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 Crossroads Health LLC to Provide Overpayment and Credit Balance Resolution Services
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with Crossroads Health LLC to provide overpayment and credit balance resolution services, extending the term by two years through March 31, 2025, and increasing the amount by $240,000 to an amount not to exceed $360,000.
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BACKGROUND:
In accordance with 42 U.S.C. § 1320a-7k(d) of the Medicare and Medicaid program integrity provisions and other applicable regulations, credit balances on accounts receivables must be identified and an overpayment resolution initiated 60 days after discovery. San Mateo Medical Center (SMMC) is responsible for achieving its goals relating to the compliant, accurate and timely resolution of credit balances and overpayments. Crossroads Health LLC (Crossroads) has been providing overpayment and credit balance services to SMMC since April 2021. In December 2021, SMMC completed a Request for Proposals and Crossroads was elevated because of their documented effectiveness in resolving overpayments and credit balances.
DISCUSSION:
On April 5, 2022, SMMC entered into a new agreement with Crossroads for the term of April 1, 2022 through March 31, 2023 in an amount not to exceed $120,000 so services could be continued until SMMC could bring an amendment to this Board for approval. Crossroads has agreed to extend the term of the agreement by two years for a total of three years through March 31, 2025 with no change in their rates.
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).
The Information Services Department has reviewed and approved the IT component of this agreement.
It is anticipated that 100% of SMMC’s credit balances in accounts receivables will be identified and resolution offered to the payor within 60 days of discovery.
PERFORMANCE MEASURE:
|
Measure |
FY 2021-22 Estimated |
FY 2022-23 Projected |
|
Percentage of SMMC’s credit balances in accounts receivables identified, and resolution offered to the payor within 60 days of discovery |
N/A |
100% |
FISCAL IMPACT:
The term of the amended agreement is April 1, 2022 through March 31, 2025. This amendment increases the agreement amount by $240,000 to an amount not to exceed $360,000 for the three-year-term. Funds in the amount of $120,000 are included in the SMMC FY 2022-23 Recommended Budget. Funds in the amount of $120,000 will be included in the SMMC FY 2023-24 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 is covered by the County’s General Fund contribution to SMMC and is within the existing annual appropriation.
ATTACHMENT:
RFP Matrix