Inactive

This is a SOURCES SOUGHT ANNOUNCEMENT ONLY The intent of this Sources Sought Announcement is to assist in our decision-making process for services procurement. This is not a solicitation, nor request ... This is a SOURCES SOUGHT ANNOUNCEMENT ONLY The intent of this Sources Sought Announcement is to assist in our decision-making process for services procurement. This is not a solicitation, nor request for quotes or proposals. Through the receipt of responses, this will enable a more precise type of procurement process. The Government is not obligated to, nor will it pay for or reimburse any costs associated with responding to this sources sought synopsis request. This notice shall not be construed as a commitment by the Government to issue a solicitation or ultimately award of a contract, nor does it restrict the Government to a particular acquisition approach. Any inquiries are to be made in writing by email to the point of contact, Larry Facio, Contracting Officer. Responses to this notice shall be sent by email to larry.facio@va.gov by the due date and time of 07/30/2025 by 1:00 p.m. (Pacific Time). Upon receipt of capabilities statement, Contracting Officer may request additional market research aid such as informal pricing. Description of Services: The Contractor shall: Assign the current appropriate industry standard codes after careful review of the Health Record documentation for all inpatient, outpatient, surgeries, procedures, and ancillary encounters/services. Furnish validation of the integrity, quality, and assignment of codes to the data contained in the national encoder product and EHR. The latest United States editions of the International Classification of Diseases, Current Procedural Terminology, Health Care Common Procedure System shall be used to provide uniform disease and operation terminology. Code assignment shall be in accordance with The Official Coding Guidelines (current year), published by the cooperating parties: National Center for Health Statistics, Centers for Medicare and Medicaid Services, American Hospital Association, American Medical Association and American Psychiatric Association guidelines. On those occasions when there is a question, Veterans Health Administration Coding Guidelines will take precedence. the absence of Official Coding Guidelines or VHA Coding guidance, local policies will direct how coding is accomplished. The American Hospital Association Coding Clinic and other publications may be used for training and reference purposes. Quantitative and/or qualitative reviews are required and must be performed by the facility. Ensure that the Contractor's coders providing services through this Blanket Purchase Agreement and subsequent task orders (herein referred to as Blanket Purchase Agreement) use the facility's national Veterans Affairs encoder product. 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 Current 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. These guidelines are updated at least once per year with new codes and guidance to delineate those situations where VHA may not follow the official coding guidelines. 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 according to official coding guidelines, except in such cases where VHA has determined differences are required. Internal Veterans Health Administration compliance audits use only this definition when determining if coding is accurate. The National Correct Coding Initiative (NCCI) will be applied to Current Procedural Terminology codes to ensure no unbundling has occurred. Veterans Health Administration Directive 1082 Patient Care Data Capture: http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub ID=3091 Veterans Health Administration Directive 1401 Billing for Services Provided by Supervising Practitioners and Physician Residents: http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub ID=3221 Veterans Health Administration Handbook 1400.01 Resident Supervision: https://www.va.gov/OPTOMETRY/docs/VHA Handbook 1400-01 Resident Supervision 12-19-2012.pdf Veterans Health Administration Health Information Management Clinical Coding Program Guide: https://vaww.vha.vaco.portal.va.gov/sites/HDI/HIM/vaco HIM/subsite5/subsite3/HIM%20Handbooks/Forms/HIM%20Document®20Library.aspx Veterans Health Administration Handbook 1907.01 Health Information Management and Health Records: http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088 Veterans Health Administration Directive 1233 Closeout of Veterans Health Administration Corporate Patient Data Files Including Quarterly Patient Census: http://vaww.va.gov/vhapublications/ViewPublication.asp?pub ID=5425 HIM and Consolidated Patient Accounts Centers (CPAC) Standard Operating Procedures: https://vaww.vha.vaco.portal.va.gov/sites/HDI/HIM/vaco_ HIM/subsite5/subsite3/Coding%20References/Forms/AllItems.aspx?RootFolder=%2Fsites%2FHDI%2FHIM%2Fvaco%5FHIM%2Fsubsite5%2Fsubsite3%2FCoding%20References%2FCoding%20Resources%2Fcpac&FolderCTID=0x01200078A544A04CD5274BA1F70B598C57B05D&View=%7B60252EDE%2D0E1F%2D4A0E%2D9C5C%2D02D9C06B32EE%7D Practice Brief Monitoring Coding Accuracy and Productivity: https://vaww.vha.vaco.portal.va.gov/sites/HDI/HIM/vaco HIM/subsite5/subsite3/Practice%20Briefs%20and%20Fact%20Sheets/Practice%20Brief%20Monitoring%20Coding%20Accuracy%20and%20Productivity%200ctober%202018%20Updated.docx 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 contract 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 (AHIMA) established code of ethical principles as stated in the Standards of Ethical Coding published by AHIMA. All coding and auditing activities shall be performed remotely and will reference Veterans Affairs' electronic health record documentation. 