The URL can be used to link to this page

Browse Search

Home My WebLink About20172648RESOLUTION RE: APPROVE PROFESSIONAL SERVICES AGREEMENT FOR DIAGNOSTICS IMAGING/RADIOLOGY AND AUTHORIZE CHAIR TO SIGN - RADIOLOGY IMAGING ASSOCIATES (RIA) WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Professional Services Agreement for Diagnostics Imaging/Radiology Imaging between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Public Health and Environment, and Radiology Imaging Associates (RIA), commencing July 20, 2017, and ending July 19, 2018, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Professional Services Agreement for Diagnostic Imaging/Radiology between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Public Health and Environment, and Radiology Imaging Associates (RIA) be and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 31st day of July, A.D., 2017, nunc pro tunc July 20, 2017. BOARD OF COUNTY COMMISSIONERS WELD CO, NTY, COLORADO ATTEST:¢ J jelfo;ok Weld County Clerk to the Board Coun Attorney Date of signature: :•S(t �( Ju ie A. Cozad, Chair Steve Moreno, Pro-Tem arbara Kirkmeyer cc! HLCST, ST( -T Cot Mw) F5/(/t-7 2017-2648 HL0049 C/PtiatiA0 tf/;17/ Memorandum TO: Julie A. Cozad, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH Executive Director Department of Public Health & Environment DATE: July 17, 2017 SUBJECT: Radiology Imaging Associates (RIA) Contract for Diagnostic Imaging/Radiology Enclosed for the Board's approval is a contract between Radiology Imaging Associates, PC (RIA) and the County of Weld, by and through the Board of Commissioners for Weld County, on behalf of the Weld County Department of Public Health and Environment (WCDPHE). With the approval of the Board, the WCDPHE will enter into a contract with RIA to provide the professional component of diagnostic imaging/radiology services (the reading of x-rays) provided to designated eligible patients. The Health Department has three programs that will utilize these services. These include the Tuberculosis Control, Women's Wellness Connection and Weld Prenatal -Sunrise programs. Specific services will include the reading of mammograms, ultrasounds, hysterosalpingograms, and two -view chest x-rays. WCDPHE will reimburse RIA for the professional services at the current Medicare rate in effect at the time the services are performed. The term for this contract is from July 20, 2017, through July 19, 2018, and upon mutual written agreement may be extended for additional one year terms. This agreement was approved for placement on the Board's agenda via pass -around dated July 6, 2017. I recommend approval of this Professional Services Agreement with Radiology Imaging Associates (RIA) for diagnostic imaging/radiology services. 2017-2648 '110i PROFESSIONAL SERVICES AGREEMENT THIS PROFESSIONAL SERVICES AGREEMENT entered into effective July 20, 2017, between THE BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, on behalf of the WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT ("WCDPHE") and RADIOLOGY IMAGING ASSOCIATES, P.C., a Colorado professional corporation ("RIA"); WITNESSETH: WHEREAS, RIA, either by itself or through its qualified employees, agents or other representatives, is licensed to practice medicine in the State of Colorado, and specializes in the practice of radiology, which includes the ability to conduct radiological interpretations for patients; and WHEREAS, WCDPHE is engaged in providing, promoting and ensuring quality breast and cervical cancer screening for underserved women in Colorado and connect them to resources, and also, for patients participating in their Tuberculosis Control Program, Womens Wellness Connection Program and Weld Prenatal -Sunrise Program; and WHEREAS, WCDPHE wishes to engage RIA to provide professional services as an independent contractor for WCDPHE for exams and/or procedures performed at North Colorado Medical Center (the "Facility"), and RIA wishes to accept such engagement as an independent contractor with WCDPHE, pursuant to the terms and conditions contained hereinafter; NOW THEREFORE, in consideration of the premises, the agreements and mutual covenants herein contained, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto agree as follows: I. Professional Services. (a) Services to be rendered by RIA, IVCDPHE hereby agrees to retain RIA, and RIA hereby agrees to serve WCDPHE, as herein set forth, for the "Term" (as that term is hereinafter