36C25223Q0148.docx

36C25223Q0148

PAGE 1 OF

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.

UEI:

EFT:

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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

537-23-1-5064-0001 36C25223Q0148 St.Onge,Donald 414-844-4819 11-30-2022

10:00AM

CST

36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 3001 Green Bay Road North Chicago

IL

60064 X X 561499 $19 Million N/A X 36C537 Department of Veterans Affairs Jesse Brown VA Medical Center 820 S. Damen Ave.

Chicago

IL

60612-3728 36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 3001 Green Bay Road North Chicago

IL

60064

Department of Veterans Affairs Financial Services Center PO Box 149971 Austin

TX

78714-9971 877-353-9791 512-460-5540 See CONTINUATION Page Contractor to provide Medical Coding services for the Jesse Brown VA Medical Center in accordance with the Statement of Work.

See CONTINUATION Page X X X

ASHLEY JOHNSON

Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA (continuation from Standard Form 1449)

OFFERORS MUST COMPLETE AND RETURN ALL INFORMATION DESIGNATED HEREIN PRIOR TO THE TIME SPECIFIED IN BLOCK 8 OF SF 1449 IN ORDER TO BE CONSIDERED FOR AWARD.

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

1. CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

CONTRACTOR NAME _____________________________________

ADDRESS ________________________________________________

CITY-STATE-ZIP __________________________________________

POINT OF CONTACT/TITLE ________________________________

SAM UEI NO. ____________________________________________

CAGE CODE _____________________________________________

CONTRACTOR’S PAST PERFORMANCE POINT OF CONTACT

(IF DIFFERENT THAN ABOVE):

NAME: __________________________________________

EMAIL ADDRESS:_________________________________

b. GOVERNMENT: DONALD ST. ONGE, CONTRACT SPECIALIST

ASHLEY JOHNSON, CONTRACTING OFFICER

CONTRACTING OFFICE CODE: 36C252

MILWAUKEE WI 53214

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

a. FAR 52.232-33 PAYMENT BY ELECTRONIC FUNDS TRANSFER – SYSTEM FOR AWARD MANAGEMENT (OCT 2018)

3. INVOICES:

a. Invoices shall be submitted monthly in arrears in accordance with: 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

b. Payments shall be made in arrears upon receipt of a properly prepared invoice

c. The VA has mandated electronic invoice submission to the Veterans Affairs Financial Services Center (VAFSC). VAFSC has partnered with Tungsten Network e-Invoicing network, for submissions of all electronic invoices to VA. Tungsten Network electronic invoicing is free to all VA vendors. In order to submit electronic invoices, all VA vendors must register with Tungsten Network by submitting an email to VA.Registration@Tungsten-Network.com or calling 1-877-489-6135 for Enrollment.

d. Contractor shall submit an electronic invoice by the tenth (10th) of the following month services were performed to the Veterans Affairs Financial Services Center (VAFSC) e-Invoice through the website at https://portal.Tungsten-Network.com/Login.aspx. For questions regarding the submission of VA electronic invoices, Tungsten Network customer service may be contacted at 1-877-489-6135.

e. All invoices shall reference the vendor name and address, customer name, contract number, appropriate obligation/funding order number, description of services provided, quantity, unit price, and total invoice amount (any additional info). Invoices shall also include any payment discount terms.

4. GOVERNMENT INVOICE ADDRESS (See SF1449 Block 18):

a. All invoices from the contractor shall be submitted electronically in accordance with 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

b. Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests.

c. VA’s Electronic Invoice Presentment and Payment System – The Veterans Affairs Financial Services Center (VAFSC) uses a third-party contractor, Tungsten Network e-Invoice, to transition vendors from paper to electronic invoice submission. Please go to this website: http://www.tungsten-network.com/customer-campaigns/veteransaffairs/ to begin submitting electronic invoices, free of charge.

d. As of July 1, 2020, the VA10091 form has been eliminated and the VAFSC is requiring our vendors to update and add their information in the Customer Engagement Portal (CEP) at https://www.cep.fsc.va.gov/. This is for new vendors being added to FMS only.

