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 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 of the agreement through March 31, 2026, and increasing the maximum amount authorized to be expended by $200,000, to an amount not to exceed $2,595,225.
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BACKGROUND:
In accordance with Medicare and Medicaid program integrity provisions, credit balances on accounts receivables must be identified, and an overpayment resolution initiated to return the funds to the payor within 60 days after discovery. Crossroads Health LLC (Crossroads) has been providing overpayment and credit balance services to San Mateo Medical Center (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 an 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 December 31, 2025, and increasing the maximum amount authorized to be expended into the agreement to $2,395,225.
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 balances has increased substantially due to additional compliance audits being performed. These additional audits are the result of SMMC's Federal ...
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