36C24620Q0973_1.docx

36C24620Q0973

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1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

659-21-1-5037-0001 36C24620Q0973 Stephanie M. Patterson 757-315-2510 09-23-2020 10:00am Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 X X 541519 $30 Million Net 30 N/A X W.G. Bill Hefner Veterans Affairs Medical Center 1601 Brenner Avenue Salisbury NC 28144 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

Department of Veterans Affairs Financial Services Center

PO BOX 149971

Austin TX 78714-9971 X See CONTINUATION Page Medical Coding Services in accordance with the Performance Work Statement (PWS) for W.G. Bill Hefner VAMC in Salisbury, NC. for a Base + 3 Option Periods contract.

See CONTINUATION Page X X X Stephanie M. Patterson Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C246 Stephanie M. Patterson

Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Department of Veterans Affairs Financial Services Center

PO BOX 149971

Austin TX 78714-9971

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

CODING SERVICES: Inpatient Facility Coding each Discharge in accordance with (IAW) Performance Work Statement (PWS) section 2.1.25 Contract Period: Base POP Begin: 10-01-2020 POP End: 09-30-2021

CODING SERVICES Inpatient Professional Encounters/Services Coding each encounter IAW PWS section 2.1.26

CODING SERVICES: Outpatient Coding each encounter IAW PWS section 2.1.27

CODING SERVICES: Surgery Coding each encounter IAW PWS section 2.1.28

DELIVERABLES (CLINs 0001 - 0004): Weekly and Monthly Reports IAW sections 3.0 and 4.0 of the PWS. NOT SEPARATELY PRICED

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Inpatient Facility ( Diagnosis Related Grouping) Coding IAW PWS section 2.2.8

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Inpatient Professional Encounter Coding Including Surgery IAW PWS section 2.2.8

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Outpatient Encounter/Service Coding Including Surgery IAW PWS section 2.2.8

DELIVERABLES (CLINs 0006 - 0010): Project Plan IAW PWS sections 2.2.7 and 4.0. Final Report Audit Results IAW PWS sections 2.2.9 and 4.0 Education Plan IAW PWS sections 2.2.9 and 4.0. NOT SEPARATELY PRICED

CODING SERVICES: Inpatient Facility Coding each Discharge in accordance with (IAW) Performance Work Statement (PWS) section 2.1.25 Contract Period: Option 1 POP Begin: 10-01-2021 POP End: 09-30-2022

CODING SERVICES Inpatient Professional Encounters/Services Coding each encounter IAW PWS section 2.1.26

CODING SERVICES: Outpatient Coding each encounter IAW PWS section 2.1.27

CODING SERVICES: Surgery Coding each encounter IAW PWS section 2.1.28

DELIVERABLES (CLINs 0001 - 0004): Weekly and Monthly Reports IAW sections 3.0 and 4.0 of the PWS. NOT SEPARATELY PRICED

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Inpatient Facility (Diagnosis Related Grouping) Coding IAW PWS section 2.2.8

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Inpatient Professional Encounter Coding Including Surgery IAW PWS section 2.2.8

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Outpatient Encounter/Service Coding Including Surgery IAW PWS section 2.2.8

DELIVERABLES (CLINs 0006 - 0010): Project Plan IAW PWS sections 2.2.7 and 4.0. Final Report Audit Results IAW PWS sections 2.2.9 and 4.0 Education Plan IAW PWS sections 2.2.9 and 4.0. NOT SEPARATELY PRICED

CODING SERVICES: Inpatient Facility Coding each Discharge in accordance with (IAW) Performance Work Statement (PWS) section 2.1.25 Contract Period: Option 2 POP Begin: 10-01-2022 POP End: 09-30-2023

CODING SERVICES Inpatient Professional Encounters/Services Coding each encounter IAW PWS section 2.1.26

CODING SERVICES: Outpatient Coding each encounter IAW PWS section 2.1.27

CODING SERVICES: Surgery Coding each encounter IAW PWS section 2.1.28

DELIVERABLES (CLINs 0001 - 0004): Weekly and Monthly Reports IAW sections 3.0 and 4.0 of the PWS. NOT SEPARATELY PRICED

