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FBO DAILY - FEDBIZOPPS ISSUE OF OCTOBER 05, 2017 FBO #5795
DOCUMENT

R -- Off Site Medical Coding - Attachment

Notice Date

10/3/2017
 

Notice Type

Attachment
 

NAICS

541611 — Administrative Management and General Management Consulting Services
 

Contracting Office

Department of Veterans Affairs;VA Sierra Pacific Network (VISN 21);VA Northern California HealthCare System;5342 Dudley Blvd, Bldg 209;McClellan CA 95652-2609
 

ZIP Code

95652-2609
 

Solicitation Number

36C26118Q0003
 

Response Due

10/10/2017
 

Archive Date

1/8/2018
 

Point of Contact

maria.teodoro-tanksley@va.gov
 

E-Mail Address

maria.teodoro@va.gov
(maria.teodoro@va.gov)
 

Small Business Set-Aside

N/A
 

Description

This is a Sources Sought Constitutes Market Research The Department of Veterans Affairs San Francisco Medical Center, San Francisco, CA is conducting market research to determine if there are sufficient number of qualified vendors to issue a Veteran-owned set aside. In accordance with United States Code Title 38 Section 8127(d), we are seeking vendors in the following categories: (1) Service Disabled Veteran Owned Small Business (2) Veteran Owned Small Business The responses from this notice will be used to make the appropriate set aside determination. The proposed solicitation will be issued as a Request for Quotation under FAR Parts 12 and 13. The contractor shall provide medical coding service for the Veterans Affairs San Francisco Medical Center, San Francisco, CA. The Performance Work Statement is attached to this notice. Interested contractors should provide a capabilities statement demonstrating their experience providing similar services. The period of performance for this contract will be a base year plus four option years. All interested contractors must respond by email to Maria.Teodoro@va.gov before 3:00 P.M. Pacific Time on 10Oct 2017. SDVOSB and VOSB vendors are registered in the Vendor Information Pages (VIP) VetBiZ. DO NOT SEND ANY PROPOSALS at this time. Submitting a capability statement is welcome. DISCLAIMER This SSN is issued solely for information and planning purposes only and does not constitute a solicitation. All information received in response to this notice that is marked as proprietary will be handled accordingly. Responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this Sources Sought Notice. Performance Work Statement San Francisco VA Health Care System (SFVAHCS) Section 1: Purpose 1.1 Purpose: This is a service contract to provide medical coding services for the SFVAHCS. This contract supports our outpatient and inpatient coding program. 1.2 Place of Performance: San Francisco VA Health Care System (SFVAHCS) 4150 Clement Street San Francisco, CA 94121 Section 2: Definitions & Acronyms Acronyms: CBOC Community Based Outpatient Clinic COR Contracting Officer Representative PWS Performance Work Statement QASP Quality Assurance Surveillance Plan VA Veterans Affairs SFVAHCS San Francisco VA Health Care System Section 3: General Information 3.1 The Contractor shall provide all labor, equipment, supplies, management, supervision, personnel, and transportation necessary to assure that all services are in accordance with the contract and all applicable laws and regulations. The contractor shall ensure all work meets performance standards specified in this Performance Work Statement (PWS) and referenced documents. Unclear policies will be discussed with the Coding Compliance Specialist, Coding Lead, HIMS Chief, Assistant Chief for clarification. 3.2 Contractor shall provide staff coverage adequate to meet VA deadlines. Failure to comply with this contractor requirement more than three times in the calendar year will result in termination of the contract. 3.3 Upon request of the Contracting Officer, Contractor shall remove any contract staff that do not comply with SFVAMC policies or meet the competency requirements for the work being performed. 3.4 The Contractor shall ensure that high standards to coding must be maintained. Coding must maintain a minimum of 95% accuracy with a desired accuracy rate of 98% to be the goal. Any questions regarding the coding will be discussed with the contractor point of contact. 3.5 If coding errors are found via internal/external audits, The Contractor shall correct all errors found at no cost to SFVAHCS. If a trend is identified, The Contractor shall develop and implement a corrective action plan to educate and track contract coders. Section 4: Specific Tasks 4.1 Coding Process The Contractor shall: Carefully read and review health record documentation for outpatient cases as provided by SFVAHCS to include all Community Based Outpatient Clinics (CBOC) associated with it. Assure that all coders working on this contract use appropriate DSS-Nuance encoder software. Assign appropriate International Classification of Diseases (ICD) Clinical Modification (CM) and Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) codes at a minimum of 95% accuracy, and enter into the system in accordance with the documentation and the provider s scope of practice Adhere to all coding guidelines as approved by the Cooperating Parties and accepted VA regulations, including: The Official Guidelines and Reporting as found in the CPT Assistant, a publication of the American Medical Association for