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, Current Procedural Terminology Assistant, Centers for Medicare and Medicaid Services/American Medical Association, Ambulatory Patient Classifications ) in a simulated Medicare payment environment. Task One - Coding Services: The Contractor shall use skills, training, and knowledge of International Classification of Diseases, Current Procedural Terminology, and Healthcare Common Procedure Coding System Level II code sets and guidelines and other generally accepted available resources to review health record documentation and providers' scope of practice to assign diagnostic and procedural codes at a minimum 95% accuracy rate and within required performance timelines. 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 as specified under each individual task order; shall include required encoder/HR data elements in accordance with Veterans Health Administration Handbooks, Guides and protocols as specifically outlined in the task order. 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. New Insurance/Late Check Out encounters may not have been coded due to new insurance identified or late check-out and were not identified in the daily coding reports. New Insurance/Late Check Out encounters shall be coded within the turnaround time stated in the local policy or approved by the facility task order Contracting Officer. The Contractor shall use the 1995 or 1997 Evaluation and Management guidelines as documented in the facility policy. Individual facilities may also require the Evaluation and Management calculator contained within the encoder software. Veterans Health Administration provides a wide variety of primary and specialty care services in the outpatient setting. Inpatient admissions include those for acute care/specialty care, observation, and admissions to the Community of Living nursing care, and domiciliary units to include non-Veterans Affairs Fee services. The Contractor shall abstract other identified data items and enter the data into the local EHR, encoder program, or write the information on source documents as agreed with the local facility. 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 national encoder product and EHR communication tools to provide billing staff with a standardized reason why they believe an outpatient encounter cannot be billed. Encounters believed to be not billable will be marked with the appropriate reason in the national encoder product/EHR. Reasons may include but are not limited to Agent Orange exposure or lonizing 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. The Contractor shall provide all labor, materials, transportation and supervision necessary to perform coding and abstracting using either the 1995 or 1997, per VA Medical Center policy, the Evaluation and Management guidelines on encounters and standard industry guidelines, e.g. Coding Clinics and Current Procedural Terminology Assistant, as specified by the Veterans Affairs Administration Center. The Contractor shall utilize Veterans Health Administration national encoder, industry standard guidelines, Veterans Health Administration and local policies, and other generally accepted contractor supplied reference materials to assign and/or validate diagnostic and procedural codes reflective of documentation. The Contractor shall utilize the standardized reasons in the encoder application to communicate specific document information to Billing. The Contractor shall utilize the national encoder product and EHR, if necessary, to reflect code changes and names(s) of provider(s). If requested by the facility, the Contractor may place a local coder on-site if available in accordance with the task order 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. When assigning multiple Current Procedural Terminology codes, the contractor shall verity that they are not components of a larger, more comprehensive procedure that can be described with a single code. The Contractor shall identify those encounters, if any, where documentation does not substantiate an appropriate code(s). The contractor shall identify duplicate encounters or encounters created in error because the patient was not seen. The Contractor shall code based on reading and reviewing the documentation in the electronic health record. The contractor shall complete data entry into the encoder as part of this Contract. Completion of source documents in lieu of using the national encoder product may be arranged only upon agreement between the facility task order Contracting Officer and the contractor for a contingency plan when the national encoder is down. The Contractor shall coordinate with the local Contracting Officer's Representative for implementation of contingency plans for data entry when required. The contractor shall assign modifiers as appropriate to override Correct Coding Initiative edits. For Inpatient Episodes/Admission Services: Accurately abstract inpatient information and enter into the national encoder minimizing national data acceptance errors and following facility policy for corrective action. Opening and transmitting inpatient episodes will follow local facility protocol. Accurately abstract inpatient information and enter into the national encoder minimizing national data acceptance errors and following facility policy for corrective action. Opening and transmitting inpatient episodes will follow local facility protocol. The Contractor shall