United Rheumatlgy Annual Practice Membership Agreement Parties. This Annual Practice Membership Agreement (this Agreement ) is by and between United Rheumatlgy, LLC ( URLLC ) and the party set frth belw (the Medical Grup ). This Agreement will becme effective n the latest f the dates set frth in the signature blck belw (the Effective Date ). Services. During the term f this Agreement, URLLC shall prvide the administrative services described in Schedule 1 (the Administrative Services ), as elected by Medical Grup and subject t any applicable participatin requirements f any subcntractrs f URLLC. The Administrative Services are categrized as ne Cre Service Bundle and multiple A La Carte Service Bundles (cllectively, the Service Bundles ). Medical Grup will have access t the Cre Service Bundle upn payment f the Base Annual Practice Membership Fee. Medical Grup may select and/r terminate ne r mre A La Carte Service Bundle. Upn terminatin f an A La Carte Service Bundle, URLLC shall cease prviding the Administrative Services included in the A La Carte Service Bundle, and the Administrative Service Fee will be adjusted accrdingly. Term. This Agreement will be fr an initial perid f tw (2) years frm the Effective Date, and will autmatically renew fr successive ne (1) year perids thereafter (cllectively, the Term ), prvided that neither URLLC nr Medical Grup gives ntice f its intent nt t renew this Agreement at least ninety (90) days befre the end f the initial Term r any renewal Term, r unless therwise terminated as prvided in Sectin 4 f the Terms and Cnditins. Fees. Base Annual Practice Membership Fee: ($2,500) per full time practitiner ($1,250) per part time practitiner (prvides less than 20 hurs f services t Medical Grup per week) The fllwing discunts n the Base Annual Practice Membership Fee depending n grup practice size shall apply: 6-9 full-time practitiners --5% discunt 10 r mre full-time practitiners --10% discunt
A La Carte Fees: The A La Carte Fee will be based n the Medical Grup s electin f additinal A La Carte Service Bundles belw. A La Carte Service Bundles. Schedule 1, Sectin B describes the services ffered in each A La Carte Service Bundle. Please refer t Schedule 1 fr a cmplete explanatin f each A La Carte Service Bundle, and select which A La Carte Service Bundles the Medical Grup wishes t participate in belw. If yu require further infrmatin, please cntact Amanda Byrnes at Amanda@unitedrheumatlgy.rg Yu d nt have t make any A La Carte selectins at this time. If yu make a decisin t utilize an A La Carte service in the future, cntact Amanda Byrnes. Detailed Practice Assessment Service Bundle: $ Cmpliance and Audit Prgram Service Bundle: $ Revenue Cycle Management Service Bundle: $ Super-Grup Aggregatin & Supprt Service Bundle: $ Terms & Cnditins. The Standard Terms and Cnditins included with this Agreement apply t, and are hereby incrprate by reference int, this Agreement. IN WITNESS WHEREOF, Medical Grup and URLLC have executed this Membership Subscriptin Agreement, as f the day and year set frth belw. URLLC UNITED RHEUMATOLOGY, LLC Medical Grup RHEUMATOLOGY ASSOCIATES, P.C. By: Max Hamburger, M.D. Title: Chief Executive Officer Date: Address: 315 Middle Cuntry Rad, Smithtwn, New Yrk 11787 By: Title: Date: Address: 8902 N. Meridian St. Ste 210 Indianaplis, Indiana 46260! 2
Schedule 1 DESCRIPTION OF SERVICES: SERVICE BUNDLES A. Cre Service Bundles. URLLC shall prvide the fllwing Cre Service Bundles t all members, subject t each member s cmpliance with any subcntractr s plicies, prcedures and qualificatin requirements: I. Practice Management Supprt Service Bundle Practice Assessment Benchmarking Rapid Diagnstic URLLC prvides key perfrmance indicatr data n semi-annual basis t be cmpared with peers and measured against industry standards, indicating areas f peratinal prductivity and financial strengths and weakness. II. Grup Purchasing URLLC will negtiate terms fr best market price grup purchasing, mnitr custmer cmpliance and track and reprt vendr partner perfrmance. Frm time t time, ur GPO partners Matrix GPO, UBC, CuraScript and ExpressScripts will ntify thse wh have established an accunt f additinal value pprtunities. III. Clinical Pathway Develpment Service Bundle Identify and priritize cnditins and episdes f care fr prtcl develpment. Cllect and review existing published prtcls frm ACR, AHRQ guideline clearinghuse and ther surces. Cllect and assess published research and literature related t cnditins and care episdes. Review perfrmance data frm Medical Grup t establish and revise measures and benchmarks. Establish a cntinuus quality imprvement prcess t review and revise pathways n an nging basis. IV. Rheumatlgy Best Practices & Infrmatin Subscriptin Service Bundle! 3