e. For assistance setting up e-Invoice, the below information is provided:

i. * Tungsten Network e-Invoice Setup Information: 1-877-489-6135

* Tungsten Network e-Invoice email: VA.Registration@Tungsten-Network.com

* FSC e-Invoice Contact Information: 1-877-353-9791

* FSC e-invoice email: vafsccshd@va.gov

5. ACQUISITION OF COMMERCIAL ITEMS:

This Request for Quote (RFQ) solicitation is issued under the authority of FAR Part 13.5 Simplified Procedures for Certain Commercial Items in which simplified acquisition procedures in FAR Part 13 will be used. FAR Part 14 and 15 will not be used. From this RFQ, the Government intends to award a firm fixed price contract where the contractor provides a price that is not subject to any adjustment on the basis of the contractor’s cost experience in performing the contract.

6. RFQ QUESTIONS:

In order to maintain integrity of this solicitation and subsequent award date, all offerors are advised that any question and answer requests must be submitted in a written form via e-mail to the Contracting Officer Ashley Johnson at ashley.johnson6@va.gov and the Contract Specialist Donald St. Onge at Donald.st.onge@va.gov no later than Thursday November 17, AT NOON LOCAL TIME. Contracting will issue a consolidated response via solicitation amendment to https://sam.gov Contract Opportunities within 2 business days to all parties.

7. CONTRACTING OFFICER AUTHORITY:

The Contracting Officer is the only person authorized to approve changes or modify any of the requirements under this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitment or issue changes that will affect price, quantity or quality of performance of this contract. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer, the change shall be considered to have been made without authority and no adjustment will be made in the contract price to cover any increase in cost incurred thereof.

8. IDENTIFICATION, PARKING, SMOKING AND VA REGULATIONS:

a. All VA property is considered Federal property and all Federal laws are applicable.

b. It is the responsibility of the Contractor to park in the appropriate designated parking areas. Information on parking is available from the VA Police Section. The VA will not invalidate or make reimbursement for parking violations of the Contractor under any conditions.

c. All VA facilities are drug free. Possession of drugs, to include Marijuana and all Marijuana bi-products are prohibited. Enclosed containers, including tool kits, shall be subject to search. Violations of VA regulations may result in citation answerable in the United States (Federal) District Court, not a local district, state, or municipal court.

d. All contractor personnel are required to adhere to all VA rules and regulations.

e. Smoking is prohibited on the entire campus, both inside and outside the VA Facility

f. Possession of weapons is prohibited. Enclosed containers, including tool kits, shall be subject to search. Violations of VA regulations may result in citation answerable in the United States (Federal) District Court, not a local district, state, or municipal court.

g. VHA DIRECTIVE 1192: This Veterans Health Administration (VHA) directive establishes policy and provides guidance for the prevention of seasonal influenza in VHA facilities through the vaccination or masking of health care personnel (HCP). AUTHORITY: Title 38 United States Code (U.S.C.) 7301(b), 7318(b). Contractor is responsible in ensuring that all aspects of this directive are implemented, including providing face masks and influenza vaccines for all employees working at a VA facility.

9. VHA SUPPLEMENTAL CONTRACT REQUIREMENTS FOR COMBATTING COVID-19

1. Contractor employees who work in or travel to VHA locations must comply with the following:

a. Documentation requirements:

1) If fully vaccinated, contractors shall show proof of vaccination.

i. NOTE: Acceptable proof of vaccination includes a signed record of immunization from a health care provider or pharmacy, a copy of the COVID-19 Vaccination Record Card (CDC Form MLS-319813_r, published on September 3, 2020), or a copy of medical records documenting the vaccination.

2) If unvaccinated, contractors shall show negative COVID-19 test results dated within three calendar days prior to desired entry date. Test must be approved by the Food and Drug Administration (FDA) for emergency use or full approval. This includes tests available by a doctor’s order or an FDA approved over-the-counter test that includes an affiliated telehealth service.

