAF with encounter form where appropriate |
B. INPATIENT (includes Same Day Surgery and Observation) Submission to SMMC of complete, accurate and timely charge slips and additional documentation needed for billing and invoicing: “Complete” shall mean: Charge slips shall include: • Date of Service • Appropriate CPT code • Physician signature and title on slip and accompanying invoice • Patient name • Medical Record number “Timely” shall mean: Contractor charge slips are submitted to the SMMC within three calendar days of date of service. “Additional documentation” shall mean: • Discharge summary is completed in the time and manner specified in the Medical Staff Bylaws • Operative notes are complete in the time and manner specified in the • Medical Staff Bylaws • History and Physical is complete in patient chart • Short Stay/Admission form completed with CPT for all surgeries |