R– VISN 5 Medical Coding Service

Notice Type: Sources Sought Notice

Posted Date: 23-OCT-18

Office Address: Department of Veterans Affairs;VAMC (613);VISN 5 Contract Satellite Office;510 Butler Avenue, Building 306A;Martinsburg WV 25405

Subject: R-- VISN 5 Medical Coding Service

Classification Code: R - Professional, administrative, and management support services

Solicitation Number: 36C24519Q0024

Contact: Bradley Davis mailto:[email protected]

Description: Department of Veterans Affairs

Martinsburg VAMC

Department of Veterans Affairs Medical Center

SOURCE SOUGHT

THIS IS A SOURCES SOUGHT ANNOUNCEMENT IS FOR INFORMATION & PLANNING PURPOSES ONLY; IT IS NEITHER A SOLICITATION ANNOUNCEMENT NOR A REQUEST FOR PROPOSALS OR QUOTES AND DOES NOT OBLIGATE THE GOVERNMENT TO AWARD A CONTRACT. A CONTRACT MAY NOT BE AWARDED AS A RESULT OF THIS SOURCES SOUGHT ANNOUNCEMENT. REQUESTS FOR A SOLICITATION WILL NOT RECEIVE A RESPONSE. RESPONSES TO THIS SOURCES SOUGHT MUST BE IN WRITING. THE PURPOSE OF THIS SOURCES SOUGHT ANNOUNCEMENT IS FOR MARKET RESEARCH TO MAKE APPROPRIATE ACQUISITION DECISIONS AND TO GAIN KNOWLEDGE OF POTENTIAL QUALIFIED SERVICE DISABLED VETERAN OWNED SMALL BUSINESSES, VETERAN OWNED SMALL BUSINESSES, 8(A), HUBZONE AND OTHER SMALL BUSINESSES INTERESTED AND CAPABLE OF PERFORMING THE WORK. DOCUMENTATION OF TECHNICAL EXPERTISE MUST BE PRESENTED IN SUFFICIENT DETAIL FOR THE GOVERNMENT TO DETERMINE THAT YOUR COMPANY POSSESSES THE NECESSARY FUNCTIONAL AREA EXPERTISE AND EXPERIENCE TO COMPETE FOR THIS ACQUISITION. RESPONSES TO THIS NOTICE SHALL INCLUDE THE FOLLOWING: (A) COMPANY NAME (B) ADDRESS (C) POINT OF contact (D) PHONE, FAX, AND EMAIL (E) DUNS NUMBER (F) CAGE CODE (G)TAX ID NUMBER (H) TYPE OF SMALL BUSINESS, E.G. SERVICES DISABLED VETERAN OWNED SMALL BUSINESS, VETERAN-OWNED SMALL BUSINESS, 8(A), HUBZONE, WOMEN OWNED SMALL BUSINESS, SMALL DISADVANTAGED BUSINESS, OR SMALL BUSINESS HUBZONE BUSINESS AND (I) MUST PROVIDE A CAPABILITY STATEMENT THAT ADDRESSES THE ORGANIZATIONS QUALIFICATIONS AND ABILITY TO PERFORM AS A CONTRACTOR FOR THE WORK DESCRIBED BELOW.

Performance Work Statement

Executive Summary.

VISN 5 Blanket Purchase Agreement, BPA, for Medical Coding April 1, 2019 to March 31, 2024.

Place of Performance:

Baltimore VA Medical Center

Beckley VA Medical Center

Louis Johnson (Clarksburg) VA Medical Center

Martinsburg VA Medical Center

Perry Point VA Medical Center

Washington DC VA Medical Center

Scope of Service.

Coding

This process involves the review of medical records and assignment of procedural and diagnostic codes to all outpatient and inpatient care provided in accordance with official VHA Coding guidelines: Center for Medicare and Medicaid Services (CMS) guidelines, Current Procedural Terminology (CPT) of the American Medical Association (AMA), and VA Correct Coding Initiative (CCI), and local VHA coding policies. Coder will also comply with following VHA handbooks and Directives.

