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Home My WebLink AboutPSA - Prepare Ambulance Billing Cost Report for 2019 - Blue & Co. LLC1316 COUNTY -CITY BUILDING crf� : } PHONE 574/ 235-9251 227 W. JEFFERSON BOULEVARD PFACE FAx 574/ 235-9171 SOUTH BEND. INDIANA 46601-1930 o CITY OF • r BOARD OF PUBLIC 1 January 14, 2020 Ms. Tina Severs Blue & Co., LLC 500 N. Meridian St., Suite 200 Indianapolis, IN 46204 RE: Professional Services Agreement Dear Ms. Severs: The Board of Public Works, at its meeting held on January 14, 2020, approved the above referenced agreement to prepare the ambulance bill cost report for 2019 in the amount of $4,000. Enclosed please find a copy of the agreement for your records. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, Linda M. Martin, Clerk Enclosure GARY A. GILOT ELIZABETH A. MARADIK THERESE J. DORAU JORDAN V. GATHERS JOSEPH R. MOLNAR %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. South Bend Fire Department EMS January 7, 2020 Page 2 CPAs, like all providers of personal financial services, are now required by law to inform their clients of their policies regarding privacy of client information. CPAs have been and continue to be bound by professional standards of confidentiality that are even more stringent than those required by law. Therefore, we have always protected your right to privacy. We retain records relating to professional services that we provide so that we are better able to assist you with your professional needs and, in some cases, to comply with professional guidelines. In order to guard your information, we maintain physical, electronic, and procedural safeguards that comply with our professional standards. In the interest of facilitating our services to the South Bend Fire Department EMS, we may communicate by facsimile transmission or send electronic mail over the internet. Such communications may include information that is confidential to the South Bend Fire Department EMS. While we will use our best efforts to keep such communications secure in accordance with our obligations under applicable laws and professional standards, you recognize and accept that we have no control over the unauthorized interception of these communications once they have been sent, and you consent to our use of these electronic devices. Our fees will be $4,000 for the cost report for 2019. You will be invoiced upon completion of the cost report. Our invoices are due and payable within 30 days. Interest will be charged at a rate of 1.5% per month on balances in excess of 30 days. Our engagement is contingent upon your obligation to furnish us with timely information necessary to complete the report prior to the filing due date which is June 1, 2020. In the event our work is suspended or terminated as a result of non-payment, you agree that we will not be responsible for your failure to meet government and other filing deadlines, or for penalties or interest that may be assessed against you resulting from your failure to meet such deadlines. Our engagement does not include any services or advice with respect to the design, operations or maintenance of your computerized systems or the processing and storage of your data. It is mutually agreed that our accounting firm is not responsible for any claims or damages related to your computerized systems. Management is responsible for the substantive outcome of our work and therefore has a responsibility to be in a position in fact and appearance to make an informed judgment on the results of our services. This includes establishing and monitoring the performance of our services to insure it meets management's objectives and evaluating the adequacy of the services performed and any findings or results. You are responsible for making any decisions that involve management functions relating to our services and accept full responsibility for those decisions. It is our understanding that you are the designated level official responsible and accountable for overseeing our services. South Bend Fire Department EMS January 7, 2020 Page 3 We believe the foregoing correctly sets forth our understanding, but if you have any questions, please let us know. If you find the arrangements acceptable, please acknowledge your agreement to the understanding by signing and returning the letter to us. We are pleased to have you as a client and look forward to a long and mutually satisfying relationship. Should you have any questions please contact Tina Severs at 317.713.7946. Sincerely, 16(" t cam, , mac. ACCEPTED BY: SOUTH BEND FIRE DEPARTMENT NAME: