Inactive

PERFORMANCE WORK STATEMENT Acq-Plan 36C245-22-AP-2958 Page 2 of 2 PERFORMANCE WORK STATEMENT MEDICAL CODING The Veterans Affairs VA Maryland Health Care System (VAMHCS) is a dynamic and progressive he... PERFORMANCE WORK STATEMENT Acq-Plan 36C245-22-AP-2958 Page 2 of 2 PERFORMANCE WORK STATEMENT MEDICAL CODING The Veterans Affairs VA Maryland Health Care System (VAMHCS) is a dynamic and progressive health care organization dedicated to providing quality, compassionate and accessible care, and service to Maryland s veterans. The Baltimore, Perry Point, and Loch Raven VA Medical Centers, and five community-based outpatient clinics, all work together to form this comprehensive health care delivery system. Nationally recognized for its outstanding patient safety and state-of-the-art technology, the VA Maryland Health Care System is proud of its reputation as a leader in veterans health care, research, and education. The health care system is known for providing comprehensive service to veterans across the state, including medical, surgical, rehabilitative, neurological, primary, mental health and long-term care on both an inpatient and outpatient basis. To ensure the provision of quality patient care, the health care system employs approximately 3,000 professional, technical, administrative and support personnel who work together to meet the needs of Maryland s veterans. This staff is reinforced by over 1,300 community volunteers who donate more than 120,000 hours of service a year to supplement the care and compassion provided to hospitalized veterans throughout the state. As a leader in education, the VA Maryland Health Care System prides itself on an active affiliation with the University of Maryland School of Medicine and other local colleges and universities. Over 1,000 residents, interns and students from various disciplines are trained throughout the health care system each year. Additionally, most of the physicians who work for the VA Maryland Health Care System hold dual appointments at the University of Maryland School of Medicine. This close alliance allows the health care system to offer veterans the latest clinical practices and procedures available. The VAMHCS is committed to provide quality care for our patients. Medical coding is a key component of quality care and we are committed to ensure that every medical record is coded accurate, timely, and reflect the scope of services provided. APPLICABLE DOCUMENTS In the performance of the tasks associated with this Performance Work Statement (PWS), the contractor shall comply with all applicable guidance, including: 5 U.S.C. § 552a, as amended, "The Privacy Act of 1974" VHA Handbook 1907.01, Health Information Management and Health Records VHA Handbook 1907.03, Health Information Management Clinical Coding Program Procedures VA Handbook 0710, Personnel Suitability and Security Program, September 10, 2004, VA Directive and Handbook 6102, "Internet/Intranet Services," July 15, 2008 VA Directive 6500, VA Information Security Program," September 20, 2012. VA Handbook 6500.6, "Contract Security SCOPE OF WORK The scope of this task order is to obtain a full range of medical coding services. The contractor shall assign the current appropriate International Classification of Diseases; Common Procedural Terminology; and Healthcare Common Procedural Coding System codes based on health record documentation of outpatient, surgical, inpatient care, and services provided at or under the auspices of the VAMHCS or sister facilities, to include all Community Based Outpatient Clinics, or care provided by non-VA organizations under the auspices of the VA. The contractor shall code Outpatient Encounters including Radiology, Lab or other Ancillary Services, Surgical to include pathology and anesthesia services, Inpatient Professional Services; and Inpatient Episodes/Admission Services; shall include required encoder/ Veterans Health Information Systems and Technology Architecture data elements in accordance with Veterans Health Administration Handbooks. Other identified cases to be coded include but not limited to: Veteran Tortfeasor Claims; Veteran Workers Compensation, Humanitarians, beneficiaries of the Military Health System (TRICARE is the healthcare program servicing military beneficiaries), Civilian Health and Medical Program of the Department of Veterans Affairs, Ineligibles, Fugitive Felon, Prosthetics, non-Veterans Affairs Fee Services, and New Insurance/Late Checkout. PERIOD AND PLACE OF PERFORMANCE The period of performance (POP) shall be one (1) twelve (12) month base period, and three (3) four (12) month option periods. Contractor shall work virtually from the contractor s location. Contractor shall be available Monday through Friday 07:30 AM - 4:30 PM EST, excluding all Federal holidays, after hours and weekends unless necessary for the successful completion of the projects. There is ten (10) Federal holidays set by law (USC Title 5 Section 6103) that the VA follows: Under current definitions, four are set by date: HOLIDAY DATE New Year s Day January 1 Juneteenth June 19 Independence Day July 4 Veterans Day November 11 Christmas Day December 25 If any of the above falls on a Saturday, then Friday shall be observed as a holiday. Similarly, if one falls on a Sunday, then Monday shall be observed as a holiday. The other six are set by a day of the week and month: HOLIDAY DATE MLK Day 3rd Monday in January POTUS Washington s B-day 3rd Monday in February Memorial Day Last Monday in May Labor Day 1st Monday in September Columbus Day, Discoverer s Day or Indigenous Peoples Day 2nd Monday in October Thanksgiving Day 4th Thursday in November TRAVEL Travel to the place of performance shall be priced within each task and not reimbursed separately. WORK SITUATION The VAMHCS accomplishes medical coding through VA Employees, and two contract companies that provide services as described in this PWS. The work is coordinated by a Program Manager (VA Employee). The number of hours worked by each contractor will range between 2,080 hours to 10,400 hours per year. SPECIFIC TASKS AND DELIVERABLES Services performed shall be of a non-personal nature. VA organizations will not provide supervision of contractor