reporting outpatient ambulatory procedures and evaluation and management services, The Official Guidelines for Coding and Reporting in the Coding Clinic for current ICD-CM, a publication of the American Hospital Association, and VHA guidelines for coding as found in the Handbook for Coding Guidelines V11 August 2011, Health Information Management, Department of Veterans Affairs. Note: While Veterans Health Affairs (VHA) does ask for reimbursement from Medicare or Medicaid payers, the VHA coding policy is to code only according to coding guidelines. Our own compliance audits use only this definition when determining if any encounter or Patient Treatment File (PTF) is correctly coded. The Correct Coding Initiative. The CPT Evaluation and Management codes assure documentation substantiates the code level assigned. VA Directive 2002-023, Definition of Encounters for VA Purposes. When assigning multiple CPT codes, verify they are not components of a larger, more comprehensive procedure that can be described with a single code. Assign modifiers as appropriate to override Correct Coding Initiative edits. Identify  and document those  encounters created in error because the patient was not seen Not use "incident to" rules. Physicians at Teaching Hospitals rules as outlined in the Resident Supervision Handbook 1400.1. Provide a workload report each week indicating the events coded for the prior week in the following categories: 1. Number of inpatient events coded 2. Number of inpatient pro fees coded 3. Number of outpatient encounters coded 4. Number of lab encounters coded 5. Number of VASQIP events code Provide a backlog report weekly which shows evens suspended and events to be coded as follows: 1. Inpatient events: Events not coded due to lack of documentation 2. Inpatient events: Events not coded for any other reason 3. Inpatient Pro Fees: Number of records requiring inpatient pro fee coding 4. Outpatient encounters: Number of outpatient encounters to be coded 5. Outpatient encounters: Number of outpatient encounters suspended 6. Lab encounters: Number of lab encounters to be coded 7. Lab encounters: Number of lab encounters suspended 8. Number of VASQIP events to be coded Expected turnaround time is 2 work days from receipt of work for all types; provided there is sufficient documentation. Lack of documentation for any work type must be communicated to VA within the expected turnaround time period. Work is considered completed when it is received back at VA with data entry done for all only work. Inpatient events are considered complete when the event has been closed and released. VA shall transmit inpatient events but may call upon vendor to transmit to meet transmission deadlines for weekend and holiday coverage. Errors shall be corrected at no cost to VA. Vendor s coding supervisors shall be available to participate in monthly conference calls with clinical staff regarding coding and documentation issues. Additionally, the contractor shall assure that all coders follow up by using the query process with providers to obtain all missing documentation, clarification of terminology or other documentation, and any other coding or documentation requirements necessary for accurate coding and billing. Site specific coding guidelines will be provided on an as needed basis in instances where established guidelines are not clear. 4.2 Outpatient Encounters including Radiology, Laboratory or other Ancillary Services     Contractor shall: Use 1995 Evaluation and Management (E&M) guidelines on all encounters except the following specialties: Mental Health, Neurology and Ophthalmology which shall be coded with the 1997 E&M guidelines. Ensure that individual coders are elector initial each and every document that they have coded for paper- based records. Enter complete data entry, including CPT codes, modifiers, and diagnoses for the encounter or occasion of service when on-line coding is performed into Appointment Management or Patient Clinical Encounter (PCE). Link all diagnoses reported to CPT codes for the service using the Clinical Information Data Capture functionality. Associate the provider with the CPT code performed by him/her at that encounter and for diagnostic services, consultation services and therapy services enter the ordering provider in the slot in PCE. Note: The association in Veterans Health Information Systems and Technology Architecture (VISTA) is very important to create a correct bill and for the budget allocation for each fiscal year for VA. Contractor shall correct any missing associations when doing on-line coding at no charge. Use a CPT code for all encounters. When the documentation does not support a diagnosis code clearly flag those documents for further review at the facility. Review all applicable survey questions (Service Connected, Agent Orange, Ionizing Radiation, Head and Neck Cancer, Military Sexual trauma and Combat Veteran) at the diagnosis level when prompted and assign to facility Utilization Review Nurse if appropriate.   