Loren Data's SAM Daily™

FBO DAILY ISSUE OF OCTOBER 02, 2012 FBO #3965
DOCUMENT

Q -- FY13 | 442 | MEDICAL CODING | Maxim Healthcare | SRG - Attachment

Notice Date

9/30/2012
 

Notice Type

Attachment
 

NAICS

561499 — All Other Business Support Services
 

Contracting Office

Department of Veterans Affairs;Network Contracting Office;NCO 19;4100 E. Mississippi Avenue, Suite 900;Glendale CO 80246
 

ZIP Code

80246
 

Solicitation Number

VA25912Q0818
 

Archive Date

10/8/2012
 

Point of Contact

STEVEN R. GARDNER
 

Small Business Set-Aside

N/A
 

Award Number

VA259-13-F-2804
 

Award Date

10/1/2012
 

Awardee

MAXIM HEALTHCARE SERVICES, INC.;7227 LEE DEFOREST DR;COLUMBIA;MD;210463236
 

Award Amount

150,000.00
 

Description

CODING STATEMENT OF WORK - CHEYENNE VA MEDICAL CENTER CODING PROCESSES Contractor will: oCarefully read and review health record documentation for inpatient and outpatient cases as provided by Cheyenne VA Medical Center (CVAMC). oAssign appropriate ICD-9-CM and CPT/HCPCS codes at 95% accuracy rate and enter the codes into the system in accordance with the documentation and the provider's scope of practice. oAdhere to all coding guidelines and accepted VA regulation, including: 1.The Official Guidelines and Reporting as found in the CPT Assistant, a publication of the American Medical Association for reporting outpatient ambulatory procedures and evaluation and management services, 2.The Official Guidelines for Coding and Reporting in the Coding Clinic for ICD-9-CM, a publication of the American Hospital Association, and VHA Guidelines for coding as found in the Handbook for Coding Guidelines current version, Health Information Management, Department of Veterans Affairs. Note: While VHA does ask for reimbursement from third party payers, the VHA coding policy is to code according to coding guidelines. Our own compliance audits use only this definition when determining if any encounter is correct. 3.The Correct Coding Initiative. The CPT Evaluation and Management codes assure documentation substantiates the code level assigned. 4.VHA Resident Supervision Handbook. 5.VA Coding Guidelines. oCVAMC will provide access to VHA publications. oWhen assigning multiple CPT codes, verify they are not components of a larger, more comprehensive procedure that can be described in a single code. oAssign modifiers as appropriate to override Correct Coding Initiative edits. oIdentify and document those encounters created in error because the patient was not seen. oProvide a workload report each week indicating the events coded for the prior week in the following categories: oNumber of inpatient events coded oNumber of inpatient pro fees coded oNumber of outpatient encounters coded oNumber of lab encounters coded oNumber of NSQIP events coded oProvide a backlog report weekly which shows events suspended and events to be coded as follows: oInpatient events: Events not coded due to lack of documentation oInpatient events: Events not coded for any other reason oInpatient Pro Fees: Number of records requiring inpatient pro fee coding oOutpatient encounters: Number of outpatient encounters to be coded oOutpatient encounters: Number of outpatient encounters suspended oLab encounters: Number of lab encounters to be coded oLab encounters: Number of lab encounters suspended oNumber of NSQIP events to be coded oExpected turnaround time is 5 work days from receipt of work for all types, provided there is sufficient documentation. Lack of documentation for any work type must be communicated to CVAMC within the expected turnaround period. Work is considered completed when it is received back at CVAMC with data entry done for all online work. Inpatient events are considered complete when the event has been closed and released. CVAMC will transmit inpatient events. oExpected average productivity due to hourly invoicing is: oInpatient - 4/hours oOutpatient - 10/hour oNSQIP - 7/hour oErrors will be corrected at no cost to CVAMC. Outpatient Encounters including Radiology, Lab or other Ancillary Services Contractor will: oUse primarily 1995 Evaluation and Management guidelines on encounters except when 1997 guidelines provide a better code. oEnter complete data entry, including CPT codes, modifiers, and diagnoses for the encounter or occasion of service when on-line coding is performed into PCE. Associate the provider with the CPT code performed by him/her at that encounter. Note: The association in VistA is very important to create a correct bill and for the budget allocation for each fiscal year for VA. Contractor will correct any missing associations when doing on-line coding at no charge to CVAMC. oWhen coding, it is expected the contractor will search the record for an appropriate diagnosis. oNot validate any cases that already have initials and a date (of validation) in comments in PCE as these have already been validated by VA staff. oLink CPT procedure codes with the proper diagnosis. oRadiology encounters need to have the ordering physician listed as a secondary provider in the encounter. The ordering provider's name should also