defined). During the Term, RIA shall, during the coverage hours as described in Section I(b) below, be available to furnish medical services as provided herein at the Facility (collectively, "Physician Services"). Physician Services for radiological exams and/or procedures for the following: (I) WWC Breast Imaging Services to include: Mammograms, Breast Ultrasounds, Breast MRI and Breast Procedures (2) Chest X-rays for Tuberculosis Control Program (3) ZIKA OB Ultrasounds for Weld Prenatal -Sunrise Program. RIA shall cause any radiologist engaged by it to perform services for WCDPHE to be reasonably available to discuss with a patient's or client's physician any reading or related service provided by the radiologist with respect to that patient or client. Any radiologist employed by or retained by RIA or whose services are subcontracted by RIA to provide services at the Facility must, as a continuing condition precedent to RIA's obligations under this Agreement, (A) hold at all times a currently valid and unlimited license to practice medicine in the State of Colorado, (B) hold and maintain board certification in radiology or be eligible therefore. Unless the parties otherwise agree, all of the Physician Services provided by RIA shall be rendered by such qualified and licensed physician or physicians as are reasonably agreed to by the parties. (b) RIA's Performance of duties, All Physician Services shall be primarily rendered at a facility designated by the RIA, five (5) days a week, during normal office hours, being Monday through Friday. 2. Compensation. As compensation for RIA's services hereunder during the Term, WCDPHE shall pay RIA the amount indicated on Exhibit B. RIA will be paid within 15 days of the end of the month for all amounts to be paid with respect to that month. 3. Term and Termination. The Term ("Term") of this Agreement shall be for an initial term of one (1) year, beginning upon the date first written above, and will continue thereafter on a year-to-year basis. Notwithstanding the foregoing, either party may terminate this Agreement at any time, without cause, upon sixty (60) days' prior written notice. �o /7 a-6 Af 4. Certain Covenants and Agreements of WCDPHE. (a) Except as otherwise expressly provided in this Agreement, WCDPHE shall furnish and maintain, or cause to be furnished and maintained all of the supplies, equipment, facilities and services required in the operation of WCDPHE at its own cost and expense and subject to its standard practices and procedures relating to budgeting and procurement. (b) WCPDH shall employ or contract to employ, and shall retain full administrative control and responsibility for, all non -physician technical and clerical personnel it deems necessary for the proper operation of WCDPHE. (c) WCDPHE Shall comply with all applicable laws, rules and regulations with respect to its business, and in such a manner as to ensure patient safety. (d) WCDPHE will, at its sole cost and expense, carry or cause to be carried general liability and other insurance with respect to its business operations in such amounts and with such coverage as is standard in the industry. WCDPHE agrees to provide RIA with a certificate of insurance evidencing such required coverage upon request of RIA. (e) WCDPHE will ensure that at the time of scheduling of each examination under this agreement, that WCDPHE will be identified as the guarantor for billing purposes. 5. Independent Contractor Status. (a) Independent Contractor Generally. RIA will be at all times an independent contractor providing Physician Services pursuant to this Agreement. Nothing in this Agreement shall give WCDPHE control over the manners, methods, details, procedures or decisions in which RIA conducts the practice of medicine, or performs the Physician Services, except as expressly provided under this Agreement to the contrary. 