Subject:
Title
Agreement with Reimbursement Solutions Group, LLC DBA Solutions Group for Solutions Group Deductible Management and Insurance Identification Pilot Project.
label
Recommended Action:
Recommended Action
Approval and execution by the County Administrator of the Agreement with Reimbursement Solutions Group, LLC DBA Solutions Group (Solutions Group) for Solutions Group Deductible Management and Insurance Identification Pilot Project.
• This agreement continues a successful mini pilot conducted last FY year, smaller in scope, generating $160,000 in revenue for a cost of $5000.
• The agreement is anticipated to be most effective in the early months of the calendar year when medical deducible have not yet been met.
• This agreement is to provide an innovative way to successfully be reimbursed for ambulance services provided to the public. Contract services include deductible management and enhanced services to identify insurance after the division has exhausted their resources, prior to sending an account to a collection agency.
• Total amount of agreement over the 18-month pilot program is $300,000.00. The vendor’s services are expected to increase the department’s revenue collection ability by $1,500,000.00 over the 18-month period. County staff will continue to collect the revenue; the vendor’s services will increase the County’s success rate for collections.
• Revenues of $1,500,000.00 and expenses of $300,000.00 are projected proportionately over the 18-month term. Monthly revenues and expenses will vary based on transport volume.
• Funding in the amount of $300,000.00 for this agreement is included in the current-year FY24 budget of the Safety and Emergency Services Department in the EMS Fund and in the budget submitted for FY25.
Contract Number: 24-0283-N in the total not to exceed amount of $300,000.00, with an estimated total annual expenditure of $200,000.00, effective for 18 months as a pilot project.
Body
Strategic Plan:
Deliver First-Class Services to the Public and Our Customers
5.1 - Maximize partner relationships and public outreach
5.2 - Be responsible stewards of the public’s resources
5.3 - Ensure effective and efficient delivery of county services and support
5.4 - Strive to exceed customer expectations
Summary:
The medical billing industry over the past ten plus years has grown increasingly complex in labor intensiveness and difficulty in collecting eligible revenue. Service providers must redesign and strategically seek out innovative ways in which to successfully be reimbursed for ambulance services provided to the public. Deductible management has proven to be an effective tool in which to achieve this goal and has become an industry best practice. This strategy involves actively monitoring claims within established parameters to time the billing of claims whereby the reimbursement is obtained from the patient’s insurance provider vs. through patient self-pay. Statistically, the probability of collecting on medical obligations significantly decreases once the ambulance transportation cost becomes a patient responsibility. This method of monitoring typically results in the deductible, or a significant portion, being applied to the hospital bill, which generally exceeds the current national average deductible amount of $2,000 vs. being applied to smaller auxiliary service fees, such as ambulance transportation.
Background/Explanation:
To conduct a limited analysis on the effectiveness of this strategy, Safety and Emergency Services (SES) conducted an internal pilot program utilizing this service for a cost of $5,000.00, providing the vendor 4,500 accounts for Deductible Management and 500 accounts for Insurance Discovery. Utilizing these features on a limited scope, resulted in Deductible Management producing revenue of approximately $172,000.00 and Insurance Identification revenue in the amount $20,000.00. SES has decided to expand to a formal pilot to access the entirety of the services provided by Solutions Group to fully analyze the benefit of this service to the department and the public it serves. It is fiscally beneficial to get this agreement in place as close to beginning of year as possible, as this is the time in which patient deductibles are reset and will facilitate maximizing revenue collections.
Following the completion of the pilot project, SES may solicit a competitive process for a longer-term contract if feasible.
Fiscal Impact:
This Agreement, in a not-to-exceed amount of $300,000.00 for the eighteen (18) month Pilot program, is projected to generate an additional $1.5M in ambulance service fee revenue. Funding for this agreement is included in the current-year FY24 budget of the Safety and Emergency Services Department in the EMS Fund and in the budget submitted for FY25.
Delegated Authority:
Authority for the County Administrator to sign this Purchase Authorization is granted under Code Section 2-185.
Staff Member Responsible:
Jim Fogarty, Bureau Director, Safety and Emergency Services
Merry Celeste, Division Director, Purchasing & Risk, Administrative Services
Joe Lauro, Director, Administrative Services
Partners:
N/A
Attachments:
Agreement