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File #: 2107   
Type: Consent Status: Passed
File created: 5/11/2020 Department: Arrowhead Regional Medical Center
On agenda: 5/19/2020 Final action: 5/19/2020
Subject: Authorization of Arrowhead Regional Medical Center for Medicare Enrollment
Attachments: 1. ATT- ARMC- 5-19-20-Application for Reassignment of Benefits CMS 855R Form, 2. Item #11 Executed BAI
REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF THE COUNTY OF SAN BERNARDINO
AND RECORD OF ACTION

May 19, 2020
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center

SUBJECT
Title
Authorization of Arrowhead Regional Medical Center for Medicare Enrollment
End

RECOMMENDATION(S)
Recommendation
1. Designate the Director of Arrowhead Regional Medical Center (ARMC) as the authorized official for the County of San Bernardino (County), on behalf of ARMC, for Medicare program purposes, which grants the Director the legal authority to accept the assignment by individual practitioners of their right to bill the Medicare program and receive Medicare payments for some or all of the services they render to Medicare beneficiaries at ARMC, through the completion and execution of the Medicare Enrollment Application - Reassignment of Medicare Benefits (CMS-855R) and to commit the County to fully abide by the statutes, regulations, and program instructions of the Medicare program, subject to the Medicare Enrollment Application (CMS-855R) template or any amendments to the Medicare Enrollment Application (CMS-855A) template being reviewed by County Counsel.
2. Direct the Director of ARMC to maintain Medicare Enrollment Applications (CMS-855R) or any amendments to Medicare Enrollment Applications (CMS-855R) on file with ARMC due to the Medicare Enrollment Applications (CMS-855R) including Social Security numbers.
(Presenter: William L. Gilbert, Director, 580-6150)
Body

COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Provide for the Safety, Health and Social Service Needs of County Residents.
Pursue County Goals and Objectives by Working with Other Agencies.

FINANCIAL IMPACT
Approval of the recommendations will not result in the use of Discretionary General Funding (Net County Cost) as Medicare Enrollment will result in reimbursements for services provided to Medicare Patients. Applications are non-financial.

BACKGROUND INFORMATI...

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