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: Agreement with Healthcare Cost Solutions, Inc. to Provide Hospital Coding Services
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with Healthcare Cost Solutions, Inc. to provide hospital coding services for the term of April 1, 2021 through March 31, 2026, in an amount not to exceed $1,800,000.
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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 maximize compliance with Medicare, Medicaid, and other federal health care program regulations.
SMMC completed a Request for Proposal in November 2020 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. In addition, all diagnosis and procedures on patient charts will be reviewed to better quantify SMMC's overall coding accuracy. This agreement is going to your Board late due to prolonged negotiations with the vendor.
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 County fiscal obligations by a maximum of $25,000 (in aggregate).
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