personnel. Contractor personnel shall at no time allow an employer-employee relationship to develop with VA organizations or their staff and VA organizations will refrain from any activities that create the appearance of such a relationship. Contractors shall not perform inherently governmental functions including decision-making, supervision of government employees, supervision of contractors on other contracts and activities that create the appearance of performing such functions. The Contractor shall provide all deliverables in Microsoft Office formats, unless otherwise specified by the Government. CONTRACTOR PROJECT MANAGEMENT PLAN (CPMP) The contractor shall deliver a CPMP that lays out the contractor s approach, timeline, and tools to be used in execution of this effort. The CPMP shall take the form of both a narrative and graphic format that will display the schedule, milestones, risks, and resource support. The CPMP shall also include how the contractor shall coordinate and execute planned, routine, and ad hoc data collection reporting requests as identified within the PWS. The CPMP shall be updated as needed throughout the period of performance (PoP). Deliverable: Contractor Project Management Plan (CPMP) MEDICAL CODING SERVICES The contractor shall: Assign the current appropriate industry standard codes after careful review of the Health Record documentation for inpatient, outpatient, surgeries, procedures, and ancillary encounters/services. Assign ICD-10 CM/PCS codes upon implementation. Furnish validation of the integrity, quality, and assignment of codes to the data contained in the outpatient Patient Care Encounter, inpatient Patient Treatment File, and non-Veterans Affairs episodes of care under Veterans Affairs auspices. The latest United States editions of the International Classification of Diseases, Current Medical Information and Terminology, of the American Medical Association and the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association shall be used to provide uniform disease and operation terminology, which is complete and scientifically accurate. Code assignment shall be in accordance with National Center for Health Statistics, Centers for Medicare and Medicaid Services, American Hospital Association, American Medical Association and American Psychiatric Association guidelines, as appropriate. On those occasions when there is a question, Veterans Health Administration Coding Guidelines take precedence. Local policies will direct how coding is accomplished and what quantitative and/or qualitative reviews are performed by the facility. The American Hospital Association Coding Clinic and other publications may be used for training and reference purposes. Ensure that the contractor s coders providing services through this contract use the facility s national Veterans Affairs encoder product. All coding must be completed through the encoder product. The national Veterans Affairs encoder is a single transparent interface with the Veteran Affairs electronic health record system Veterans Health Information Systems and Technology Architecture and the Graphical User Interface version of Veterans Health Information Systems and Technology Architecture. All coding is required to be done via the national Veterans Affairs encoder; no other system shall be used or interfaced with the Veterans Affairs systems, unless directed by the COR. Contractor shall be responsible for running the Code Me Report in the Nuance Clintegrity software package, as needed. Contractor will pull the Code Me Report, as instructed by the Coding Supervisor. All items on the report should include all visits that were downloaded and assigned to the contractor from the Nuance Clintegrity package. Coders will review medical notes to determine what codes are to be included on the record. 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. The contractor shall adhere to all coding guidelines as approved by the Cooperating Parties (American Hospital Association, American Health Information Management Association, Centers for Medicare and Medicaid Services, and the National Center for Health Statistics), as mandated by Health Insurance Portability and Accountability Act and accepted Veterans Affairs regulations, including the following applicable documents: The Official Guidelines and Reporting as found in the Common Procedural Terminology Assistant, a publication of the American Medical Association for reporting outpatient ambulatory procedures and evaluation and management services, The current Official Guidelines for Coding and Reporting in the Coding Clinic for International Classification of Diseases, a publication of the American Hospital Association, and The current Veterans Health Administration guidelines for coding as found in the Veterans Health Administration Health Information Management Coding Guidelines, Health Information Management, and Department of Veterans Affairs. This workbook is updated at least once per year with new codes and guidance. The contractor must ensure that they have the current version and the guidance is followed. Note: While Veterans Health Administration does ask for reimbursement from third party payers, the Veterans Health Administration 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 is coded correctly. The Correct Coding Initiative the Common Procedural Terminology Evaluation and Management codes assure documentation substantiates the code level assigned. Veterans Health Administration Directive 2009-002 Patient Care Data Capture: http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1821 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 Veterans Health Administration Handbook 1907.03 Health Information Management Clinical Coding Program Procedures: http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2794 Veterans Health Administration Handbook 1907.01 Health Information Management http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 Veterans Health Administration Directive 2011-025 Closeout of Veterans Health Administration Corporate Patient Data Files including Quarterly Patient Census: http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2419 Other directives that Veterans Affairs may issue from time to time. All written deliverables will be phrased in layperson language. Statistical and other technical terminology will not be used without providing a glossary of terms. Upon request of the Contracting Officer, the contractor shall remove any contractor staff that do not comply with Veterans Health Administration policies or meet the competency requirements for the work being performed. The 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. 