Action 23.
Regular Board of Supervisors Meeting
Health & Social Services
- Meeting Date:
- 07/26/2016
- Title:
- Approval of Untimely Claims from Canyon Vista Medical Center for Title 36 Patients
- Submitted By:
- Mary Gomez, Health & Social Services
- Department:
- Health & Social Services
Presentation:
No A/V Presentation
Recommendation:
Approve
Document Signatures:
BOS Signature NOT Required
# of ORIGINALS
Submitted for Signature:
Submitted for Signature:
0
NAME
of PRESENTER:
of PRESENTER:
Mary Gomez
TITLE
of PRESENTER:
of PRESENTER:
Director, CHSS
Mandated Function?:
Not Mandated
Source of Mandate
or Basis for Support?:
or Basis for Support?:
Docket Number (If applicable):
Information
Agenda Item Text:
Approve payment of several over six month claims submitted by Canyon Vista Medical Center for Title 36 Patients in the amount of $32,735 for service dates in 2015 and 2016.
Background:
Cochise County signed an agreement with Canyon Vista Medical Center (CVMC) in April, 2015 to provide Level I behavioral health services for County residents under court ordered treatment. This agreement was negotiated when the unit on the 4th floor of CVMC's new facility opened. The agreement allowed us to transport our Title 36 patients there instead of to Tucson facilities or to facilities located even further away from Cochise depending upon bed availability for this difficult population. Our daily rate for these services at CVMC is $900 and is competitive with Tucson facilities. Having this Level I facility available in our County has resulted in more timely admission of patients and decreased expenses for the transport of individuals requiring care.
When the unit first opened, there were multiple challenges in operations and with billing for services rendered. At the same time, we at the County were transitioning responsibility for claims adjudication from CHSS to CAO. With the initial patient claims, there was some miscommunication between CVMC and County staff and CVMC did not bill for some patient services within the six month time frame required by the agreement. Complications included CVMC not receiving timely notification from primary insurers about payment status of claims within the six month time frame. These untimely claims were denied by the County.
After multiple meetings and discussions with all involved, we are now requesting that an exception be made for these untimely claims and CVMC be paid for the services they rendered. The total cost to the County to pay these untimely claims would be $32,735. Please see spreadsheet attached with Protected Health Information removed - CAO and CHSS have full claims information on file to adjudicate.
County and CVMC staff have been meeting monthly to discuss billing and other issues with services provided under the T36 process, especially those services provided to inmates. CVMC has assured us that their staff now understand all of the billing requirements for these claims and that all claims after these have been, and will continue to be, submitted timely.
When the unit first opened, there were multiple challenges in operations and with billing for services rendered. At the same time, we at the County were transitioning responsibility for claims adjudication from CHSS to CAO. With the initial patient claims, there was some miscommunication between CVMC and County staff and CVMC did not bill for some patient services within the six month time frame required by the agreement. Complications included CVMC not receiving timely notification from primary insurers about payment status of claims within the six month time frame. These untimely claims were denied by the County.
After multiple meetings and discussions with all involved, we are now requesting that an exception be made for these untimely claims and CVMC be paid for the services they rendered. The total cost to the County to pay these untimely claims would be $32,735. Please see spreadsheet attached with Protected Health Information removed - CAO and CHSS have full claims information on file to adjudicate.
County and CVMC staff have been meeting monthly to discuss billing and other issues with services provided under the T36 process, especially those services provided to inmates. CVMC has assured us that their staff now understand all of the billing requirements for these claims and that all claims after these have been, and will continue to be, submitted timely.
Department's Next Steps (if approved):
Process claims described above.
Impact of NOT Approving/Alternatives:
Financial loss for CVMC and damage to relationship between CVMC and County into the future.
To BOS Staff: Document Disposition/Follow-Up:
None needed.