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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
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San Mateo Medical Center
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DATE:
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December 23, 2006
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BOARD MEETING DATE:
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January 23, 2007
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SPECIAL NOTICE/HEARING:
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None
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VOTE REQUIRED:
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Majority
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TO:
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Honorable Board of Supervisors
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FROM:
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Nancy J. Steiger, Chief Executive Officer, San Mateo Medical Center
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SUBJECT:
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Agreement with CHIS, Inc.
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RECOMMENDATION:
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Adopt a resolution:
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A.
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Authorizing execution of an Agreement with CHIS, Inc. to provide coding of San Mateo Medical Center’s medical records admissions/discharges using the ICD-9CM coding guidelines, for the term January 1, 2007 to December 31, 2009, in an amount not to exceed $615,000.
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B.
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Authorizing the Chief Executive Officer (CEO) of San Mateo Medical Center or the CEO's designee to execute contract amendments which modify the County's maximum fiscal obligation by no more than $25,000 (in aggregate), and/or modify the contract term and/or services so long as the modified term or services is/are within the current or revised fiscal provisions.
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VISION ALIGNMENT:
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Commitment: Responsive, effective and collaborative government
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Goal 20: Government decisions are based on careful consideration of future impact, rather than temporary relief or immediate gain.
The Agreement contributes to this commitment and goal as coding has a direct impact on the amount of reimbursement San Mateo Medical Center receives. The Agreement will maximize San Mateo Medical Center’s billing process and ensure that all state and federal regulations are met.
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Performance Measure:
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Measure
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FY 06-07
Projected
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FY 07-08
Projected
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FY 08-09
Projected
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Percent of accuracy of acute inpatient coding and ICD-9 Emergency Department Coding.
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95%
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95%
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95%
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Percent of inpatient medical records with a turnaround time of 5-7 days.
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95%
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95%
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95%
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Percent of Emergency Department record coding with a turnaround time of 3 days.
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98%
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98%
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98%
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BACKGROUND:
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SMMC contracts with outside services to complete coding for inpatient and Long Term Care discharges, Emergency Department (ED) visits, and ambulatory surgery. This is to ensure appropriate payment for services. Billing regulations require that we apply ICD-9-CM/CPT codes to diagnoses, activities and procedures in order to bill for services. In addition, regulations for outpatient Medicare billing went into effect August 1, 2000. These stringent coding guidelines require that the Medical Records Department have access to the highest level of expertise in order to maximize billing reimbursements and ensure that all state and federal regulations are met. Correct coding benefits SMMC, as it has a direct impact on the amount of reimbursement the Hospital receives for services.
CHIS has provided high quality coding services to the Hospital since 1998. CHIS, Inc. codes SMMC’s and the clinics’ medical records’ admissions and discharges using the ICD-9-CM coding system. CHIS also provides clerical support for purging and screening of medical records.
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DISCUSSION:
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The coding contract has a major impact in maintaining the revenue collection at SMMC. A Request for Proposals (RFP) was conducted in September 2006. Proposals were received from three vendors. CHIS, Inc. was selected from among the three vendors that responded to the RFP. CHIS, Inc.’s rates per procedure are lower and are fixed for the term of the Agreement. In addition, CHIS, Inc. has no travel, lodging or personal expense charges. Fees are based on services provided. CHIS is the only company, of those responding to the RFP, that is located in California.
The contractor has assured compliance with the County's Contractor Employee Jury Service Ordinance, as well as all other contract provisions that are required by County ordinance and administrative memoranda, including but not limited to insurance, hold harmless, non-discrimination and equal benefits.
County Counsel has reviewed and approved this Agreement. Risk Management has approved the insurance coverage. ISD has reviewed and supports this Agreement.
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FISCAL IMPACT:
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The term of the previous Agreement with CHIS, Inc was September 1, 2003 to August 31, 2006 with a maximum amount of $575,000. An interim Agreement with a maximum amount of $100,000 for the term September 1, 2006 to December 31, 2006 was approved by the County Manager to allow services to continue while a RFP was conducted. The term of the new Agreement with CHIS, Inc. is January 1, 2007 to December 31, 2009. The maximum amount payable to the Contractor under the new Agreement is $615,000. Funds are included in the SMMC’s FY2006-07 Adopted Budget and will be included in future year request.
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