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. Communication: 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. The contractor shall maintain weekly communication with the Contracting Officer s Representative or other designee (i.e., coding supervisor/team leader) regarding progress, workload status and/or problems. The contractor shall make every effort to ensure that issues raised by the local facility are addressed within the timeframe specified to in the task order or agreed to with the facility Contracting Officer s Representative. The contractor shall ensure that communications that contain Personally Identifiable Information, Personal Health Information and/or individually identifiable health information/record are encrypted to prevent inappropriate/unauthorized access or disclosure. The Veterans Affairs facility Contracting Officer s Representative will advise the contractor of the encryption to be used. Contract coders shall code in accordance with all Common Procedural Terminology / Common Procedural Coding Systems coding rules such as Correct Coding Initiative Bundling Guidelines, and use the Healthcare Common Procedural Coding Systems, level II codes, where appropriate. Contract coders shall exclude coding information such as symptoms or signs characteristic of the diagnoses, findings from diagnostic studies, or localized conditions, which have no bearing on current management of the patient or as appropriate. Contract coders shall clarify conflicting, ambiguous, or non-specific information appearing in the record by consulting with their supervisor, if necessary, discuss with the local Veterans Affairs contact. The contractor shall code using the appropriate Common Procedural Terminology for inpatient professional services or nursing home professional services as well as the proper current International Classification of Diseases codes for all diagnoses. The contractor shall abstract other identified data items and enter the data into the local Veterans Health Information Systems and Technology Architecture system, encoder program, or write the information on source documents as agreed with the COR or designee. This information shall include a decision as to whether or not an encounter is billable, based on non- compliance with documentation and resident supervision guidelines. Coders will utilize the Case Comment communication tool to provide billing staff with a standardized reason (case comment) why they believe an outpatient encounter cannot be billed. Encounters believed to be not billable will be marked with the appropriate Case Comment. Case Comments may include but is not limited to Agent Orange exposure or Ionizing Radiation, telephone care, non-billable provider, insufficient documentation, or other types of care that cannot be billed. Contractor shall be available to answer any follow up questions regarding the episode and provide references in support of their code selection. Contractor will also record episodes as required. If requested by the facility, the contractor may place a local coder on-site if available when the coder lives in the area of a Veterans Affairs facility requesting work. No travel costs will be charged in this scenario. The contractor shall ensure that individual coders are clearly identified on all work; any paper documents shall clearly identify the individual coder. 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. Quality Control and Performance Metrics: The contractor is responsible for continuous quality control of their own work product using quality control methods such as auditing. Coding accuracy will be determined by the number of correct codes compared to total number of codes, correct Diagnosis Related Group assignment, and correct review and data entry of identified data items. The contractor must maintain a 95% accuracy level. Failure to meet the required level of accuracy may result in cancellation of this contract. The designated contacts for the facility and the contractor will discuss any questions regarding coding or expected work. The contractor shall have in place the following Coding Quality Control/Performance Process whereby the contractor shall: Meet the expected turnaround time as stated below or as included on the task order. Work is considered completed when it is received back at the Veterans Affairs facility with data entry done via the encoder or the documentation is at the Veterans Affairs facility. The contractor must perform on-going quality assessments of not less than 5% of all coded data elements and provide weekly results to the Veterans Affairs facility Contracting Officer s Representative to ensure that the 95% accuracy rate is met. The 5% shall be picked utilizing consistent random sampling methods. The contractor shall track results by coder to assure appropriate follow-up to codes that need to be corrected. Coding errors are to be corrected within 24 hours of identification at no additional cost to the Government. The contractor shall monitor to ensure that the 95% quality standard is met on an on-going basis. If monitoring demonstrates that work has fallen below the quality standard, the contractor must develop a corrective action plan and include it with the weekly report to the Contracting Officer s Representative. Contractor shall review any coded data when questioned by VHA 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. Changes to the coding data must be in writing. Required corrections shall be made at no additional cost to the Government. All workload assigned to the contractor shall be completed within three (3) calendar days of the assigned date. The contractor s productivity shall be at a minimum: Code nine (9) outpatient encounters per one (1) hour billed Code