Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise Rogers, Chief, Health System
Chester J. Kunnappilly, MD, Chief Executive Officer, San Mateo Medical Center
Subject: Agreement with Healthcare Cost Solutions, Inc. for Compliance Coding Audits
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Healthcare Cost Solutions, Inc. for compliance coding audits of facility and clinic medical records, for the term of February 1, 2018 through January 31, 2021, in an amount not to exceed $1,125,000.
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BACKGROUND:
Accurate coding is essential for proper billing compliance and revenue capture, in addition to building a comprehensive health database that accurately identifies the acuity of patient care and an accurate case mix index. In order to ensure the accuracy of its coding by employee coders and providers, San Mateo Medical Center (SMMC) has identified an ongoing need for compliance coding audits. Coding audits are essential due to annual coding updates, to reduce risk, and to maximum compliance with Medicare, Medicaid, and other federal health care program regulations.
SMMC completed a Request for Proposal in November 2017 for a vendor to perform compliance coding audits. Healthcare Cost Solutions (HCS) was chosen based on experience, pricing, and institutional knowledge gained from working with SMMC previously.
DISCUSSION:
HCS will perform retrospective medical record clinical coding and documentation audits at SMMC. This agreement will increase the number of outpatient charts from 6% to 33%, and reviews will now be performed twice a year instead of annually. In addition, all diagnosis and procedures on patient charts will be reviewed to better quantify SMMC's overall coding accuracy.
The agreement and Resolution have been reviewed and approved by County Counsel as to form.
The Resolution contains the County's standard provisions allowing amendment of the Coun...
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