Patient Data Capture

http://vaww.va.gov/vhapublications/ViewPublication.asp pub_ID=3091

Veterans Health Administration Directive 2011-006 Revised Billing Guidance for Services provided by Supervising Practitioners and resident:

http://vaww1.va.gov/vhapublications/ViewPublication.asp pub_ID=2363

Veterans Health Administration Handbook 1400.01 Resident Supervision:

http://vaww.va.gov/vhapublications/ViewPublication.asp pub_ID=2847

Patient Treatment File (PTF) Coding Instructions

http://vaww.va.gov/vhapublications/ViewPublication.asp pub_ID=1650

Veterans Health Administration Handbook 1907.01 Health Information Management and Health Records:

http://vaww.va.gov/vhapublications/ViewPublication.asp pub_ID=3088

CLOSEOUT OF VETERANS HEALTH ADMINISTRATION CORPORATE PATIENT DATA FILES INCLUDING QUARTERLY INPATIENT CENSUS:

http://vaww.va.gov/vhapublications/ViewPublication.asp pub_ID=5425

VHA Clinical Coding Program Guide

Contractor is responsible for the management and supervision of its staff. Contractor is

Responsible for training its staff on Veterans Affairs policy, guidelines, and procedures. Contractor will pull the Code Me Assigned from VA Coding Supervisor each morning. All items on the report should include all visits that were downloaded and assigned to the contractor from the Nuance package the previous workday. Coders will review medical notes in VISTA CPRS to determine what codes are to be included on the record.

The contractor shall identify the provider (Medical Doctor, Nurse Practitioner, Clinical Nurse Specialist, Physician s Assistant, Clinical Psychologist, etc.), code for each billable provider under VA regulations and provide this information to the billing staff. Contract coders are required to code all assigned encounters to include billable and complex/ or high cost ambulatory procedures

The contractor shall correct coding errors found in the VA s Patient Care Encounter (PCE).

Uses the encoder software application that is mandated for use by all facility HIM departments for coding in accordance with the latest version of the VHA Clinical Coding Program Guide, provided by the HIM team. The encoder software is the communication tool that relays coded billable encounters to CPAC.

Codes all inpatient discharges and inpatient billable professional services in accordance with current VHA policy.

Validates or assigns codes for billable outpatient Patient Care Encounters (PCE) in accordance with current VHA policy, as well as other identified billable cases to include, but not limited to:

Veteran Tort Feasor Claims

Veteran Workers Compensation

Humanitarian

Tricare

CHAMPVA

Ineligibles

Fugitive Felons

Prosthetics

New Insurance/Late Check Out encounters

Assigns codes for surgical cases performed in the Operating Room (OR) in accordance with current VHA policy.

Reviews or assigns appropriate codes to accurately reflect the patient s diagnoses and procedures for all inpatient discharges and billable (inpatient and outpatient) clinical encounters using the official coding guidelines for clinical classification systems such as, but not limited to, current editions of International Classification of Disease-Clinical Modification (ICD-CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Diagnostic and Statistical Manual of Mental Disorders (DSM), Coding Clinic, and CPT Assistant. The VHA HIM Coding Council annually publishes and updates the VHA Coding Guidelines that outlines correct coding guidance for many VHA-specific issues and is to be used as VHA s national coding guide.

Codes or validates repetitive service encounters as assigned by the CPAC facility revenue staff. Repetitive services are those visits that occur multiple times, such as physical therapy, chemo, dialysis, etc. HIM will provide the following data elements when coding/validating the encounter:

Initial date plan established

Date of injury if applicable

Referring provider

Diagnosis, procedure, modifier codes

Initial start date

Creates prosthetic service encounters in accordance with current VHA policy as assigned by CPAC facility revenue staff.

Reviews billable encounters designated as non-service connected and billable ancillary services, such as laboratory and radiology.

