Title
Authorize the Chief Executive Officer for Natividad Medical Center (NMC) or his designee to execute renewal and amendment No. 4 to the agreement (A-14865) with R1 RCM Inc. for billing and claim denial appeal services, extending the agreement an additional two (2) year period (retroactive December 1, 2021 through November 30, 2023) for a revised full agreement term of December 1, 2015 through November 30, 2023, and adding $50,000 for a revised total agreement amount not to exceed $240,000.
Report
RECOMMENDATION:
It is recommended the Board of Supervisors:
Authorize the Chief Executive Officer for Natividad Medical Center (NMC) or his designee to execute renewal and amendment No. 4 to the agreement (A-14865) with R1 RCM Inc. for billing and claim denial appeal services, extending the agreement an additional two (2) year period (retroactive December 1, 2021 through November 30, 2023) for a revised full agreement term of December 1, 2015 through November 30, 2023, and adding $50,000 for a revised total agreement amount not to exceed $240,000.
SUMMARY/DISCUSSION:
R1 RCM provides physician advisory services to support case management by providing utilization review recommendations such as level of care, admission status, and clinical appeal management. Utilization review is essential to billing compliance and is required by CMS and Medi-Cal.
Medi-Cal require that each hospital day is adjudicated through the utilization review process. Any hospital day(s) with questionable level of care or admit status need to be reviewed by a California licensed physician who is not involved in the care of the patient; no Medi-Cal claims can be submitted until this process is completed. R1 RCM also provides denial management support through case review, clinical appeals and peer discussion.
OTHER AGENCY INVOLVEMENT:
The Office of County Counsel reviewed and approved this renewal and amendment No. 4 as to form, and the Auditor-Controller reviewed and approved as to pay...
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