review documentation to determine and provide additional information such as the referring providers name, stop and start times for anesthesia, etc. as outlined in SOP with CPAC in coding case comments. Accurately abstract inpatient information and enter into the national encoder minimizing national data acceptance errors and following facility policy for corrective action. Opening and transmitting inpatient episodes will follow local facility protocol. The Contractor shall review documentation to determine and provide additional information such as the referring providers name, stop and start times for anesthesia, etc. as outlined in SOP with CPAC in coding case comments. The Contractor shall re-review any coded data when questioned by Veterans Affairs staff and assigned to VHA HIM coding using appropriate status due to a billing edit, when a denial is received, or when a retrospective review is completed, 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 contractor shall use the following during re-review processes: 1. Those codes that were coded and not supported in the documentation, violate a coding rule 2. Those Current Procedural Terminology, Healthcare Common Procedure Coding System or International Classification of Diseases diagnosis codes that should have been coded and were not, 3. Inappropriate Current Procedural Terminology, Healthcare Common Procedure Coding System or International Classification of Diseases codes 4. Unbundled codes 5. Inaccurate Diagnosis Related Groups assignments 6. All other data elements incorrectly entered by the Contract coder, or not entered when appropriate, e.g. coder case comment, provider, adequacy of documentation. Note: All subsequent reviews completed after the initial review work will be forwarded to the contractor's designated contact person for resolution. The contractor along with the VA facility shall jointly determine a communication mechanism whereby the contractor shall access dailv unless otherwise indicated on the task order. Veterans Affairs reserves the right to validate all coding, audit results and/or accuracy statistics submitted. 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. Inpatient Facility coding: 1. All data must be accepted by Veterans Health Administration Corporate Data Warehouse within 5 calendar days from the date of patient discharge, including any error. corrections must be re-transmitted and accepted. The only exceptions are Patient Treatment File discharges from Contract or Community Nursing Home and non-Department of Veterans Affairs Purchased Care patient files. 2. Inpatient facility coding is performed on all inpatient episodes of care, to include Observation and non- Veterans Affairs care under Veterans Affairs auspices, regardless of billable status. Applicable coding guidelines will be followed. 3. A Present on Admission field entry is required for patients that are admitted to certain levels of care. The Present on Admission field is not required for Community Living Center and Domiciliary patients. The Present on Admission provides information on whether a diagnosis was present at the time of a patient's admission. The indicator is required to be assigned to all diagnosis codes involving inpatient admission. Each diagnosis, principal and secondary, and external causes of injury are required to have a Present on Admission indicator appended. 4. Non- Veterans Affairs purchased care coding utilizes the non-Veterans Affairs invoice, as well as submitted clinical documentation if received Inpatient Professional Encounters/Services coding: 1. Inpatient Professional Encounters/Services coding is to be completed within five (5) calendar days of the date coding is assigned 2. Identify and link Current Procedural Terminology/Healthcare Common Procedure Coding System and International Classification of Disease codes, identify the provider, and the date(s) of service. 3. Contractor may be required to create the Inpatient Professional Service encounter in the Patient Care Encounter application in order to code the service. Outpatient Coding: 1. All coding is to be completed within five (5) calendar days of the date coding is assigned. 2. Outpatient encounters include face-to-face encounters and other occasions of service that are captured within the Patient Care Encounter. These services are captured through completion of electronic encounter forms; review of documentation by qualified coding staff; and automated data capture. Assign or validate diagnostic and procedural codes reflective of documentation: correct outpatient encounter, if necessary, to reflect code changes and name(s) of provider(s). 3. Typically, outpatient coding does not require the coder to create encounters. Most outpatient encounters are initiated at the location of the visit, at time of patient check-in, and when the provider completes the visit at patient check-out and or completion of the encounter form. Surgery case coding to include anesthesia and pathology: 1. Surgical coding must be completed immediately after the procedure when possible and no later than one week from the date of surgery. 2. Surgery case coding includes the entry of coded procedures and diagnoses for all surgery cases. It is necessary to assign or validate diagnostic and procedural codes reflective of documentation for all cases in the surgery package. 3. Assign and enter the diagnostic codes and procedural codes with associated modifiers reflective of documentation using the encoder into the surgery package. 4. Anesthesiology visits for surgery performed in the Operation Room may require coders to create encounters for the services if they do not exist. 