REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
March 12, 2024
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Patient Accounts Department Policy and Procedure Manuals
End
RECOMMENDATION(S)
Recommendation
Accept and approve the revisions of policies and the report of the review and certification of the Patient Accounts Department Policy and Procedure Manual, included and summarized in Attachments A through D.
(Presenter: William L. Gilbert, Director, 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 Policy and Procedure Manuals of the Arrowhead Regional Medical Center (ARMC) Patient Accounts Department are non-financial in nature.
BACKGROUND INFORMATION
The ARMC Operations, Policy, and Procedure Manuals are prepared in compliance with County policies, California Code of Regulations Title 22, Chapters 1 and 5, Centers for Medicare and Medicaid Services (CMS), The Joint Commission, and other appropriate regulations and guidelines. Per CMS and The Joint Commission, all ARMC Operations, Policy, and Procedure 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 and policies 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.
The Patient Accounts Department Policy and Procedure Manual (Manual) was reviewed by the hospital Department Head, Clinical, Administrative and Executive Committees, and Administration. The Manual contains policies and procedures regarding department organization and function, customer service, and billing of patient accounts. The Manual contains a total of 25 policies, which include seven policies with major revisions (including two that are deleted), eight policies with minor revision, two new policies, and eight policies reviewed with no revisions.
ARMC completed the 2022-2023 review of the Manual and recommends the revisions summarized in Attachment A. Review and update of this manual is certified in Attachment B.
The major revisions to the seven policies includes:
• Policy No. 400.00 v7, Billing Policy and Procedure - Updates reflect the Epic billing system workflow, updated procedures, added definitions, grammar changes, and spelled out acronyms.
• Policy No. 406.01 v4, Outpatient Pharmacy Billing - Deleted as the procedure in the policy is no longer performed in the Epic billing system.
• Policy No. 701.00 v6, Patient Notification of Debt Collection Referral - Updates were made to comply with Assembly Bill 1020 Health Care Debt and Fair Billing, updated the name of “Central Collections” to the new name “Revenue Recovery Department”, changed patients’ statement interval process, spelled out acronyms, and added references.
• Policy No. 702.00 v4, Bad Debt-Delf Pay Accounts Assigned to Revenue Recovery Department - Updates were made to comply with Assembly Bill 1020 Health Care Debt and Fair Billing to purse reasonable collections efforts as stipulated in the Centers for Medicare & Medicaid, the Provider Reimbursement Manual Part 1 15-1, Chapter 3 Section 310, updated the name of “Central Collections” to the new name “Revenue Recovery Department”, spelled out acronyms, and added references.
• Policy No. 802.00 v10, Adjustment Request Policy and Procedure - Updates were made to replace Meditech-Electronic Health Records billing system with the Epic billing system workflow, updated process, and spelled out acronyms.
• Policy No. 804.00 v4, P/BR Switches - Deleted as Principle-based reserving (P/BR) is no longer used in the Epic billing system.
• Policy No. 901.00 v6, Paid Accounts Review Policy and Procedures - Updated process and made changes to reflect the Epic billing system workflow.
The minor revisions to the eight policies and Index include updates, such as removing the Meditech billing system reference, adding the Epic billing system reference, adding other references, spelling out acronyms, clarifying processes, and updating policy names.
The two new policies added to the manual are included in Attachment C, and consist of the following:
• Policy No. 407.00 v1, Medicare Hospice Election - The purpose of the new policy is to ensure compliance with the Centers for Medicare & Medicaid regulations and the requirements for Medicare Hospice Elections accounts.
• Policy No. 408.00 v1, Medicare Dialysis End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Consolidated Billing - The purpose of this new policy is to ensure compliance with the Centers for Medicare & Medicaid regulations and requirements for Medicare Dialysis billing.
On February 27, 2024 (Item No. 10), the Board accepted and approved the report of review and certification of ARMC Operations, Policy, and Procedure Manuals listed in Attachment D.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (Charles Phan, Deputy County Counsel, 387- 5455) on February 14, 2024; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on February 16, 2024; Finance (Jenny Yang, Administrative Analyst, 387-4884) on February 22, 2024; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387- 5423) on February 26, 2024.