Bill_Review_Response_Data.xlsx

This file is a Bill Review Response Data spreadsheet that tracks medical billing analysis for the County of San Mateo's Workers' Compensation program across fiscal years 2024, 2025, and 2026. The data encompasses 32,485 total bills processed, categorized by bill type (Hospital, Medical, Reversal, and Duplicate) with completion year tracking. The spreadsheet documents the complete audit trail of bill review activities, including original charges submitted, allowance determinations, clinical and audit reductions applied, PPO and negotiated rate adjustments, and final allowed amounts. Each bill type is assigned a specific transaction code ($600.00 for Hospital Bills, $7.50 for Medical Bills, $8.50 for certain Medical Bills, and negative values for Reversals and Duplicates), with the grand total reflecting $42.86 million in total charges processed and $13.86 million in final allowed amounts across the three-year period.

The data demonstrates the cost containment impact of the bill review process, with total reductions of $956,826.34 attributable to PPO and negotiated rate adjustments and $748,045.71 from audit and clinical reviews. In fiscal year 2024, 11,405 bills were processed with $16.27 million in charges reduced to $5.72 million in allowed amounts; fiscal year 2025 processed 10,183 bills with $11.32 million in charges reduced to $3.65 million in allowed amounts; and fiscal year 2026 processed 10,897 bills with $15.27 million in charges reduced to $4.50 million in allowed amounts. PPO and negotiated fees totaled $211,148.74 across the entire period, while total fees assessed reached $1,109,424.24, indicating the operational costs of maintaining the managed care cost containment services referenced in the County's RFP for Third-Party Administration and Managed Care Cost Containment Services.