REQUEST FOR INFORMATION -- MEDICAL CODING SERVICES

Notice Date

March 26, 2001

Contracting Office

Veteran's Affairs Medical Center, Contracting Officer (672-BO-3), Business Office, 10 Casia Street, San Juan, PR 00921-3201

ZIP Code

00921-3201

E-Mail Address

ana.alvarado@med.va.gov (ana.alvarado@med.va.gov)

Description

This is a Request for Information (RFI) being released by the Department of Veterans Affairs Medical Center, San Juan, PR. THE GOVERNMENT DOES NOT INTEND TO AWARD A CONTRACT ON THE BASIS OF THIS SOLICITATION OR TO OTHERWISE PAY FOR THE INFORMATION SOLICITED. The purpose of this Request for Information (RFI) is: 1) to announce the intentions of the Departments of Veterans Affairs to explore the possibility of contracting out for Medical Service Coding; 2) to provide an opportunity for industry and other interested parties to provide VAMC with a feedback on this matter; 3) To assist VAMC in their efforts to improve their understanding of the industry and its capabilities to meet the specified requirements in the desired time frame; and 4) to obtain PRICE, and other market information, or capabilities for planning purposes. ALTHOUGH "PROPOSAL" AND "OFFEROR" ARE USED IN THIS RFI, YOUR RESPONSE WILL BE TREATED AS INFORMATION ONLY IT SHALL NOT BE USED AS A PROPOSAL. AS FOLLOWS ADDITIONAL INFORMATION, REQUIREMENTS IN REGARDS TO THIS RFI. The VA Medical Center, San Juan, Puerto Rico is exploring the possibility in contracting an on-site medical coding services. The Firm/Offeror will provide all necessary materials, time, transportation, supervision and the necessary personnel to perform the job as herein is described. VA will provide space and ADP equipment necessary to perform these services. The schedule for the on-site will be probably after VA normal working hours (8:00am to 4:30pm). Caseloads may vary depending on the complexity of the cases. The coding services will be for Outpatient only, (i.e. professional fees (office visits), surgical procedures, ancillary tests/treatments, non-surgical procedures, medical equipment & supplies. The workload is estimated in approximately 8,500 billable cases per month. GENERAL: The VA Medical Center (VAMC,) San Juan, Puerto Rico has a requirement for on-site Medical Coding Services for six (6) months from date of award with the Government having the option to for an additional three (3) months. The Firm/Offeror will provide the necessary medical coders in accordance with the requirements of this section. The VA will provide space and the ADP equipment necessary to perform these services. SCOPE OF WORK: The Firm/Offeror shall provide all labor, materials, transportation and supervision necessary to perform coding and review of coding for patient care in the ambulatory care setting, specifically, Ambulatory Surgery Unit, Endoscopy Suites, and Cardiac Cath Lab, Outpatient clinics visits. This coding will include all latest applicable ICD-9-CM and CPT codes specifically all diagnostic and procedural coding including Evaluation and Management codes for professional fees. Specific Medical Center ambulatory workload statistics are attached to this document to inform the Firm/Offeror of the complexity of the coding reviews required. QUALIFICATIONS: Coding staff shall possess any of the following American Health Information Management Association (AHIMA) certifications: Accredited Record Technician (ART), Certified Coding Specialist (CCS or CCS-P), or Registered Health Information Administrator (RHIA). Should in the event not coding staff possess any of the above mentioned certifications, a credentialed supervisor shall monitor and validate daily performance. The Firm/Offeror employees must also be citizens of the United States and proficient in spoken and written English. All coders are required to have a minimum of two years of continuous coding experience in a comparable facility at a level that meets or exceeds VA's current population. The Firm/Offeror will be responsible to ensure that the Firm/Offeror employees providing work are fully trained and completely competent to perform the required work. The Firm/Offeror shall submit with their quote, a roster indicating names of coders along with a copy of their credentials, who may be providing service to the VAMC. No changes of employees will be allowed without prior authorization by the Contracting Officer, in writing, thirty (30) days in advance. The Firm/Offeror is required to maintain records that document competence/performance levels of The Firm/Offeror employees working on this contract in accordance with JCAHO, VHA, HCFA and other regulatory body requirements. The The Firm/Offeror will provide a current copy of the competence assessment checklist and semi-annual performance evaluation to the Contracting Officer's Technical Representative (COTR) for each The Firm/Offeror employee working on this contract. WORK STATEMENT: The coders will be responsible for coding and/or reviewing the coding on encounter forms within designated Clinics and Services. Clinics/Services may be added or deleted at the discretion of the Medical Center based on the coding accuracy of the Clinic. The coding of charts will be performed for same of service provided and shall include ICD-9 codes, CPT procedure codes, evaluation and management coding (professional fees), HCPCS and Modifiers as applicable. The Firm/Offeror shall provide the following materials to the