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COUNTY OF SAN MATEOInter-Departmental Correspondence |
San Mateo Medical Center |
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DATE: |
May 21, 2003 |
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BOARD MEETING DATE: |
June 10, 2003 |
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TO: |
Honorable Board of Supervisors |
FROM: |
Nancy J. Steiger, Chief Executive Officer |
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SUBJECT: |
Agreement with Health Advocates, LLP |
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Recommendation |
Adopt a Resolution authorizing the President of the Board to execute an agreement with Health Advocates, LLP for cost recovery services. |
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Background |
Since 1977, San Mateo Medical Center (SMMC) has been using outside service providers to find payment sources for uninsured accounts. A Request for Proposals (RFP) process was conducted by SMMC in October 2002. San Mateo Medical Center was seeking proposals from interested parties to recover costs from selected uninsured inpatient accounts. The accounts will be referred to the Contractor by SMMC supervisory staff when program linkage such as Medi-Cal has been identified, but the patient is hard to locate or fails to follow-up with the necessary paperwork. The Contractor will assist patients and in some circumstances, function as a designated representative for patients to complete the necessary documentation. Once approval of insurance eligibility is established, the Contractor is required to deliver all eligibility documents to SMMC and bill the appropriate insurance program.
After a review of the proposals received, Health Advocates, LLP of Sherman Oaks, California, was selected as the Contractor who most closely met the specifications of the RFP. |
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Discussion |
The process of locating discharged patients, obtaining documents and representing the patient at an administrative hearing is very specialized, lengthy, and time consuming. Without a contractual arrangement for these services, many inpatient accounts would be charged to Medically Indigent Adult (MIA) funds and be otherwise uncollectible.
In the past two years, SMMC has increased its efforts to enroll clients in insurance programs in part by placing more patients in Medi-Cal pending status. With the assistance of Health Advocates, SMMC expects to recover a minimum of $500,000 in additional insurance revenue over the next twelve months by utilizing these program services. Additionally, SMMC is able to claim a percentage of the contract cost through the Medi-Cal Administrative Activity (MA-A) program because the agreement provides that Health Advocates comply with the State Department of Health Services (DHS) regulations and policies regarding MA-A as outlined in the agreement between DHS and the County. |
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Vision Alignment |
The agreement with Health Advocates keeps the County's commitment of ensuing basic health and safety for all and goal number 1: Residents have access to healthcare and preventive care. The contract contributes to this commitment and goal by providing a process whereby Health Advocates will assist patients to complete the application process for insurance benefits. |
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Fiscal Impact |
The term of this agreement is May 1, 2003 to April 30, 2005, with an option for a third year. The maximum amount of the agreement for the two-year term is $600,000. Health Advocates, LLP will be paid on a contingency basis. Reimbursement is based on the amount collected from the identified health program. There is no net county cost. The revenue is included in the FY2002-03 Approved Budget and will be included in future year budget requests. |