Meeting_Body
FINANCE, BUDGET AND AUDIT COMMITTEE
OCTOBER 16, 2019
Subject
SUBJECT: WORKERS' COMPENSATION MEDICAL BILL REVIEW SERVICES
Action
ACTION: APPROVE CONTRACT AWARD
Heading
RECOMMENDATION
Title
AUTHORIZE the Chief Executive Officer to award a firm fixed unit rate Contract No. PS61721000 to Lien On Me, Inc. for Workers' Compensation Medical Bill Review Services, in an amount not-to-exceed $2,576,976 for the four-year base term, effective July 1, 2020 through June 30, 2024, plus $1,314,258 for the first, two-year option period, and $1,340,724 for the second, two-year option period, for a combined not-to-exceed amount of $5,231,958, subject to resolutions of protest(s), if any.
Issue
ISSUE
The current contract for this service expires on June 30, 2020. Review of medical bills for workers' compensation claims ensures Metro pays for various medical services in accordance with the State of California approved fee schedules and pre-established rates contracted with Preferred Provider Organization (PPO) providers.
Discussion
DISCUSSION
The review of medical bills is consistent with industry best practice and is one of a variety of techniques government agencies and private entities employ to lower workers' compensation related medical expenditures. Bill review service providers take gross medical billings from physicians, hospitals, pharmacies and other medical service providers and recommend reductions in conformance with the State of California Fee Schedule and negotiated rates between service providers (PPO contracts). Bill review service providers have custom dedicated software that apply the bill review reduction in accordance with the California Fee Schedule and detect duplicate billings at the line level. In addition to reviewing bills, bill review service providers have the ability to integrate PPO networks with their bill review system to determine the highest level of savings per line item and maintain the appropriate software to...
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