credential coders: the latest versions of the International Classification of Disease-Ninth Edition-Clinical modification (ICD-9-CM) Coding System and Current Procedural Terminology 4th Edition (CPT-4) books, and any reference materials as deemed appropriate for the The Firm/Offeror's employees use to perform the work outlined herein. Training on VISTA shall be provided by the VA Medical Center (see paragraph 7 for further orientation information). The coders shall perform their coding according to existing medical record documentation. When incomplete or inconsistent information is identified, the coder will report findings to supervisor for further report to the VA Chief, HIMS for actions. They will work with members of the health care team to perform the coding activities with the highest possible degree of accuracy. Thoroughly reviews the patient record to ensure all conditions for which care was given have been Documented by the physician in the proper sequence of importance, and all operations and procedures have been described appropriately and are related to the clinical diagnosis recorded. Ensures that all diagnoses and procedures that may impact the facility's reimbursement are identified and documented by the physician, sequenced correctly, and coded in an accurate and ethical manner for optimum reimbursement. Determines correct codes for routine, and/or new and unusual diagnosis and procedures not clearly listed in ICD-9-CM and CPT. Directly consults with physician for clarification of clinical data when encountering conflicting or ambiguous information. Keeps abreast of regulatory changes affecting coded information, required by the Health Care Financing Administration (HCFA), the Office of Statewide Health Planning Department, and others, as appropriate and applies current Uniform Hospital Discharge Data Set (UHDDS) definition for code selection. QUALITY OF WORK: The VA will monitor, weekly, the Firm/Offeror employees work to ensure contract compliance. Any corrective actions taken due to improper codes will be entered directly into the VISTA System. The objective of the coding review is to evaluate whether they are completely and accurately coding diagnosis and procedures according to official coding guidelines. References used by the The Firm/Offeror during the course of the review shall include: ICD-9 Official Coding Guidelines, CPT Assistant, Coding Clinic, National Correct Coding Initiative and any others. The Firm/Offeror will code work with an accuracy rate of 98%. Work will be evaluated monthly by the COTR who will randomly review 50 completed cases. Should the The Firm/Offeror's error rate exceed 2% of the total cases coded for the month, that percentage will be deducted from the The Firm/Offeror's invoice. Example: 100 cases completed, 50 cases reviewed with 5 errors = 10%. Current invoice amount will be reduced by 10%. The Firm/Offeror will perform the functions required under the contract in accordance with Federal and State guidelines. The The Firm/Offeror will not participate nor be a party to any activities which are in Conflict with Federal and/or State guidelines. In the event the Firm/Offeror encounters said conflicting situations, the Firm/Offeror will notify the COTR or the Contracting Officer to resolve such issues. The Contracting Officer will document and be responsible for resolution of any such situations. Either the VA or the Firm/Offeror will be responsible for any delays or failures to perform due to causes beyond each party's control. The VA and the Firm/Offeror may, upon mutual consent, modify the timing and schedule of services. HOURS OF WORK: The Firm/Offeror will not be required to furnish such services on a national holiday. ORIENTATION: The VA Medical Center will provide the contracted coders with 8 to 16 hours of computer orientation training. All contracted staff are required to attend this mandatory orientation Coders must demonstrate competency with VISTA Program or they will be replaced as deemed appropriate by the Contracting Officer's Technical Representative (COTR) and approved by the Contracting Officer. JCAHO, VHA (VETERANS HEALTH ADMINISTRATION) AND OTHER SPECIAL REQUIREMENTS: The Firm/Offeror employees will attend an area/program/unit specific orientation meeting before or during the start up of the commencement of work on site. The VA will schedule, conduct and document this meeting. The Firm/Offeror is required to develop and maintain their employees credentials and qualifications for the job, a current competence assessment checklist, an assessment of knowledge, skills, abilities and behaviors required to perform a job correctly and skillfully; a current performance evaluation supporting ability of the Firm/Offeror employee to successfully perform the work required; and listing of relevant continuing education for the last two years. PERSONNEL POLICY: General: The Firm/Offeror shall assume full responsibility for the protection of its personnel furnishing service under this contract in accordance with the personnel policy of the Firm/Offeror, such as providing worker's compensation, professional liability insurance, health examinations, income tax withholding, and Social Security payments. The Firm/Offeror is required to comply with applicable Federal and State worker's compensation and occupational disease statutes. The Firm/Offeror's commercial operations that would not be