nine (9) code 9 inpatient records with professional fees or twelve (12) inpatient records without professional fees per eight (8) hours billed. Code and close twenty-five (25) surgery cases per eight (8) hours billed Deliverables: TABLE OF DELIVERABLES Deliverable # Deliverable Description QTY Unit Due Date 1 Contractor Project Management Plan (CPMP) 1 1 Upon submission 2 Monthly status report 52 EA To start after 5 days of kick-off Minimum Qualification of the Medical Coders The contractor shall provide experienced, competent, credentialed personnel to perform coding and/or auditing activities. A. Contract coders shall be certified as a Professional Coder or equivalent and must have a minimum of two years of inpatient, surgery, and/or outpatient coding experience. PERFORMANCE METRICS The Government will utilize a Quality Assurance Surveillance Plan (QASP) throughout the life of the POP to ensure that the Contractor is performing the services required by this PWS in an acceptable manner. The Government reserves the right to alter or change the QASP at its own discretion. A Performance Based Service Assessment Survey will be used in combination with the QASP to assist the Government in determining acceptable performance levels. The COR will determine if the performance of the Contractor is below a metric standard and deem it unacceptable. The COR will then notify the Contracting Officer. The table below defines the Performance Metrics associated with this effort. PERFORMANCE METRICS CHART Performance Objective Performance Standard Acceptable Performance Levels Disincentive A. Quality of deliverables 1. Shows understanding of requirements Satisfactory or higher Performance documented in CPARS 2. Efficient and effective in meeting requirements 3. Meets technical needs and mission requirements 4. Offers quality services/products B. Timeliness of deliverables 1. Quick response capability Satisfactory or higher 2. Products completed, reviewed, delivered in timely manner Performance documented in CPARS 3. Notifies customer in advance of potential problems C. Project Staffing 1. Expertise of Contractor staff Satisfactory or higher Performance documented in CPARS 2. Personnel possess necessary knowledge, skills, and abilities to perform tasks Personnel and Time The contractor shall provide qualified Medical Coders for tasks indicated within this PWS. Normal working hours are 8:00 AM to 4:30 PM, Monday through Friday except Federal Holidays. There will be times when performance of tasks will be required earlier or later in the day to accommodate the various work shifts of the Medical Center and construction operations. Daily time will be kept via time sheets that contract individuals complete daily and provide to the COR. Vacation days of the support personnel need to be coordinated with the COR. In the case of absences greater than one week the contractor may be required to provide back-fill as the requirement of the contract is 80 hours per week. Contractor should have a pre-designated back- up individual with the proper clearances to provide support in the event of a scheduled or unscheduled absence. Individuals must be US citizens, speak English fluently and understandably, and be able to communicate effectively in English. Individuals will be required to complete security questionnaires and have a favorable result to be able to work on the contract. Work attire is business casual and may be adjusted based on the work to be accomplished. Business casual includes khaki slacks, cargo pocket trousers, polo shirt without emblems, dress, or casual shirts. The wearing of hats (baseball style) is not permitted. Footwear shall be appropriate for office setting. Contractor shall provide the name of a Program Manager (Lead) responsible for the performance of the work. The individual should have full authority to act for the contractor on all matters relating to daily operations of this contract. The Contractor shall designate this person in writing to the COR before the contract start date. All contact information must be provided (telephone numbers, email address, etc.). Government Furnished Property & Services The VA shall provide normal office administrative support services, which require the use of telephones, computers, and utilities. However, the VA shall NOT provide the equipment. Presentation of Tasks for Billing/Invoicing Contractor will bill per month with total hours worked and hourly rate. The Contractor shall provide the daily timesheet and a list of detailed activities and accomplishments as back up documentation with the submission of all invoices. VA payments of invoices always are paid in arrears. ***ANY QUESTIONS SHOULD BE DIRECTED TO AMY.WALTER1@VA.GOV, NCO5 CONTRACTING***

Inactive

*SOURCES SOUGHT ANNOUNCEMENT* Reference #36C24523Q0074 THIS IS A SOURCES SOUGHT ANNOUNCEMENT. IT IS FOR INFORMATION & PLANNING PURPOSES ONLY; IT IS NEITHER A SOLICITATION ANNOUNCEMENT NOR A REQUEST FO... *SOURCES SOUGHT ANNOUNCEMENT* Reference #36C24523Q0074 THIS IS A SOURCES SOUGHT ANNOUNCEMENT. IT 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. ALL RESPONSES ARE DUE 10/31/2022 BY 9:00 AM EST RESPONSES TO THIS NOTICE SHALL INCLUDE THE FOLLOWING (NOTICE***IF YOU FAIL TO INCLUDE THIS INFORMATION, YOUR COMPANY WILL NOT RECEIVE CONSIDERATION FOR THIS REQUEST FOR INFORMATION***): Responses to this Sources Sought should include company name, address, point of contact, phone number, point of contact e-mail, DUNS Number, Cage Code, size of business pursuant to North American Industrial Classification System (NAICS) 561410, Product Service Code (PSC) R408, (size standard of $8M). Respondents shall also answer the following questions: 1. Size status and representations of your business, such as but not limited to: Service-Disabled Veteran Owned Small Business (SDVOSB), Veteran Owned Small Business (VOSB), HUBZone, Woman Owned Small Business (WOSB), Small Business (SB), Large Business, etc. 2. Is your company considered small under the NAICS code identified under this Source Sought? 3. Is your company the manufacturer, distributor, or equivalent source for the type of items required with the characteristics referenced above? 