6. Miscellaneous. (a) Rights to Payment. RIA's rights to payment for Physician Services rendered during the Term shall survive termination of the Term. (b) Waiver of Breach. The waiver by either party hereto of a breach or violation of any provision of this Agreement shall not operate as, or be construed to constitute, a waiver by such party of any subsequent breach of the same or other provision hereof. (c) Successor Parties; Nonassignability. This Agreement shall be binding upon and inure to the benefit of any successor or assignee of any party hereto. Except as expressly provided herein, no party may assign this Agreement or any right or obligation hereunder. Except as expressly contemplated to the contrary in this Agreement, no party may assign this Agreement or any right or obligation hereunder, by operation of law or otherwise, to any party without the prior written consent of the other party. As used herein, a merger, consolidation, conversion or other similar reorganization transaction involving a party shall be deemed to be an attempted assignment of this Agreement. (d) Notices. Any notice required or desired to be given under this Agreement shall be deemed given if in writing, and mailed, certified mail, return receipt requested, postage prepaid, and hand delivered as follows (with the date of such delivery being deemed to be one day after its deposit in United States mail, or the date of actual hand delivery): If to WCDPHE: If to RIA: Weld County Department of Public Health Attn: Tanya Geiser, Director, Admin Services 1555 North l7°i Avenue Greeley, CO 80631 Radiology Imaging Associates, PC Attn: Aimee Cagande, RCM Senior Manager 10700 E. Geddes Avenue, Suite 200 Englewood, Colorado 80112 Either party may change that party's address for receipt of notice by delivering to the other party a proper notice setting out the sending party's new address. (e) Governing Law, Binding Arbitration, This Agreement will be governed and interpreted under the laws of the State of Colorado without giving effect to the conflicts of law principles thereof Entire Agreement/Amendment. This Agreement supersedes all prior agreements between the panics hereto, and constitutes the entire agreement existing between or among the parties hereto, respecting the subject matter, and neither party shall be entitled to other benefits than those specified herein. (I) Severabiiity. Should any provision or part of this Agreement be deemed to be unenforceable, ineffective or be modified by any court of competent jurisdiction in any respect, such determination shall not invalidate or render ineffective the balance of the provisions hereof and the remainder of this Agreement shall be reformed, and as reformed may be thereby enforced by any court of law with competent jurisdiction so as to most closely achieve the results intended hereby, consistent with applicable laws. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be duly executed, effective as of the date first above written. "WCDPHE" "RIA": Weld County Depanment of Public Health & Environment Radiology Imaging Associates, PC As Its Authorized: Chair As Its Authorized: NWT AM AWNMNCB4v °Zo / 7- 2 a y E- `+- L U U t>., y C t%1 ey0 ce \ .is' va 0 •C CU v1 U E c U W o II 3 c 3 cy U.) O as rn cG U cn su >0 ;� U < Cw2 " 3To g ,.a W Cn "Li . V U 0 E .a Fs U ¢ 2 3 z Uw tb3 Oz°C .... co o vnO- ye.. F�--D u s-0 W O V U �:Es 4.)I- 2 v�O 6Oa,> F.0 tu aVUP o°° O En ¢ a 06-.2 Fes.. �U Ucn0 u O 3m ag c# - LU CI] m U N $ 2 Q u c o 0cry = o - 3m C� ? u �° a W ' • U c. 0 0 a) Q. " u 2 U as 3 R x V U •6. y u u O y O 10 O Co . -10 u u a CA ri .i c e VUl OFFICE VISITS 'END` �..�n. •.z �, ,. ',NOTES New Patient; detailed history, exam, straightforward decision -making; 30 minutes New Patient; comprehensive history, exam, moderate complexity decision -making; 45 minutes I Established Patient; detailed history, exam, moderately complex decision -making; 25 minutes W Z'.0 = co cc co 0o m oo as a as O+ Established Patient; expanded history , ry, exam, straightforward decision -making; ( S minutes ti BREAST SCREENING AND'DIAGNOSTIC SERVICES • s a.. .. �.'4�'.s .xw�* w�*' 'v3e . �. #«�m`" `�' x .. ....._fir .. ., _., ..:. .. ` ..� ., Radiological examination, surgical specimen runcture aspiration of cyst of breast xcision ot cyst, libroadenoma or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion; open; one or more lesions Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker tsreast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous; stereotactic guidance; each additional lesion C tireast topsy, with placement of ocalization device and imaging of biopsy specimen, percutaneous; magnetic resonance guidance; each additional lesion riacement 01 breast localization device, percutaneous; stereotactic guidance; first lesion i yaw 1 riacement of breast localization device, percutaneous; stereotactic guidance; each additional lesion O C — C Iii v .