3) Documentation cited in this section shall be digitally or physically maintained on each contractor employee while in a VA facility and is subject to inspection prior to entry to VA facilities and after entry for spot inspections by Contracting Officer Representatives (CORs) or other hospital personnel.

4) Documentation will not be collected by the VA; contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information.

2. Contractor employees are subject to daily screening for COVID-19 and may be denied entry to VA facilities if they fail to pass screening protocols. As part of the screening process contractors may be asked screening questions found on the COVID-19 Screening Tool. Check regularly for updates.

a. Contractor employees who work away from VA locations, but who will have direct contact with VA patients shall self-screen utilizing the COVID-19 Screening Tool, in advance, each day that they will have direct patient contact and in accordance with their person or persons who coordinate COVID-19 workplace safety efforts at covered contractor workplaces. Contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information.

3. Contractor must immediately notify their COR or Contracting Officer if contract performance is jeopardized due to contractor employees being denied entry into VA Facilities.

4. For indefinite delivery contracts: Contractor agrees to comply with VHA Supplemental Contract Requirements for any task or delivery orders issued prior to this modification when performance has already commenced.

10. SECURITY & PRIVACY CONTROL:

1. GENERAL

Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

2. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS

a. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.

b. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.

c. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.

d. Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.

e. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor’s employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.

3. VA INFORMATION CUSTODIAL LANGUAGE

a. Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d) (1).

b. VA information should not be co-mingled, if possible, with any other data on the contractors/subcontractor’s information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met. If co-mingling must be allowed to meet the requirements of the business need, the contractor must ensure that VA’s information is returned to the VA or destroyed in accordance with VA’s sanitization requirements. VA reserves the right to conduct on- site inspections of contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with VA directive requirements.

c. Prior to termination or completion of this contract, contractor/subcontractor must not destroy information received from VA, or gathered/created by the contractor in the course of performing this contract without prior written approval by the VA. Any data destruction done on behalf of VA by a contractor/subcontractor must be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management and its Handbook 6300.1 Records Management Procedures, applicable VA Records Control Schedules, and VA Handbook 6500.1, Electronic Media Sanitization. Self-certification by the contractor that the data destruction requirements above have been met must be sent to the VA Contracting Officer within 30 days of termination of the contract.

d. The contractor/subcontractor must receive, gather, store, back up, maintain, use, disclose and dispose of VA information only in compliance with the terms of the contract and applicable Federal and VA information confidentiality and security laws, regulations and policies. If Federal or VA information confidentiality and security laws, regulations and policies become applicable to the VA information or information systems after execution of the contract, or if NIST issues or updates applicable FIPS or Special Publications (SP) after execution of this contract, the parties agree to negotiate in good faith to implement the information confidentiality and security laws, regulations and policies in this contract.

4. SECURITY INCIDENT INVESTIGATION

a. The term “security incident” means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COTR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access.

5. LIQUIDATED DAMAGES FOR DATA BREACH

a. Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract.

b. The contractor/subcontractor shall provide notice to VA of a “security incident” as set forth in the Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level of risk associated with the data breach for the potential misuse of any sensitive personal information involved in the data breach. The term 'data breach' means the loss, theft, or other unauthorized access, or any access other than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material breach and grounds for contract termination.

c. Each risk analysis shall address all relevant information concerning the data breach, including the following:

1) Nature of the event (loss, theft, unauthorized access);

2) Description of the event, including:

a) date of occurrence;

b) data elements involved, including any PII, such as full name, social security number, date of birth, home address, account number, disability code;

3) Number of individuals affected or potentially affected;

4) Names of individuals or groups affected or potentially affected;

5) Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of protection for the data, e.g., unencrypted, plain text;

6) Amount of time the data has been out of VA control;

7) The likelihood that the sensitive personal information will or has been compromised (made accessible to and usable by unauthorized persons);

8) Known misuses of data containing sensitive personal information, if any;

9) Assessment of the potential harm to the affected individuals;

