Sources Sought Notice – Q– MEDICAL CODING SERVICES – STL
Notice Type: Sources Sought Notice
Posted Date:
Office Address:
Subject: Q-- MEDICAL CODING SERVICES - STL
Classification Code: Q - Medical services
Solicitation Number: VA25517Q0033
Contact:
Description:
VA Heartland Network
This Sources Sought Notice is for planning purposes only and shall not be considered as an invitation for bid, request for quotation, request for proposal, or as an obligation on the part of the Government to acquire any products or services. Your response to this Sources Sought Notice will be treated as information only. No entitlement to payment of direct or indirect costs or charges by the Government will arise as a result of contractor submission of responses to this announcement or the Government use of such information. This request does not constitute a solicitation for proposals or the authority to enter into negotiations to award a contract. No funds have been authorized, appropriated, or received for this effort.The information provided may be used by the
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, or Veteran Owned Small Businesses, interested and capable of providing the services described below.
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 or Veteran-owned small 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. Potential contractors must also list any GSA contract under Category 51 506 that may pertain to this announcement.
The VA Heartland Network 15, Contracting Office located at
The NAICS code for this service is 561410 - Document Preparation Services
Important information: The Government is not obligated to, nor will it, pay for or reimburse any costs associated with responding to this sources sought synopsis request. This notice shall not be construed as a commitment by the Government to issue a solicitation or ultimately award a contract, nor does it restrict the Government to a particular acquisition approach. The Government will in no way be bound to this information if any solicitation is issued. Currently a service-disabled veteran-owned small-business set-aside is anticipated under FAR 6.206 - Set-asides for Service-Disabled Veteran-Owned Small Business Concerns. However, if response by Service Disabled Veteran Owned Small Business firms or Veteran Owned Business firms proves inadequate, an alternate set-aside may be utilized.
If interested in bidding on this potential procurement, and are qualified to perform, please acknowledge by sending an email to the email address of the contracting officer below no later than 10/21/2016.
Attention:
Phone: 913-946-1958 Fax: 913-946-1998
STATEMENT OF WORK
1. SCOPE OF WORK
The intent of this solicitation is to furnish a quality coding audit and provide coding services for the VA
2. FACILITY DESCRIPTION AND COMPLEXITY
The VA
3. CONTRACTOR REQUIREMENTS
Contractor shall provide all labor, material (including coding books, etc.) and supervision necessary to perform: coding of and/or coding auditing for inpatient, observation, diagnostic tests, ambulatory surgery/ambulatory cases and outpatient (clinic) data collection, evaluating the accuracy, completeness, and consistency of coding diagnoses, procedures and professional service evaluation and management codes, in accordance with official coding guidelines (
All coding and coding audits will utilize the computerized medical record system (CPRS). The coding and coding audits will be conducted by remote data view. Should the information not be contained in CPRS (including VistA Imaging) or VistA, the contractor will immediately notify the Contracting Officer's Technical Representative (COR) or designee.
Contractor shall be responsible for providing their staff with laptops, reference material, software/encoder tools for conducting audits, and training materials. Contractor shall be proficient in the use of the laptops, reference materials, software/encoder tools and shall provide with their proposal evidence of the use of an encoder.
The estimated number of coding and coding audits are as follows:
Coding Outpatient, 3000 per month
Coding Outpatient Radiology/Diagnosis Only, as needed
Coding Inpatient/Census only, without professional fees, including surgery within stay 100 per quarter
Coding Inpatient, without professional fees, including surgery as needed
Coding Audits-The monthly inpatient coding audit estimated number must include a minimum of ten (10) inpatient episodes for Diagnostic Related Groups (DRGs), Secondary Diagnoses, Procedures, Operations and Present on Admission (POA) indicators. The monthly outpatient coding audit estimated number must include a minimum of ninety (90) outpatient claims for professional services to exclude laboratory, radiology, telephone and prosthetic encounters. These outpatient claims may include ambulatory surgeries or invasive procedures. The sample size will be representative of each of the time periods shown in the Scope of Work.
Contractor shall utilize the VA
Contractor shall provide the coding audit findings to the Chief, HIM, COR, management, and other designated medical center personnel for the previous month by the eighth (8th) day (including Federal Holidays) of the current month. HIM medical center personnel will review proposed changes prior to final written report for mutually agreed upon changes to the Contractor by the thirteenth (13th) day (including Federal Holidays) of the current month.