practical. INSURANCE EVIDENCE OF COVERAGE: The Firm/Offeror shall furnish evidence of insurance. SPECIAL THE FIRM/OFFEROR RESPONSIBILITIES: The Firm/Offeror must possess all licenses, permits, accreditation and certificates as required by law. The Firm/Offeror must perform the required work in accordance with JCAHO, VA and other regulatory standards. CONFIDENTIALITY: The Firm/Offeror understands and agrees as a contracting agency for coding medical records for the VA Medical Center, that the information in the medical records of all patients is confidential. Strict confidentiality is to be maintained, Rules of Confidentiality expected to be conformed with are delineated in 38 U.S.C. 3301, 38 U.S.C. 4132 5 U.S.C. 552 (a) et. seq. Agency employees accessing the VA VISTA Computer System will sign a computer security access agreement and will abide by the agreement.SECURITY REQUIREMENTS FOR THE FIRM/OFFEROR EMPLOYEES: The Firm/Offeror shall insure the confidentiality of all patient and employee information and shall be held liable in the event of breech of confidentiality. Any person, who knowingly or willingly discloses confidential information from the VA Medical Center, San Juan, Puerto Rico, may be subject to fines. RECORDS: The Firm/Offeror personnel who obtain access to hardware or media which may store drug or alcohol abuse data, Sickle Cell Anemia treatment records, records or tests or treatment for or infection with HIV, medical quality assurance records, or any other sensitive information protected under 38 U.S.C. 4132 or 3305, as defined by the Department of Veterans Affairs, shall not access the records unless absolutely necessary to perform their contractual duties. Any individual who has access to these data will disclose them to no one, including other employees of the Firm/Offeror not involved in the performance of the particular contractual duty for which access was obtained. Violation of these statutory provisions, as stated in department regulations by the Firm/Offeror's employees may involve imposition of criminal penalties.SYSTEM OF RECORDS: The Department of Veterans Affairs system(s) of records to which the Firm/Offeror personnel will have access in order to maintain is "Patient Medical Records-VA (24VA136). SYSTEM SECURITY: The Firm/Offeror shall provide VHA with the full assurance that security measures have been implemented which are consistent with OMB Circular A-130 and VA Departmental Standards. PROCEDURES FOR ACCESS: Access requirements to VA information systems by The Firm/Offerors and The Firm/Offeror personnel shall meet or exceed those requirements established for WIA employees as described in VHA Directives and in any subsequent WIA policy statements. A written and signed request for user access by VHA Management, or designee(s), constitutes management approval (sponsorship to initiate a request for access to any sensitive automated information system. Access shall be granted to non-VA users only if the purpose for access meets criteria of the Privacy Act and VA Confidentiality regulations and transfer. The Firm/Offeror's employees will be required to sign before starting work under this contract and abide by the VA Computer Access Security Agreement and Confidentiality Agreement. In the performance of official duties, the Firm/Offeror's employee has regular access to printed and electronic files containing sensitive information, which must be protected under the provisions of the Privacy Act of 1974, and other applicable laws and regulations. The employee is responsible for (1) protecting that information from unauthorized release or from loss, alteration or unauthorized deletion, and (2) following applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in a computer access agreement which the employee signs. Complies with safety rules and regulations for safe performance and fire protection. Attends scheduled training sessions. IDENTIFICATION PARKING, SMOKING, AND VA REGULATIONS: The Firm/Offeror's personnel shall wear visible identification at all times while on the premises of the VAMC. It is the responsibility of the Firm/Offeror to park in the appropriate designated parking areas. THIS RFI IS NOT A REQUEST FOR PROPOSAL AND IS NOT TO BE CONSTRUED AS A COMMITMENT BY THE GOVERNMENT TO ISSUE A SOLICITATION OR ULTIMATELY AWARD A CONTRACT. RESPONSES WILL NOT BE CONSIDERED AS PROPOSALS NOR WILL ANY AWARD BE MADE AS A RESULT OF THIS SYNOPSIS. All information contained in the RFI is preliminary, as well subject to modification, and is not way binding on the Government. ANY SUBMISSIONS WILL BE CONSIDERED TO BE PUBLIC INFORMATION. Any information submitted is voluntary. RESPONSES TO THIS SYNOPSIS WILL BE USED BY THE GOVERNMENT TO MAKE APPROPRIATE ACQUISITION DECISIONS. FIRMS RESPONDING TO THIS ANNOUNCEMENT WHICH FAIL TO PROVIDE ALL OF THE REQUIRED INFORMATION CANNOT BE USED TO HELP THE GOVERNMENT MAKE THE ACQUISITION DECISIONS WHICH IS THE INTENT OF THIS SYNOPSIS. Responses to this notice shall be mailed to Veterans Affairs Medical Center, ATTN: Ana G. Alvarado, Contracting Officer (672/BO-3), 10 Calle Casia, San Juan, Puerto Rico 00921-3201 or electronically to the originating party. Please provide responses electronically with this subject: RFI for On-site Medical Coding Services. Responses must be received no later than 4:30 p.m.(local time) on April 18, 2001.

Record

Loren Data Corp. 20010328/SPMSC013.HTM (W-083 SN50H259)