Utilizes the standardized case comments in the encoder software application to communicate specific documentation information to facility COR in accordance with current VHA policy. Coders will enter the Needs SC/SA Determination case comment for patients with a SC or SA condition that may be related to the treatment provided for the encounter.

Resolves all suspended encounters within an agreed upon timeframe, not to exceed 30 days. For those not resolved within the established timeframe, due dates will be negotiated between contractor and VAMC HIM departments and the CPAC PMO HIM policy analyst.

When there is conflicting or ambiguous documentation in the patient s electronic health record, the patient's physician(s) will be consulted for clarification. Physician queries must be written clearly and concisely and the coder not lead the physician to provide a particular response. All attempts to contact the Provider must be tracked utilizing the Nuance Physician Query Tracking tool.

Encounters assigned appropriately to Contractor through the Reject/Recode process will be managed and followed-up on by the Contract Coding supervisor

with action and reconciliation within five (5) business days of receipt.

Monitors and resolves backlogs and incomplete work on a weekly basis using the following reports:

Code Me for assignment of coding workload after review (initial scrub) - Daily

Not Coded in CCM Weekly

Suspended encounter Weekly

Notifies facility COR when a code(s) has been changed based on retrospective review. The errors identified must be documented on the retrospective coding review spreadsheet., this notification should be done via an encrypted email notification.

The contractor shall submit a copy of current staff credentials prior to performance of work as a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), a Certified Coding Specialist (CCS, CCS-P), Certified Professional Coder (CPC), Certified Professional Coder Hospital (CPC-H).

Contractor is responsible to perform continuous quality control by auditing their own work. Coding accuracy will be determined by the number of correct codes compared to total number of codes, correct DRG assignment, and correct review and data entry of identified data items. The contractor must maintain a 95% accuracy level.

Contractor shall maintain frequent communications with the designated Medical Center employee or COR regarding progress, workload status and/or problems. The contractor shall make every effort to ensure issues raised by the facility are addressed in a timely manner. The contractor and the facility staff shall work as partners in accomplishing the work.

Time and Place of Performance.

All coding and auditing activities shall be performed remotely and will utilize Veterans Affairs electronic health record. The contractor shall provide all labor, materials, transportation, and supervision necessary to perform coding and validation reviews for inpatient, observation, diagnostic tests, ambulatory surgery/medicine procedures and outpatient (clinic) data collection, evaluating the completeness and accuracy of coding diagnoses and procedures in accordance with official coding guidelines (Coding Clinics, Common Procedural Terminology Assistant, Centers for Medicare and Medicaid Services /American Medical Association, Ambulatory Patient Classifications ) in a simulated Medicare payment environment. The site of performance shall be at contractor s designated location within the United States.

Contractor staff must be capable of performing the required services during the core hours specified in this agreement, currently Monday through Saturday from 7:00AM to 5:00PM., The contractor shall specify a contact person and phone number who is available for

personal contact, at a minimum, during regular business hours of the facility that owns

the work, for the duration of the work. Contractor shall be required to begin provision of services at the time and place of performance within one week of award date. Contractor should demonstrate experience working with the DC VAMC and preferably be familiar with the requirements to work remotely within the VHA.

Performance and Contract Reporting Requirements.

This is a task order / delivery order services contract. Contractor must designate, in writing to the Contracting Officer or designee, Contracting Officer Representative (COR), a coordinator who will be responsible for scheduling, problem solving and other communication needs related to this contract.

The contractor shall provide to the facility COR a weekly status report, citing number

coded, date to be coded, number remaining to be coded, number of suspended

encounters, and any issues needing resolution. The date due, format, and method is to be

determined by the facility COR.

Coder Education and Experience:

The contractor shall provide experienced, competent, credentialed personnel to perform coding

and/or auditing activities.

