Requirement Description.pdf

Performance Work Statement (PWS) WSNC Clinical Documentation Integrity (CDI) Improvement Requirement

Location: Western States Network Consortium (WSNC) Period of Performance: 5 Year Contract (1-year Base and 4 1-year options)

A. Scope

This PWS outlines the requirements for providing CDI Improvement and Coding training across the WSNC. In the context of HIMS (Health Information Management Systems), CDI stands for Clinical Documentation Integrity. CDI Professionals play a crucial role in ensuring that clinical documentation is accurate, complete, and consistent, which is essential for proper reimbursement and reliable health data for research and reporting. They help maintain the integrity of patient records and contribute to the overall quality of care in healthcare settings. A Clinical Documentation Improvement and Coding Program requires specialized training to review health records for completeness, appropriate documentation and correct assignment of diagnosis and procedure codes. An effective, comprehensive CDI program is mandated by the National HIMS Program office per VHA Directive 1907.01 and the VHA Clinical Documentation Integrity Program Guide. To ensure staff are equipped with the skill set and remain current with ever-changing guidelines, frequent ongoing training is required. This training must be vetted through a nationally recognized accrediting body, such as the American Health Information Management Association (AHIMA).

For development, implementation or maintenance of a facility CDI program, the vendor must follow the VHA HIM CDI Program Guide and other VHA or Facility CDI processes.

This CDI Improvement and Coding Training Program includes specialized training to review health records for completeness, appropriate documentation and correct assignment of diagnosis and procedure codes. Training will include both in-person and virtual classroom training, web-based on-demand training and one-on-one support. The on-demand training will allow staff the ability to take the online CDI and/or Coding training curriculum on their own time as well as new staff hired at facilities.

Upon completion of the CDI training curriculum, the attendee (Provider/ Physician Champion) should be able to:

Understand International Classification of Disease, 10th Edition or most current edition as available, Clinical Modification/Procedural Code Set (ICD-10-CM/PCS) fundamentals

Documentation clarification opportunities for inpatient and outpatient CDI

Tips for engaging fellow medical staff in CDI

Identify common documentation deficiencies in the medical record Identify diagnoses frequently in need of documentation clarification to support accurate code assignments

Understand Medical Severity -Diagnosis Related Grouping (MS-DRG) assignment and the impact of diagnosis assignment

Understand inpatient quality measures and the Physician Champion’s role in CDI

Upon completion of the CDI training curriculum, the attendee (CDI Professional) should be able to:

Understand and apply the ICD-10-CM Official Guidelines for Coding and Reporting from a CDI perspective

Identify diagnoses frequently in need of documentation clarification to support accurate code assignment

Understand best practices associated with VHA, CMS and TJC compliant query process’s

Learn and understand tips for working, communicating and educating Providers to improve clinical documentation

How to recognize the important clinical indicators for diagnoses across major body systems

Understand MS-DRG assignment is calculated and the impact of diagnosis assignment

Understand how correct code assignment impacts reimbursement

Assessment of documentation workflow practices

Perform initial medical record audit of provider notes

Validate against submitted ICD-10 code(s) on claims

Identify documentation deficiencies

Identify existing HCC chronic conditions not captured within 12 months

Identify opportunities and ensure accuracy and completeness of clinical documentation used for measuring and reporting physician outcomes

Identify risks and missed opportunities due to under coding

Formal written strategy plan to address documentation deficiencies

Formal meeting to review audit findings and strategy plan for the CDI, Coding and Nursing Informatics

B. Applicable Documents

VHA Directive 1907.01 - VHA HEALTH INFORMATION MANAGEMENT AND HEALTH

RECORDS

VHA Directive 1605 - VHA PRIVACY PROGRAM

VHA Clinical Documentation Integrity Program Guide

VHA Directive 6300 - Records Management

VHA HIM Clinical Coding Program Guide Version 1.9

VHA Coding Guidelines

C. Performance Requirements / Tasks

Implementation of a CSI and Coding training program focused on education of Clinical Documentation Integrity Specialists (CDIS), CDI Registered Nurse Advisor (CDI RNA), Coding Staff, CDI Specialist, Provider and Physician Champion (coding workforce). The training program must implement work plans, the importance of concurrent review of medical records, and validation of diagnosis codes and query processes. Through collaboration with the Veterans Affairs Medical Center (VAMC), the contractor will determine coding and clinical documentation content requirement topics to provide maximum improvement at each medical center or under individual Task Orders (TO). Specific curriculum providing CDIS and coding education on surgical coding (all surgical specialties), Cardiovascular, ENT, Orthopedic, Ophthalmology, Neurology, Neurosurgery, Geriatrics, Urology, Gastroenterology, Nephrology, OB/GYN, Oncology, Hematology, Infusions, Interventional Radiology and Primary Care/General Medicine. The program will meet the below required tasks.

1) Task 1: Survey sights coding records to identify problem areas and work to focus on classroom training (in-person and virtual) for maximum benefit. This will be coordinated with the site Point of Contact (POC) to review, validate, and approve training materials and topics.