� sic 7.3 • t" 4•' 6 kr u 4 v u u 4 b s as t e c B d c a @ I- •u . v y o N w o. 3 c m LL C 3 c c =. E c c d o d O o 0 a g C a o ea E •O o E '3 H o E EE "u a el 0 :ova •u a t•1 0 E .3 CO Lei 0 H y C 4 •0D 0 C) u 'y' e 73 Ca u e,' C Id' _ L e m C c P. y s C .5 9 O o v 0 CA C: m E 0 Ca C m E 0`o Da C E C E as DDa E E cM E E ='Q y u F. E d es c E iti �p = 00 = 0q U v v u u o 0 = O .� > '> '> •> •> QCJ I.) = '2 E .S 0' •- Lt a= 3 E to C '0 O '0 O '0 O •o o R ? '`� C 9 Cl. i E u u O v a.. O C. O C. O C.. O - = O 'moo C O E .= E• v ad 1. 0�.. ,= U C .0 , O d ¢V u E CO 5 R E E Q n`9 G• A V , ar a- u O ? G v .. 3 sss. 3 3 3 H E m E u'-» •3 • °q 'C. A c ` L . ` u>`i O. v>i C. LA C. CA to n. a 0 i 0 C 'O C .V 5 ` O O O 0 0 0 C C 0 EZ L p c7 ya� . L a .0 CS L .c CS L . CS 6, CU E V C0 E O OS 7 5 a c s., m t it t n t n to A c E a i L77 -Q M O a a 2 r � k7 00 F• •,, C N 'V N O- O N'O - N r1 la= - N • A. .c 7 O O O N N N 00 00 00 00 00 00 00 00 00 C V(Ojo*.CT+C.o+VN.j,.= ) n3E:oh0,a c,o, Os es V,�ca aacc c ice, percutaneous; ultrasound guidance; each additional lesion 9 ice, percutaneous; magnetic resonance guidance; first lesion o N ON M n tom•• f^! N r.1 SEND NOTES O O O = r ine neeme aspiration without imaging guidance Fine needle aspiration with imaging guidance Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s) as r 1.s Cytopathology, evaluation of fine needle aspirate: interpretation and report 88305 Surgical pathology, gross and microscopic examination 88307 Surgical pathology, gross and microscopic examination; requiring microscopic evaluation of surgical margins G0202 Screening Mammogram, Digital, Bilateral G0204 Diagnostic Mammogram, Digital, Bilateral G0206 Diagnostic Mammogram, Digital, Unilateral 400 Anesthesia for procedures on the integumentary system, anterior trunk, not otherwise specified. Medicare Base Units 3 77053 Mammary ductogram or galactogram, single duct 77058 Magnetic Resonance Imaging, breast, with and/or without contrast, unilateral REQUIRES WWC PREAPPROVAL. 77059 Magnetic Resonance Imaging, breast, with and/or without contrast, bilateral REQUIRES WWC PREAPPROVAL. 77065 Diagnostic Mammography, unilateral, includes CAD 77066 Diagnostic Mammography, bilateral, includes CAD 77067 Screening Mammography, bilateral Various Pre -operative testing; CBC, urinalysis, pregnancy test, etc. These procedures should be medically necessary for the planned surgical procedure. CERVICAL SCREENING AND DIAGNOSTIC SERVICES • 88164 Cytopathology (conventional Pap test), slides cervical or vaginal reported in Bethesda System, manual screening under physician supervision 88165 Cytopathology (conventional Pap test), slides cervical or vaginal reported in Bethesda System, manual screening and rescreening under physician supervision 88141 Cytopathology (conventional Pap test), cervical or vaginal, any reporting system, requiring interpretation by physician 88142 Cytopathology (liquid -based Pap test) cervical or vaginal , collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143 Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation; manual screening and rescreening under physician supervision 88174 Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision 88175 Cytopathology, cervical or vaginal , collected in preservative fluid, automated thin layer preparation; screening by automated system and manual rescreening, under physician supervision 87624 Human Papillomavirus (HPV) high -risk types 87625 Human Papillomavirus, types 16 and IS only 57452 Colposcopy of the cervix 57454 Colposcopy of the cervix, with biopsy and endocervical curettage 57455 Colposcopy of the cervix, with biopsy 57456 Colposcopy of the cervix, with endocervical curettage 57460 Colposcopy with loop electrode biopsy(s) of the cervix Requires WWC Preapproval Unless Done After HSIL or AIS Pap test. O V eo C O •.9 4 U u U o u = c 7:1- c U u c ro C 2 6. U ...... C 00 a E N = O U C U E U u U C• O a u O N pU • G .O O .. U. E U C., 0s iE Iri ..D I- CO NN s 00 to 00 00 N N r N C1 K N Cs C1 C1 N p d S 00 O 00 0 L.AI7I VIL h Colposcopy with loop electrode conization of the cervix Requires WWC Preapproval unless done after HSIL or AIS Pap test. I 5 n sO} �� _��..,..x�.- _ CLINICAL SERVICES ANDPROCEDURES SPECIFICALLY :NOT ALLOWED _ I \ AII consultations should be billed through the standard "new patient" office visit CPT codes 99203 or 99204. Consultations billed as 99204 must meet the CPT coding guidelines for this code. CPT code 99204 is not appropriate for WWC screening visits. The type and duration of office visits should be appropriate to the level of care necessary for accomplishing screening and diagnostic follow-up. Reimbursement rates should not exceed those published by Medicare. While the use of 993XX-series codes may be necessary in some programs, the 993XX Preventive Medicine Evaluation visits themselves are not appropriate for WWC programs. 