|
|
|
|
|
|
|
|
|
COUNTY OF SAN MATEO
Inter-Departmental Correspondence
Health System
|
|
|
|
DATE:
|
March 17, 2011
|
BOARD MEETING DATE:
|
April 26, 2011
|
SPECIAL NOTICE/HEARING:
|
None
|
VOTE REQUIRED:
|
Majority
|
|
|
TO:
|
Honorable Board of Supervisors
|
FROM:
|
Jean S. Fraser, Chief, Health System
Susan Ehrlich, MD, MPP, Chief Executive Officer
San Mateo Medical Center
|
SUBJECT:
|
Agreement with Healthcare Cost Solutions for Compliance Coding Reviews at San Mateo Medical Center
|
|
|
RECOMMENDATION:
|
Adopt a Resolution authorizing the:
|
A)
|
President of the Board to execute an Agreement with Healthcare Cost Solutions to provide coding compliance reviews on government reimbursed charges at San Mateo Medical Center for the term May 1, 2011 through April 30, 2014, for a maximum fiscal obligation of $300,000; and
|
|
|
B)
|
Chief of the Health System or 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.
|
|
|
BACKGROUND:
|
San Mateo Medical Center (SMMC) is currently subject to a Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG) of the United States Department of Health and Human Services in order to promote compliance with Medicare, Medicaid, and other federal health care programs and their related regulations. The OIG emphasizes the importance of evaluation in compliance, and the CIA requires regular monitoring of government reimbursed charges at SMMC.
|
|
|
In May 2010 SMMC conducted a Request for Proposals (RFP) for Hospital Compliance Auditing. Two proposals were received and evaluated. Healthcare Cost Solutions (HCS) was selected as the vendor for their experience, price and institutional knowledge working with providers at SMMC.
|
|
|
|
|
|
|
DISCUSSION:
|
Contractor will perform scheduled compliance audits monthly for all service lines including inpatient and outpatient, emergency department, long-term care and psychiatry. Services will include consultation to the Compliance Officer on inpatient and outpatient coding unit structure and monitoring government regulations related to clinical documentation and Diagnosis Related Group (DRG), Current Procedural Terminology (CPT) and Ambulatory Payment Classification (APC) assignment on inpatient and outpatient discharges. Contractor will also audit Professional and Technical Evaluation and Management codes and will provide education and feedback to physicians on specific issues identified.
|
|
|
Once an issue has been identified, HCS will provide a written analysis, including all supporting documentation and recommendations for corrective action. Contractor will be available to answer and research questions on any coding and or compliance issues. The anticipated outcome is improved coding accuracy which ultimately affects SMMC’s revenue cycle.
|
|
|
County Counsel has reviewed and approved this Agreement and Resolution as to form. The Contractor’s insurance has been reviewed and approved by Risk Management.
|
|
|
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.
|
|
|
This Agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing compliance oversight through coding audits, which ultimately effects revenue cycle. It is anticipated that SMMC’s cost per adjusted patient day will increase from $881 to $918.
|
|
|
Performance Measure:
|
Measure
|
FY 2009-10
Actual
|
FY 2010-11
Projected
|
SMMC Cost Per Adjusted Patient day
|
$881
|
$918*
|
*Due to increase in operating costs
|
|
|
FISCAL IMPACT:
|
The term of the Agreement is May 1, 2011 through April 30, 2014. The maximum fiscal obligation is $300,000. Funds in the amount of $16,000 are included in the SMMC Adopted FY 2010-11 Budget. Funds in the amount of $100,000 will be included in the SMMC FY 2011-12 Recommended Budget. Similar arrangements will be made for future years.
|
|
|
Expenses at SMMC are covered by fees for services or third-party payors whenever possible. The portion of expenses for services provided to the medically indigent or to those covered by programs that do not meet the full costs of care are covered by the County’s General Fund contribution to SMMC.
|