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Inpatient Facility (Diagnosis Related Grouping) Coding IAW PWS section 2.2.8

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Inpatient Professional Encounter Coding Including Surgery IAW PWS section 2.2.8

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Outpatient Encounter/Service Coding Including Surgery IAW PWS section 2.2.8

DELIVERABLES (CLINs 0006 - 0010): Project Plan IAW PWS sections 2.2.7 and 4.0. Final Report Audit Results IAW PWS sections 2.2.9 and 4.0 Education Plan IAW PWS sections 2.2.9 and 4.0. NOT SEPARATELY PRICED

TOTAL OPTION 2:

CODING SERVICES: Inpatient Facility Coding each Discharge in accordance with (IAW) Performance Work Statement (PWS) section 2.1.25 Contract Period: Option 3 POP Begin: 10-01-2023 POP End: 09-30-2024

CODING SERVICES Inpatient Professional Encounters/Services Coding each encounter IAW PWS section 2.1.26

CODING SERVICES: Outpatient Coding each encounter IAW PWS section 2.1.27

CODING SERVICES: Surgery Coding each encounter IAW PWS section 2.1.28

DELIVERABLES (CLINs 0001 - 0004): Weekly and Monthly Reports IAW sections 3.0 and 4.0 of the PWS. NOT SEPARATELY PRICED

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Inpatient Facility (Diagnosis Related Grouping) Coding IAW PWS section 2.2.8

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Inpatient Professional Encounter Coding Including Surgery IAW PWS section 2.2.8

EXTERNAL AUDIT TASK AUDIT: EACH CHART: Outpatient Encounter/Service Coding Including Surgery IAW PWS section 2.2.8

DELIVERABLES (CLINs 0006 - 0010): Project Plan IAW PWS sections 2.2.7 and 4.0. Final Report Audit Results IAW PWS sections 2.2.9 and 4.0 Education Plan IAW PWS sections 2.2.9 and 4.0-NOT SEPARATELY PRICED

TOTAL OPTION 3:

GRAND TOTAL (BASE + OPTIONS

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36C24620Q0973

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B.3 PERFORMANCE WORK STATEMENT (PWS)

Salisbury VAMC Coding Contract Performance Work Statement (PWS) Off-site Medical Coding Services W.G. Bill Hefner VAMC, Salisbury NC

1.0 Description of Services:

1.1 The contractor shall:

1.1.1 Assign the current appropriate industry standard codes after careful review of the Health Record documentation for all inpatient, outpatient, surgeries, procedures, and ancillary encounters/services.

1.1.2 Assign International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10 CM/PCS) codes upon implementation.

1.1.3 Furnish validation of the integrity, quality, and assignment of codes to the data contained in the outpatient Patient Care Encounter, inpatient Patient Treatment File, and non-Veterans Affairs episodes of care under Veterans Affairs auspices.

1.1.4 The latest United States editions of the International Classification of Diseases, Current Medical Information and Terminology, and Current Procedural Terminology, and Healthcare Common Procedure Coding System shall be used to provide uniform disease and operation terminology, which is complete and scientifically accurate.

1.1.5 Code assignment shall be in accordance with National Center for Health Statistics, Centers for Medicare and Medicaid Services, American Hospital Association, American Medical Association and American Psychiatric Association guidelines, as appropriate. On those occasions when there is a question, Veterans Health Administration Coding Guidelines take precedence. Local policies will direct how coding is accomplished and what quantitative and/or qualitative reviews are performed by the facility. The American Hospital Association Coding Clinic and other publications may be used for training and reference purposes.

1.1.6 Ensure that the contractor’s coders providing services through this task order use the facility’s national Veterans Affairs encoder product. All coding must be completed through the encoder product. The national Veterans Affairs encoder is a single transparent interface with the Veteran Affairs’ electronic health record system Veterans Health Information Systems and Technology Architecture and the Graphical User Interface version of Veterans Health Information Systems and Technology Architecture. All coding is required to be done via the national Veterans Affairs encoder; no other system shall be used or interfaced with the Veterans Affairs systems.