9938X codes shall be reimbursed at or below the 99203 rate, and 9939X codes shall be reimbursed at or below the 99213 rate. Medicare's methodology for the payment of anesthesia services are outlined in the Medicare Claims Processing Manual, Chapter 12, pages 99-107, available here: htto://www.curs.hhs.govlmanuals/downloads/clm I04cI2.ndf This charge should be used with caution to ensure programs do not reimburse for supplies, the cost of which, has already been accounted for in another clinical charge. Breast MRI can be reimbursed in conjunction with a mammogram when a client has a BRCA gene mutation, a first -degree relative who is a BRCA carrier, or a lifetime 5 risk of 20-25% or greater as defined by risk assessment models such as BRCAPRO that are largely dependent on family history. Breast MRI can also be used to better assess areas of concern on a mammogram or for evaluation of a client with a past history of breast cancer after completing treatment. Breast MRI should never be Cervical biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) Use this code for cervical polyp removal Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser Loop electrode excision procedure Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure). Only for diagnostic purposes following AGC Pap. Endometrial sampling (biopsy) performed in conjunction with colposcopy (List separately in addition to code for primary procedure). Only for diagnostic purposes following AGC Pap. Surgical pathology, gross and microscopic examination Pathology consultation during surgery, first tissue block, with frozen section(s). single specimen Immunohistochemistry antibody slide Immunohistochemistry antibody slide Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided) Pre operative testing; CBC, urinalysis, pregnancy test, etc, These procedures should be medically necessary for the planned surgical procedure. Human t'apillomavirus, low -risk types I Cl) L) & Gra cil _ cet C a - U . _ U d \ e U 2 e - § ' U 3 ; .CC - ■ ■ . k 2 CC o \ V O cia % , a. $ a 2 § -0 k J f = E % 4 @ E To' To Lo _ - 7 : / _ § 0 �_ co 2 © ' % % 0 / til . /.• 2 I I • 0 , f 2� . : \• 157461 G \ 0 � in �0 r•-• k e k 0GQ\gc- k k k■ k\ Z >, >. CPT CODES •�G�G-orq/ 2 0 N N ( 00 �� g©d _CM n� rt performed alone as a breast cancer screening tool. Breast MRI cannot be reimbursed to assess the extent of disease in a woman who has just been diagnosed with breast cancer. Codes 19081-19086 are to be used for breast biopsies that include image guidance, placement of localization device, and imaging of specimen. These codes should not be used in conjunction with 19281-19288. Codes 19281-19288 are for image guidance placement of localization device without image -guided biopsy. These codes should not be used in conjunction with 19081- 19086. 1.5 N Tr For a bilateral breast ultrasound, a modifier 50 should be added to either 76641 or 76642 to indicate a bilateral procedure. The Medicare Physician Fee Schedule assigns a "I" bilateral indicator to both CPT codes 76641 and 76642 which means that Medicare will allow 150 percent of the standard reimbursement rate. There should not be two CPT codes billed if a bilateral ultrasound exam is needed. 10 Due to Medicare claims processing issues, CMS will not be able to process the new mammography codes. Therefore no reimbursement fees have been assigned to these codes. Use only G0202, G0204, and G0206 until this has been resolved. 00 00 Y '.D.i Y 4 D E 2 O u e I - u al) c 0 0 c 2 F vi u u i 0 a) s E u Q E 'fl Y a• N r t VD 1', 0O Exhibit B Reimbursement for each radiological interpretation and/procedure shall be as follows: Service Reimbursement Screening and Diagnostic Mammograms * Current Year CO Medicare Allowable Breast Ultrasound * Current Year CO Medicare Allowable Breast MRI * Current Year CO Medicare Allowable Breast Procedures /Biopsies * Current Year CO Medicare Allowable Chest X-rays Current Year CO Medicare Allowable OB Ultrasounds Current Year CO Medicare Allowable *These services must be listed on the WCDPHE Reimbursable Services and Procedures list in order to be covered and paid by WCDPHE. See Exhibit A. Hello