REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF THE COUNTY OF SAN BERNARDINO
AND RECORD OF ACTION
June 9, 2020
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title v=
Agreement with R1 RCM Inc. for Physician Advisory Services
End
RECOMMENDATION(S)
Recommendation
Approve Agreement with R1 RCM Inc. in the amount not to exceed $750,000 for the period of June 9, 2020, through June 8, 2025, for secondary physician review process for certain patients that require inpatient hospitalization.
(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.
FINANCIAL IMPACT
Approval of the recommendation with R1 RCM Inc. (R1) will not result in the use of Discretionary General Funding (Net County Cost). The not to exceed cost of $750,000 is funded by State Medi-Cal, Federal Medicare, private insurances, and/or other departmental revenue. Funding sources may change in the future pending any legislative activity related to the repeal and/or replacement of the Affordable Care Act. Sufficient appropriation and revenue are included in the Arrowhead Regional Medical Center (ARMC) 2020-21 recommended budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
The approval of this Agreement will allow ARMC to utilize secondary physician review processes for all patients that require inpatient hospitalization, but do not meet the criteria using the state approved Interqual or MCG software, which align clinical decisions with payer criteria to lower denial of payments and improve patient care. The service provided by R1 will allow ARMC to get the secondary review within 60 minutes for Emergency Department cases and within two hours for medical necessity cases. The state requires a secondary physician review process for Medi-Cal reimbursement. The review of the medical recor...
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