ATTACHMENT E -QASP.pdf

ATTACHMENT E

Quality Assurance Surveillance Plan

Contract Name:

Medicare Pricer Contract

Contract Number:

TBD

Contractor’s Name:

TBD

Contract Description:

The Performance Work Statement (PWS) describes the need of the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Community Care (OCC) to obtain resources to price health care claim data using Medicare payment methodologies so OCC may validate the payment accuracy of claims paid through VA Community Care. The PWS sets forth the requirements the contractor must adhere to in the performance of work under this contract.

This is a performance-based service in which the contractor shall provide all resources necessary to accomplish established objectives outlined. The overall responsibility of the contractor is to plan, coordinate, organize, manage, and perform the activities described herein.

1. PURPOSE:

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

• What will be monitored;

• How monitoring will take place;

• Who will conduct the monitoring; and

• How monitoring efforts and results will be documented.

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

2. GOVERNMENT ROLES AND RESPONSIBILITIES:

The following personnel shall oversee and coordinate surveillance activities:

a. Contracting Officer (CO): The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned CO: Terri Duenas Assigned CS: Adam Vulgamore Organization or Agency: SAC-V

b. Contracting Officer’s Representative (COR): The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

Assigned COR: Jeff Mashburn Organization or Agency: VHA/OCC/Business Operations & Administration

Other Key Government Personnel: Portia Johnson, PM Organization or Agency: VHA/OCC/Business Integrity & Compliance

3. CONTRACTOR REPRESENTATIVES:

The following employees of the contractor serve as the contractor’s points of contact for this contract:

a. Primary contract Point of Contact: TBD POC Contact information: TBD

b. Alternate contract Point of Contact: TBD POC Contact information: TBD

4. PERFORMANCE STANDARDS:

Performance standards define desired services. The Government performs surveillance to determine if the contractor meets or does not meet these standards.

PERFORMANCE STANDARDS MATRIX TABLE:

Task Required Service

Performance Standards

AQL

Method of

Surveillance Incentive

Task #2:

Medicare Pricing with a manual, Web- Based Portal Input

The contractor creates a web-based portal that allows VA to manually input de-identified data for a specific episode of care and immediately produce accurate, comparable Medicare prices as a pdf file.

100% accuracy and a total of 4 Exceptions* per year for both tasks

Direct Observation, Periodic Inspection, Progress Meetings

Positive past performance ratings and possible option renewal.

Task #3:

(Optional)

Medicare Pricing with Bulk Data Input

The contractor creates an ability to accept bulk, de-identified data from VA for a specific episode of care and produce accurate, comparable Medicare prices as a pdf file.

Direct Observation, Periodic Inspection, Progress Meetings

Positive past performance ratings and possible option renewal.

* An Exception is defined as a specific pricing error that impacted the accuracy of one or more claims.

5. INCENTIVES

The Government shall use positive past performance and the possible exercising of option periods and as incentives. Incentives shall be based on meeting or not meeting performance standards.

6. METHODS OF QA SURVEILLANCE

Various methods exist to monitor performance. The COR may use any surveillance methods listed below in the administration of this QASP:

a. Direct Observation: Can be performed periodically or through 100% surveillance.

• May be used on Tasks 2 & 3

b. Periodic Inspection: Evaluates outcomes on a periodic basis. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.

c. Progress Meetings: Designed to evaluate performance through information obtained through discussions and reporting from progress or status meetings.

7. RATINGS

Metrics and methods are designed to determine if performance meets or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

a. ACCEPTABLE PERFORMANCE: The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

b. UNACCEPTABLE PERFORMANCE: When unacceptable performance occurs, the COR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file.

8. DOCUMENTING PERFORMANCE

The program personnel that will be using this contract will inform the COR of the occurrence of any “Exceptions” they identify.

The Acceptable Quality Levels (AQL) listed in the table above indicates that up to a total of four (4) Exceptions per year will be allowed whether Task #3, Medicare Pricing with Bulk Data Input, is exercised or not because both tasks will use the same system for pricing.

In instances where the number of Exceptions exceeds a total of 4, the COR will work with the CO in requiring the contractor to provide a Corrective Action Plan (CAP) documenting how the contractor will correct the unacceptable performance and avoid the recurrence of Exceptions.

If the COR believes there may be performance issues other than pricing accuracy, the COR will work with the CO to discuss any next steps. The CO may again require the contractor to develop a CAP addressing any other performance issues and documenting how the contractor will correct the unacceptable performance and avoid a recurrence. The CO will identify when the contractor must present their corrective action plan to the COR. The Government shall review the contractor's corrective action plan to determine acceptability.

9. FREQUENCY OF MEASUREMENT

Frequency of Measurement – During contract performance, whenever Exceptions occur, Program personnel will make note of the Exception and inform the COR.

Signatures:

Contractor Point of Contact

Contracting Officer’s Representative