CLOSED CLAIMS
Added: Aug 24, 2010 12:22 pm
This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice.
This requirement is being issued under the Simplified Acquisition Procedures as a Request for Quotation (RFQ) VA-255-10-RQ-0521. This announcement constitutes the only solicitation. Proposals are being requested and a written solicitation will not be issued.
The government contemplates a firm fixed price contract from this procurement. This procurement will be an unrestricted acquisition. The solicitation and document incorporates provisions and clauses are those in effect through Federal Acquisition Circular (FAC 2005-35, Effective 14 July 2009).
The North American Industry Classification System (NAICS) is 524291 with a size standard of 7 million dollars.
All prospective Offerors must be actively registered in the Central Contractor Registration. Offeror may register online at https://www.bpn.gov/CCR/scripts/index.html.
The award will be made to the low priced Offeror deemed Technically acceptable.
The quotation shall consist of two (2) CLINS, Contract Lines for the Base Year and (1) CLIN for Option Years. (See Scope of Work)
JOB DESCRIPTION: The contractor shall provide all material and labor necessary to perform Disputed Healthcare Claims Processing as Outlined in the Scope of Work. The intent of this contract is to procure a unique solution for processing disputed healthcare claims for the Department of Veteran Affairs, VISN 15, which includes facilities in Wichita, Topeka, and Leavenworth Kansas; Kansas City, Columbia, Poplar Bluff, and St. Louis Missouri and Marion, Illinois as well a the Community Based Outpatient Clinics associated with these facilities. (See Scope of Work).
SCOPE: Healthcare claims processing is comprised of four basic components: Insurance identification and verification, medical encounter coding, invoice preparation and transmittal, and maintenance of accounts receivable. This contract shall focus on the disputed healthcare claims portion of the accounts receivable component for closed accounts only.
SPECIAL INSTRUCTIONS: Contractor Check-in – The contractors representative will schedule all work with Phyllis Thompson Wichita Kansas Veterans Hospital at 316-685-2221, ext. 53253 , prior to performance of services. The Contractor shall report all issues to the Contracting Officer’s Technical Representative (COTR) Phyllis Thompson while performing work for all the VISN 15 locations.
Offerors that fail to furnish required representations or technical information as required by FAR Clause 52.212-1 cited below or reject the terms and conditions of this solicitation may be excluded from consideration.
The following FAR Clauses and Provisions are incorporated by reference and apply to this acquisition. FAR provision 52.212-1 Instructions to Offerors of Commercial Items (Sep 2006). FAR provision 52.212-3 Offeror Representations and Certifications Commercial Item (Nov 2006). Note: In order to complete the Representations and Certifications for the referenced provisions you must go to the Air Force Web Site at http://farsite.hill/af.mil/Vffar1.htm locate the referenced provision, copy and paste it to a Word Document and complete. If you are registered in the Online Representations and Certifications Application (ORCA) website at https://orca.bpn.gov/ and have the information posted you are only required to submit a signed copy of section (k) of FAR Clause 52.212-3 in place of FAR 52.212-3. FAR 52.212-4 Contract Terms and Conditions Commercial Items (Feb 2007) and FAR 52.247-34 FOB Destination (Nov 1991). FAR 52.212-5 Contract Terms and Conditions required to Implement Statues of Executive Order Commercial Items (Nov 2006) apply to this acquisition. Specific clauses cited in FAR 52.212-5 that are applicable to this acquisition are 52.222-3 Convict Labor (June 2003), 52.222-19 Child Labor Cooperation with Authorities and Remedies (Jan 2006), 52.222-21 Prohibition of Segregated Facilities (Feb 1999), 52.222-26 Equal Opportunity (Apr 2002), 52.222-35, Equal Opportunity for Special Disabled Veterans, Veterans of the Vietnam Era and Other Eligible Veterans (Sep 2006), 52.222-36 Affirmative Action for Workers with Disabilities (Jun 1998), 52.232-34 Payment by Electronic Funds Transfer-Other than Central Contractor Registration (May 1999), 52.232-36 Payment by Third Party (May 1999).