A. Contract coders shall have a minimum of two years experience in International

Classification of Diseases, Common Procedural Terminology, and Healthcare Common

Procedural Coding System coding and completed the baseline International Classification

of Diseases,10th edition requirements listed below or as required to hold a current/active

credential;

B. Contract coders/validation staff shall possess formal training in anatomy and physiology, medical terminology, pathology and disease processes, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines

for current classification systems (International Classification of Diseases, Common Procedural Terminology, and Healthcare Common Procedural Coding System).

1. Coders/auditors shall be credentialed and have completed an accredited program for

coding certification, an accredited health information management or health information technician. For the purpose of this Contract, a certified coder/auditor is someone with one of the following active credentials listed below. Other credentials shall not be accepted.

a. Personnel with responsibilities for International Classification of Diseases 10th

edition code determination/application activities shall hold a current/active

American Health Information Management Association or American

Academy of Professional Coders credential.

b. Personnel shall have successfully completed the required baseline

International Classification of Diseases, 10th edition, Clinical Modification/Procedure Coding System continuing education units (CEUs)required by their credentialing organization as follows: American Health Information Management Association requires Registered Health Information Technician 6 CEUs; Registered Health Information Administrator 6 CEUs;

Clinical Documentation Improvement Practitioner 12 CEUs; Certified Coding

Specialist -P 12 CEUs; Certified Coding Specialist 18 CEUs; and Certified Coding Associate 18 CEUs.

c. Certification as an American Health Information Management Association

International Classification of Diseases, 10th Edition, Clinical

Modification/Procedure Coding System trainer is also acceptable.

d. American Academy of Professional Coders credential holders shall have taken

and passed the required International Classification of Diseases International

Classification of Diseases, 10th Edition Proficiency Assessment.

C. Coding Contract Supervisors should have at the minimum 2 years experience coding with VHA.

D. Credentials for Coding/Auditing: American Health Information Management Association credentials as a Registered Health Information Administrator Registered Health Information Technician, Certified Coding Specialist, and Certified Coding Specialist Physician, or American Academy of Professional Coders as a Certified Professional3

Staffing

Full time employees (FTE)shall be described as individuals working at least 40 hours or more.

The contract will staff at least 75% of its workforce with FTE s for coding Inpatient and Surgical work types. The remaining 25% can be part time employees working a minimum of 20 hours per week.

Invoicing

All invoicing will be submitted on a Monthly basis. Pricing is based per unit.

Request for Proposal (RFP) Transaction Based Cost Structure:

CLIN #

Medical Coding

Transactions per Month

Rate

Total Monthly Cost

Total Annual Cost

CLIN 0001

Outpatient Encounter

CLIN 0002

Inpatient Professional Fees & Ancillary Encounters

CLIN 0003

Surgical Cases

CLIN 0004

Inpatient Discharges

Total Estimated Annual Cost:

Privacy and Security

VA will provide the Contractor access to VISTA, VA's patient record computer system, Computerized Patient Record System (CPRS) that contains: patient medical records, medication profiles, laboratory and radiology data, and other diagnostic test results. Access will be for the purpose of:

Obtaining patient specific information;

Requesting specialty consults, laboratory, radiology, or other diagnostic tests;

Communicating with VA Staff about patient care issues;

Checking formulary status of drugs; and

Providing for completion of tasks requested by Government in support of this contract.

MEDICAL RECORDS REQUIREMENTS:

Authorities: Contractor providing services to VA patients shall be considered as part of the Department Healthcare Activity and shall comply with the U.S.C.551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of Claimant Records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical Quality Assurance Records) 38 U.S.C. 7332 (Confidentiality of Certain Medical Records), Title 5 U.S.C. '' 522a (Records Maintained on Individuals) as well as 45 C.F.R. Parts 160, 162, and 164 (Health Insurance Portability and Accountability Act).

VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY

1. GENERAL

Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

2. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS

a. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.

b. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.

c. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive VA119-15-A-0008 Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.

d. Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.

e. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor's employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.

Link/URL: https://www.fbo.gov/spg/VA/MaVAMC613/MaVAMC613/36C24519Q0024/listing.html