HomeMy WebLinkAbout961691.tiff RESOLUTION
RE: APPROVE AGREEMENT CONCERNING SERVICES TO COLORADO ACCESS
MEMBERS BETWEEN HEALTH DEPARTMENT AND NORTH COLORADO FAMILY
MEDICINE AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Agreement Concerning Services to
Colorado Access Members between the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Weld County Health
Department, and Western Health Network, Inc., operators of North Colorado Medical Center,
dba North Colorado Family Medicine, commencing May 1, 1996, and ending December 31,
1996, with further terms and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Agreement Concerning Services to Colorado Access Members
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Health Department, and Western
Health Network, Inc., operators of North Colorado Medical Center, dba North Colorado Family
Medicine, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 23rd day of September, A.D., 1996, nunc pro tunc May 1, 1996.
BOARD OF COUNTY COMMISSIONERS
, WL. KmeyeCt2 /
UNTY, COLORAD
EL '' Ma%
1- h •
1861 ?r. o g ty Clerk to the Board
Ov(11, 7 hl.Q ay, 1 \E. axter,
Pro- em
eputy Clerk tcJhe Board d/
Dale K. Hall APP AS TO FORM: 1ILSX4e.wocQj• ���,,IEtr
Constance L. Harbert
unt ttorney �J
W. H. e s r V
961691
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AGREEMENT CONCERNING SERVICES
TO COLORADO ACCESS MEMBERS
THIS AGREEMENT is made and entered into this S 'day of ,1996,
by and between Western Health Network, Inc., an Arizona non-profit corpora ion, operators
of North Colorado Medical Center, dba North Colorado Family Medicine ("NCFM"), and the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Weld County Health Department ("WCHD").
BACKGROUND INFORMATION
WHEREAS,NCFM has entered into an agreement with Colorado Access, a Colorado
non-profit corporation("Colorado Access") in which NCFM has agreed to provide covered
services to the Medicaid members of Colorado Access; and
WHEREAS,NCFM desires the services of WCHD in providing prenatal services to
Colorado Access members consistent with the terms and conditions hereinafter set forth;
WHEREAS, WCHD has the necessary credentials and the appropriate personnel to
provide prenatal services in the State of Colorado, and is willing and able to provide covered
prenatal services to Colorado Access members;
WHEREAS, the parties desire to reduce the terms of their agreement to writing;
NOW THEREFORE, for and in consideration of the covenants, conditions, agreements,
and stipulations hereinafter expressed, the parties do hereby agree as follows:
1. Recitals. The above set forth recitals are hereby incorporated as though set forth
herein verbatim.
2. Term of Agreement. This Agreement shall be effective from the date of its
signing, nunc pro tunc cjy( /, /9 96 ,through December 31, 1996, and shall
automatically renew from year to }'ear, unless sooner terminated, pursuant to the provisions
contained herein.
3. Services to be Provided. WCHD agrees to provide routine covered prenatal
services to Colorado Access members at the request of NCFM, and under the supervision of the
WCHD Physician Advisor, pursuant to protocols, policies and procedures established by
WCHD, as well as those established by Colorado Access. The protocols, policies and procedures
established by Colorado Access for routine prenatal services are attached hereto and incorporated
herein as Exhibit A.
4. Referrals. In order to maintain compliance with Colorado Access primary care
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physician referral/authorization policies, and procedures, all WCHD referrals and authorizations
for prenatal and obstetric services to Colorado Access members will be coordinated through
NCFM physician faculty and NCFM's Managed Care Services Coordinator. A copy of the
Colorado Access primary care physician referral/authorization policies and procedures will be
provided to WCHD at the time this Agreement is signed.
5. Member Eligibility. WCHD will confirm a patient's eligibility/membership
status with Colorado Access with NCFM's Managed Care Services Coordinator, in the event of
any question concerning such status.
6. Billing. WCHD will provide NCFM with a summary of services rendered to
Colorado Access members on a weekly basis. The summary will include the following
information: Patient name, Date of Birth, Colorado Access/Medicaid identification number, date
of service, service rendered(CPT code), and WCHD service provider. WCHD will provide in
a timely manner any additional information which may be required by NCFM in processing the
billing information. NCFM will forward all billing statements to Colorado Access in a timely
manner, and in compliance with Colorado Access requirements, so that payment will be timely
made.
7. Compensation. In consideration for the services to be provided by WCHD as set
forth in this Agreement, NCFM agrees to pay WCHD the following:
NCFM will reimburse WCHD for prenatal services provided to Colorado Access
members, and approved by Colorado Access, at the rates set forth in Exhibit B, attached hereto
and incorporated herein. NCFM shall be entitled to withhold up to five(5%) percent of the total
amount paid to NCFM by Colorado Access for services provided under the terms of this
Agreement by WCHD to cover the costs incurred by NCFM associated with this program.
