REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
November 16, 2021
FROM
WILLIAM L. GILBERT, Director, Arrowhead Regional Medical Center
SUBJECT
Title
Reimbursement Agreement with MultiPlan, Inc. to Establish Out-of-Network Standing Rates
End
RECOMMENDATION(S)
Recommendation
Approve Reimbursement Agreement with MultiPlan, Inc., to establish out-of-network reimbursement rates for emergency and inpatient services for patients, for the period of November 16, 2021 through September 30, 2026.
(Presenter: William L. Gilbert, Director, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
FINANCIAL IMPACT
Approval of the Agreement with MultiPlan, Inc. will not result in the use of Discretionary General Funding (Net County Cost). This agreement provides Arrowhead Regional Medical Center (ARMC) a solution to maximize reimbursements for providing emergency services for those with out-of-network health plans. Adequate appropriation and revenue have been included in the ARMC 2021-22 budget and will be included in future recommended budgets.
BACKGROUND INFORMATION
This agreement with MultiPlan Inc. (MultiPlan) will provide standing reimbursement rates for emergency and inpatient services for patients with certain out-of-network health plans. The agreement with Multiplan facilitates prompt payment by offering a predetermined discounted rate. When a patient has an insurance carrier that is out-of-network and not contracted with ARMC, the payer must typically reimburse based on out-of-network rates. In this instance, Multiplan would represent a group of these payers using the predetermined discounted rate, which expedites reimbursement and improves patient satisfaction by removing the patient from the dispute process. Claims are submitted directly to Multiplan for pricing.
Currently, ARMC's process for receiving patient reimb...
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