APPENDIX C - SOW Technical Exhibits Performance Requirements Summary ACTIONS TAKEN IN LIEU OF PERFORMANCE REQUIREMENTS METHOD OF MONITORING NONCOMPLIANCE Only County funded patients will LACDMH Accounts Payable Non-reimbursement by County for be invoiced to LACDMH. will review a sampling of claims billable to alternate payor 100% of laboratory orders are for invoices and lab orders for source. Notification to LSP of uninsured clients. alternate eligibility. unsatisfactory billing practices. LSP LACDMH will track all shall be given the opportunity to occurrences of improper billing. propose a corrective action plan to The frequency of inappropriate ensure billing accuracy. LACDMH billing is expected to decrease may require LSP to provide eligibility during course of contract. inquiry information on a regular basis or take other corrective measures should frequency of inappropriate billing continue. Ordered laboratory tests results DMH clinicians are instructed to Possible non-reimbursement of will be delivered within the next contact the Office of the claim. business day. 90% of routine Medical Director when ordered labs and 99.1% of STAT requested laboratory results are and critical labs will be delivered not returned or deemed within the required timeframes unsatisfactory. The Office of the specified in the SOW. Medical Director will review. LSP does not process DMH will develop a report. Non-reimbursement of claim or unauthorized laboratory tests. reimbursement only for “deemed ordered” test. DMH may review order acceptance practices with management and propose additional solutions to prevent occurrence of improper processing. Laboratory samples obtained and LSP shall provide a quarterly LACDMH may conduct root cause handled appropriately by LSP’s report of lost, mishandled, or analysis with LSP and develop a courier or delivery personnel. otherwise unusable samples. corrective action plan to reduce 100% of laboratory samples will LACDMH will review frequency frequency of such events. LSP may be labeled properly. of cases and nature of be penalized or may be required to The designated laboratory specimens lost. provide replacement sample shall be cleaned and all waste acquisition services free of charge. disposed after every shift. EXHIBIT 4
APPENDIX C - SOW Technical Exhibits Performance Requirements Summary PERFORMANCE REQUIREMENTS METHOD OF MONITORING ACTIONS TAKEN IN LIEU OF NONCOMPLIANCE Only County funded patients will be invoiced to LACDMH. 100% of laboratory orders are for uninsured clients. LACDMH Accounts Payable will review a sampling of invoices and lab orders for alternate eligibility. LACDMH will track all occurrences of improper billing. The frequency of inappropriate billing is expected to decrease during course of contract. Non-reimbursement by County for claims billable to alternate payor source. Notification to LSP of unsatisfactory billing practices. LSP shall be given the opportunity to propose a corrective action plan to ensure billing accuracy. LACDMH may require LSP to provide eligibility inquiry information on a regular basis or take other corrective measures should frequency of inappropriate billing continue. Ordered laboratory tests results will be delivered within the next business day. 90% of routine ordered labs and 99.1% of STAT and critical labs will be delivered within the required timeframes specified in the SOW. DMH clinicians are instructed to contact the Office of the Medical Director when requested laboratory results are not returned or deemed unsatisfactory. The Office of the Medical Director will review. Possible non-reimbursement of claim. LSP does not process unauthorized laboratory tests. DMH will develop a report. Non-reimbursement of claim or reimbursement only for “deemed ordered” test. DMH may review order acceptance practices with management and propose additional solutions to prevent occurrence of improper processing. Laboratory samples obtained and handled appropriately by LSP’s courier or delivery personnel. 100% of laboratory samples will be labeled properly. The designated laboratory shall be cleaned and all waste disposed after every shift. LSP shall provide a quarterly report of lost, mishandled, or otherwise unusable samples. LACDMH will review frequency of cases and nature of specimens lost. LACDMH may conduct root cause analysis with LSP and develop a corrective action plan to reduce frequency of such events. LSP may be penalized or may be required to provide replacement sample acquisition services free of charge. EXHIBIT 4
1042376_5AppendixC-SOWTechnicalExhibits1-5.docx