R -- PROVIDE ADMINISTRATIVE & SUPPORT SERVICES FOR MEDICARE, MEDICAID AND PRIVATE INSURANCE CLAIMS PROCESSING & RELATED SERVICES

Notice Date

January 18, 2001

Contracting Office

Department of Health and Human Services, Indian Health Service, Division of Acquisitions and Grants Management, Acquisitions Management Branch, 12300 Twinbrook Parkway, Suite 450A, Rockville, MD 20852

ZIP Code

20852

Response Due

February 20, 2001

Point of Contact

Doreen Chino-Lente, CO, 301-443-5774; Elmer Brewster, PO,301-443-1016

Description

SOURCES SOUGHT: This sources sought synopsis requests information needed by the Government prior to release of any potential solicitation. OFFERORS MUST PROVIDE INFORMATION REQUESTED IN THIS SYNOPSIS. This is not a Request for Proposal and in no way obligates the Government to neither award a contract, nor will the Government compensate interested parties for any information which they may provide in response to this synopsis. SUBJECT: SEEKING QUALIFIED SMALL AND SMALL DISADVANTAGED BUSINESSES TO PROVIDE ADMINISTRATIVE SUPPORT SERVICES FOR MEDICARE, MEDICAID AND PRIVATE INSURANCE MEDICAL CLAIMS PROCESSING & RELATED SERVICES. POC Doreen Chino-Lente, Contracting Officer, 301-443-5774 or Elmer Brewster, Program Officer 301-443-1016. BACKGROUND: The Indian Health Service (IHS) provides Inpatient/Outpatient medical care services to the Native American population in 35 states, in 49 hospitals and over 150 clinics. The user population is about 1.4 million. In providing these services, IHS bills and collects payment from third party payers, Medicare, Medicaid and private insurers. The IHS recognizes that minimal staffing and workload are problems that contribute to coding and billing backlogs. Billing backlog, coding of services and accounts receivable follow-up on denials are commom operational problems of third party claims to third party payers. To be eligible, the billing or coding staff MUST HOLD A CERTIFICATION of certified coding specialists for hospital or physician practices. DESC: The IHS, Office of Public Health is seeking support services as follows: 1) Quantitive analysis by reviewing medical records to assure the presence of all component parts such as patient and record identification, signature and dates where required, and the presence of all reports that appear to be indicated by the treatment rendered; 2) Qualitative analysis by evaluating the record for documentation consistency and adequacy. Ensure that the final diagnosis accurately reflects the care and treatment rendered. Review records for compliance with established third party reimbursement agencies and special screening criteria; 3) Assign and sequence a variety of codes including but not limited to ICD/CPT/HCPCS codes based on the medical record analysis. Assure the final diagnoses and operative procedures as documented by the provider are valid and complete. When multiple diagnoses and procedures are listed, assure the procedure is related to the proper diagnosis; 4) Analyze and abstract information from the medical record to identify secondary complications and co-morbid conditions to assure appropriate assignment under the Diagnostic Related Group (DRG), Ambulatory Patient Classification (APC) systems and other alternate resources; 5) Analyze provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT/HCPC code; 6) Provide ongoing education,updates and briefings for the medical staff, business office staff, and other health care providers on changing coding conventions, rules, regulations and guidelines; 7) Perform audits in accordance with the facility compliance plan and performance improvement study designs, which may include findings from provider documentation trends, coding peer reviews, and reimbursement denials. Provide reports of findings and feedback to parties involved, and 8) Send complete bill (i.e., UB 92 or HCFA 1500) to appropriate payer. The Statement of Work rquirements fall under NAICS CODE 561990. Interested small businesses must demonstrate in their qualification statements that they are qualified to perform work under this NAICS CODE. Each small business/small disadvantaged business shall provide specific details or personnel capabilities; office locations, size of firm (employees revenue); fiinancial resources, other contracts both fedeal and commercial, and capabilities/experience necessary to perform work listed above. Small Businesses shall submit requested information to DHHS, IHS, Division of Acquisitions and Grants Management, Attn: Contracting Officer, 12300 Twinbrook Parkway, Suite 450A, Rockville,MD 20852 NLT February 20, 2001.

Record

Loren Data Corp. 20010122/RSOL011.HTM (W-018 SN50B1R3)