5. Instructions for surgery coding are contained in the official coding guidelines and the Veterans Health Administration Coding Guidelines. CC. Task One Deliverables: 1. Inpatient Facility Coding 2. Inpatient Professional Encounter/Services Coding 3. Outpatient Coding 4. Surgery case coding to include pathology and anesthesia services. Task Two - External Auditing Service: The facility task order will specify the period of performance for all audit services. External audits provide validation of the integrity, quality, and assignment of codes to the data contained in the national encoder product and EHR at each medical center as evidenced by proper documentation of the care or service provided to the patient External Audits of coded data will be performed on any of the Veterans Health Administration required coding activities (e.g., inpatient, outpatient, surgery). These audits will be performed separate from normal coding activities and will conform to the task order as developed by the site. These audits will address accuracy of coded data. health record documentation issues. to include recommended remediation of specific documentation deficiencies, process improvement and identify educational needs. Audit accuracy expectations are 95% and above. The contractor shall be responsible for reviewing all national coding guidelines, Veterans Health Administration Handbooks and Guides, Health Information Management Consolidated Patient Agreement Center Service Level Agreement, Veterans Health Administration Coding Guidelines, etc. as well as each facility's policies prior to commencement of an audit. References will be provided by the facility as needed, see referenced Practice Brief Monitoring Coding Accuracy and Productivity To ensure the review findings have value to the facility, the VHA standard reporting tool provided will be utilized for the audit. All reviews will utilize electronic auditing of the Computerized Health Record System whenever possible. Veterans Affairs and Non-Veterans Affairs records may be either scanned documents or hardcopy. The reviews will be conducted by remote data view and remote image view. Should the information not be contained in the EH, the medical center will overnight the documentation to the vendor. A detailed project plan may be requested by a facility should the audit require a significant level of effort and expertise. If the plan elements are not spelled out in the task order, the project plan at a minimum should include: 1. Specific timelines for completing the audit 2. Timeframe for the facility reports 3. Number of reviewers If a sample size or the number of records to be audited is not stated in the task order the contractor shall develop a sample size that assures a 95% confidence level of accuracy for each of the auditing tasks specified on the task order, and may include inpatient hospitalizations, outpatient visits, and non-Veterans Affairs records. The contractor shall submit with the proposal for each task order a detailed description of how they arrived at the sample size. At a minimum the sample size must include a review of the coding activities as specified on the task order and may include any or all of the following: 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 records. The facility may also provide a list of specific records to audit. Outpatient, Inpatient Professional, Surgery, and Inpatient facility Audits: 1. Audit includes Evaluation and Management, Current Procedural Terminology procedures, Healthcare Common Procedure Coding System and International Classification of Diseases diagnosis codes. Encounters/quarter are identified by billed episode and then audited against these three criteria. If the encounter does not have a Current Procedural Terminology code associated with the visit, then that data point is not audited. 2. Use the 1995 or 1997 Evaluation and Management guidelines as specified in the facility policy. Review the Evaluation & Management code to determine if correct and identify the reasons) if not. 3. Determine the accuracy and sequencing of the diagnoses coded and identify the reason(s) if not. 4. Determine the accuracy of Current Procedural Terminology/Healthcare Common Procedure Coding System codes and modifiers and the reason(s) if not accurate. 5. Inpatient review criteria may include: principal and secondary diagnosis code (accuracy, omission, etc.), Diagnosis Related Groups accuracy, correct Present on Admission assignment. 6. The Contractor shall have a methodology for resolving coding questions by reviewers and ensuring inter-reviewer consistency and reliability. 7. The contractor shall review findings with Chief, Health Information Management, facility Contracting Officer's Representative, management, and other designated medical center personnel. Any discrepancies identified during this process must be resolved prior to final written report. 