10) Data breach analysis as outlined in 6500.2 Handbook, Management of Security and Privacy Incidents, as appropriate; and

11) Whether credit protection services may assist record subjects in avoiding or mitigating the results of identity theft based on the sensitive personal information that may have been compromised.

d. Based on the determinations of the independent risk analysis, the contractor shall be responsible for paying to the VA liquidated damages in the amount of $37.50 per affected individual to cover the cost of providing credit protection services to affected individuals consisting of the following:

1) Notification;

2) One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant credit bureau reports;

3) Data breach analysis;

4) Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to assist affected individuals to bring matters to resolution;

5) One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and

6) Necessary legal expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs.

6. TRAINING

a. All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA information and its systems:

1) Sign and acknowledge (either manually or electronically) understanding of and responsibilities for compliance with the Contractor Rules of Behavior, Appendix E relating to access to VA information and information systems.

2) Successfully complete the VA Cyber Security Awareness and Rules of Behavior training and annually complete required security training.

3) Successfully complete the appropriate VA privacy training and annually complete the required privacy training; and

4) Successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access [see training requirements above.]

b. The contractor shall provide to the contracting officer and/or COR a copy of the training certificates and certification of signing the Contractor Rules of Behavior for each applicable employee within 1 week of the initiation of the contract and annually thereafter, as required.

c. Failure to complete the mandatory annual training and sign the Rules of Behavior annually, within the timeframe required, is grounds for suspension or termination of all physical or electronic access privileges and removal from work on the contract until such time as the training and documents are complete.

HIPAA COMPLIANCE

Contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the Contractor will be required to enter into a Business Associate Agreement (BAA) with VA (see Attachment A). Contracted employees shall sign a Non-Disclosure Agreement prior to work.

36C25223Q0148

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B.2 PRICE SCHEDULE

AUTHORITY: The Contractor shall provide all labor, materials, transportation, and supervision necessary to perform the services as set forth in the Performance Work Statement PWS).

Qty

Qty

Qty

Qty

Qty

ESTIMATED TOTAL OF BASE AND ALL OPTION YEARS: $______________________

B.3 PERFORMANCE WORK STATEMENT

1. Title of Project: Health Information Management Service (HIMS) Coding Support

2. Background: The Veterans Health Administration (VHA) currently captures and stores information including diagnoses, treatment, and providers for all inpatient and outpatient care provided to patients treated at a VA healthcare facility, and for patients treated at other healthcare facilities at VA expense. All VA facilities store this information in an integrated computer system called “Veterans Health Information Systems and Technology Architecture” (VistA). Each facility has its own VistA database and selected data from the local databases is uploaded into various national systems.

Inpatient information is stored in the Patient Treatment File (PTF), which was developed in 1983. PTF is a computerized abstract of each patient discharge and contains over 100 different data items which describe the characteristics of the patient and the reason for the hospital stay. PTFs are completed for inpatients treated at any level of a VA facility (hospital, nursing home, domiciliary, observation), and for patients receiving care at non-VA facilities at VA expense. The PTF software package is subject to change with additions, modifications, deletions, etc. of the transaction types and data fields or replacement to meet data collection needs. See Attachment A for current PTF transaction types.

Outpatient information is entered through VistA Patient Care Encounter (PCE), Event Capture (EC) or Appointment Manager (AM) software modules. Coded data for all professional services – inpatient or outpatient – are captured through PCE. Some of the data elements captured are the date and time of service, identification of the provider, diagnoses and procedures for all care provided including ancillary services, minor and major procedures, and diagnostic studies.

The value of coded data to managers and researchers depends on how accurately it portrays the actual clinical events that take place in the medical center. Data validity begins with practitioners providing timely and complete medical record documentation including an accurate recording of all diagnoses and procedures.

Beginning September 1, 1999, Current Procedural Terminology (CPT) procedure coding and inpatient Diagnosis Related Groups (DRGs) became a basis for facility and professional charges for bills submitted to third party carriers. Coders are held responsible for the accuracy of these codes and compliance with federal legislation and VHA guidelines.