4. If your company is a large business, do you have any authorized distributors? If so, please provide the name(s), telephone Number(s), Point(s) of Contact and size status of the businesses authorized to distribute your products. 5. Does your company have an FSS contract with GSA or the VA NAC or a GWAC contract holder with any other federal agency? If so, please provide the contract number. 6. If your company holds a FSS GSA/VA NAC contract other federal GWAC contract holder, are the items you are providing information on available on your schedule/contract? 7. General pricing of your products is encouraged. Pricing shall be used for the purpose of market research only. It shall not be used to evaluate for any type of award. Information provided by potential sources shall be utilized by the Government to determine market availability and procurement strategy. An award of a contract shall not result from this Sources Sought Notice. Vendors who can meet the requirements listed above SHALL provide the following information: Business Name Business Address DUNS NUMBER SAMS NUMBER Business Point of Contact, including phone number and email address Business size Business Socioeconomic Status Federal Supply Scheduling (FSS) number, if the items required by the Government are available for purchase on an FSS contract. Any other pertinent capability information that relates to the above stated requirement. DISCLAIMER This RFI is issued solely for information and planning purposes only and does not constitute a solicitation. All information received in response to this RFI that is marked as proprietary will be handled accordingly. In accordance with FAR 15.201(e), 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 RFI. PERFORMANCE WORK STATEMENT Acq-Plan 36C245-22-AP-2958 Page 20 of 20 PERFORMANCE WORK STATEMENT MEDICAL CODING The Veterans Affairs VA Maryland Health Care System (VAMHCS) is a dynamic and progressive health care organization dedicated to providing quality, compassionate and accessible care, and service to Maryland s veterans. The Baltimore, Perry Point, and Loch Raven VA Medical Centers, and five community-based outpatient clinics, all work together to form this comprehensive health care delivery system. Nationally recognized for its outstanding patient safety and state-of-the-art technology, the VA Maryland Health Care System is proud of its reputation as a leader in veterans health care, research, and education. The health care system is known for providing comprehensive service to veterans across the state, including medical, surgical, rehabilitative, neurological, primary, mental health and long-term care on both an inpatient and outpatient basis. To ensure the provision of quality patient care, the health care system employs approximately 3,000 professional, technical, administrative and support personnel who work together to meet the needs of Maryland s veterans. This staff is reinforced by over 1,300 community volunteers who donate more than 120,000 hours of service a year to supplement the care and compassion provided to hospitalized veterans throughout the state. As a leader in education, the VA Maryland Health Care System prides itself on an active affiliation with the University of Maryland School of Medicine and other local colleges and universities. Over 1,000 residents, interns and students from various disciplines are trained throughout the health care system each year. Additionally, most of the physicians who work for the VA Maryland Health Care System hold dual appointments at the University of Maryland School of Medicine. This close alliance allows the health care system to offer veterans the latest clinical practices and procedures available. The VAMHCS is committed to provide quality care for our patients. Medical coding is a key component of quality care and we are committed to ensure that every medical record is coded accurate, timely, and reflect the scope of services provided. APPLICABLE DOCUMENTS In the performance of the tasks associated with this Performance Work Statement (PWS), the contractor shall comply with all applicable guidance, including: 5 U.S.C. § 552a, as amended, "The Privacy Act of 1974" VHA Handbook 1907.01, Health Information Management and Health Records VHA Handbook 1907.03, Health Information Management Clinical Coding Program Procedures VA Handbook 0710, Personnel Suitability and Security Program, September 10, 2004, VA Directive and Handbook 6102, "Internet/Intranet Services," July 15, 2008 VA Directive 6500, VA Information Security Program," September 20, 2012. VA Handbook 6500.6, "Contract Security SCOPE OF WORK The scope of this task order is to obtain a full range of medical coding services. The contractor shall assign the current appropriate International Classification of Diseases; Common Procedural Terminology; and Healthcare Common Procedural Coding System codes based on health record documentation of outpatient, surgical, inpatient care, and services provided at or under the auspices of the VAMHCS or sister facilities, to include all Community Based Outpatient Clinics, or care provided by non-VA organizations under the auspices of the VA. The contractor shall code Outpatient Encounters including Radiology, Lab or other Ancillary Services, Surgical to include pathology and anesthesia services, Inpatient Professional Services; and Inpatient Episodes/Admission Services; shall include required encoder/ Veterans Health Information Systems and Technology Architecture data elements in accordance with Veterans Health Administration Handbooks. Other identified cases to be coded include but not limited to: Veteran Tortfeasor Claims; Veteran Workers Compensation, Humanitarians, beneficiaries of the Military Health System (TRICARE is the healthcare program servicing military beneficiaries), Civilian Health and Medical Program of the Department of Veterans Affairs, Ineligibles, Fugitive Felon, Prosthetics, non-Veterans Affairs Fee Services, and New Insurance/Late Checkout. PERIOD AND PLACE OF PERFORMANCE The period of performance (POP) shall be one (1) twelve (12) month base period, and three (3) twelve (12) month option periods. Contractor shall work virtually from the contractor s location. Contractor shall be available Monday