International Classification of Diseases, a publication of the American Hospital Association

1.3.3 The current Veterans Health Administration guidelines for coding as found in the Veterans Health Administration Health Information Management Coding Guidelines, Health Information Management, and Department of Veterans Affairs. This workbook is updated at least once per year with new codes and guidance. The contractor must ensure that they have the current version and the guidance is followed. Note: While Veterans Health Administration does ask for reimbursement from third party payers, the Veterans Health Administration coding policy is to code only according to coding guidelines. Our own compliance audits use only this definition when determining if any encounter or Patient Treatment File is coded correctly.

http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=2794

established code of ethical principles as stated in the Standards of Ethical Coding published by American Health Information Management Association.

The Joint Commission One Renaissance Blvd Oakbrook Terrace, IL 60181

1.15 Exclusions and Sanction Certification: The contractor shall provide annual written certification to the CO which certifies that all employees, Sub-Contractors, and their employees have been checked to ensure that all agents providing services under the task order have been found not to be listed on the List of Parties Excluded from Federal Programs and the Health and Human Services/Office of the Inspector General Cumulative Sanction Report. The annual certification shall be provided within three weeks after award and within three weeks after the exercise of any options periods.

1.16 The contractor shall be responsible to train new Contract staff (including subcontractors, if applicable) on Veterans Affairs policy and procedures and ensure completion of any Veterans Affairs mandatory training, security clearances, or other tasks required for contractor staff to perform the services outlined in this PWS.

Administration to execute Health Insurance Portability and Accountability Act compliant Business Associate Agreements with appropriate parties that collect, receive, use, or disclose Veterans Health Administration Protected Health Information to perform activities, functions, or services for Veterans Health Administration.

2.0. Specific Mandatory Tasks and Deliverables:

2.0.1 The contractor shall not commence performance on the tasks in this Performance Work Statement (PWS) until the CO has conducted a kick off meeting or has advised the contractor that a kick off meeting is waived.

2.0.2 The contractor shall provide the specific deliverables described below by the timeframes specified.

2.0.3 The contractor and the COR shall meet via teleconference, at minimum, quarterly to review and discuss workload quantities for the quarter and projected workload requirements for the upcoming quarter. Any workload requirements that affect the scheduled quantities shall be mutually agreed upon by contractor and COR. The CO shall approve and execute any revisions to the schedule via modification.

2.1 Task One - Coding Services:

2.1.23.1 Those codes that were coded and not supported in the documentation, violate a coding rule

2.1.23.2 Those Current Procedural Terminology or International Classification of Diseases diagnosis codes that should have been coded and were not, 2.1.23.3 Inappropriate Current Procedural Terminology or International Classification of Diseases codes

2.1.23.4 Unbundled codes

2.1.23.5 Ancillary encounters with only a diagnosis of V72.5 or V72.6

2.1.23.6 Inaccurate Diagnosis Related Groups assignments

2.1.23.7 All other data elements incorrectly entered by the Contract coder, or not entered when appropriate, e.g. coder case comment, provider, adequacy of documentation.

Note: All subsequent reviews completed after the initial review work will be forwarded to the contractor’s designated contact person for resolution. The contractor along with the VA facility shall jointly determine a communication mechanism whereby the contractor shall access daily unless otherwise indicated on the task order. Veterans Affairs reserves the right to validate all coding, audit results and/or accuracy statistics submitted.

2.1.25 Inpatient Facility Coding:

2.1.25.1 Inpatient facility coding is to be completed within seven (7) calendar days from the date of discharge.

2.1.25.2 Per VHA Directive 2011-025, all Patient Treatment File data must be accepted by the Austin Information Technology Center and/or Veterans Health Administration Corporate Data Warehouse no later than seven (7) calendar days from the data of patient discharge. The only exceptions are Patient Treatment File discharges from Contract or Community Nursing Home and non-Department of Veterans Affairs Purchased Care patient files. Error corrections must be re-transmitted by the closeout deadline.