NCFM will forward payments to WCHD by the fifteenth day of each month for relevant
payments received by NCFM from Colorado Access in the preceding month. NCFM will also
forward to WCHD copies of any relevant Colorado Access advice of payment for any denied or
partial payment services. NCFM shall not be responsible for any payments due WCHD that
were denied, delayed or partially reduced due to inaccurate, missing or information not timely
provided to NCFM by WCHD.
In the event NCFM fails to timely submit a billing statement to Colorado Access for the
services provided to Colorado Access members by WCHD, and WCHD has provided to NCFM
in a timely manner all necessary information so that NCFM could have presented a timely
request for payment,NCFM shall nevertheless be responsible for payment of the appropriate
amount for such services to WCHD. NCFM shall not be responsible for any payment denied,
delayed or partially reduced by Colorado Access that is beyond the reasonable control of NCFM.
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8. Medical Records. Medical records for this program will be maintained at
WCHD, with duplicate records maintained at NCFM in order to facilitate the provision of after-
hour care, as well as other medical services that are not related to the prenatal services. WCHD
agrees to photocopy patient charts and progress notes on a daily basis and forward them to
NCFM, Attn: Medical Records daily. NCFM will provide to WCHD care providers transcription
services for stat progress notes, letters and patient-related special need situations.
9. Confidentiality. Each party agrees to keep any and all records and information
confidential, in compliance with all laws and regulations concerning the confidentiality of such
records.
10. Colorado Access Requirements nce Corning Records and Reports So long as
WCHD provides NCFM with all records and reports as set forth in this Agreement,NCFM shall
be solely responsible for providing all information to Colorado Access as required, and for
maintaining records as required for Colorado Access. Any requirements by Colorado Access
concerning Quality Assurance and Utilization Management shall be the sole responsibility of
NCFM. WCHD agrees, however, to provide any information NCFM may request, if such
information is in WCHD's possession, and does not require any further compilation, analysis,
investigation, or the like, in order for WCHD to produce such information.
11. Authority to Subcontract. NCFM warrants that it has obtained any necessary
authorization, and that NCFM has the authority to enter into this Agreement with WCHD.
12. Parties' Relationship. The parties to this Agreement intend that the relationship
between them contemplated by this Agreement is that of independent entities working in mutual
cooperation. No employee, agent, or servant on one party shall be or shall be deemed to be an
employee, agent, or servant of another party to this Agreement.
13. Limitations - Liabilities- Indemnification. Each party shall not be responsible
or liable for acts or omissions or failure to act by the other party. Accordingly,to the extent
permitted by law, WCHD agrees to indemnify and hold NCFM harmless from any and all
liability incurred by acts or omissions or failures to act by WCHD, and likewise,NCFM agrees
to indemnify and hold WCHD harmless from any and all liability incurred by acts or omissions
or failures to act by NCFM.
Because WCHD is a department of the Weld County government,NCFM acknowledges
that its agreement to indemnify and hold harmless WCHD extends to Weld County, its
employees, agents, subcontractors and assignees. Because NCFM is a department of North
Colorado Medical Center, WCHD acknowledges that its agreement to indemnify and hold
harmless NCFM extends to Northern Colorado Medical Center and Western Health Network, its
employees, agents, subcontractors and assignees. The term"Liability" includes, but is not
limited to, any and all claims, damages, and Court awards including costs, expenses, and attorney
fees incurred as a result of any act or omission by the applicable party who acted or failed to act.
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14. Non-Assignment. This Agreement shall not be assignable without prior written
consent of WCHD or NCFM, whichever is the non-assigning party.
15. Termination. Either party may terminate this Agreement for cause, upon ten(10)
days written notice, and for any reason, so long as thirty (30) days written notice of its intent to
so terminate is given to the other party. If this Agreement is so terminated,NCFM shall pay that
compensation to WCHD which duly reflects the amount not previously reimbursed for actual
services rendered to Colorado Access members by WCHD during the term of this Agreement,
and pursuant to the terms and provisions of this Agreement.
16. Notices. Any notice provided for in this Agreement shall be in writing and shall
be served by personal delivery or by certified mail, return receipt requested, postage prepaid, at
the addresses set forth in this Agreement, until such time as written notice of a change is received
from the party wishing to make a change of address. Any notice so mailed and any notice served
by personal delivery shall be deemed delivered and effective upon receipt or upon attempted
delivery. This method of notification will be used in all instances, except for emergency
situations when immediate notification to the parties is required.
