246-22-Q-0033 Questions 12152021.docx

Notice ID: 246-22-Q-0033 Coding and Billing Audit Services – OCAO IHS Questions/Clarifications

1. [SAM.gov - Statement of Work (2)] It states that this would be an all-inclusive firm fixed price contract and states that the vendor would bill quarterly after each audit. Would this be one invoice to OCAO following each quarter’s activity?

Yes, the invoice should be itemized by facility.

2. [SAM.gov - Statement of Work (2)] “Vendors are free to send pricing freely or on an SF 1449 form.” Is Microsoft Excel acceptable for pricing layout? Yes

3. [SAM.gov - Statement of Work (3)] Do Past Performances have to be conducted within a defined window of time? For example, within the past 3 years. Preferable to have recent past performances.

4. Scope of Work #7 – If a new service is added during the term of the contract is there an opportunity to modify the contract depending on the size and scale of the new audit requirements? If necessary, but do not see that happening during the period.

5. Scope of Work #10 – This contract pricing language varies from the SAM.gov listing. The Scope document states that the vendor would price the work based on number of active providers during the quarter and the Statement of Work on SAM.gov states “All-inclusive firm fixed-price for Coding and Billing Audit Services to include training.” These descriptions are contrary to each other and significantly impacts pricing estimates. Please clarify. All inclusive firm-fixed pricing to include training.

6. Schedule of Work – Please confirm that no ODC are available for travel expenses and that these costs should be incorporated into the overall price. Correct

7. Qualifications – Samples of Completed Audit Reports: is it acceptable for portions of the report(s) include redacted sections? What information would need to be redacted? All reports should be sent secure email.

8. Is there a # days/sessions requested for the training? Trainings shall be provided on site bi-annually and as needed via Skype, Zoom, etc. Generally, the site visits are one day for small facilities and 2-3 days for our hospitals. Visits are coordinated with facility staff to allow time for provider reviews and training with staff.

9. Is training addressing each service type requested for training? The training sessions are usually generalized for coders, billers and providers. Individual education is provided when the audits are reviewed with the providers.

10. Is it requested that the billing audit include 10 claims per provider, 10 claims per service provided, and 10 claims per type of claim for each facility.

At a minimum of 10 visits per provider, those ten visits should include a variety of services, not all the same service. The Aged claims requirement would have to include claims that have a third party payer and will more than likely be a different set of claims being audited due to the timeframes.

1. Requirement #8 under the Scope for this solicitation states that UB-04 and CMS-1500 Claims forms will need to be reviewed for some Medicare Part A (Institutional) claims, but the SOW does not say anything about what other claim types may need to be reviewed for Outpatient claims. Will all other claims use the HIPAA X12 transaction set or are there other claim formats that may need to be reviewed for Outpatient claims? Claims will be reviewed for multiple payers on the UB-04, CMS-1500 and ADA-2012/2019 claim forms.

1. Is there a single data source or consolidated database that houses all of the documents and claims and billing information that will need to be reviewed for the Quarterly audits, or will that contractor need to access multiple data sources for each audit? There will be one database per facility, some data may need to be manually collected and sent to the vendor once claims are selected, for example, explanation of benefits, copies of checks, etc.

1. Will the Oklahoma City Area Indian Health Service (OCA IHS) provide conference rooms and work space for contractors to come on site to provide quarterly in-service training and out briefs to IHS senior leadership, or will the contractor be required to secure their own meeting and work space? Yes, the facilities will provide space for meetings and trainings.

1. Will all work products (audit reports, recommendations, analysis of receivables, etc.) be delivered to a single COR, or will there be multiple CORs, one for each facility Contract? Products will be delivered to the leadership at each facility as well as the COR overseeing the contract.

1. Will OCA IHS provide the contractor access to the 3M Encoder Tool during the audit, or will the contractor be required to secure their own access to this tool? The contractor will be required to secure their own access.

1. What is the frequency of work per the requirement for Coding and Billing personnel?

The contractor will need to decide how much personnel will be required to meet the terms of the contract

2. Is the frequency of work daily at 8 hours per day or just quarterly? The contractor will decide how much daily work is required to meet the terms of the contract.

3. In accordance with HHSAR 304 1300(b), Please clarify if it is mandatory that hired auditors report in person to assigned location(s) per the SOW. The auditors are not required to report in person, training and reviews are required on site bi-annually, the audits can be performed off site.

4. Per the SOW, will the Government be providing technical equipment (i.e. laptops) for remote auditors? No, the Government will not supply any equipment, only access.

5. How many hours does it take to audit a provider in a quarter? That will depend on the experience of the auditor and the type of visit being audited.

6. What is the number of associated clinics that is required to be audited per 11.2.1 Task 2, line b. “Contractor shall conduct billing and data capture audit for 10 random visits for each medical provider and associated clinic (all providers/clinic types as noted in background section of the SOW) for each facility? It varies based on the clinic size, some clinics offer dental, optometry, audiology and podiatry services, all of those services for that clinic would need to be audited by an experienced certified coder, the smaller clinics may only offer medical services.

Can the government extend the submission date for the RFQ by three (3) weeks? No extensions at this time.

On page B-3, the SOW states, “The government reserves the right to add a provider(s) if such provider is added at a respective facility during the period of performance of this contract.” Is there overlap with providers seeing patients at other facilities? Yes, in rare instances.

What EMR is currently being used and is it one system (single EMR) or ad hoc systems? It is one system

Are the records electronic, paper, or hybrid? Electronic

What is the insurance make-up of patients at each facility? On average 60% of the patient population has a third party resource, Medicare, Medicaid, Private Insurance and VA.

Which facilities must have on-site services and cannot support VPN remote access? On-site training and review services are required bi-annually at each site, the other services can be performed remotely.

On page B-3 and B-4, under Task 1c and Task 2d, the SOW states, “The Contractor shall provide an Exit Conference at the completion of the audit and preliminary electronic data tables and narrative documentation of findings and recommendations to the HIM Administrator, Business Office Manager, Executive Leadership Team and COR.” Where will the exit conference take place (government facility or will the vendor need to secure the location). Is a virtual conference an option? Conference will occur on site for the bi-annual visits and the facility will make room accommodations, the others can be performed virtually.

Can the government add a CLIN for travel with a NTE? No, it should be included in the quote.

The incumbent (McManis, Monsalve & Associates. HHSI246201800026A) has a contract end date of 12/31/2018 according to USASpending.gov. Has IHS/OCAO been doing this work internally since then, or what this contract extended and is currently running? Services have been provided by incumbent on a 5-year contract that ends 3/31/22.