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THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. CALIFORNIA
Adopted this Order on April 10, 1984 by tM following vote:
AYES: Supervisors Powers, Fanden, Schroder, McPeak, Torlakson
NOES: None
ASSENT: None
ABSTAIN: None
SUBJECT: Medi-Cal Reimbursements
The Interim County Administrator transmitted to the Board the report
dated March 29, 1984 from the Auditor-Controller (copy of which is attached
hereto and by reference incorporated herein) , commenting on components of
the. Medi-Cal Accounts Receivable and the need for an analysis of said accounts
as well as suggesting an optimum time to undertake a study.
IT IS BY THE BOARD ORDERED that receipt of said report is ACKNOWLEDGED
and that the County Administrator is DIRECTED to share said report with the
County's Legislative Delegation and appropriate State officials.
Further, IT IS ORDERED that the installation of the new data processing
system should be completed prior to the initiation of the analysis.
I hereby certify that this Is a true and correct copy of
an action taken and entered on the minutes of the
Board of Supervisors on the date shown.
ATTESTED: Ar /00
J.R. OLSSON, COUNTY CLERK
and ex officio Clerk of tho Board
By Deputy
Orig. Dept.: Clerk of the Board
Cc: County Administrator
Legislative Delegation
Acting Health Services Director
Auditor-Controller nn
11®0i,49
Office of C'.nntra C0_
RECEIVED COUNTY AUDITOR-CONTROLLER r,,_�ta,Cr
PR �� Contra Costa County
9.R. OLSSOBN Martinez, California MAR 3 0 1984
CLERK.OARA COSUA RVIS0RS
Deputy March 29, 1984
By
Counf; Hdministrator
TO: Charles Dixon, Interim County Administrator
Attention: C. L. Van Marter, Assistant County Administrator - Human Services
FROM: Donald L. Bouchet, Auditor-Controller
By: Kenneth J. Corcor , Assistant Accounting Manager
SUBJECT; Medi-Cal Reimbursement
This responds to the questions and issues raised in your March S, 1984
memo on the subject.
As you pointed out, the starting point for our recent discussions with
the State was in November/December 1983 when the Board expressed concern over
the growing cash deficit in the Health Services Department (HSD) and the large
Medi-Cal receivable balance which contributed to that deficit. The reason for
the Board's focus on this area was primarily due to your December 7, 1983 memo
which included a great deal of analysis of the. Medi-Cal receivables and the
age of those receivables. All of the numbers used in your memo were provided
by this office from the County's official records. I have re-verified that the
numbers used in your memo to the Board, which were subsequently used in discussions
with the State, were in agreement with the official records. It is significant
to note that the Medi-Cal gross receivable and the related contractual allowances
were closely scrutinized by my staff, HSD staff, Arthur Young & Co. , and certified
to by Peat, Marwick, Mitchell & Co. in their annual audit. Therefore, I dispute
any inference by the State or anyone else that the records are inaccurate.
During the last several weeks there has been much discussion about
the reasons for the variance between the amount of claims we show as outstanding
versus what the State reported. As you know, the principle reason for the
difference is that the State was merely reporting the unpaid claims in its system
while our records reflect all unpaid claims. We all recognize now that the
claiming mechanism is extremely complicated and there are significant numbers of
unpaid claims which are not currently in the State system. These claims can
generally be categorized as follows:
-- claims recently produced by the CHAS system which are awaiting
attention from the billing staff at Patient Accounting. Note
that when the claim is produced on the CHAS system (shortly
after discharge) it is recorded as a receivable.
-- claims which are ready to be sent to the State as soon as the
necessary Medi-Cal labels are received and affixed to it.
-= claims which are ready with the exceptions of a T.A.R. (Treatment
Authorization) from the State Medi-Cal Field Office.
000140
' -2-
Charles Dixon, Interim County Administrator March 29, 1984
Attention: C. 1. Van Marter, Assistant County Administrator
Medi-Cal Reimbursements
-- claims which have been submitted to the State and fully or
partially rejected for some reason; these claims require
special follow-up to identify and correct the reason for
the rejection.
In theory, to completely resolve the questions which have been raised,
we would need to select a particular date, identify all unpaid Medi-Cal claims
in our system at that date, and ask the State to provide detail on the individual
claims in its system on that date. Utilizing the County's Information Center,
I believe we could generate a report of all unpaid claims in our system and the
State could probably do the same. Using these two reports staff could compile
a list of the variances and identify the reasons for the difference. Since the
unpaid claims are mainly within the HSD Patient Accounting Office, the research
and analysis would require staff from that office to complete the task. This
would be an enormous and time consuming process as there are literally thousands
of unpaid claims (especially outpatient claims) . A decision on whether this
undertaking should be attempted must consider the other priorities Nu Med has
established within that office, namely, getting claims out the door to increase
our cash flow. It is our opinion that the current priorities are most appropriate
at this time.
One other factor that might be considered is the fact that the HSD is
planning a global write-off of old, uncollectible accounts receivable balances
before the fiscal year end. This write-off would include old Medi-Cal receivables
where our collection attempts have been exhausted. Once this process is completed,
the size of the receivables will be more manageable and easier to analyze.
In conclusion, it is the position of this office that the type of in-
depth analysis suggested in your memo is needed but, given the current staff priorities,
it should not be started until Patient Accounting has eliminated the current
billing backlogs. Also, I want to point out that the efforts of the Board and
our legislators in attempting to rectify the Medi-Cal billing/processing problems
have not been in vain. It is my understanding that we now have a much improved
communications line with the State's field office and that certain recently
implemented changes have assisted both the HSD and the Social Service Department
in effectively dealing with that office.
I am available to meet with you or other interested parties on this
issue should further discussion be necessary.
KJC:ell
cc: Gordon Soares, Management and Administration Director, Health Services
Betty Garrison, Patient Accounting
Pat Godley, HSD Fiscal Officer (Nu Med)
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