COUNTY OF SAN MATEO

Inter-Departmental Correspondence

San Mateo Medical Center

 

DATE:

May 2, 2006

BOARD MEETING DATE:

June 6, 2006

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

 

TO:

Honorable Board of Supervisors

FROM:

Nancy J. Steiger, Chief Executive Officer, San Mateo Medical Center

SUBJECT:

Agreement with Health Advocates, LLC

 

RECOMMENDATION:

Adopt a Resolution authorizing the President of the Board to execute an agreement with Health Advocates, LLC for cost recovery services for the term May 1, 2006 to April 30, 2009, in an amount not to exceed $2,280,000.

 

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all.

Goal 5: 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.

 

Performance Measure(s):

Measure

FY 2006-07
Actual

FY 2007-08

FY 2008-09
Projected

Cost Recovery

$2,000,000

$2,000,000

$2,000,000

       
 

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 March 2006. 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, LLC of Sherman Oaks, California, was selected as the Contractor who most closely met the specifications of the RFP.

 

DISCUSSION:

The process of locating discharged patients, obtaining documents and representing the patient at an administrative hearing is very specialized and lengthy. 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 $2,000,000 in per diem charges 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 (MAA) program because the agreement provides that Health Advocates comply with the State Department of Health Services (DHS) regulations and policies regarding MAA as outlined in the agreement between DHS and the County.

The Agreement includes all provisions that are required by county ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination, equal benefits and jury service policy.

County Counsel and Risk Management have reviewed and approved the Agreement.

 

FISCAL IMPACT:

The term of this agreement is May 1, 2006 to April 30, 2009. The maximum amount of the agreement for the three year term is $2,280,000. Health Advocates, LLC will be paid on a contingency basis. Reimbursement is based on the amount collected from the identified health program. The Medical Center expects to receive approximately $3,720,000 in net revenue over the term of the agreement. There is no net county cost associated with this agreement.

 

Exhibit A

Request for Proposal Matrix

1.

General Description of RFP

Cost Recovery for San Mateo Medical Center

2.

List key evaluation criteria

Service, program costs, and turn around time

3.

Where advertised

RFP was sent to the known companies that provide cost recovery services.

4.

In addition to any advertisement, list others to whom RFP was sent

TWIN Medical

Health Advocates, LLC

NCO Financial Systems

Paralign

5.

Total number sent to prospective proposers

3

6.

Number of proposals received

3

7.

Who evaluated the proposals

Financial Services & Case Management Team

8.

In alphabetical order, names of proposers (or finalists, if applicable) and location

Health Advocates, LLC

13412 Ventura Blvd.

Sherman Oaks, CA 94123

NCO Financial Systems

507 Prudential Rd.

Horsham, PA 19044

TWIN Medical

8350 Auburn Blvd., Suite 135

Citrus Heights, CA 95610