4.3 Surgical Coding   Contractor shall:   Code surgical reports and associated anesthesia reports using CPT and current ICD diagnoses. All surgical procedures, anesthesia codes and adjunct procedures for anesthesia shall be recorded electronically. The appropriate P-modifier for the patient s American Society of Anesthesiology class shall be appended to the anesthesia code. When on line coding is performed, all data shall be entered into the VISTA surgical package. Operation reports shall be provided along with Anesthesia records and/or Pathology reports where applicable. On-line anesthesia reports are scanned images loaded after the date of surgery. The date of the surgery is contained on the document.           4.4 Inpatient Professional Services Contractor shall:   Code using CPT and current ICD for inpatient professional services. HCPCS shall not be used. Code Nursing Home cases using appropriate nursing home CPT codes. These cases shall be clearly labeled. A list  of inpatients  shall be provided and the contractor shall mark off the cases, or input back into the Local Area Network that cases are completed. When on-line  coding  is performed, contractor shall load the codes into the Professional Fee Clinic in Appointment Management and associate the CPT codes with the provider who performed it. Code only notes that substantiate that the patient was actually seen with 99xxx series codes. Use required modifier 26 for Pathology, Radiology, or other diagnostic tests when the data is entered. Enter Professional Fee data into Compliant Coding Module. 4.5 Inpatient Census Coding Contractor shall: Code quarterly a snapshot (midnight - March 30, June 30, September 30, and December 31) of active inpatient Census, utilizing available documentation to extract diagnosis. The appropriate ICD-CM and ICD-PS codes shall be entered into the Census PTF record for transmission to Austin within seven days of Census generated. 4.6 Inpatient Non-VA Purchased Care Coding Contractor shall code inpatient PTF for non-VA purchased care. 4.7 Concurrent Coding Contractor shall provide concurrent coding services when requested by SFVAHCS.   Section 5: General Specifications Coders Contractor is responsible for providing personnel to perform coding activities. There shall be no reimbursement charge for mileage, travel times, meals, parking, etc. Contractor shall maintain frequent communications with the Contract Officer Representative and Chief Health Information Management Section, regarding progress, workload status and/or problems. Contractor shall maintain Public Key Infrastructure (PKI) encryption for Outlook email communication with Veterans Affairs employees. Upon request of the Contracting Officer, Contractor shall remove any Contractor staff that do not comply with SFVAHCS policies or meet the competency requirements for the work being performed. Contractor shall abide by the American Health Information Management Association established code of ethical principles as stated in the Standards of Ethical Coding, published by American Health Information Management Association.     5.2 Required Coder Knowledge and Skills   Coders performing work must:   Read and interpret health record documentation to identify all diagnoses and procedures that affect the current outpatient encounter visit, ancillary, inpatient professional fees and surgical episodes.  . Possess formal training in: anatomy and physiology, medical terminology, pathology and disease processed, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD-CM and CPT). Apply knowledge of current Diagnostic Coding and Reporting Guidelines for outpatient services. Apply knowledge of CPT format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly. Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT. Code in accordance with Correct Coding Initiative Bundling Guidelines. Use the Healthcare Common Procedural Coding Systems (HCPCS), where appropriate. Exclude from coding information such as symptoms or signs characteristic of the diagnoses, findings from diagnostic studies or localized conditions that have no bearing on current management of the patient. Be knowledgeable on first pass inspection of service connection determination and special eligibility categories; Initial service connection shall be made by the coder; Questionable service connection/special eligibility determination shall be addressed by the CPAC Facility Utilization Review Nurse and coding shall be held until final determination can be made. 5.3 Required Coder Education and Experience Coders must be credentialed and have completed an accredited program for coding certification, an accredited health information management or health information technician. A certified coder is someone credentialed by the:   American Health Information Management Association (AHIMA) and includes Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS) and CCS-Physician, or American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) or CPC-Hospital. Personnel with responsibilities for ICD-10 code determination/application activities must hold a current/active American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) credential. Personnel shall have successfully completed the required baseline ICD-10-CM/PCS continuing education units (CEUs) required by their credentialing organization as follows: AHIMA requires RHIT 6; RHIA 6; CDIP 12; CCS-P 12; CCS 18; and CCA 18. Certification as an AHIMA ICD-10 CM/PCS trainer is also acceptable. AAPC credential holders shall have taken and passed the required ICD-10 Proficiency Assessment.   Supervisory Coders must have a minimum of three years experience in VHA coding. Credentialed Coders must have a minimum of two years experience in VHA coding.   