52.212-2 Evaluation-Commercial Items (JAN 1999) Technical, past performance, and quality control when combined, are approximately equal to cost or price. Vendors shall provide three (3) references with contact numbers and a technical plan to complete the records Retirement, long-term records Storage, Scanning and Indexing per the Scope of Work. 52.237-1
This solicitation is being issued as a Request for Quotation (RFQ). Offers shall be clearly marked with RFQ referencing number # VA-255-10-RQ-0521 and mailed to the Point of Contact Listed below no later than then 2 September 2010 at 1:00 a.m. Central Standard Time (CST).
The point of contact for this procurement is John Eric Cross, Contracting Officer, Department of Veterans Affairs Heartland Network 15, Contracting Office 4101 S 4th Street Trafficway Leavenworth, KS 66048-5055.
VA25510RQ0521 Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 15
8/24/10, 12:22 PM Reimbursable health insurance less than $250
Added: January 8, 2008
STATEMENT OF WORK (SOW) ACCOUNTS RECEIVABLE FOLLOW-UP GENERAL OBJECTIVES AND REQUIREMENTS 1. Title of Project: VISN 9 MidSouth Customer Accounts Center (MCAC) - Account Receivable Follow-up, Claims less than $250 and less than 90 days old. 2. Background: The VA's revenue program is responsible for billing to and collecting from an insurance company for medical treatment provided to a veteran for a non-service connected condition. Public Law 99-272 granted VA authority to seek reimbursement from third party health insurers for the cost of medical care furnished to an insured nonservice-connected (NSC) veteran. Public Law 101-508 expanded VA's recovery program by providing authority to seek reimbursement from third party payers for the cost of medical care provided to insured service-connected veterans treated for their NSC conditions. 3. Purpose of Project: The primary purpose of this Statement of Work (SOW) is to accomplish the following 3rd party Accounts Receivable objectives: " Collection and follow-up on all open 3rd party accounts receivable assigned to the contractor by the MCAC to achieve optimum collection from the insurance carrier(s) " Follow-up activities are appropriately documented in the AR Comment field in VistA " Results of follow-up activity are provided monthly to the MCAC " Follow-up on all receivables at intervals established with the MCAC, until they are recommended for closure resulting from an Explanation of Benefits (EOB) with valid documented justification (e.g., insurance terminated, not a covered service), or paid by the insurance carrier " Claims that are appealed for medical reasons are referred, on a daily basis,, at minimum on a weekly basis, to the appropriate MCAC staff to complete the appeal process and specific information needed for the appeal is provided by the contractor " The MCAC retains the right to assign or not assign contractor to re-bill/re-print claim " VISNs/VAMCs retain the right to assign or not assign contractor to re-bill claims. " Mutually agreed upon time schedules and deadlines are met consistent with VA policies and procedures " Follow-up priorities regarding aged receivables are established " Contractor maintains timely and meaningful communications with appropriate MCAC staff Additionally, this SOW shall establish and maintain a productive cost-effective AR follow-up system that: " Allows the MCAC to meet and/or exceed their MCCF goals by optimizing third party reimbursements, in part through aggressive follow-up on account receivables (AR) " Incorporates performance metrics that monitor the accuracy and timeliness of the system 4. Scope of Work: Solicitation is for the following tasks. The contractor shall: Review and analyze placed claims to determine the appropriate actions required for accurate claims processing by the third party payer. Contractor will document any notes regarding conversations with carries or veterans, appeals submitted, corrections submitted, rebills submitted, payment postings/mispostings/offsets, and any other activities related to the proper disposition of such claims. Contractor will gather information necessary to further claims processing via Vista VPN access granted by the VA. Contractor will continue follow-up on all claims until complete resolutions (paid or otherwise deemed uncollectible), or until receivable is aged past the contract stipulations. The following guidelines will apply: o The Contractor shall contact the third party payer, either through web access to carrier systems, automated telephone systems, or actual telephone conversations with carrier representatives, to discuss and obtain appropriate rebilling and/or denial information. The Contractor shall batch claims by payer for contact purposes in order to maximize efficiency. o The Contractor shall contact the carriers for unpaid claims in accordance with VA Handbooks and local requirements. o Upon contact with an insurance carrier, the Contractor will electronically document the following: (1) Insurance Company Point of Contact; (2) Telephone number or web address used; (3) Description of current status and nay followup action(s) required; (4) Appropriate followup date based on conversation; (5) any carrier specific internal control numbers needed; and (6) action taken after contact. o The