be entered in CCM Comments. oResident services: The primary provider for all clinics is the attending if there is attending documentation that meets VHA Resident Supervision guidelines. If the attending documentation does not meet the guidelines, is incomplete, or is not present, the primary provider is changed to the resident and the encounter is marked not billable by entering reason code 25 in CCM comments so that the facility charge can be billed even if the professional fee cannot be billed. oContractor will use the appropriate reason codes in Comments in CCM, not in Claims Tracking, for making an encounter not billable - CVAMC reason codes are listed in the CVAMC procedures. oIf contractor re-codes an event with changes, comments will be placed in the Comments field in CCM, not Claims Tracking. CVAMC will review whether event has been billed and needs action due to code changes. Emergency Department Contractor will code: oCPT and ICD-9-CM for emergency room service or a level 1 office visit for encounters for prescription refills only. Inpatient PTF and Pro Fees Contractor will: oFollow VA Coding Guidelines and coding procedures for coding the inpatient PTF's and Professional Fees (Pro Fees). oContractor will use the 801 screen to code the Pro Fees. oContractor will complete all inpatient PTF's and Pro Fees within the fourteen (14) day rolling closeout period. GENERAL SPECIFICATIONS oContractor is responsible for providing personnel to perform coding activities. oContractor will maintain frequent communications with the CVAMC Chief of Heath Information Management Service (HIMS), regarding progress, workload status and/or problems. oUpon request of the CVAMC Chief of HIMS, Contractor will remove any contractor staff that do not comply with VA Coding Guidelines or policies or meet the competency requirements for the work being performed. oContractor will abide by the American Health Information Management Association established code of ethical principles as stated in the Standards of Ethical Coding, published by AHIMA. oContractor will provide all labor, material (hardware and software, including coding books) and supervision necessary to perform coding for this contract. Contractor shall provide the list of software to CVAMC Chief of HIMS, and a list of the coders' names that will perform their duties under this contract. oCoder will ensure their materials are the current version, including books and software. oContractor will be notified of any official QuadraMed training held at CVAMC and invited to attend at contractor's expense. oContractor is required to maintain records that document competence / performance levels of employees working on this contract in accordance with JHACO and other regulatory body requirements, including any VA guidelines or requirements. oContractor will provide a current copy of competence assessment checklist and annual performance evaluation to the COTR (CVAMC Chief of HIMS) for each employee working on this contract. oContractor must keep abreast of regulation changes affecting coded information, required Centers for Medicare and Medicaid System (CMS), the Office of Inspector General and others as appropriate, including all VA Guidelines and Regulations. oContractor shall be responsible for providing a contact person(s) and telephone numbers for the duration of the job. oContractor will possess all licenses, permits, accreditation, and certificates as required by law. oContractor must perform work in accordance with JCAHO standards. oContractor is required to validate any order for test procedures, in the medical record, to validate medical necessity. oAll deliverables, associated working papers, and other material deemed relevant by VA generated by the contract in the performance of this task order are the property of the United States Government. All individually identifiable health records shall be treated with the strictest confidentiality. Access to records shall be limited to essential personnel only. oOn-line records shall be secured at all times. oAt the conclusion of the contract all copies of individually identifiable health records shall be destroyed with certification of destruction. The contractor shall comply with the Privacy Act, 38 USC 5701, 38 USC 7332 and the Health Insurance Portability and Accountability Act (HIPAA regulations). oContractor will be responsible for insuring the confidentiality of all patient information and shall be held liable in the event of any breach of confidentiality. oAccess requirements to VA information system by contractors and contractor personnel shall meet or exceed those requirements as described in VHA Directives. Access shall be granted to non-VA users only if the purpose of access meets criteria of the Privacy Act, HIPAA and confidentiality regulations. o Contractor must certify that all employees working on this contract have received Privacy Training and Cyber Security Training. oContractor's employees will be required to sign access forms before starting work under the contract that require them to abide by the VA computer access