R--Medical Coding

This is a Sources Sought Constitutes Market Research The Department of Veterans Affairs Pacific Island Health Care System (VAPIHCS) HI 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 VA Pacific Islands Health Care System (VAPIHCS) HI. 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 contact@example.gov before 3:00 P.M. Pacific Time on 30 May 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. Statement of Work for Contract Coding VA Pacific Islands Health Care System PURPOSE The purpose of this contract is to assign ICD, CPT-4 and HCPCS codes based on medical record documentation of outpatient patient care (including radiology, lab, or other ancillary services), inpatient admission/hospitalizations, and inpatient professional services provided under the auspices of VA Pacific Islands Health Care System (VAPIHCS). This is to support the current inpatient and outpatient coding program. BACKGROUND The Under Secretary for Health directed that as of October 1, 1996, VHA facilities were to begin collecting and reporting coded diagnostic, procedural and practitioner data for all ambulatory care encounters. While VHA facilities had been electronically reporting information about each outpatient visit to the national Outpatient Clinic System (OPC), the new requirement forced a major shift in the way VHA medical centers collected and stored ambulatory care information. Outpatient information is entered through the VISTA Patient Care Encounters (PCE). Facilities now report patient identity, date and time of service, practitioners (by HCFA Individual Provider Taxonomy type code), place of service, active problem(s) (ICD codes) and service(s) (CPT codes) for every ambulatory encounter and/or ancillary service. The value of PCE data to managers and researchers depends on how accurately it portrays the actual clinical events that take place in the medical center. Data validity begins with practitioner s accurately recording diagnosis and procedures. That information must be accurately entered into the facility s computer system (VISTA). The VA Pacific Island Health Care System (VAPIHCS) operates the Honolulu Ambulatory Care Clinic, 60 bed skilled nursing home (Center for Aging), 12 bed PTSD residential rehabilitation program, 16 bed psychiatric ward, and outpatient clinics in Hilo, Kona, Maui, Kauai, Guam, and American Samoa. VAPIHCS is affiliated with the University of Hawaii. The affiliation has medical students, interns and residents who frequently rotate. Additionally, there are students in psychology and nursing. Also, due to high demand and low availability, many specialties are contracted out to Tripler Army Medical Center, Guam Naval Hospital and other community health care entities. SCOPE OF WORK Contract coders must use their skills and knowledge of ICD, CPT-4, HCPCS Level II and any available resources to select the diagnostic and procedural codes. Contractors must code outpatient, inpatient care (including authorized and unauthorized purchased/fee care), census (Community Living Center (CLC) and Post traumatic stress disorder residential rehabilitation program (PRRP) based on the documentation in the medical record including the Computerized Patient Record System (CPRS), VISTA, VISTA Imaging, and the Department of Defense s (DOD) electronic medical record systems (CIS, AHLTA, CHCS, JANUS, and JLV). CMS currently allows the use of either 1995 or 1997 Evaluation & Management (E&M) coding guidelines. VAPIHCS utilizes CMS 1997 E&M Guidelines for Mental Health, Neurology and Ophthalmology encounters and CMS 1995 E&M Guidelines are used for all other encounters. Data entry into the VISTA system will be done as part of this contract, and will include establishment of inpatient Patient Care Encounters (PCE) for those encounters VISTA does not currently capture , i.e. anesthesia, pathology and inpatient professional fees, DOD purchased care, and any others which are subsequently found not to be automatically entered into PCE. Additionally, the contractor shall assure that coders follow up with providers to obtain 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. Service Connection/Special Eligibility. Contract coders shall 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 Revenue Utilization review nurse and coding shall be held until final determination can be made. Electronic coding software shall be utilized for all encounters coded. Currently, VAPIHCS uses Nuance Compliance Coding Module (CCM) and VIP Workplace. CCM is comprised of PCE Record Manager, for outpatient coding, VIP Workplace for inpatient coding and Clintegrity as a standalone coding reference. CCM will update the coding changes in VISTA PCE, PTF, and the surgery package. It is through CCM that coding outpatient workload is generated and assigned to coders. This is what is referred to as a Code Me report. Software guidelines can be found in the user guide available within each software component. Additional guidelines will be provided by the site Coding Supervisor for inpatient workload assignment and when needed. Workload may also be assigned by paper documentation/ and or email delivery for authorized and unauthorized purchased/fee outpatient and inpatient care. All coders are expected to follow all ICD, CPT-4, and HCPCS coding guidelines and to adhere to the Standards of Ethical Coding. A copy of these standards is contained in the latest version of the VHA Handbook for Coding Guidelines, Health Information Management, and Department of Veterans Affairs. It is available on the VHA HIM s webpage through the intranet: http://vaww.vhahim.va.gov. The Handbook for Coding Guidelines is a guideline. It is meant to assist coders, but does not take precedence over definitive coding source, e.g., ICD, CPT, HCPCS, DSM-V, CPT Assistant, and AHA Coding Clinic. Coders are expected to verify the correct billable provider when coding each billable visit or episode of care. Contractor shall provide Coding Supervisor updates on any coding error coded by the provider Contractor shall provide all labor, materials, transportation and supervision necessary to perform coding and abstracting using standard industry guidelines (AHA Coding Clinic, CPT Assistant, CMS/AMA, etc.). VAPIHCS policies and procedures will be followed. Unclear policies will be discussed with the VAPIHCS HIMS Coding Supervisor, or designee, for clarification. Contractor shall provide staff coverage adequate to meet 7 day VA deadlines. PTF (Patient Treatment file) is closed within 7 calendar days from receipt of work for all types, provided there is sufficient documentation. Lack of documentation for any work type must be communicated to coding supervisor. Contractor shall specify a contact person and phone number for the duration of the work. Contractor shall maintain daily communication with the Coding Supervisor or other designated medical center employee (i.e. team leader) regarding progress, workload status and/ or problems. Upon request of the Contracting Officer, Contractor shall remove any contract staff that do not comply with VAPICHS policies or meet the competency requirements for the work being performed. VAPIHCS will provide access to the Network for VISTA/CPRS, VISTA Imaging and Nuance CCM, VIP Workplace, and Clintegrity Encoder software for all contract coders. All applications will be accessed via Citrix, through VPN, for all remote coders. The Coding Supervisor or VA appointed designee may conduct data validation of the contractor on a monthly basis to confirm that contractual coding meets accuracy requirements. 