Medical Grup will have access t a number f services including: Frum and discussin grups List Serves A searchable library and archive f infrmatin and tlkits including: Cding and cmpliance Malpractice educatins and charting best practices Practice amalgamatin/clinical integratin resurces, including implementatin steps & resurces Practice management case studies and best practices Relevant industry alerts Plicies and prcedures Prtcls/ clinical pathways B. A La Carte Service Bundles. The Medical Grup may elect the fllwing Services, subject t each member s cmpliance with any subcntractr s plicies, prcedures and qualificatin requirements: I. Managed Care Cntracting Service Bundle Access t a preferred prvider relatinship t Fulcrum Strategies, a managed care cnsultant, at discunted rates as a subscribing member wh will prvide:! 4
Health plan cntracting services t supprt Medical Grup in health plan negtiatins. Prvide individual cntracting assistance including managed care negtiatin supprt. Develp cntracting terms and cnditins. Develp and incrprate value-based payment arrangements. II. Detailed Practice Assessment Service Bundle On-site cmprehensive peratinal analysis f Medical Grup s peratins and financial vitality, including but nt limited t the fllwing: Interviews and peratin reviews with practice managers, physicians and administrative leads. Observatin f wrk flws and review f peratinal data. Staff and physician analysis. Human resurce management. In-depth financial, revenue cycle and peratinal benchmarking and prcess analysis. Managed care cntracting. Plicy and Prcedure (P&P) review. III. Cmpliance and Audit Prgram Service Bundle Cmprehensive review f Medical Grup s P&Ps, adherence t such standards and bserved P&P vilatins relating t: Fraud and Abuse. HIPAA privacy and security. CLIA. OSHA. Wrkplace safety. Disaster planning and recvery. Wrkfrce benefits, including FMLA, state statutes and applicable labr laws & regulatins. Audit and reprting f cmpliance with cntracting requirements. Recmmending preparing, training & implementing P & Ps and supprting an nging mnitring prgram t ensure cmpliance fr Medical Grup.! 5
IV. Revenue Cycle Management Supprt Service Bundle Revenue cycle management service prvides administrative and peratinal supprt fr charge entry, payment psting, claim status mnitring, accunts receivable management, scheduling, eligibility verificatin, crdinatin f benefits and verpayments, custmized billing reprts and analysis, claims audits, denial appeals, recveries, payment lgs, cllectin services, establishing and maintaining lck bxes and fee-schedule management. Training, ptimizatin (Flat-fee basis based n practice size) and educatin prgrams will be available t Medical Grups, including: ICD-10 training Billing audits t ensure supprt fr cdes is prperly dcumented in charts Wrk flw reviews Best practice prcess management, including specific billing prtcls and pre-claims submissin editing and payer-specific claim fllw-up guidelines. V. Super-Grup Aggregatin & Supprt Service Bundle Services t supprt practice amalgamatin, including: Cnsulting, including facilitatin and prject management supprt. Sharing f lessns learned and best practices frm successful supergrups.! 6
Please Cmplete The Fllwing Infrmatin Table Practice Name Legal Entity Name (if different frm practice name) Primary DEA n Legal Entity CuraScript SD Accunt # (if applicable) Address City State Zip Primary Cntact Name Primary Cntact Title Primary Cntact Phne # Primary Cntact Persn Email Address Sharehlder r Bard member? List all Physicians # f lcatins In huse Infusin Y/N! 7
Annual Drug Spend (Supply usage reprt fr 2014) Current Supplier Current Supplier Cntract/Term Primary Order Methd (Online, Phne, Fax, Email etc) Current GPO Name Current GPO Term EMR/EHR (System name /Vendr) Practice Management System (System name /Vendr) Claims System (System name / Vendr) Inventry System (System name / Vendr) Inventry Cabinets Y/N # f Inventry Cabinets Current Inventry Cabinet Term! 8