Section 6: Quality Control Processes The contractor shall: Return coded records or notify SFVAHCS, HIMS Chief that the daily assignment of work is complete usually within one business day and never later than 5 business days after receipt. Completed workload shall be communicated back to the SFVAHCS designee daily to keep our billing workflow moving. Alternate timetables are acceptable based on agreement of the contractor. When the contractor cannot meet this deadline due to unforeseen circumstances, contractor shall notify SFVAHCS by the 4th business day after receipt. Perform on-going  quality assessment of not less than 5% of all coded services and provide monthly results to HIMS to ensure that the minimum 95% accuracy rate is met. The Contractor shall continually monitor and supervise the work performed by the contract coders on a continuous and ongoing basis, at no cost to SFVAHCS. Track results by coder to assure appropriate follow-up and education. Failure to provide the results of the audit on a monthly basis shall result in a 20% reduction in the negotiated price for all records for that month. Failure to report results within the specified time frame three times during a calendar year shall result in termination of the contract. Re-review  any coded data where a question is found  by VA during our pre-bill process or when a denial is received to either make changes or substantiate the coding with appropriate coding rules and references.   This service is included in the price of the work. The re-review may be based on an e-mail message so a designated person must log on periodically until notified that it is no longer necessary. Use the following during review processes: Include all CPT codes, and a maximum of 4 current ICD-CM codes in the denominator for the audit percent. Include the appropriate Resident Supervision Modifier GR in the audit, as well as Modifiers 24, 25, 50, 51, 52, 53, 57, 58, 59, 78 and 79 in the denominator. Modifier 91 is required for labs. Anesthesia modifiers in surgical cases and Medicare podiatry modifiers as appropriate. For each element, document the correct number of codes coded (numerator) and the total number of correct codes coded (denominator) on the Standard VA CBI audit. For each element, select an error code indicated in the legend of the Standard VA CBI audit form when a coding error has been identified. Count each one of the following as an error: those codes that were coded and not supported in the documentation, Evaluation and Management level and appropriateness to service (established, new, or consult), violate a coding rule and/or those CPT or diagnosis codes that should have been coded and were not and/or unbundled codes. Use the Standard Veterans Affairs Compliance Business Integrity audit form for reporting the data. The Standard VA CBI audit contains 6 elements for review for an individual patient visit E/M Code Principle CPT Code Secondary CPT Codes - Include all CPT codes Primary ICD-9-CM, ICD-10-CM/PCS Code Secondary ICD-9-CM ICD-10-CM/PCS, Codes - Include a maximum of 4 secondary ICD- ICD-10-CM/PCS 9-CM, codes Modifiers Section 7: Ad hoc Quality Assurance (QA)/Medical Records Review In addition to recurrent quality monitors stated in Section 6.0, ad hoc medical record reviews/audits for outpatient, inpatient, non-VA purchased care and professional fees shall be completed on an as needed basis. SFVAHCS may require these special QA audits to meet national and local requirements. The same coding guidelines shall apply to the coding audits as in the daily coding listed in this statement of work. The errors identified out of the selected sample will be counted as one error for the sample. They are as follows, primary (first listed code) sequence errors, incorrect or missing modifiers, unbundled codes, codes not supported by the current encounter/visit in the documentation or that violate a coding rule, diagnoses or procedure codes that were not coded and or were the incorrect codes, (within the computer system) provider selected linking errors, for inpatient diagnostic related group (DRG) errors and missing coder comments required for claims processing. The reason for change will be documented. Finding shall be documented on and excel spreadsheet per coding review, along with findings and supporting coding documentation from coding authorities (ICD/PCS, CPT, HCPCS coding guidelines, American Psychiatric Association, VHA handbooks and directives, and CMS guidelines) on or by the agreed date. Reviews are subject to dispute and a dispute resolution shall be conducted in those cases.
 

Web Link

FBO.gov Permalink
(https://www.fbo.gov/spg/VA/VANCHCS/VANCHCS/36C26118Q0003/listing.html)
 

Document(s)

Attachment
 

File Name: 36C26118Q0003 36C26118Q0003.docx (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=3831445&FileName=36C26118Q0003-000.docx)

Link: https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=3831445&FileName=36C26118Q0003-000.docx

 

Note: If links are broken, refer to Point of Contact above or contact the FBO Help Desk at 877-472-3779.
 

Record

SN04704407-W 20171005/171003231506-1f425fd584c43416998e49d962101af0 (fbodaily.com)
 

Source

FedBizOpps Link to This Notice
(may not be valid after Archive Date)

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