Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Amendment to the Agreement with Trifecta Group, Inc. to Provide Revenue Cycle Advisor Services
RECOMMENDATION:
title
Adopt a resolution authorizing an amendment to the agreement with Trifecta Group, Inc. to provide revenue cycle advisor services, extending the term of the agreement through May 31, 2026, and increasing the amount of the agreement by $735,000 to an amount not to exceed $1,735,000.
body
BACKGROUND:
San Mateo County Health and San Mateo Medical Center (SMMC) are implementing a new electronic health record (EHR) system (Epic), which will include significant advances in revenue cycle capabilities that address accounts receivable management, net revenue, claim denials, and increased workflow automation. To support this project, a Request for Proposals for revenue cycle advisory services for the Epic transition was completed in June 2023, and Trifecta Group, Inc. (Trifecta) was elevated due to their knowledge and expertise of California safety net public hospitals, FQHC billing, and the Epic system.
In October 2023, SMMC entered into an agreement with Trifecta for the term of October 1, 2023, through September 30, 2025, in an amount not to exceed $1,000,000.
DISCUSSION:
Trifecta has been providing documentation of current billing and collection workflows; creating benchmark data; performing a gap analysis between Epic best practices and current processes in SMMC’s patient financial services (PFS); and assessing staffing, procedures, and work distribution to maximize effectiveness and efficiencies in preparation for the transition to Epic while concurrently providing guidance on the Epic build.
This amendment will extend the term of the agreement by eight months and increase the not to exceed amount by $735,000 to an amount not to exceed $1,735,000 in order to add additional resources to support management of SMMC’s current patient accounting system (Invision) for a period of time after the new Epic system is live (referred to as “Legacy A/R” management), including the processing of payment remittance files.
Additionally, this resource will be used to oversee elements of the Legacy A/R vendor workflows and outcomes, providing subject matter expertise to Legacy A/R vendor staffing, and monitoring account adjustments to ensure integrity and alignment with departmental protocols. This resource will support the current claims editing system’s processing and reporting to ensure claims submission and payment remittance processing are monitored and managed timely. This resource will provide training to the Legacy A/R vendor staffing and provide support services to further assist/accommodate PFS management and front-line PFS staff to acclimate to the Epic environment and mitigate loss of revenue.
County Attorney has reviewed and approved the resolution and amendment as to form.
The resolution contains the County’s standard provisions allowing amendment of the County fiscal obligations by a maximum of $25,000 (in aggregate).
It is anticipated that all electronic payments received will be posted within 90 days of receipt.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Estimated |
FY 2024-25 Projected |
|
Number of days for all electronic payments received to be posted |
≤90 days |
≤30 days |
FISCAL IMPACT:
The term of the amended agreement is October 1, 2023, through May 31, 2026. The amendment increases the amount payable under the agreement by $735,000 to an amount not to exceed $1,735,000 for the 32-month term. Funds in the amount of $367,500 are included in the SMMC FY 2024-25 Recommended Budget. Funds in the amount of $367,500 are included in the SMMC FY 2025-26 Recommended Budget.
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 is covered by the County’s General Fund contribution to SMMC and is within the existing annual appropriation.