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Health department seeks extension of reimbursement contract for Medicare appeals
Summary
The Department of Public Health asked the committee to extend a contract with a reimbursement and revenue-optimization firm that helps prepare cost reports and manage group Medicare appeals; DPH reported $3.3 million recovered in contingent-fee recoveries over five years and said the extension includes a contingent-fee cap of $2 million and fee-for-service elements.
San Francisco — The Department of Public Health asked the Budget & Finance Subcommittee to extend an existing contract with a reimbursement services firm that prepares cost reports and manages Medicare disproportionate share appeals on a contingent-fee basis.
Greg Sass, chief financial officer for DPH, said the firm prepares cost reports, supports audits and attaches agency issues to group appeals to reduce litigation costs and administrative burden. He said the department has recovered $3.3 million under contingent-fee arrangements over the last five years while paying about $600,000 in contingent fees and roughly $1.7 million in fee-for-service work.
Sass said the contract terms include a $2 million contingent-fee compensation cap and roughly $2 million in fee-for-service compensation over a four-year term, and that the department has worked with the firm since 1996. He said the initial RFP was issued in February 2005 and this extension represents the second four-year extension permitted by the contract. Supervisors questioned whether the work had been put out to bid; Sass and DPH staff said the work was competitively procured in 2005 and that the firm’s ongoing involvement on pending appeals favors continuity for currently active cases.
The committee approved the contract extension and forwarded the resolution to the full board with the committee’s recommendation.