The facility has varying degrees of coding backlogs. Episodes of care to be coded include outpatient encounters, ancillary services, major or minor surgery episodes, diagnostic studies, inpatient PTF, and/or inpatient professional services.

3. Period of Performance:

Base Period: Date of Award through 30 November 2023 Option Year One: 1 December 2023 through 30 November 2024 Option Year Two: 1 December 2024 through 30 November 2025 Option Year Three: 1 December 2025 through 30 November 2026 Option Year Four: 1 December 2026 through 30 November 2027

4. Scope of Work: The purpose of this contract is to obtain services to assign Classification of Diseases (ICD), CPT-4, and Healthcare Common Procedural Coding Systems (HCPCS) Level II codes based on medical record documentation of outpatient and inpatient care provided at or under the auspices of a Veterans Health Administration facility and perform coding audits. The Contractor shall provide all resources necessary to accomplish the deliverables described in the statement of work (SOW), except as may otherwise be specified.

a. Assign ICD, CPT-4, and HCPCS Level II codes based on medical record documentation of outpatient and inpatient care provided at or under the auspices of a Veterans Health Administration facility

b. Furnish validation of the integrity, quality, and assignment of codes to the data contained in the outpatient Patient Care Encounter (PCE), inpatient Patient Treatment File (PTF), the non-VA database and the integrated billing package.

c. Contract performance periods will consist of a base year and four additional option years.

5. Description of Services:

5.1 Task One - Coding Services:

A. The contractor shall use skills, training, and knowledge of International Classification of Diseases, Common Procedural Terminology, and Healthcare Common Procedural Coding System Level II code sets and guidelines and other generally accepted available resources to review health record documentation and providers’ scope of practice to assign diagnostic and procedural codes at a minimum 95% accuracy rate and within required performance timelines.

B. The contractor shall code Outpatient Encounters including Radiology, Lab or other Ancillary Services, Surgical to include pathology and anesthesia services, Inpatient Professional Services; and Inpatient Episodes/Admission Services as specified under each individual task order; shall include required encoder/ Veterans Health Information Systems and Technology Architecture data elements in accordance with Veterans Health Administration Handbooks and protocols as specifically outlined in the task order. Other identified cases to be coded include but not limited to: Veteran Tortfeasor Claims; Veteran Workers’ Compensation, Humanitarians, beneficiaries of the Military Health System (TRICARE is the healthcare program servicing military beneficiaries), Civilian Health and Medical Program of the Department of Veterans Affairs, Ineligibles, Fugitive Felon, Prosthetics, non-Veterans Affairs Fee Services, and New Insurance/Late Checkout.

C. New Insurance/Late Check Out encounters may not have been coded due to new insurance identified or late check-out and were not identified in the daily coding reports. New Insurance/Late Check Out encounters shall be coded within the turnaround time stated in the local policy or approved by the Contracting Officer.

D. The contractor shall use the 1995 or 1997 Evaluation and Management guidelines as specified in the facility policy.

E. Veterans’ Health Administration provides a wide variety of primary and specialty care services in the outpatient setting. Inpatient admissions include those for acute care/specialty care, observation, and admissions to the Community of Living nursing care, and domiciliary units to include non-Veterans Affairs Fee services.

F. The contractor shall abstract other identified data items and enter the data into the local Veterans Health Information Systems and Technology Architecture system, encoder program, or write the information on source documents as agreed with the local facility. This information shall include a decision as to whether or not an encounter is billable, based on non-compliance with documentation and resident supervision guidelines. Coders will utilize the Case Comment communication tool to provide billing staff with a standardized reason (case comment) why they believe an outpatient encounter cannot be billed. Encounters believed to be not billable will be marked with the appropriate Case Comment. Case Comments may include but is not limited to Agent Orange exposure or Ionizing Radiation, telephone care, non-billable provider, insufficient documentation, or other types of care that cannot be billed. Contractor shall be available to answer any follow up questions regarding the episode and provide references in support of their code selection. Contractor will also record episodes as required.

