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 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 two years through April 30, 2025, and increasing the amount by $602,400, to an amount not to exceed $1,602,400.
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BACKGROUND:
San Mateo Medical Center’s (SMMC) Patient Financial Services division has been utilizing a third-party software system for editing and managing insurance claims since 1994.
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, with anticipation that an extension will be needed.
DISCUSSION:
SMMC continues to have a need for a claims editing software and management system to fulfill their operational needs. For that reason, SMMC wishes to extend the agreement to avoid a break in services while SMMC undergoes the transition to a new electronic health record system (Epic). The continued use of a claims editing and management system and the contract with TruBridge will be evaluated during the Epic project implementation.
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 five-year term for this agreement.
It is anticipated that through using TruBridge’s software, the percentage of clean claim processing without the need to obtain additional information will increase to 93%.
PERFORMANCE MEASURE:
|
Measure |
FY 2022-23 Estimated |
FY 2023-24 Projected |
|
Percentage of clean claim processing without the need to obtain additional information |
70% |
93% |
FISCAL IMPACT:
The term of the amended agreement is from May 1, 2020, through April 30, 2025. The amendment increases the amount payable under the agreement by $602,400 to an amount not to exceed $1,602,400 for the five-year term. Funds in the amount of $96,384 are included in the SMMC FY 2022-23 Adopted Budget. Funds in the amount of $289,152 will be included in the SMMC FY 2023-24 Recommended Budget. Similar arrangements will be made for future years.
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.