2.1.25.3 Inpatient facility coding is performed on all inpatient episodes of care, to include Observation and non- Veterans Affairs care under Veterans Affairs auspices, regardless of billable status. Applicable coding guidelines will be followed.

2.1.25.4 All inpatient facility coding will be entered into the Patient Treatment File utilizing the encoder software.

2.1.25.5 The Veterans Health Administration Handbook 1907.04 establishes procedures and covers the responsibilities and requirements for the appropriate use of the Patient Treatment File and provides specific instructions for completing each Patient Treatment File transaction (e.g., admission transaction (101), Patient Movement Transaction (501), Surgical Transaction (401), etc.).

2.1.25.6 A Present on Admission field entry is required for patients that are admitted to certain levels of care. The Present on Admission field is not required for Community Living Center and Domiciliary patients. The Present on Admission provides information on whether a diagnosis was present at the time of a patient's admission. The indicator is required to be assigned to all diagnosis codes involving inpatient admission. Each diagnosis, principal and secondary, and external causes of injury are required to have a Present on Admission indicator appended.

2.1.25.7 Non- Veterans Affairs purchased care Patient Treatment File coding utilizes the non- Veterans Affairs invoice, as well as submitted clinical documentation if received.

2.1.26 Inpatient Professional Encounters/Services Coding:

2.1.26.1 Inpatient Professional Encounters/Services coding is to be completed within seven (7) calendar days of the date coding is assigned.

2.1.26.2 Veterans Health Administration Directive 2009-002 Patient Care Data Capture: It is Veterans’ Health Administration policy to capture and report inpatient billable professional services and inpatient professional mental health services to support the continuity of patient care, resource allocation, performance measurement, quality management, provider productivity, research, and third-party payer collections. This directive requires the capture of defined inpatient professional mental health services regardless of the third-party billing status.

2.1.26.3 Mental Health Inpatient Professional Services are inclusive of daily evaluation and management, therapy sessions, consultations, etc. For purposes of patient care data capture, mental health services include inpatient professional services performed by a psychiatrist with the credentials of Medical Doctor or Doctor of Osteopathic Medicine, psychologist with the credentials of Doctor of Philosophy or Doctor of Psychology, master level social workers, or physician extender with the credentials of Nurse Practitioner, Clinical Nurse Specialist or Physician Assistant in an inpatient setting, location of the service notwithstanding.

2.1.26.4 Evaluation and Management services are used to capture the provider’s professional encounters/services performed in an inpatient setting. The Diagnostic Coding and Reporting Guidelines for Outpatient Services (Hospital-Based and Physician Office) should guide coders when coding inpatient diagnoses for physician professional services. Use the 1995 or 1997 Evaluation and Management guidelines as specified in the facility policy.

2.1.26.5 Identify and link Current Procedural Terminology and International Classification of Disease codes identify the provider, and the date(s) of service.

2.1.26.6 Guidelines for capturing the inpatient professional encounter/services are contained within the current Veterans Health Administration Coding Guidelines.

2.1.26.7 Contractor may be required to create the Inpatient Professional Service encounter in the Patient Care Encounter application in order to code the service.

2.1.27 Outpatient Coding:

2.1.27.1 All coding is to be completed within seven (7) calendar days of the date coding is assigned.

2.1.27.2 Outpatient encounters include face-to-face encounters and other occasions of service that are captured within the Patient Care Encounter. These services are captured through completion of electronic encounter forms; review of documentation by qualified coding staff; and automated data capture within radiology and laboratory Veterans’ Health Information Systems and Technology Architecture packages.

2.1.27.3 Applicable coding guidelines will be followed; outpatient coding guidelines are contained with the current Veteran Health Administration Coding Guidelines. Use the 1995 or 1997 Evaluation and Management guidelines as specified in the facility policy.

2.1.27.4 Assign or validate diagnostic and procedural codes reflective of documentation; correct the Patient Care Encounter, if necessary, to reflect code changes and name(s) of provider(s).