G. The contractor shall provide all labor, materials, transportation, and supervision necessary to perform coding and abstracting using either the 1995 or 1997, per VA Medical Center policy, the Evaluation and Management guidelines on encounters and standard industry guidelines, e.g., Coding Clinics and Common Procedural Terminology Assistant, as specified by the Veterans Affairs Administration Center.

H. The contractor shall adhere to all coding guidelines as approved by the Cooperating Parties and accepted Veterans Affairs regulations.

I. The contractor shall utilize Veterans Health Administration national encoder, industry standard guidelines, Veterans Health Administration and local policies, and other generally accepted contractor supplied reference materials to assign and/or validate diagnostic and procedural codes reflective of documentation.

J. The contractor shall utilize the standardized Case Comments in the encoder application to communicate specific document information to Billing.

K. The contractor shall utilize Patient Care Encounter / Patient Treatment File / Surgery or other database, if necessary, to reflect code changes and names(s) of provider(s).

L. The contractor shall review and determine whether documentation is adequate to support billable services.

M. If requested by the facility, the contractor may place a local coder on-site if available in accordance with the contract when the coder lives in a Veterans Affairs facility requesting work. No travel costs will be charged in this scenario.

N. The contractor shall ensure that individual coders are clearly identified on all work; any paper documents shall clearly identify the individual coder.

O. When assigning multiple Common Procedural Terminology codes, the contractor shall verify that they are not components of a larger, more comprehensive procedure that can be described with a single code.

P. The contractor shall identify those encounters, if any, where documentation does not substantiate an appropriate code(s).

Q. The contractor shall identify duplicate encounters or encounters created in error because the patient was not seen.

R. The contractor shall code based on reading and reviewing the documentation in the health record including the Computerized Patient Record System and Veterans Health Information Systems and Technology Architecture Imaging. The contractor shall complete data entry into the encoder application that is integrated with the Veterans Health Information Systems and Technology Architecture system as part of this Contract. Completion of source documents in lieu of Veterans Health Information Systems and Technology Architecture entry may be arranged only upon mutual agreement between the facility task order Contracting Officer and the contractor.

S. The contractor shall coordinate with the local Contracting Officer’s Representative for implementation of contingency plans for data entry when required.

T. The contractor shall assign modifiers as appropriate to override Correct Coding Initiative edits.

U. For Inpatient Episodes/Admission Services:

1. Complete all Patient Treatment File Transactions (e.g., 101, 401, 501, 601, and 701/702) in accordance with Veterans Health Administration Handbooks, 1907.03 HIM Clinical Coding Program Procedures and 1907.04 Patient Treatment File Coding Instructions.

2. Opening and transmitting Patient Treatment Files will follow local facility protocol.

V. The contractor shall review documentation to determine why an ancillary or other diagnostic test was ordered and assign an International Classification of Diseases diagnosis code, as appropriate based on date of service, to that test. Contractor shall add the referring providers name in coding case comments.

W. The contractor shall re-review any coded data when questioned by Veterans Affairs staff due to a billing edit, when a denial is received, or when a retrospective review is completed, to either make changes or substantiate the coding with appropriate coding rules and references. This service is included in the price of the work. The contractor shall use the following during re-review processes:

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

2. Those Common Procedural Terminology or International Classification of Diseases diagnosis codes that should have been coded and were not,

3. Inappropriate Common Procedural Terminology or International Classification of Diseases codes

4. Unbundled codes

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

6. Inaccurate Diagnosis Related Groups assignments

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.

X. 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 date due, format, and method is to be determined by the facility COR.

1. Inpatient Facility coding: Inpatient facility coding is to be completed within seven (7) calendar days from the date coding is assigned.

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.

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.

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

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.).

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.

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

Y. Inpatient Professional Encounters/Services coding:

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

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.

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.

4. Evaluation and Management services are used to capture the provider’s professional encounters/services performed in an inpatient setting.