Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Colleen Chawla, Chief, San Mateo County Health
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Amendment to the Agreement with TruBridge, LLC to Provide a Claims Editing Software and Management System
RECOMMENDATION:
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Adopt a resolution authorizing an amendment to the agreement with TruBridge, LLC to provide a claims editing software and management system, extending the term by one year through April 30, 2026, and increasing the amount by $225,000, to an amount not to exceed $1,827,400.
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BACKGROUND:
In June 2017, a Request for Proposals was conducted for a software system that would provide claims editing and management. TruBridge, LLC (TruBridge) was selected for its significant billing expertise, user-friendly software, and the ability to interface with the necessary systems within County infrastructure.
In June 2020, SMMC and TruBridge entered into an agreement for the term of May 1, 2020 through April 30, 2023, with two one-year options to extend, in an amount not to exceed $1,000,000. There was a subsequent amendment extending the term through April 30, 2025, and increasing the amount not to exceed to $1,602,400.
DISCUSSION:
SMMC continues to have a need for a claim editing software and management system to fulfill their operational needs in collecting outdated accounts receivables. The extension provides a period of overlap that covers two transitions: TruBridge to ClaimSource and Invision to Epic. Extending TruBridge services will provide a paced transition allowing the department to focus on completing legacy work while SMMC billing teams adjust to the new software platforms.
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 County’s Contract Compliance Committee has approved a waiver request for a six-year term for this agreement.
It is anticipated that through using TruBridge’s software, the percentage of clean claim processing will increase to 93%.
PERFORMANCE MEASURE:
|
Measure |
FY 2024-25 Estimated |
FY 2025-26 Projected |
|
Percentage of clean claim processing |
91% |
93% |
EQUITY IMPACT:
TruBridge continued service of providing a claim editing software and management system will positively impact equitable health care delivery by ensuring timely submission of claims to all payors. SMMC’s patients span a wide spectrum of races, ethnicities, gender, and gender-identities. Within the past 18 months, the largest cohorts of specialty care patients at SMMC were female (52%), Hispanic or Latino (63%), and primarily Spanish speaking (55%). Claims submitted by TruBridge represent a diverse population of patients whose services are billed compliantly.
FISCAL IMPACT:
The term of the amended agreement is May 1, 2020 through April 30, 2026. The amendment increases the amount payable under the agreement by $225,000 to an amount not to exceed $1,827,400 for the six-year term. Funds in the amount of $37,500 are included in the SMMC FY 2024-25 Adopted Budget. Funds in the amount of $187,500 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.