2.1.27.5 Typically outpatient coding does not require the coder to create encounters. Most outpatient encounters are initiated at the location of the visit, at time of patient check-in, and when the provider completes the visit at patient check-out and or completion of the encounter forms.

2.1.28 Surgery Case Coding to Include Anesthesia and Pathology:

2.1.28.1 Surgical coding must be completed immediately after the procedure when possible and no later than one week from the date of the procedure.

2.1.28.2 Surgery case coding includes the entry of coded procedures and diagnoses for all surgery cases. It is necessary to assign or validate diagnostic and procedural codes reflective of documentation for all cases in the surgery package.

2.1.28.3 Assign and enter the diagnostic codes and procedural codes with associated modifiers reflective of documentation using the encoder into the surgery package.

2.1.28.4 Validate that all cases successfully pass from the Surgery Package to Patient Care Encounter using the Patient Care Encounter Filing Status Report.

2.1.28.5 Assign and enter associated billable anesthesia and pathology services related to the surgery using the encoder into the Patient Care Encounter.

2.1.28.6 Anesthesiology visits for surgery performed in the Operation Room may require coders to create encounters for the services as they may not already exist in Patient Care Encounter.

2.1.28.7 Instructions for surgery coding are contained in the Veterans Health Administration Coding Guidelines.

2.1.29 Task One Deliverables:

2.1.29.1 Inpatient Facility Coding

2.1.29.2 Inpatient Professional Encounter/Services Coding

2.1.29.3 Outpatient Coding

2.1.29.4 Surgery case coding to include pathology and anesthesia services.

2.2 Task Two – External Auditing Service:

2.2.1 Audit services shall be performed monthly.

2.2.1.1 The VISN 6 External Audit Spreadsheet will be utilized to capture data for the audit. The Coding Supervisor or Lead Coder(s) shall pull the records to be audited in the last week of the month and provide to the contractor on or before 3PM on the last workday of the month.

2.2.1.2 The contractor shall complete audits on the 7th work day of the following month.

2.2.6 The number of records to be audited per month are:

2.2.6.1: 5 Patient Treatment File records for each inpatient coder for Inpatient Facility Diagnosis Related Grouping;

2.2.6.2: 15 Professional Fee Encounter for each inpatient coder for Inpatient Professional Encounters Coding including Surgery;

2.2.6.3: 5 Outpatient Surgery/Encounters for each surgery coder for Outpatient Encounter/Service Coding including Surgery;

Records may include inpatient hospitalizations, outpatient visits, and non-Veterans Affairs records. The coding activities may include any or all of the following: inpatient hospitalizations, ambulatory surgery, diagnostic tests (endoscopy, bronchoscopy, cardiac catheterization, Percutaneous Transluminal Coronary Angioplasty, pulmonary function, radiology, laboratory, etc.), primary care, mental health, medicine sub-specialty, surgery, observation, and non-Veterans Affairs records.

2.2.8 Outpatient, Inpatient Professional, Surgery, and Inpatient Facility Audits:

2.2.8.1 Audit includes Evaluation and Management, Current Procedural Terminology procedures, and International Classification of Diseases diagnosis codes.

Encounters/quarter are identified by billed episode and then audited against these three criteria. If the encounter does not have a Current Procedural Terminology procedure code associated with the visit, then that data point is not audited.

2.2.8.2 Use the 1995 or 1997 Evaluation and Management guidelines as specified in the facility policy. Review the Evaluation & Management code to determine if correct and identify the reason(s) if not.

2.2.8.3 Determine the accuracy and sequencing of the diagnoses coded and identify the reason(s) if not.

2.2.8.4 Determine the accuracy of Current Procedural Terminology/Healthcare Common Procedural Coding System codes and modifiers and the reason(s) if not accurate.

2.2.8.5 Inpatient review criteria may include: principal and secondary diagnosis code (accuracy, omission, etc.), Diagnosis Related Groups accuracy, correct Present on Admission assignment.

2.2.8.6 The contractor shall have a methodology for resolving coding questions by reviewers and ensuring inter-reviewer consistency and reliability.