security and confidentiality agreement. oContractor will be paid monthly, in arrears, upon receipt of a proper invoice for the services furnished in the previous month. The contractor will submit a monthly statement of cases coded. The COTR (CVAMC Chief of HIMS) will compare the invoice cost to the monthly statement of cases coded. Payment will be made upon written certification from the COTR (CVAMC Chief of HIMS) that services have been performed. Invoice must include the following: oCompany's name oTax ID number oFunding Obligation number oDescription of services (to include the total number of encounters coded) oHours worked by each coder oPeriod of service oAmount oAddress to remit Invoices may be submitted via US Postal Service or fax: Cheyenne VA Medical Center Chief of HIMS, 136 2360 East Pershing Blvd Cheyenne, WY 82001 Required Coder Knowledge and Skills Coders performing work must: oRead and interpret health record documentation to identify all diagnoses and procedures that affect the current outpatient visit or ancillary service. oPossess formal training in anatomy and physiology, medical terminology, pathology and disease processes, pharmacology, health record format and content, reimbursement methodologies and conventions, rule and guidelines for current classification systems (ICD-9-CM and CPT). oApply knowledge of current Diagnostic Coding and Reporting Guidelines for outpatient services. oApply knowledge of CPT format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly. oApply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT. oCode in accordance with CCI Bundling Guidelines. oUse the HCFA Common Procedural Coding Systems (HCPCS), where appropriate. oExclude 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. oClarify conflicting, ambiguous or nonspecific information appearing in the record by consulting with their supervisor who will, if necessary, discuss with CVAMC Chief of HIMS. Required Coder Education and Experience Coders must be credentialed and have completed an accredited program for coding certification, an accredited health information management or health information technician. A certified coder is someone credentialed by the: oAmerican Health Information Management Association (AHIMA) and includes RHIA, RHIT, CCS and CCS-P, or oAmerican Association of Procedural Coders (AACP) as a CPC or CPC-H, Credentialed Coders must have a minimum of two years experience in the area they will be coding. Contractor may utilize an experienced, but non-credentialed coder who is eligible to sit for the coding exams, provided: Each instance of using a non-credentialed coder is pre-approved by the Chief of HIMS via email; 100% of the non-credentialed coder's work is reviewed by a credentialed contractor's supervisor prior to returning work to CVAMC and the name of the non-credentialed coder appears on each invoice for those records s/he has coded. QUALITY CONTROL PROCESSES The contractor will: oProvide a list of coded records bi-weekly. oPerform on-going assessment of not less than 5% of all coded services and provide bi-weekly (every other week) result to CVAMC to ensure that the 95% accuracy rate is met. Track results by coder to assure appropriate follow-up. Failure to provide the results of the audit on a bi-weekly basis will result in a 20% reduction in the negotiated price for work generated that week. Failure to report results within the specified time frame three times during a calendar year will result in termination of the contract. oMonitor to ensure that the 95% quality standard is being 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 data for that week. The table below indicates the adjustment level in negotiated price for reduced accuracy rates. When accuracy rate is 94%The reduction will be 5% for that week When accuracy rate is 93%The reduction will be 15% for that week and the following week oRe-review any coded data where VA finds a question during our pre-bill process or when a denial is received to either make changes or substantiate the coding with appropriate coding rules and references. This service is included in the price of the work. oUse the following during the review processes: 1.Select a representative sample of all coding. 2.Count each one of the following as an error: ?Those codes that were coded and not supported in the documentation, violate a coding rule and/or ?Those CPT or diagnosis codes that should have been coded and were not and/or ?Unbundled codes.
 

Web Link

FBO.gov Permalink
(https://www.fbo.gov/spg/VA/VARMCCC/VARMCCC/Awards/VA259-13-F-2804.html)
 

Document(s)

Attachment
 

File Name: VA259-12-Q-0818 VA259-12-Q-0818.doc (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=489564&FileName=VA259-12-Q-0818-002.doc)

Link: https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=489564&FileName=VA259-12-Q-0818-002.doc

 

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

Record

SN02904913-W 20121002/120930233443-4c3aa57b35f0cce6d930fe303e797cff (fbodaily.com)
 

Source

FedBizOpps Link to This Notice
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