|
|
|
|
|
|
COUNTY OF SAN MATEO
Inter-Departmental Correspondence
|
Information Services
|
|
|
DATE:
|
June 6, 2005
|
BOARD MEETING DATE:
|
June 21, 2005
|
SPECIAL NOTICE/HEARING:
|
None
|
VOTE REQUIRED:
|
Majority
|
|
|
TO:
|
Honorable Board of Supervisors
|
FROM:
|
Chris Flatmoe, CIO/Director of Information Services
|
SUBJECT:
|
Execution of an agreement with Data Systems Group (DSG)
|
|
|
RECOMMENDATION:
|
Adopt a Resolution:
|
|
|
2. Authorizing the execution of an Agreement with Data Systems Group to provide hardware and software support for correct filing of payable claims, for the term of July 1, 2005 to June 30, 2007, in an amount not to exceed $204,351.28.
|
3. Grant signature authority to the Chief Information Officer/Director of Information Services to execute subsequent amendments and minor modifications not to exceed $25,000 and to make minor changes in the type of services provided under the Agreement.
|
|
|
VISION ALIGNMENT:
|
Commitment: Ensure basic health and safety for all County residents.
|
Goal(s): Extending the contract with Data Systems Group keeps the commitment to responsive, effective, and collaborative government, including a revenue increase of approximately $127,476, and specifically goal number 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain and goal number 22: County and local governments effectively communicate, collaborate, and develop strategic approaches to issues affecting the entire County. This contract contributes to these goals because Data Systems Group is assisting San Mateo Medical Center in facilitating effective communication and collaboration between County departments and state, federal, and private insurance agencies.
|
|
|
Performance Measure(s):
|
Measure
|
FY 2004-05
Actual
|
FY 2005-06
Projected
|
Number of payable claims filed
|
53,030
|
55,682
|
Revenue generated
|
$17,891,031
|
$18,785,583
|
|
|
BACKGROUND:
|
Over the past several years, Data Systems Group has been working with the County supplying and supporting the insurance claims editor program in the San Mateo Medical Center Business Services Office. Data Systems Group is a partner with San Mateo Medical Center and has modified its software to allow clean claim submissions with fewer errors to improve payments. Currently, we are losing revenue claims due to the following:
1) Unable to verify accurate eligibility
2) Referrals not authorized in a timely manner
The largest area of lost revenue is patient eligibility verification. The lack of proper eligibility verification accounts for approximately 30% of the Medical Center’s lost revenue. An additional 10% of lost revenue is due to the inability of timely payer authorizations.
|
|
|
DISCUSSION:
|
The “Denial Manager Module” of the Data Systems Group software suite will allow us to capture lost revenue due to unwarranted denials. This software tool provides Business Services the mechanism to identify and check values of what is denied. The module also provides Business Services access to denial codes, which allows them to work with the appropriate departments to correct denial information and obtain the potentially lost revenue. With this “Denial Manager Module” we expect an estimated 20% decrease in unwarranted denials, resulting in a revenue increase of approximately $127,476.
We feel it is in the best interest of the County to waive the Request for Proposal Process as the DSG insurance claims management system is currently interfacing with San Mateo Medical Center’s Invision System and a competitive bid process to establish a new system interface would not be cost effective.
|
|
|
FISCAL IMPACT:
|
Funding for this Agreement is included in the ISD FY 2005-06 recommended budget; and will be paid by the San Mateo Medical Center through the ISD work authorization process.
|