2.2.8.7 The contractor shall review findings with Chief, Health Information Management, facility COR, management, and other designated medical center personnel. Any discrepancies identified during this process must be resolved prior to final written report.

2.2.8.8 The contractor shall be responsible for conducting at a minimum an exit conference with management officials at the discretion of the medical center to be coordinated with the COR.

2.2.9 Audit Reports

Reports on findings will be prepared to allow use by medical center staff in re-reviews, education or to provide management updates. Final report elements may be specified in VISN 6 External Audit Spreadsheet. Documentation of audit findings will be as requested by the facility and may include record ID, breakdown of record type (i.e., outpatient, inpatient), breakdown by code (Current Procedural Terminology, International Classification of Diseases, Evaluation and Management, modifier, etc.) of total number of codes reviewed; number of correct codes, accuracy rate, Diagnosis Related Groups reviewed (# correct; accurate); any code changes/errors and reason/reference for error; identified weaknesses and recommendation for correction. Also include any documentation issues/deficiencies and recommendation for improvement/remediation.

2.2.9.3 Education Plan: To be included in the audit process, weaknesses identified during the audit shall be used to provide a facility specific education/training plan, based on Veterans Health Administration coding and documentation regulations and guidelines, and local policy to present to Veterans Integrated Service Network/Veterans Affairs Medical Center management officials, physicians/clinicians, sub-specialties if needed, and for Veterans Health Administration coding staff to include any recommended remediation. Plan shall be submitted to the local COR within seven (7) calendar days following the audit.

2.2.10 Task Two Deliverables

2.2.10.1 Project Plan, if required

2.2.10.2 Audit: Inpatient facility (Diagnosis Related Group) coding

2.2.10.3 Audit: Inpatient professional encounter coding including surgery coding

2.2.10.4 Audit: Outpatient encounter/services coding including surgery coding

2.2.10.5 Report on audit results

2.2.10.6 Education Plan

2.3 Task Three – On-site Training Workshop

The Contractor shall provide, at a minimum, a two-hour educational session for Veterans Health Administration coding staff, Veterans Affairs Medical Center management officials, physicians/clinicians, sub-specialties providers or other staff. Contractor is required to develop specific coding education utilizing actual charts and identified coding issues specific to the Veterans Health Administration coder and/or Veterans Affairs facility, and based on Veterans Health Administration guidelines, regulations, and local policy.

2.3.1. Task Three Deliverable: Training Workshop

3.0 Reporting Requirements

3.0.1 The contractor shall provide to the facility COR a weekly status report, citing number coded, date to be coded, number remaining to be coded, number of suspended encounters, and any issues needing resolution. The report shall be submitted to the COR via email on or before noon each Wednesday.

3.0.2 The contractor shall provide the facility COR with monthly progress reports commensurate with the length of the project. The contractor can determine the format that will adequately capture the information. Any format revisions will be mutually agreed upon by the contractor and COR.

The progress report shall:

3.0.2.1 Cover all work completed during the preceding reporting period.

3.0.2.2 Identify project activity, issues and resolutions, escalation process for outstanding issues, and remediation for any issues that cause the project to be delayed (both anticipated and unanticipated).

3.0.2.3 Provide a cumulative total, per CLIN, of remaining quantity and available balance.

3.1. Deliverables:

4.0 Schedule of Deliverables

The contractor shall meet the Delivery Schedule for each deliverable specified below:

Objective Delivery Due

2.1 Task One – Coding Services

Coding Within 7 calendar days of the date coding of discharge.

Encounter/Services Coding Within 7 calendar days of the date of discharge.

the date coding is assigned.

when possible and no later than one week from the date of the procedure.

2.2 Task Two - External Audit

If required, within 15 calendar days of request

Facility Complete by the 7th work day of the month following the quarter

professional encoder coding including surgery coding Complete by the 7th work day of the month following the quarter

encounter coding Complete by the 7th work day of the month following the quarter

results Within 15 business days of audit completion.

2.3 Training Workshop