through Friday 07:30 AM - 4:30 PM EST, excluding all Federal holidays, after hours and weekends unless necessary for the successful completion of the projects. There is ten (10) Federal holidays set by law (USC Title 5 Section 6103) that the VA follows: Under current definitions, four are set by date: HOLIDAY DATE New Year s Day January 1 Juneteenth June 19 Independence Day July 4 Veterans Day November 11 Christmas Day December 25 If any of the above falls on a Saturday, then Friday shall be observed as a holiday. Similarly, if one falls on a Sunday, then Monday shall be observed as a holiday. The other six are set by a day of the week and month: HOLIDAY DATE MLK Day 3rd Monday in January POTUS Washington s B-day 3rd Monday in February Memorial Day Last Monday in May Labor Day 1st Monday in September Columbus Day, Discoverer s Day or Indigenous Peoples Day 2nd Monday in October Thanksgiving Day 4th Thursday in November TRAVEL Travel to the place of performance shall be priced within each task and not reimbursed separately. WORK SITUATION The VAMHCS accomplishes medical coding through VA Employees, and two contract companies that provide services as described in this PWS. The work is coordinated by a Program Manager (VA Employee). The number of hours worked by each contractor will range between 2,080 hours to 10,400 hours per year. SPECIFIC TASKS AND DELIVERABLES Services performed shall be of a non-personal nature. VA organizations will not provide supervision of contractor personnel. Contractor personnel shall at no time allow an employer-employee relationship to develop with VA organizations or their staff and VA organizations will refrain from any activities that create the appearance of such a relationship. Contractors shall not perform inherently governmental functions including decision-making, supervision of government employees, supervision of contractors on other contracts and activities that create the appearance of performing such functions. The Contractor shall provide all deliverables in Microsoft Office formats, unless otherwise specified by the Government. CONTRACTOR PROJECT MANAGEMENT PLAN (CPMP) The contractor shall deliver a CPMP that lays out the contractor s approach, timeline, and tools to be used in execution of this effort. The CPMP shall take the form of both a narrative and graphic format that will display the schedule, milestones, risks, and resource support. The CPMP shall also include how the contractor shall coordinate and execute planned, routine, and ad hoc data collection reporting requests as identified within the PWS. The CPMP shall be updated as needed throughout the period of performance (PoP). Deliverable: Contractor Project Management Plan (CPMP) MEDICAL CODING SERVICES The contractor shall: Assign the current appropriate industry standard codes after careful review of the Health Record documentation for inpatient, outpatient, surgeries, procedures, and ancillary encounters/services. Assign ICD-10 CM/PCS codes upon implementation. Furnish validation of the integrity, quality, and assignment of codes to the data contained in the outpatient Patient Care Encounter, inpatient Patient Treatment File, and non-Veterans Affairs episodes of care under Veterans Affairs auspices. The latest United States editions of the International Classification of Diseases, Current Medical Information and Terminology, of the American Medical Association and the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association shall be used to provide uniform disease and operation terminology, which is complete and scientifically accurate. Code assignment shall be in accordance with National Center for Health Statistics, Centers for Medicare and Medicaid Services, American Hospital Association, American Medical Association and American Psychiatric Association guidelines, as appropriate. On those occasions when there is a question, Veterans Health Administration Coding Guidelines take precedence. Local policies will direct how coding is accomplished and what quantitative and/or qualitative reviews are performed by the facility. The American Hospital Association Coding Clinic and other publications may be used for training and reference purposes. Ensure that the contractor s coders providing services through this contract use the facility s national Veterans Affairs encoder product. All coding must be completed through the encoder product. The national Veterans Affairs encoder is a single transparent interface with the Veteran Affairs electronic health record system Veterans Health Information Systems and Technology Architecture and the Graphical User Interface version of Veterans Health Information Systems and Technology Architecture. All coding is required to be done via the national Veterans Affairs encoder; no other system shall be used or interfaced with the Veterans Affairs systems, unless directed by the COR. Contractor shall be responsible for running the Code Me Report in the Nuance Clintegrity software package, as needed. Contractor will pull the Code Me Report, as instructed by the Coding Supervisor. All items on the report should include all visits that were downloaded and assigned to the contractor from the Nuance Clintegrity package. Coders will review medical notes to determine what codes are to be included on the record. 