Contractor may contact patients or patient representatives for the purpose of obtaining additional information that may be requested by the carrier, new insurance information, information releases or to seek assistance in completing documents being requested by the carrier. All veteran contact will be in accordance with local requirements. No patient or patient representative will be asked to provide any payment to the VA and at no time will any type of consumer collection activity take place. If a carrier issues payment directly to a veteran and the carrier refuses to reissue payment directly to the VA, such claim(s) will be referred to Regional Counsel. o Contractor will forward information on claims that require referral to a Regional Counsel for further collection activity. Criteria for claims referral include: 1. Litigation Issues - Refer bill if payment is denied because of VA related litigation. 2. Veteran Not Responsible for Cost of Care - Refer bill if payment is denied because veteran is not required to pay VA for the care. 3. Refusal to Pay Government Hospital - Refer bill if payment is denied because insurer is not required to pay a government hospital/facility. 4. Veteran Paid Directly - Refer bill if payment is sent to the veteran instead of VA and veteran fails to respond to notification. 5. Veteran fails to respond to Insurance Carrier Request for Information: Refer bill if veteran fails to respond to insurance carrier requests for information, such as claim form to be completed. o The Contractor shall review the patient insurance information provided by the VA for each claim to ensure accuracy, and will provide any updated insurance information obtained through follow-up activity to the VA via e-mail to a representative designated by the MCAC. a) Provide collection and follow-up on all 3rd party open account receivables assigned to the contractor by the MCAC b) Enter follow-up activities into the AR Comment field in the appropriate VistA database c) Provide at least monthly to the MCAC, the results of follow-up activity (Actual frequency to be determined by the MCAC and indicated on the task order) d) Follow-up on all receivables at intervals established with the MCAC, until they are recommended for closure resulting from an Explanation of Benefits (EOB) with valid documented justification (e.g., insurance terminated, not a covered service), or paid by the insurance carrier e) Provide, at least monthly, a detailed report (frequency to be determined by the MCAC and specified in the task order) of each payment posted to an insurance claim that the contractor has provided quality follow-up which is documented electronically f) To complete any appeal's process, refer to the appropriate MCAC claims that should be appealed for medical reasons g) If contractor is not assigned the option to re-bill claim on denied claims the Contractor identifies, Contractor will report these back to the VISN/VAMC on a daily basis. h) Establish, based on mutual agreement with the MCAC, time schedules and deadlines i) Jointly establish priorities with the MCAC j) Provide a mechanism to ensure timely and meaningful communications with appropriate MCAC staff 5. General Requirements " The contractor shall provide collection and follow-up on all open account receivables assigned to the contractor by the MCAC. Follow-up and collection activities shall be accomplished to achieve optimum collection from the insurance carrier(s). Activities and outcome will be documented in the VistA AR comment field. This includes a review of VistA reports as well as appropriate processing of correspondence including insurance remittances or EOBs. " If the Contractor is assigned an insurance carrier that the VISNs/VAMCs have a current contract payor agreement with, the VISN/VAMCs will furnish the Contractor with payment requirements. Contractor will ensure all Contract AR staff are familiar with specificity of agreement. " The contractor shall provide adequate, experienced personnel to provide AR Follow-up services to the MCAC while being able to meet the established performance standards. " The contractor shall be responsible for having trained staff at the contractor's expense for VA AR follow-up in place at the time the contract is awarded. The contract staff must be trained in all aspects of AR follow-up requested under the contract. The cost of any additional training required by the contractor's staff shall be borne by the contractor. " The contractor is responsible for correcting any errors made by their employees at no charge to the VA. " Contractor will operate within federal law and within VA and VHA directives and guidelines for this contract. " VA bills health insurance carriers for treatment of veterans' non-service connected conditions. Any questions regarding a veteran's service connected status should be referred to the appropriate MCAC. " The VA is not authorized to bill Medicare or Medicaid. However, VA does bill TrailBlazer Health Enterprises, a Medicare Fiscal Intermediary to obtain an electronic Medicare Remittance Advice (MRA) to send with claims to secondary payers. A current list of services that are excluded from the e-MRA billing process will be provided to contracted staff from MCAC staff. Cnotify the MCAC to resubmit the claim with