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. QUALITY CONTROL PROCESS The contractor shall: Complete all encounters received via pull list or other mechanism within 5 days of provision of the complete medical record to the contractor. Completed workload shall be communicated back to the VAMC designee daily in order to keep our billing workflow moving. Alternate timetables are acceptable based on mutual agreement of the contractor and PIHCS. When the contractor cannot meet this deadline due to unforeseen circumstances, contractor shall notify VAPIHCS by the 4th business day after receipt. Perform on-going quality assessment of not less than 5% of all coded services and provide weekly results to VAPIHCS to ensure that the 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 VAPIHCS. Provide copies of results of the routine monitors to the Coding Supervisor on a weekly basis, with any time spent correcting errors made by contract staff provided at no additional cost to VAPIHCS. Results are to be tracked by coder to assure appropriate follow-up. Re-review any coded data where a question is found by VA during the pre-bill process or when a denial (usage of e-denials website) is received. Corrections shall be made or existing coding substantiated according to 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 standard VA CBI audit form during review processes and to report 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 Codes Secondary ICD Codes Include a maximum of 4 secondary ICD codes Modifiers Include the appropriate Resident Supervision Modifier GR as well as Modifiers 24, 25, 50, 51, 52, 53, 57, 58, 59, 78, and 79 in the denominator. Modifier 91 may be required for labs. Anesthesia modifiers in surgical cases and Medicare podiatry modifiers should be used as appropriate. For each element, document the correct number of codes (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: Codes that were coded but not supported in the documentation, the E/M level/or type of service (established, new or consult), violate an established coding guideline. Those CPT or diagnosis codes that should have been coded and were not and/or Unbundled codes. The contractor shall include all anticipated expenses for travel within the proposed cost for this contract. Contractor coding prices may be quoted per encounter or per hour. If per hour quote is given, contract coders will code, at a minimum, an average of 13 inpatient discharges without professional fees per 7.5 hour work day, 9 inpatient discharges with professional fees per 7.5 hour work day, or 10 outpatient encounters (including separated professional fees) per hour. Number of encounters coded will be included with the billing invoice in instances where an hourly rate is charged. Contractor shall include a price per encounter or per hour for data entering outpatient encounter information (including inpatient profession fees) into Vista s PCE package or in Nuance CCM software (non-coding). If per hour quote is given, contract coders will data enter at a minimum, an average of 30 outpatient encounters per hour. Number of encounters data entered will be included with the billing invoice in instances where an hourly rate is charged. Data entering encounters is described as creating a PCE record, inputting encounter information including ICD codes, CPT codes, clinic names, date and time of services, and provider name, and checking out the encounter so the encounter is closed and ready to transmit. The contractor shall agree that all deliverables, associated working papers, and other material deemed relevant by the contractor in the performance of this task order are the property of the United States Government. The contractor shall agree that all individually identifiable health records will be treated with the strictest confidentiality. Access to records shall be limited to essential personnel only. Records shall be secured when not in use. At the conclusion of the contract, all copies of individually identifiable health records shall be destroyed or returned to the VA. The contractor shall comply with the Privacy Act, 38 USC 5701, AND 38 USC 7332. Contractor staff shall sign confidentiality statements as required. Mandatory training requirement on VA privacy Act/HIPAA shall be completed. REQUIRED CODER KNOWLEDGE AND SKILLS Coder s performance requirements: Read and interpret health record documentation to identify all diagnosis and procedures that affect the current outpatient encounter visit, ancillary, inpatient admission/hospitalization, and inpatient professional services. Possess formal training in: anatomy and physiology, medical terminology, pathology and disease processes, pharmacology, health record format and content, reimbursement methodology, and conventions, rules and guidelines for current classification systems (ICD and CPT) Apply knowledge of current diagnostic coding and procedural reporting guidelines for outpatient services. Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT. Code in accordance with Correct Coding Initiative (CCI) edits guidelines (i.e., bundling versus unbundling). Use the Healthcare Common Procedural Coding System (HCPCS) codes, where appropriate. Documented information such as signs and symptoms characteristic of the diagnoses, finding from diagnostic studies or localized conditions that have no bearing on current management of the patient should not be coded. Possess training in and apply knowledge of what constitutes a service connected or special eligibility service when interpreting health record documentation Provide a list of coded records bi-weekly The coders will be working remotely from hone and/or at the Contractors Facility PERIOD OF PERFORMANCE The period of performances is a base plus four years. REQUIRED CODER EDUCATION AND EXPERIENCE Coders shall be credentialed and have completed accredited program for coding certification, accredited health information management or health information technician. A certified coder is someone credentialed by the: The American Health Information Management Association (AHIMA) and includes RHIA, RHIT, CCS, CCS-P, or American Association of Professional Coders (AAPC) as a CPC or CPC-H. 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. Contractor may place a local coder on-site in accordance with this contract.