NCFM: North Colorado Family Medicine
c/o Mike Bloom
1650 16th Street:
Greeley, Colorado 80631
WCHD: Weld County Department of Health
do Judy Nero
1517 16th Avenue Court
Greeley, Colorado 80631
17. Modification and Breach. This Agreement contains the entire Agreement and
understanding between the parties to this Agreement and supersedes any other agreements
concerning the subject matter of this transaction, whether oral or written. No modification,
amendment, novation, renewal, or other alteration of or to this Agreement and the attached
exhibits shall be deemed valid or of any force or effect whatsoever,unless mutually agreed upon
in writing by the undersigned parties. No breach of any term, provision, or clause of this
Agreement shall be deemed waived or excused, unless such waiver or consent shall be in writing
and signed by the party claimed to have waived or consented. Any consent by any party hereto,
or waiver of, a breach by any other party, whether express or implied, shall not constitute a
consent to, waiver of, or excuse for any other different or subsequent breach.
18. Severability. If any term or condition of this Agreement shall be held to be
invalid, illegal, or unenforceable, this Agreement shall be construed and enforced without such a
provision, to the extent this Agreement is then capable of execution within the original intent of
the parties.
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BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
,t4
YBarbara J. Kirkmeyer, Chair O0
,2t 23. / 9%
��^Date /���
F. / AS-;I&T: LI/ Wain
Rv ta1 ^' . : E,unty Clerk to the Board
?-• b
` q
i► Deputy Cler; I. the Board
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APPENDIX A: COLORADO ACCESS PRENATAL SERVICES POLICIES
Fr
SAMPLE TABLE OF PAYMENT RATES FOR
DIFFERENT OB BILLING SCENARIOS
Per Walt+ baNerywl
CARE TYPE GLOBAL PER VISIT Postpartun m Ca
•D
Per Volt+ Delivery Only
BREAKDOWN
Antepartum,Vaginal Delivery
Vaginal Delivery 59400,91039.00 X6685,$29.08 wfPostpartum Care:
Minimum of 4 1$visits with a max • 1 Welt X5565, 829.08+
antepartumvisits req of$87.24 6vh1 X ,$0. 839 .8$5 x.00
•
66410,$063.92. $722.08
• 3 visits X6586,$87.24+
69410,$603.92• $761.16
Antepartum,C-Section Delivery
CSection 68510,$1402.39 X6688,$29.08 wlPostpartum Care:
Minimum of 4 1-3 visits with a max • 1 visit X5665,$29,08+
antepartum visits req of $87.24 80 .3066.47
• lilt X8666,868.16
59515,$827.39.866.65
• S visits X6565,$87.24+
69516,8827.39=$914.83
Antepartum,Vaginal Delivery
Antepartum Care,44 w oetpartum Care:
Visits Not Applicable 58425,5224.98 4-8 visits 4.98+
4.8 vis 9868426,
6822 4 ��8698+
Antepartum,C-Section Delivery
wlPostpartum Care:
4-6 visits 58425,8224,98+
69615,$827.39• $1062.37
4 Antepartum,9aglnel Delivery
Antepartum Care,7 or w/Postparttnn Care:
more Welts • Not Applicable 69428,$374.76 7 or 69410,m r .92= 038 84
more v3 11 visits 59426, .76+
Antepartum,C-Section Delivery
wlPostpaitum Care:
7 or more visits 69428,$374,76+
59515,$827.39• $1202.14
Vaginal Delivery Antepartum Can,Vaginal
Including postpartum Delivery wlPoatpartum Care:
care Not Applicable 69410,8863.92 • 1 visit X5565, $29.08+
69410,2883.92• $193.00
• 2 visits X6685,$58.18+
59410,$863.92• 8722.08
• 3 visits X5585,$87.24+
69410,9863.92• $751.18
— Antepartum care wNaginai
Vaginal Delivery Only Not Applicable 69409.$682.02 Delivery r h Only:
• 529.08+
69409,$582.02.$611.10
• 2 visits X5555,$68.15+
69409.$682.02.6640.10
Updated 4/10/98 2
E 30Vd LL96 EEC C0E 99300V OGvxn-nn a, : n ran.+ of 961691
• 3 Wail X5665,$87.24
59409,3682,02=. $669.28
Cesarean Delivery Antspsrtum Can,b-Section —
Including postpartum Delivery w/Postpaituni Care
Care Not Applicable 69516,$827.39 • 1 visit X5585,$29.08+
59516,$827.39 a $858.47
• 2 visits X5585,$58.18+
58515.$827.39= $865.58
• 3 visits X5585,$8724+
695151$827.39= $914.83
Antepartum Care wlC•Bection
Cesarean Delivery Delivery Only;
Only • 1 visit X5585,$29.08+
Not Applicable 69514,$745.82 69514,$746.62= $774.90
• 2 visits X5685,$58.18+
59614,$745.82= $803.98
• 3 visits X6566,$87.24+
69514,$745.82=$833.06
Postpartum care only Not Applicable 69430,$81.90 Not Applicable
The CPT codes listed In the above table are the valid codes for bUing OB claims. This table does not
Sect any codes related to OB billing that fall outside of the global biting procedures.