8. The Contractor shall be responsible for conducting at a minimum an exit conference with management officials at the discretion of the medical center to be coordinated with the Contracting Officer's Representative at the facility. The Contractor shall provide a final written report to the facility Contracting Officer's Representative within 10 calendar days. The report will be prepared to allow use by medical center staff in re-reviews, education or to provide management updates Final report elements may be specified in the individual task order or developed with assistance from the facility Contracting Officer's Representative. Documentation of audit findings will be as requested by the facility and must include, at a minimum the record ID, breakdown of record type (i.e., outpatient, inpatient), breakdown by code (Current Procedural Terminology, International Classification of Diseases, Evaluation and Management, modifier, etc.) of total number of codes reviewed; number of correct codes, accuracy rate, Diagnosis Related Groups reviewed (#correct; accurate); any code changes/errors and reason/reference for error; identified weaknesses and recommendation for correction. Also include any documentation issues/deficiencies and recommendation for improvement/remediation. The Contractor shall document in writing all records reviewed and provide such documentation to the facility Contracting Officer's Representative with the final report. Education Plan: To be included in the audit process, weaknesses identified during the audit shall be used to provide a facility specific education/training plan, based on Veterans Health Administration coding and documentation regulations and guidelines, and local policy to present to Veterans Integrated Service Network/Veterans Affairs Medical Center management officials, physicians/clinicians, sub-specialties if needed, and for Veterans Health Administration coding staff to include any recommended remediation. Plan shall be submitted to the local Contracting Officer's Representative within seven (7) calendar days following the audit. Task Two Deliverables: 1. Project Plan with description of sample size determination 2. Audit: Inpatient facility (Diagnosis Related Group) coding 3. Audit: Inpatient professional encounter coding including surgery coding 4. Audit: Outpatient encounter/services coding 5. Report on audit results 6. Education Plan Task Three - Training Workshop: A. At the task order level, the Contractor shall provide, at a minimum, a two-hour educational session based on facility needs for Veterans Health Administration coding staff, Veterans Integrated Service Network/Veterans Affairs Medical Center management officials, physicians/clinicians, sub-specialties providers or other staff. The Contractor is required to develop specific coding education utilizing actual health records and identified coding issues specific to the Veterans Health Administration coder and/or Veterans Affairs facility, and based on Veterans Health Administration guidelines, regulations, and local policy. This can be done either on site or remote at the discretion of the facility. B. Task Three Deliverable: 1. Training Workshop 2. Sign-In sheet and Completion Listing 3. Summary of Coding issues Addressed Personnel: The Contractor personnel shall possess expertise in health record coding and auditing. These skilled experienced professional and/or technical personnel are essential for successful contractor accomplishment of the work to be performed under this PWS. The Contractor shall utilize only employees, sub-contractors or agents who are physicallv located within a jurisdiction subiect to the laws of the United States. The Contractor will ensure that it does not use or disclose Protected Health Information received from Covered Entity in any way that will remove the Protected Health Information from such jurisdiction. The Contractor will ensure that its employees, sub. Contractors and agents do not use or disclose Protected Health Information received from Covered Entity in any way that will remove the Protected Health Information from such jurisdiction. Personnel providing direct Coding and Auditing services must be a U.S. citizen. The Contractor personnel shall maintain training requirements necessary for continued access to VA information systems throughout the period of performance. Contractor personnel shall possess knowledge of VA requirements for access to information systems per the requirements in section 19 and applicable documents and ensure only approved methods for accessing VA information systems are used for contract performance. Contractor Personnel: The Contractor shall: A. Have the ability to read and interpret health record documentation in order to identify all diagnoses and procedures that affect the current outpatient encounter visit, ancillary, inpatient professional fees and surgical episodes. B. Meet the education and experience (in para. 8.3) in the industry standard code sets and quidelines for International Classification of Diseases. Current Procedural Terminology, and Healthcare Common Procedure Coding System C. Apply knowledge of current Diagnostic Coding and Reporting Guidelines for outpatient services. D. Apply knowledge of Diagnostic, Procedure, Professional, and Surgical coding guidelines for inpatient services. E. Apply knowledge of Current Procedural Terminology format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly. F. Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in Current Procedural Terminology. G. Code in accordance with Correct Coding Initiative Bundling Guidelines. H. Use the Healthcare Common Procedure Coding Systems, 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. Coder/Auditor Education and Experience: The Contractor shall provide experienced, competent, credentialed personnel to perform coding and/or auditing activities. A. Contract coders shall have a minimum of two ears' experience in International Classification of Diseases, Current Procedural Terminology, and Healthcare Common Procedure Coding System coding and completed the baseline International Classification of Diseases. 10th edition requirements listed below or as required t...