RECOMMENDATION(S):

Approve and authorize the Purchasing Agent, on behalf of Health Services Department, to execute a Purchase Order with OptumInsight, Inc., in the amount of $140,000, for the period of February 1, 2012 through January 31, 2017, for Local Coverage Determination (LCD) and Correct Coding Initiative (CCI) data files necessary for Patient Financial Services and new Epic system operations with yearly updates.

FISCAL IMPACT:

100% Enterprise II Fund.

BACKGROUND:

Health Services Department, Patient Financial Services and new Epic system require Advanced Beneficiary Notice (ABN) functionality. Centers for Medicare and Medicaid Services (CMS) requires ABNs to be signed by patients requesting services that may not be covered by CMS. If ABNs are not used, services may be performed that will not be reimbursed by Medicare. By having LCD and CCI data files loaded, this will allow medical necessity and coding error checking and prevent claim denials. Patient Financial Services’ billers and coders will be able to appropriately modify claims before they are sent to payor.