Meeting_Body
FINANCE, BUDGET AND AUDIT COMMITTEE
MARCH 20, 2024
Subject
SUBJECT: WORKERS' COMPENSATION MEDICAL BILL REVIEW SERVICES
Action
ACTION: APPROVE RECOMMENDATION
Heading
RECOMMENDATION
Title
AUTHORIZE the Chief Executive Officer to execute Modification No. 2 to Contract No. PS61721000 with Lien On Me, Inc. for workers' compensation medical bill review services in the amount of $242,303, increasing the not-to-exceed amount of the four-year base term from $2,834,674 to $3,076,977, and exercise the first two-year option in the amount of $2,083,248, revising the total contract amount from $3,076,977 to $5,160,225 and extending the period of performance from July 1, 2024, to June 30, 2026.
Issue
ISSUE
Since 2019, Metro's Workers' Compensation division has experienced an increase in the average number of workers' compensation claims filed monthly, resulting in an increase in medical bills received and processed. Approval of the recommendation is required to ensure Metro pays various medical services in accordance with the State of California approved fee schedules and pre-established rates contracted with Preferred Provider Organization (PPO) providers. Additionally, this action authorizes the exercise of the two-year option term to continue providing medical bill review services through June 30, 2026.
Background
BACKGROUND
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 applies the bill review reduction in accordance with the Californi...
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