A final written report shall be provided by the Contractor to the VA
Inpatient and Observation Audits:
" Executive Summary
" Total number of records audited
" DRG accuracy rate
" Changes in relative weight
" Reasons for DRG change
" ICD-10-CM coding accuracy rate
" ICD-10-PCS coding accuracy rate
" Present on Admission (POA) accuracy rate
" Reasons for coding changes for data quality
" DRG changes by PTF 701, 501
" Coding reference for DRG changes
" Coding reference for ICD-10-CM and ICD-10-PCS coding changes
" Reference if DRG change was noted in previous audit periods
" Recommendations for improvement
The Contractor will also annotate what document (date and time) where complications and/or co-morbidities where not captured by the coder.
Surgery Package (Inpatient and Ambulatory) Audits:
" Executive Summary
" Total number of records audited
" Total number/percentage of records with coding changes by ICD diagnosis and CPT
" Total number of modifier changes (number added, number deleted)
" Types and reasons of coding change
" Coding reference for ICD-10-CM, CPT and HCPCS coding changes
" Reference if coding changes were noted in previous audit periods
" Recommendations for improvement
Diagnostic Services Audits:
" Executive Summary
" Total number of records audited
" Total number/percentage of records with coding changes by ICD diagnosis and CPT
" Total number of modifier changes (number added, number deleted)
" Types and reasons of coding change
" Coding reference for ICD-10-CM, CPT and HCPCS coding changes
" Reference if coding changes were noted in previous audit periods
" Recommendations for improvement
Outpatient Audits Provider or Coder:
" Executive Summary
" Total number of records audited
" Total number/percentage of records with coding changes by ICD diagnosis and CPT
" Total number of modifier changes (number added, number deleted)
" Types and reasons of coding change
" Coding reference for ICD-10-CM, CPT and HCPCS coding changes
" Reference if coding changes were noted in previous audit periods
" Recommendations for improvement
Contractor must provide the most recent evidence of having successfully provided services requested to customers of size and configuration similar to
Contractor must provide with the proposal general company background/composition to include: years in coding consultation business, number of employees and their positions, and names of contracts with the type of work performed, a contact person and telephone number and the number of contracts awarded of this size.
Contractor shall ensure complete electronic data entry into the VA
Placement of a Case Comment will be assigned as appropriate to each outpatient encounter per established guidelines. The Contractor will then file the encounter to PCE.
Contractor shall use 1995 & 1997 Evaluation and Management guidelines.
Contractor shall NOT use "incident to" rules.
Contractor shall maintain frequent communication with the COR or designee regarding progress, workload status and/or problems.
Contractor shall document in writing all coded cases and provide such documentation to the COR or designee at the conclusion of each day by running a coded productivity report and placing it into a shared folder.
Contractor shall be responsible for providing personnel to perform coding. Upon request of the Contracting Officer, the Contractor shall remove any Contracted staff that do not comply with VA
Contractor shall be required to maintain records that document competence/performance levels of employees working on this contract in accordance with
Contractor shall possess all licenses, permits, accreditation, and certificates as required by law.
Contractor shall be required to validate any order in the CPRS Orders Tab or Progress Note for test procedures in the health information documentation to validate medical necessity.
All associated working papers and other material deemed relevant by the
Documents/records/information shall be secured when not in use. At the conclusion of the contract all copies of individually identifiable health information shall be returned to VA
4. CONTRACTOR GUIDELINES
Contractor shall adhere to all coding guidelines accepted by
Official Guidelines for Coding and Reporting as found in the CPT Assistant, a publication of the
Official Guidelines for Coding and Reporting as found in
VHA guidelines for coding as found in the Handbook for Coding Guidelines (most recent edition), Health Information Management,
CMS Ruling - Documentation Requirements for VA Teaching Physicians as signed by
5. CODER AND CODING AUDITOR QUALIFICATIONS
The coders and coding auditors must have the current credentials of a Registered Health Information Technician (RHIT) or a Registered Health Information Administrator (RHIA). The coder and coding auditor must have at least three (3) years of training experience as a consultant in reviewing records in large tertiary care hospital, and outpatient health care organizations having all subspecialties and primary care. A resume of the coders and coding auditors must be included in the proposal, along with two (2) current client references specific to each individual coder and coding auditor, as well as proof of credentials. References and proof of credentials must be included in the proposal.
Coders and Coding Auditors must clarify conflicting, ambiguous or nonspecific documentation by consulting with their supervisor who will be identified to Contractor along with telephone number and email address in advance of the project commencement. Supervisor, if necessary, will discuss with VA
Contractor shall abide by the
6. QUALITY CONTROL
Contractor shall be responsible for developing a coding audit sample size that assures a 95% confidence level of accuracy for their employees including inpatient hospitalizations, diagnostic, ambulatory surgery, observation and outpatient encounters.
