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, increasing the amount by $1,248,075 to an amount not to exceed $1,608,075.
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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, which are primarily from Medicaid and other insurers, must be identified, and an overpayment resolution initiated, to return the funds to the payer, 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 (RFP) and Crossroads was elevated because of their documented effectiveness in resolving overpayments and credit balances.
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, with subsequent amendments extending the term through March 31, 2025, and increasing the amount by $240,000 to an amount not to exceed $360,000.
DISCUSSION:
When the RFP was originally completed in December 2021, the projection for the monthly number of credit balances that needed to be resolved by an outside vendor was 1,200. Since that time, the volume of credit balan...
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