Title
Emergency Medical Services, a division of the Chief Administrative Office, recommending the Board adopt and authorize the Chair to sign Resolution 102-2026, formalizing the designation of the Chief Administrative Officer as the authorized official for Medicare, Medi-Cal, and other medical billing programs and allowing them or their designee to sign all required documents to maintain active enrollment and to bill said programs.
FUNDING: N/A
Body
DISCUSSION / BACKGROUND
The Emergency Medical Services Division (Division) of the Chief Administrative Office provides ambulance emergency medical transport services throughout the County and bills various federal and state health care programs and commercial health insurance companies to sustain these operations. To maintain this revenue stream, it is essential that the County remain enrolled and compliant with relevant payer requirements.
Federal regulations (42 CFR 424.515) require that Medicare providers recertify their enrollment once every five years, and State regulations (22 CCR 51000.55) require that Medi-Cal providers reenroll periodically, as determined by the Department of Health Care Services (“DHCS”). Failure to complete these processes will result in Medicare or Medi-Cal billing privileges being deactivated. A request has been received by the Division from DHCS to submit a revalidation application.
The Division also bills commercial insurance providers, such as Blue Shield/Blue Cross, Aetna, United Health, Kaiser, and others. These providers often require an enrollment or certification process prior to accepting billing.
The Board transferred the ambulance billing function to the Chief Administrative Office in 2020. The Division’s management has taken administrative action to maintain enrollments and bill insurance providers under the general authority to collect revenues due to the County. These actions include certifying provider information with insurance providers and enrolling in medical billing clearinghouses.
Due to the Medi-Cal revalidation currently pending, the Division is recommending the Board adopt a Resolution formalizing the designation of the Chief Administrative Officer as the authorized official for Medicare, Medi-Cal, and all other medical billing programs. The delegation would include authorization to enroll, sign documents (contingent on Counsel approval), and take other necessary actions required for medical billing. This authority may be delegated by the CAO to a designee.
ALTERNATIVES
The Board could decline to delegate some or all of the authority recommended. If not delegated, recertification, new enrollments, and provider billing agreements would be presented to the Board for approval.
PRIOR BOARD ACTION
November 15, 2011, Legistar File 11-1300 - Authorized Official for Medicare Billing Privileges
OTHER DEPARTMENT / AGENCY INVOLVEMENT
County Counsel has reviewed the proposed Resolution.
CAO RECOMMENDATION / COMMENTS
Approve as recommended.
FINANCIAL IMPACT
There is no financial impact associated with this item.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Upon execution by the Chair, the Board Clerk will forward a certified copy of the signed resolution to the Chief Administrative Officer for submittal with any Medicare, Medi-Cal, or other medical billing programs applications.
STRATEGIC PLAN COMPONENT
N/A
CONTACT
Emma Owens, Chief Budget Officer