COMPLETED BOARD ORDER"�|E�F�Before the Board of Supervisors in and for the
County of Monterey, State of California
Agreement No. A-10757
Authorize the Purchasing Manager for Natividad
Medical Center NMC) to execute Amendment No.
4 to the Agreement with Toyon Associates Inc. for
Medicare Appeal Services at NMC in an amount not
to exceed $1,900,000 in the aggregate and $500,000
for the period July 1, 2011 to June 30, 2012
Upon motion of Supervisor Salinas, seconded by Supervisor Armenta, and carried by those
members present, the Board hereby;
Authorized the Purchasing Manager for Natividad Medical Center NMC) to
execute Amendment No. 4 to the Agreement with Toyon Associates Inc. for
medicare appeal services at NMC in an amount not to exceed $1,900,000 in the
aggregate and $500,000 for the period July 1, 2011 to June 30, 2012.
PASSED AND ADOPTED on this 14th day of June, 2011, by the following vote, to wit:
AYES: Supervisors Armenta, Calcagno, Salinas, Parker, and Potter
NOES: None
ABSENT: None
I, Gail T. Borkowski, Clerk of the Board of Supervisors of the County of Monterey, State of California, hereby
certify that the foregoing is a true copy of an original order of said Board of Supervisors duly made and entered in the
minutes thereof of Minute Book 75 for the meeting on June 14, 2011.
Dated: June 17, 2011 Gail T. Borkowski, Clerk of the Board of Supervisors
County of Monterey, State of California
By
30
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COMPLETED BOARD ORDER"�|E�F�Original Agreement No or PO#. A-10757)
RENEWAL AMENDMENT NO. 4
FOR PROFESSIONAL SERVICE AGREEMENT
BETWEEN Toyon Associates Inc AND
THE NATIVIDAD MEDICAL CENTER
FOR
Medicare Appeal Services
The parties to Professional Service Agreement, dated September 9, 2003 between the County of
Monterey, on behalf of Natividad Medical Center NMC"), and Toyon Associates Inc Contractor),
hereby agree to renew their Agreement No. A-10757) on the following terms and conditions:
1. Contractor will continue to provide NMC with the same scope of service as stated in the original
Agreement No. A-10757).
2. This Amendment shall become effective on July 1, 2011 and shall continue in full force until June
30, 2012.
3. The total amount payable by County to Contractor under Agreement No. A-10757) shall not
exceed the total sum of 1,900,000 for the full term of the Agreement and $500,000 for fiscal year
2011-2012.
4. All other terms and conditions of the Agreement shall continue in full force and effect.
5. A copy of this Amendment shall be attached to the original Agreement No. A-10757).
IN WITNESS WHEREOF, the parties hereto are in agreement with this Amendment and
Professional Service Agreement on the basis set forth in this document and have executed this
amendment on the day and year set forth herein.
CONTRACTOR
Signntvre i F~ Dated A r
Printed Ncnne Bur\ k 1 Title FM5 d ec erUl c�s
NATIVIDAD MEDICAL CENTER
Signatlo�e
NMC CEO
ApproN ed as to Legal Form:
Charles J. NICK IC, County Counsel
/1
Stacy Saetta, Deputy
Attorneys for County and N%1C
Dated
Dated 5p" 1, 7
Dated. 2011
1' f ta, q il~il! L1`
i_,t~t14,C, i
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SIGNED BOARD REPORT"�|E�I�MONTEREY COUNTY BOARD OF SUPERVISORS
MEETING: June 14, 2011
AGENDA NO.:
SUBJECT: Authorize the Purchasing Manager for Natividad Medical Center NMC)
to execute Amendment #4 to the Agreement with Toyon Associates Inc.
for Medicare Appeal Services at NMC in an amount not to exceed
$1,900,000 in the aggregate and $500,000 for the period July 1, 2011 to
June 30, 2012.
DEPARTMENT: Natividad Medical Center
RECOMMENDATION:
It is recommended that the Board of Supervisors authorize the Purchasing Manager for Natividad
Medical Center NMC) to execute Amendment #4 to the Agreement with Toyon Associates Inc. for
Medicare Appeal Services at NMC in an amount not to exceed $1,900,000 in the aggregate and
$500,000 for the period July 1, 2011 to June 30, 2012.
SUMMARY/DISCUSSION:
The Medicare/Medi-Cal Programs have established procedures which providers of healthcare
services must follow to pursue appeals of cost report audit adjustments. Toyon Associates, Inc. has
the expertise to pursue cost report appeals and/or reopenings on behalf of the hospital. Typical issues
in dispute are Disproportionate Share Hospital DSH) eligible days, Social Security Ratio, DSH
General Assistant days for interns and residents, labor and delivery room charges and bad debts.
These issues, especially DSH eligible days, represent significant reimbursement. These are
comprehensive reports that include the financial information of the hospital and require special
training and experience to complete. Toyon Associates has provided these services over the past ten
years for NMC and successfully recovered over $3.6M during Fiscal Years 2007 through 2010.
Toyon Associates, Inc will review and file an appeal within 180 calendar days of the final report date
to contest certain issues in dispute. This agreement covers cost reporting for Fiscal Years June 30,
1994 through June 30, 2010. Toyon will evaluate and provide data to the intermediaries to support
NMC's position of the disputed issues. The services provided meet all procedural requirements and
legal guidelines. Estimated annual reimbursement impact of the intermediary's adjustment is from
$50K to $1M. Payment for services is based on a contingency of 25% of the additional
reimbursement realized by NMC.
The recommended is that the Board of Supervisors authorize the Purchasing Manager for NMC to
execute amendment #4 with Toyon Associates Inc. for services rendered per the existing Agreement
for Medicare Appeal Services.
OTHER AGENCY INVOLVEMENT:
The Amendment has been reviewed and approved by County Counsel, the Auditor/Controller's
office and the Natividad Medical Center Board of Trustees.
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SIGNED BOARD REPORT"�|E�I�FINANCING:
The cost for this Amendment is $500,000 and is included in the 2011/2012 Fiscal Year
Recommended Budget. This action will not require any additional GetfeTal Fund subsidy.
Prepared by:
Juan Polanco, Chief Hospital Accountant 755-4236 Harry Weis
April 4, 2011 Chief Executive Officer
Attachments: Amendments #1, 2, 3, 4, Original Agreement, Board Order
Attachments on file with the Clerk of the Board
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