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. The contractor shall adhere to all coding guidelines as approved by the Cooperating Parties (American Hospital Association, American Health Information Management Association, Centers for Medicare and Medicaid Services, and the National Center for Health Statistics), as mandated by Health Insurance Portability and Accountability Act and accepted Veterans Affairs regulations, including the following applicable documents: The Official Guidelines and Reporting as found in the Common Procedural Terminology Assistant, a publication of the American Medical Association for reporting outpatient ambulatory procedures and evaluation and management services, The current Official Guidelines for Coding and Reporting in the Coding Clinic for International Classification of Diseases, a publication of the American Hospital Association, and The current Veterans Health Administration guidelines for coding as found in the Veterans Health Administration Health Information Management Coding Guidelines, Health Information Management, and Department of Veterans Affairs. This workbook is updated at least once per year with new codes and guidance. The contractor must ensure that they have the current version and the guidance is followed. Note: While Veterans Health Administration does ask for reimbursement from third party payers, the Veterans Health Administration 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 is coded correctly. The Correct Coding Initiative the Common Procedural Terminology Evaluation and Management codes assure documentation substantiates the code level assigned. Veterans Health Administration Directive 2009-002 Patient Care Data Capture: http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1821 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 Veterans Health Administration Handbook 1907.03 Health Information Management Clinical Coding Program Procedures: http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2794 Veterans Health Administration Handbook 1907.01 Health Information Management http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2791 Veterans Health Administration Directive 2011-025 Closeout of Veterans Health Administration Corporate Patient Data Files including Quarterly Patient Census: http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2419 Other directives that Veterans Affairs may issue from time to time. All written deliverables will be phrased in layperson language. Statistical and other technical terminology will not be used without providing a glossary of terms. Upon request of the Contracting Officer, the contractor shall remove any contractor staff that do not comply with Veterans Health Administration policies or meet the competency requirements for the work being performed. The 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. 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. Communication: 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. The contractor shall maintain weekly communication with the Contracting Officer s Representative or other designee (i.e., coding supervisor/team leader) regarding progress, workload status and/or problems. The contractor shall make every effort to ensure that issues raised by the local facility are addressed within the timeframe specified to in the task order or agreed to with the facility Contracting Officer s Representative. The contractor shall ensure that communications that contain Personally Identifiable Information, Personal Health Information and/or individually identifiable health information/record are encrypted to prevent inappropriate/unauthorized access or disclosure. The Veterans Affairs facility Contracting Officer s Representative will advise the contractor of the encryption to be used. Contract coders shall code in accordance with all Common Procedural Terminology / Common Procedural Coding Systems coding rules such as Correct Coding Initiative Bundling Guidelines, and use the Healthcare Common Procedural Coding Systems, level II codes, where appropriate. Contract coders shall exclude coding information such as symptoms or signs characteristic of the diagnoses, findings from diagnostic studies, or localized conditions, which have no bearing on current management of the patient or as appropriate. Contract coders shall clarify conflicting, ambiguous, or non-specific information appearing in the record by consulting with their supervisor, if necessary, discuss with the local Veterans Affairs contact. The contractor shall code using the appropriate Common Procedural Terminology for inpatient professional services or nursing home professional services as well as the proper current International Classification of Diseases codes for all diagnoses. The contractor shall abstract other identified data items and enter the data into the local Veterans Health Information Systems and Technology Architecture system, encoder program, or write the information on source documents as agreed with the COR or designee. This information shall include a decision as to whether or not an encounter is billable, based on non- compliance with documentation and resident supervision guidelines. Coders will utilize the Case Comment communication tool to provide billing staff with a standardized reason (case comment) why they believe an outpatient encounter cannot be billed. Encounters believed to be not billable will be marked with the appropriate Case Comment. Case Comments may include but is not limited to Agent Orange exposure or Ionizing Radiation, telephone care, non-billable provider, insufficient documentation, or other types of care that cannot be billed. Contractor shall be available to answer any follow up questions regarding the episode and provide references in support of their code selection. Contractor will also record episodes as required. If requested by the facility, the contractor may place a local coder on-site if available when the coder lives in the area of a Veterans Affairs facility requesting work. No travel costs will be charged in this scenario. The contractor shall ensure that individual coders are clearly identified on all work; any paper documents shall clearly identify the individual coder. 