7. VA REQUIREMENTS
Provide a listing of patients by category with the name, social security number, and date of service.
8. TERMS OF THE CONTRACT
The overall term for the base year of the contract will be thirty (30) days following the awarding of the contract. Subsequent option year coding and coding audits will be renewed annually based on the outcomes of the base year and each year thereafter, reviewing the previous years' workload.
If there are changes in policy regarding coding requirements the Contracting Officer will determine whether the Statement of Work (SOW) should be modified.
9. CONFIDENTIALITY AND NON-DISCLOSURE
Contractor shall insure the confidentiality and security of all patient information and shall be held liable in the event of breach of confidentiality. The Contractor shall comply with the provisions of the Privacy Act (5
Contractor shall certify that all employees performing services under this contract have received required VHA Privacy and Security training. Contractor shall be responsible for insuring the confidentiality and security of all patient information and shall be held liable in the event of any breach of confidentiality. Access requirements to
Contractor personnel shall be required to sign access agreements before starting work under this contract. These agreements require them to abide by
Contractor shall sign a Business Associate Agreement (BAA) with the
VA Information and Information System Security/Privacy
General
All contractors and contractor personnel shall be subject to the same Federal laws, regulations, standards and
Access to VA Information and VA Information Systems
A contractor shall request logical (technical) and/or physical access to
All contractors and subcontractors working with VA Sensitive Information are subject to the same investigative requirements as those of regular
http://www1.va.gov/vhapublications/index.cfm. Contractors are responsible for screening their employees. The following are
" Contract personnel not accessing
" Contract personnel with limited and intermittent access to equipment connected to facility networks on which no
"ontract personnel with limited and intermittent access to equipment connected to facility networks on which limited
The contractor agrees to -
(1) Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies--
(i) The systems of records; and
(ii) The design, development, or operation work that the contractor is to perform;
(2) Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcontract awarded without a solicitation, when the work statement in the proposed subcontract requires the redesign, development, or operation of a system of records on individuals that is subject to the Act; and,
(3) Include this Privacy Act clause, including this subparagraph (3), in all subcontracts awarded under this contract which requires the design, development, or operation of such a system of records.
In the event of violations of the Act, a civil action may be brought against the agency involved when the violation concerns the design, development, or operation of a system of records on individuals to accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of the agency when the violation concerns the operation of a system of records on individuals to accomplish an agency function. For purposes of the Act, when the contract is for the operation of a system of records on individuals to accomplish an agency function, the contractor is considered to be an employee of the agency.
(1) "Operation of a system of records" means performance of any of the activities associated with maintaining the system of records, including the collection, use, and dissemination of records.
(2) "Record" means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, education, financial transactions, medical history, and criminal or employment history and contains the person's name, or the identifying number, symbol, or other identifying particular assigned to the individual, such as a fingerprint or voiceprint, or a photograph.
(3) "System of records on individuals" means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual.
Security Incident Investigation
The term "security incident" means an event that has, or could have, resulted in unauthorized access to, loss of or damage to
ISO/Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor has access.
To the extent known by the contractor, the contractor's notice to
The contractor will simultaneously report the incident to the appropriate law enforcement entity(ies) of jurisdiction, including the VA Offices of the Inspector General and Security and Law Enforcement, in instances of theft or break-in or other criminal activity. The contractor, its employees, and its subcontractors and their employees will cooperate with
To the extent practicable, the contractor shall mitigate any harmful effects on individuals whose
Security Controls Compliance Testing
On a periodic basis,
10. CONTRACTOR TRAINING
All contractor employees and subcontractor employees requiring access to
(1) Sign and acknowledge understanding of and responsibilities for compliance with the attached National Rules of Behavior relating to access to
(2) Successfully complete Privacy Awareness and Information Security Training, and Rules of Behavior (
(3) Successfully complete Privacy and HIPAA Training (Access to VA PII/PHI) and annual refresher training as required; and
(4) Successfully complete any additional cyber security or privacy training, as required for
Training Requirements.]
The contractor shall provide to the contracting officer a copy of the training certificates for each applicable employee within one (1) week of the initiation of the contract and annually thereafter, as required. These online courses are located at the following web site: https://www.ees-learning.net/.
Failure to complete this mandatory training within the timeframe required will be grounds for suspension or termination of all physical and/or electronic access privileges and removal from work on the contract until such time as the training is completed.