a standard cover letter which explains why the claim should be processed without an MRA. This notification should be completed on a daily basis. " Contract AR staff will provide feedback to billing staff regarding specific billing-related issues. Examples of these types of billing issues that may adversely impact collections and must be shared with billing staff are: payers not processing claims in accordance with the information provided on the MRA, payers refusing to process paper claims/must submit claims electronically, claim denials due to specific coding issues (i.e. a procedure is missing a modifier or has an invalid modifier according to a payer), etc. " Unpaid insurance claims are not converted to self-pay status. The veteran shall not be told he/she will become liable if the insurer fails to pay. Eligibility for VA care is not affected by insurance coverage. " Any updated patient demographic information obtained during collection/follow-up activities, including updated insurance information, must be furnished to the appropriate MCAC designee on a daily basis. " The contractor must instruct all debtors to remit payment to the MCAC, under the appropriate VISN's or medical center's business name and address, as it appears on the UB-04 or HCFA-1450 form. " Any proposed legal action to be taken must be coordinated with the MCAC to facilitate optimum collection to facilitate optimum collections. " Contractor agrees that all deliverables, associated working papers, and other material deemed relevant by the contractor in the performance of these tasks are the property of the United States Government. " Patient Confidentiality (HIPAA compliance) and overall data security are vitally important and will be maintained at all times. All contract personnel shall be required to observe the requirements imposed on sensitive data by law, Federal regulations, and VA policies and procedures. The contractor shall be responsible for his/her employees (including subcontractors) in release of confidential/proprietary information and the divulgence to authorized recipients designed by the VAMCs and VISNs. The contractor's staff will have had background investigations performed. The MCAC will furnish a copy of the background investigation and information security forms to be completed by each contract employee working on this project. o The contractor must treat all individually identifiable health records with the strictest confidentiality. Access to records must be limited to essential personnel only. Records must be secured when not in use. At the conclusion of the contract all copies of individually identifiable health records must be destroyed or returned to the appropriate MCAC. o Contractor staff shall sign and follow confidentiality statements as required. o The contractor shall comply with the Privacy Act, 38 USC 5701 and 38 USC 7332. " Contractor shall ensure that no fraud will be committed on work performed by the contractor. The contractor's claims expediting and collection activities must be legal, ethical and in compliance with applicable legislation regulating debt collection practices. " Section 508 (a)(2)(A) required the Access Board to publish standards setting forth a definition of Electronic and Information Technology (EIT) and the technical and functional performance criteria necessary for accessibility for such technology by February 7, 2001. The Access Board published the final standards in the Federal Register at 65 FR 80500, December 21, 2000. Unless an exception applies, all of the EIT supplies and services furnished under this contract must comply with the provisions of Section 508 of the Rehabilitation Act of 1973, as amended. Those supplies and/or services meet the applicable accessibility standards at 36 CFR Part 1194. The contractor certifies, by execution of this contract or by entering into a contract with the Department of Veterans Affairs, that the supplies and services furnished comply with the accessibility standards to the extent required by law. " The Workforce Investment Act of 1998, Public Law 105-220 was enacted on August 7, 1998. Title IV of the Act is the Rehabilitation Act Amendments of 1998. Subsection 408 (b) amended Section 508 of the Rehabilitation Act of 1973. Section 508 requires Federal departments or agencies to develop, procure, maintain, or use Electronic and Information Technology (EIT). Agencies must ensure that the EIT allows Federal employees with disabilities to have access to and use of information and data that is comparable to the access and use of information and data to that of other Federal employees. Section 508 also requires that individuals with disabilities, who are members of the public seeking information or services from a Federal department or agency, access to and use of information and data that is comparable to that information and data that is available to the public not having the disabilities. " Contractor must obtain OneVA VPN access for staff assigned to this project. " All scheduled contacts between the contractor and MCAC staff must occur during regular MCAC hours of operation. " The Contractor will have forty-five (45) days from the date of task order(s) award to have all sites operational.
VA-249-08-RQ-0099 Department of Veterans Affairs
1/8/08, 12:00 AM