PSA - Prepare Ambulance Billing Cost Report for 2019 - Blue & Co. LLC

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%d ,ie, , 5rt N -WRI 260 Pdjl, r , j,"';Wy 1,b�Nw W ,r,�u; i �tlK a d'use� January 7, 2020 Mr. Todd Skwarcan South Bend Fire Department EMS 1222 S. Michigan St. South Bend, IN 46601 Dear Todd; The purpose of this letter is to confirm the cost report services we will perform, and the scope of our engagement. This engagement is by and between Blue & Co., LLC (Blue) and the South Bend Fire Department EMS. Our engagement will include the preparation of the following cost report from the information you supply us: O, Indiana Medicaid Freestanding Governmental Ambulance Provider Cost Report for the year ending December 31, 2019. Blue is responsible for preparing the cost reports listed above in compliance with cost allocation principles found in OMB Circular A-87 and CMS Pub.15-1 and based on the instructions outlined in the Indiana Health Coverage Program June 4, 2013 Medicaid bulletin BT201316. The purpose is to determine the Medicaid program ambulance costs for potential additional Medicaid reimbursement. We will not audit or otherwise verify the data you submit, although we may ask for some clarification. We will provide the South Bend Fire Department EMS a planning guide to assist in compiling the necessary data required for completion of the above report. This engagement is limited solely to cost report preparation. This engagement will begin with our request for 2019 information and will end upon our delivery of the cost report to you. We will also work with the State's contractor and answer any questions related to the above cost report year. The Office of Medicaid Policy and Planning requires that you have adequate documentation to support the cost report filed. All statements, records, schedules, working papers, or memoranda prepared by us during our engagement shall remain the exclusive property of our accounting firm.