REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
January 14, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Arrowhead Regional Medical Center Operations, Policy, and Procedure Manuals
End
RECOMMENDATION(S)
Recommendation
Accept and approve the revisions of policies of the Arrowhead Regional Medical Center Operations, Policy and Procedure Manuals, included and summarized in Attachments A through E:
1. Patient Accounts Policy and Procedures Manual
2. Administrative Policy and Procedures Manual
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Improve County Government Operations.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost). Revisions of policies of the Arrowhead Regional Medical Center (ARMC) Operations, Policy, and Procedure Manuals (Manuals) are non-financial in nature.
BACKGROUND INFORMATION
The Manuals are prepared in compliance with County policies, the California Code of Regulations Title 22, Chapters 1 and 5, the Centers for Medicare and Medicaid Services (CMS), The Joint Commission (TJC), and other appropriate regulations and guidelines. Per CMS and TJC, all Manuals are reviewed and revised, as necessary, a minimum of every one, two or three years, depending on the type of manual, and require Board of Supervisors (Board) acceptance and approval.
The Manuals are necessary to maintain compliance with policy and regulatory bodies. Adherence to the standards set forth in these Manuals will improve County government operations and provide for the safety, health, and social service needs of county residents by ensuring policies and procedures are in place for hospital operations and quality patient care.
ARMC Manuals are reviewed, as applicable, by the Department Manager, Medical Executive Committee, Quality Management Committee, and ARMC Administration. The Manuals reviewed include the Patient Accounts Policy and Procedure Manual (Patient Accounts Manual) and the Administrative Policy and Procedure Manual (Administrative Manual).
The Patient Accounts Manual contains policies and procedures regarding department organization and function, customer service, and billing of patient accounts. The manual contains a total of 24 policies, including one new policy and minor revisions to the index, as summarized in Attachment A. The Department of Patient Accounts recommends the addition of the new policy summarized in Attachment B. The index contains minor revisions due to the addition of the new policy. The new policy added to the manual is as follows:
• Policy No. 903.00 v1, Late Charges - The purpose of the new policy is to ensure that all late charges are handled in a consistent manner, maximizing reimbursement.
The Administrative Manual contains hospital-wide policies and procedures, which are required by regulation, or determined by the ARMC Administration to pertain to the entire ARMC facility/staff. These policies are important to the delivery of quality services and are necessary to maintain compliance with policy and regulatory bodies. The Administrative Manual contains 378 policies, of which two policies have major revisions. The revisions are summarized in Attachments C and D. The remaining policies were not included in this review.
The two policies with major revisions consist of:
• Policy No. 1000.20 v3, Charge Description Master (CDM) - Removed old electronic health record (EHR) references (Meditech) and made EHR references generic instead of system specific. Removed old mandates section, which no longer apply and replaced with section III. Center for Medicare and Medicaid Services (CMS) pricing transparency requirements. Added Revenue Integrity department to policy, which is now responsible for maintaining the hospital chargemaster. Change reference from Revenue Integrity department at ARMC to align with industry standards, EHR updates and CMS mandates. Revised formatting and updated terminology throughout.
• Policy No. 1000.21 v4, Establishing CDM Prices - Removed old EHR references (Meditech) and made EHR references generic instead of system specific. Updated section II, Rate review & Updates, which describes the steps ARMC takes when assigning a price to a charge or making updates. Added section III, Rate Increase, which describes the steps ARMC takes when implementing an across-the-board CDM rate increase. Added section IV, Charges, for services/items to provide more clarification on ARMC’s charges for services and items including room and board charges. Revised formatting and updated terminology throughout.
On December 3, 2024 (Item No.6), the Board accepted and approved the report of review and certification of the Manuals listed in Attachment E.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Supervising Deputy County Counsel, 387-5455) on December 12, 2024; ARMC Finance (Chen Wu, Budget and Finance Officer, 387-5285) on December 17, 2024; Finance (Jenny Yang, Administrative Analyst, 387-4884) on December 18, 2024; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on December 19, 2024.