11. BACKGROUND AND SCOPE OF WORK BY CATEGORY
Inpatient and Observation records:
The PTF was developed in 1983 and is the automated discharge database for the
Each
The information from the reports is used for local quality improvement (QI) studies,
PTF is broken down into several different abstracting transactions:
o N101 Admission Transaction - Records demographic data and type of admission, service connection, and eligibility.
o
o N701/702 Disposition Transaction - The disposition transaction is completed upon release from inpatient care, death, or transfer. This includes primary and secondary diagnoses for the entire hospitalization. The N702 will be prepared when a patient has more than one diagnostic code to be entered.
o N401 Surgical Transaction - Represents a separate incident of surgery as identified by the date of surgery.
o N601 Procedural Transaction - Represents a separate incident of a non-OR procedure as identified by the date of the procedure.
Should the facility not have observation beds, the
Outpatient Records:
In 1995, the Under Secretary for Health directed that as of
Facilities now report patient identity, date and time of service, practitioners (by
12. GLOSSARY OF TERMS
Ancillary Services - Those services other than room, board, medical and nursing services, such as laboratory and radiology that are provided to patients in the course of care. An ancillary service does not include the exercise of independent medical judgment in the overall diagnosing, evaluating and/or treating of the patient's conditions. An ancillary service is usually the result of an encounter.
CMS -
Coding - The process of assigning a number (alpha, numeric or a combination of both) from a recognized and approved coding classification system that properly identifies and defines medical services, procedures and diagnoses.
Contractor - An individual, partnership, or organization having a contractual relationship with the Government for provision of service.
CO (Contracting Officer) - The person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.
COR (Contracting Officer's Technical Representative) - Any person or persons authorized to act for the Contracting Officer within authority limits. (Lead/Facility).
CPRS (Computerized Patient Record System) - The patient's electronic health record.
CPT - Current Procedural Terminology, 4th edition, published by the
Cure Notice - A formal notification to Contractor to correct a deficient situation or risk termination of contract.
Emergency - An unforeseen combination of circumstances, or the resulting state, which requires immediate action. An emergency situation shall be declared by the Facility COR and/or the Lead COR.
Federal Holidays - The date of observance by the Federal Government of the following holidays:
Government - The
HCPCS -
ICD-10-CM - International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) is a nomenclature developed by the
ICD-10-PCS - International Classification of Diseases, 10th revision, Procedure Coding System (ICD-10-PCS) is a nomenclature developed by the
Medical Center Director (s) - The person with final responsibility for the mission of the Medical Center. A Medical Center Director may have final authority over more than one Medical Center.
Must - This word is used in connection with the Contractor and specifies that the provision is binding.
OIG -
PCE - Patient Care Encounter is VISTA software, which enables transmission of an ambulatory encounter, inpatient professional fees, or ancillary service data to the National Patient Care Database (NPCD) and/or
Personal Property - All Government property, except real property and expendable property.
Service - A job performed to the standard and within the acceptable quality level. The Contractor must do the specific job, meet the standard, and meet the acceptable quality level before performance is acceptable and the Contractor is paid.
Shall - This word is used in connection with the Contractor and specifies that the provision is binding.
Standard - A Government acknowledged measure of comparison.
Start Date - The date work under the contract is scheduled to begin.
TJC (
VAMC -
VHA -
VISTA/RESCUE - Veterans Health Information Systems and Technology Architecture.
VISTA Imaging - Captures clinical images, scanned documents, motion video and other non-textual data files making them part of the patient's electronic health record.
Will - This word is used in connection with the Government and specifies that the provision is binding.
13. OBLIGATION/PURCHASE ORDER NUMBERS
The COR shall provide the contractor with an Obligation/Purchase Order Number prior to the commencement of work under this contract. The obligation number/task order number is provided for payment purposes and must be referenced on all invoices.
14. EFFECTIVE PERIOD
The effective period of this contract shall be mutually agreed on by
15. EXTENT OF OBLIGATION
The Government is obligated only to the effect of authorized purchases actually made under this contract.
16. PURCHASE LIMITATION
Individual purchase dollar limitations shall not exceed the limitations established by each FSS contract.
17. INDIVIDUALS AUTHORIZED TO PURCHASE UNDER THE CONTRACT
Individuals (CORs) acting within the scope of their delegated procurement authority are authorized to purchase under this contract.
18. PAYMENTS/INVOICES
Payments shall be made by electronic funds transfer (EFT) or by Government commercial credit card. For purchases made by purchase order, invoices shall be mailed to:
PO Box 149971
Invoices must cite the Obligation/Purchase Order number provided by the ordering facility along with the contract number. A courtesy copy of the invoice must be emailed to the VA
19. MODIFICATIONS
Modifications of this agreement shall be in writing and mutually agreed upon by the Contracting Officer and an authorized representative of the contractor.
Link/URL: https://www.fbo.gov/spg/VA/LeVAMC/VAMCKS/VA25517Q0033/listing.html
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