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Updated 411018® 3
'30vd LL96 EE6 EOE 89300V OOvti0900 61° 1 ( (30.L) 96 . 91961691
,
CLARIFICATION
Provided to Ragwort(Provides Week of ,q1 BILLING OBSTETRICS
Currant Obstetric Referral Process
1. The first time the physician Is aware the Colorado Access(CA)mother is pregnant,the
provider needs to notify CA through the sending of an OB referral document CA will then
request the delivery date, the hospital where the mother plans on delivering,etc.
2. Six weeks from delivery,the Colorado Access'Newborn Tracker Wdl call the
physician's office to verify delivery Info and work with the physician's office on educating
the mother regarding the paperwork for enrolling the newborn,
3. After delivery, CA is to be notified of delivery.
4. CA should be notified of adverse events prior to delivery,such as premature labor.
Obstetrical Billing Procedures
After reviewing the Medicaid Este guidelines end Iooldng at the fee schedules for the OB
procedure codes, it has become apparent that providers will In most cases receive higher
payments billing at the global rate rather than per visit See the attached table for an
analysis of the breakeven points for billing globally vs.by visit. Colorado Access
recommends a procedure which is consistent with the State policy In that we suggest that
the providers bill on a Global basis whenever possible.
Providers should bill on a per visit basis when the number of visits doesn't meet the
minimum required number for billing globally. Please take care in doing so,that you are
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using the proper coding.We have already noted many examples of claims where the
provider le using E/M codes rather than the X5565 per visit code. This creates
overpayments and underpayments,the resolution of which creates additional work for all
ostem
f
fetal heart tones,routine cheimical urinalts Include:ysissi�gees tick he medical
moertt,nutritional
counseling.
In Colorado Access terms,the Initial visit of determining pregnancy Is considered as en
EJM code which does not count toward the number of visits for obstetrics. If the provider
Is a capped provider,this Initial visit would be considered part of his/her capped check.
All visits after the Initial OB exam would be based on the Medicaid fee schedule for codes
X5585, 69425 or 58426,
Colorado Access expects that providers will keep track of the number of antepertum visits
incurred have
occurred to Individualtients to
compliance with lling globally per the state pne whether a sufficient olicy.(4
If this minimum
threshold is not met,then providers should bill per visit rather than globaly. Colorado
Access le asking providers to bill either globally or per visit but not both. If a provider
starts to bill by visit,then determines that billing globally,that will be allowed but the global
enrollee. Global
bills will bement gs eval be l
uated ed by post-pawood by ihe amount did,t process for which is undaid per visit for er development
Updated 4/10/96 1 QQ 1 1
Z 909,,t L196 EEC E0E 393J0w 0fY O'0n el ' It 13tH% 96961691
APPENDIX B: PAYMENT RATE SCHEDULE*
Antepartum Care, Single visits, 151 visit x5565 $29.08
Antepartum Care, Single visits, 2 visits x5565 $58.16
Antepartum Care, Single visits, 3 visits x5565 $87.24
Antepartum Care, 4-6 visits 59425 $224.98
Antepartum Care, 7+visits 59426 $374.75
Pospartum Care (only), Single visit 59430 $81.90
*This rate table reflects the gross rate. The net rate will represent the above less the
administrative withhold.
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mEmoRAnDum
WI o Barbara Kirkmeyer, Chair
To Board of County Commissioners Date September 19, 1996
COLORADO
From
John Pickle, Director, Health Department •f
,e , yyu
Subject:
Agreement Concerning Services to Colorado Access Members
Enclosed for Board approval is an agreement between Weld County Health Department
(WCHD) and North Colorado Family Medicine (NCFM) concerning services to Colorado
Access Members.
Currently,NCFM has an agreement with Colorado Access, a Colorado non-profit
corporation, to provide prenatal services to its Medicaid members. The enclosed
agreement allows Weld County Health Department to provide these services to Colorado
Access members upon the request of NCFM.
For these services,NCFM will reimburse WCHD at the rates set forth in Exhibit B.
NCFM will be entitled to withhold up to five percent (5%) of the total amount paid by
Colorado Access for these services..
The term of this agreement is from May 1, 1996 through December 31, 1996. It is
automatically renewable from year to year unless terminated according to the provisions
as written in the agreement.
I recommend your approval of this agreement.
Enclosure
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