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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
Health System
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DATE:
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June 7, 2010
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BOARD MEETING DATE:
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June 29, 2010
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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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Jean S. Fraser, Chief, Health System
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Chris Flatmoe, CIO/Director of Information Services
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SUBJECT:
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Agreement with Data Systems Group “DSG”
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RECOMMENDATION:
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Adopt a Resolution:
1. Authorizing the President of the Board to execute an Agreement with Data Systems Group (DSG) for the licensing, maintenance and support of insurance claims editing software, for the term July 1, 2010 through June 30, 2012, in an amount not-to-exceed $259,416; and
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2. Authorizing the Chief Information Officer or his designee or the Chief of the Health System or her 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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BACKGROUND:
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DSG currently provides the San Mateo Medical Center (SMMC) with insurance claims editing software, electronic remittances processing, assistance with insurance billing compliance, product customization, and support. SMMC currently uses ICD-9 diagnosis codes on claims. The Centers for Medicare and Medicaid Services (CMMS) has mandated that all claims use ICD-10 diagnosis codes by January 2013, and, adhere to HIPAA-5010 standards by January 2012. These mandates apply to all Healthcare providers and payers.
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DISCUSSION:
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A key component of efficient and effective claims processing is a successful partnership with an experienced claims processing vendor. Looking forward, the claims processing vendor for SMMC must have an established understanding of current billing processes at SMMC in order to facilitate SMMC’s migration to the new HIPAA-5010 claims format. Additionally, as SMMC migrates from ICD-9 diagnosis codes to ICD-10 diagnosis codes, our claims processing vendor must have experience in such a migration.
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The Information Services Department “ISD” released Request for Proposal (RFP) ISD7161 in March 2010, to select a claims processing vendor who could best meet our current and future needs. The RFP review committee recommended DSG following the RFP process.
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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. Risk Management has reviewed and approved Contractor’s insurance and County Counsel has reviewed and approved the Resolution and Agreement as to form.
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Approval of this Agreement contributes to the Shared Vision 2025 outcome of a Collaborative Community by ensuring compliance with new claims formatting mandates and thereby ensuring insurance claims are successfully processed in a timely fashion so that SMMC can be quickly reimbursed for services provided.
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Measure
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FY 2009-10
Actual
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FY 2010-11
Projected
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Percent of Claims Successfully Filed
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70%
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95%
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FISCAL IMPACT:
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The term of the Agreement is from July 1, 2010 through June 30, 2012. The total not-to-exceed obligation under this Agreement is $259,416. Funds for this Agreement are included in SMMC’s and ISD’s FY2010-11 Tentatively Approved Budgets.
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