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. Quality Control and Performance Metrics: The contractor is responsible for continuous quality control of their own work product using quality control methods such as auditing. Coding accuracy will be determined by the number of correct codes compared to total number of codes, correct Diagnosis Related Group assignment, and correct review and data entry of identified data items. The contractor must maintain a 95% accuracy level. Failure to meet the required level of accuracy may result in cancellation of this contract. The designated contacts for the facility and the contractor will discuss any questions regarding coding or expected work. The contractor shall have in place the following Coding Quality Control/Performance Process whereby the contractor shall: Meet the expected turnaround time as stated below or as included on the task order. Work is considered completed when it is received back at the Veterans Affairs facility with data entry done via the encoder or the documentation is at the Veterans Affairs facility. The contractor must perform on-going quality assessments of not less than 5% of all coded data elements and provide weekly results to the Veterans Affairs facility Contracting Officer s Representative to ensure that the 95% accuracy rate is met. The 5% shall be picked utilizing consistent random sampling methods. The contractor shall track results by coder to assure appropriate follow-up to codes that need to be corrected. Coding errors are to be corrected within 24 hours of identification at no additional cost to the Government. The contractor shall monitor to ensure that the 95% quality standard is met on an on-going basis. If monitoring demonstrates that work has fallen below the quality standard, the contractor must develop a corrective action plan and include it with the weekly report to the Contracting Officer s Representative. Contractor shall review any coded data when questioned by VHA 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. Changes to the coding data must be in writing. Required corrections shall be made at no additional cost to the Government. All workload assigned to the contractor shall be completed within three (3) calendar days of the assigned date. The contractor s productivity shall be at a minimum: Code nine (9) outpatient encounters per one (1) hour billed Code nine (9) code 9 inpatient records with professional fees or twelve (12) inpatient records without professional fees per eight (8) hours billed. Code and close twenty-five (25) surgery cases per eight (8) hours billed Deliverables: TABLE OF DELIVERABLES Deliverable # Deliverable Description QTY Unit Due Date 1 Contractor Project Management Plan (CPMP) 1 1 Upon submission 2 Monthly status report 52 EA To start after 5 days of kick-off Minimum Qualification of the Medical Coders The contractor shall provide experienced, competent, credentialed personnel to perform coding and/or auditing activities. A. Contract coders shall be certified as a Professional Coder or equivalent and must have a minimum of two years of inpatient, surgery, and/or outpatient coding experience. PERFORMANCE METRICS The Government will utilize a Quality Assurance Surveillance Plan (QASP) throughout the life of the POP to ensure that the Contractor is performing the services required by this PWS in an acceptable manner. The Government reserves the right to alter or change the QASP at its own discretion. A Performance Based Service Assessment Survey will be used in combination with the QASP to assist the Government in determining acceptable performance levels. The COR will determine if the performance of the Contractor is below a metric standard and deem it unacceptable. The COR will then notify the Contracting Officer. The table below defines the Performance Metrics associated with this effort. PERFORMANCE METRICS CHART Performance Objective Performance Standard Acceptable Performance Levels Disincentive A. Quality of deliverables 1. Shows understanding of requirements Satisfactory or higher Performance documented in CPARS 2. Efficient and effective in meeting requirements 3. Meets technical needs and mission requirements 4. Offers quality services/products B. Timeliness of deliverables 1. Quick response capability Satisfactory or higher 2. Products completed, reviewed, delivered in timely manner Performance documented in CPARS 3. Notifies customer in advance of potential problems C. Project Staffing 1. Expertise of Contractor staff Satisfactory or higher Performance documented in CPARS 2. Personnel possess necessary knowledge, skills, and abilities to perform tasks Personnel and Time The contractor shall provide qualified Medical Coders for tasks indicated within this PWS. Normal working hours are 8:00 AM to 4:30 PM, Monday through Friday except Federal Holidays. There will be times when performance of tasks will be required earlier or later in the day to accommodate the various work shifts of the Medical Center and construction operations. Daily time will be kept via time sheets that contract individuals complete daily and provide to the COR. Vacation days of the support personnel need to be coordinated with the COR. In the case of absences greater than one week the contractor may be required to provide back-fill as the requirement of the contract is 80 hours per week. Contractor should have a pre-designated back- up individual with the proper clearances to provide support in the event of a scheduled or unscheduled absence. Individuals must be US citizens, speak English fluently and understandably, and be able to communicate effectively in English. Individuals will be required to complete security questionnaires and have a favorable result to be able to work on the contract. Work attire is business casual and may be adjusted based on the work to be accomplished. Business casual includes khaki slacks, cargo pocket trousers, polo shirt without emblems, dress, or casual shirts. The wearing of hats (baseball style) is not permitted. Footwear shall be appropriate for office setting. Contractor shall provide the name of a Program Manager (Lead) responsible for the performance of the work. The individual should have full authority to act for the contractor on all matters relating to daily operations of this contract. The Contractor shall designate this person in writing to the COR before the contract start date. All contact information must be provided (telephone numbers, email address, etc.). Government Furnished Property & Services The VA shall provide normal office administrative support services, which require the use of telephones, computers, and utilities. However, the VA shall NOT provide the equipment. Presentation of Tasks for Billing/Invoicing Contractor will bill per month with total hours worked and hourly rate. The Contractor shall provide the daily timesheet and a list of detailed activities and accomplishments as back up documentation with the submission of all invoices. VA payments of invoices always are paid in arrears. ***ANY QUESTIONS SHOULD BE DIRECTED TO AMY.WALTER1@VA.GOV, NCO5 CONTRACTING***