Q601--Coding Auditing Services for VHA Office of Integrity and Compliance

Veterans Health Affairs, Network Contracting Office 5, is issuing this request for information/sources sought notice in order to identify businesses that have the resources and capabilities to provide external coding auditing services for the Veterans Health Administration s Office of Integrity and Compliance. Description of Work The VHA Office of Integrity and Compliance (OIC) is seeking a contractor to conduct coding and documentation audits of VHA inpatient and outpatient encounters, coded by coders or providers, and claims billed to the VA through the VA Community Care Program. Audits of documentation and coded data will be performed on any of the VHA required coding activities (e.g., inpatient, outpatient, surgery). These audits will address accuracy of cod ed data, health record documentation issues, and include recommended remediation of specific documentation deficiencies, correction of erroneous codes, process improvement and identify educational needs. There will be approximately 34,000 cases to be audited per year and all necessary records will be made available to the contractor in electronic format. Possible audits will include, but shall not be limited to, audits related to Inpatient hospitalizations, ambulatory surgery, diagnostic tests (endoscopy, bronchoscopy, cardiac catheterization, Percutaneous Transluminal Coronary Angioplasty, pulmonary function, radiology, laboratory, etc.), primary care, mental health, medicine sub-specialty, surgery, observation, neurology, and Non-Veterans Affairs community care records, prosthetics, and DME services. Audits will include review of codes as well as the medical record documentation to validate the specific reason for the encounter and the services performed. Upon completion of each audit, the contractor will prepare a final audit report in the English language detailing all necessary and relevant information pertaining to the scope and objectives provided; the methodology; findings and recommendations of the auditor and other contract personnel. Each report will include, at a minimum, analysis of the accuracy of all coders (and possibly non-coder) supported codes within the claims, use of all modifiers, specificity of codes, deficiencies in documentation, adequacy of diagnosis for medical necessity, potential process improvements, or educational opportunities. Report results, analysis, opinions, observations, etc., should be based upon the scope of the audit as discussed with OIC. Audits do not require strict adherence to Generally Accepted Government Auditing Standards (GAGAS). Audits should be performed in a structured manner incorporating elements of GAGAS to provide a high level of professionalism, independence and objectivity to the assessment allowing for oversight and improvement of areas reviewed. Technical Requirements Contractor must possess the necessary licenses, certifications. Auditors shall hold a current/active American Health Information Management Association or American Academy of Professional Coders credential. Acceptable credentials are: 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 Professional Coder or Certified Professional Coder Hospital. Contractors must possess formal training in auditing, be familiar with GAGAS and be able to incorporate elements of GAGAS into the audit. Contract auditors must be able to obtain and maintain access to VA electronic health records systems and other necessary VA systems. Interested & Capable Responses NCO 5 is seeking responses from businesses that are interested in this procurement and consider themselves to have the resources and capabilities necessary to provide these services. Please respond with your: Business name, business type, socio-economic status (e.g., Veteran-Owned, Woman-Owned, Disadvantaged Small Business, 8(a), etc.), and person of contact (including telephone number & email address). GSA contract number, if applicable, including the contract s ultimate completion date inclusive of all remaining option periods. Capability statement and summary of previous experience performing coding auditing services for VHA and other entities. Approximate cost estimate to perform the work described per year, assuming the maximum (34,000) audits are provided. Likewise, you are encouraged to suggest a CLIN structure that should be used in the future contract (e.g., unit price per inpatient audit, unit per outpatient audit). Responses must be submitted by 11:00 AM Eastern on June 13, 2022. Responses to the information requested above may be submitted via email to contact@example.gov. This request for information/sources sought notice is for planning purposes ONLY. The results of this market research will assist in the development of (1) the requirement, and (2) the acquisition strategy (e.g., small business set-aside, full and open competition, etc.). VA assumes no responsibility for any costs incurred associated with the preparation of responses submitted as a result of this notice.