2) Task 2: Provide a combination of formal classroom education and hands-on training

a) In-person classroom training – to include an in-person trainer, accommodate training for coding workforce in group trainings as agreed to under Task 1. Sizes may vary depending on facility but no more than 20 learners per training. Must include access to CDI and coding E-learning platforms that may be provided. Must provide live/in-person accredited Coding, CDI and Provider training and provide accredited Continuing Education Units (CEU) to VA participants that have satisfactorily completed training programs.

i) The contractor trainers must be certified medical coding, CDI, Provider instructors, accredited by American Health Information Management Association (AHIMA) certification or equivalent with at least 5 years’ experience.

b) Virtual classroom training – to include webinars, recorder sessions, live virtual classroom training for coding workforce. Sizes may vary depending on facility and needs. Must include access to CDI and coding E-learning platforms. Provide accredited Continuing Education Units (CEU) to VA participants that have satisfactorily completed training programs.

i) The contractor trainers must be certified medical coding, CDI, Provider instructors, accredited by American Health Information Management Association (AHIMA) certification or equivalent with at least 5 years’ experience.

ii) Training on-line access through a web-based portal that will allow VA computers and participants to easily log in to quickly access training modules 24/7 or as needed per work schedule.

c) On-Demand Virtual training- to include webinars, recorder sessions, live virtual training for coding workforce, and access to CDI and coding E-learning platforms that may be provided. Provide accredited Continuing Education Units (CEU) to VA participants that have satisfactorily completed training programs.

i) The contractor trainers must be certified medical coding, CDI, Provider instructors, accredited by American Health Information Management Association (AHIMA) certification or equivalent with at least 5 years’ experience.

ii) Any technical issues with the on-demand training functions will be resolved or updated by contractor to VISN or VAMC HIMs chief, along with assigned Contracting Officer Representative (COR), within 2 Business Days of a reported outage or issue.

i) Training on-line access through a web-based portal that will allow VA computers and participants to easily log in to quickly access training modules 24/7 or as needed per work schedule.

d) One-on-One training- Provide a virtual or in-person trainer, to assist coding workforce, for one-on-one individual training and support. Provide accredited Continuing Education Units (CEU) to VA participants that have satisfactorily completed training programs.

i) The contractor trainers must be certified medical coding, CDI, Provider instructors, accredited by American Health Information Management Association (AHIMA) certification or equivalent with at least 5 years’ experience.

ii) Training on-line access through a web-based portal that will allow VA computers and participants to easily log in to quickly access training modules 24/7 or as needed per work schedule.

3) Task 4: Provide accredited Continuing Education Units (CEU) to VA participants that have satisfactorily completed training programs.

4) Task 5: Training Materials (PowerPoint Presentations, hard copy handouts, Pocket Guide, books/manuals):

a) Classroom training material requirements.

i) Definitions of anatomy and physiology terms (coders and clinical documentation specialists only)

ii) Provide industry-leading tools and resources to the VA in order to ensure that the mission of serving veterans can be better accomplished

iii) Definitions and go over disease processes (coders and clinical documentation specialists only)

iv) Graphics for specific areas presenting on Summarize and provide coding guidelines references from CPT, ICD-10 CM, ICD-10PCS, and HCPCS Books.

v) Summarize and provide references from CPT Assistant, Coding Clinic and from the VA Intranet.

vi) Provide documentation examples and go through each one during presentation along with supplying CPT, ICD-10CM, ICD-10 PCS, HCPCS and codes.

vii) Discuss any query opportunities from providers examples or in general we may have seen while researching.

viii) Summarize coding topic/Issues Addressed.

ix) The coding trainer will send to the VAMC contacts to review before presenting the

PowerPoint.

x) The coding trainer will make any revisions before final presentation.

xi) The coding trainer will present and take any questions from VAMC coding workforce on all topics covered in the training.

xii) The Trainer will ensure any unanswered questions or additional questions during presentations are followed up on and sent back to the VAMC for clarification.

xiii) The preferred offerings would include trainings which are designed for and address the specific documentation and coding practices within the Department of Veterans Affairs. This would include documentation and coding education focused on Veterans Equitable Resource Allocation (VERA) optimization.

b) “Pocket guides” for inpatient and outpatient coding rules and regulations.

D. Performance Standards

1) In-person and on-line training will have “participate surveys” conducted, 100% of participates will be surveyed and 95% of participants must rate training as satisfactory or higher. Participants will not earn CEUs until survey completion and are certified by VA.

2) In order to determine effectiveness of training, VISN HIMS Chief, Station HIMS Chief or equivalent, along with assigned COR, will conduct follow-up post training review of clinical documentation to ensure proper clinical information is recorded in the patient’s record.

3) In conjunction with the agency, the contractor will identify coding deficiencies and develop a training curriculum that allows for focused training aimed at the improvement of coding accuracy.

4) The contractor shall provide reports or access to the contractor system to VAMC/VISN staff to pull the following reports on a monthly/quarterly basis (frequency to be determined at the VISN level):

a) On Demand training access to include:

i) Frequency of access by user and facility

ii) Topics accessed by user and facility

iii) Course completion by user and facility

b) Resource utilization by user and facility

c) Face to face training:

i) Outline of topics covered

ii) Number of attendees by VISN/station

d) Provider documentation review report:

i) Facility and providers reviewed

ii) Types of encounters reviewed

iii) Detailed results of review to include error trends, coding/DRG changes based on corrections

5) Audit of contractors services will be reviewed by VISN HIMS Chief, Station HIMS Chief or equivalent, along with assigned COR/POC

6) Audit of contractors services will be reviewed by VISN HIMS Chief, Station HIMS Chief or equivalent, along with assigned COR/POC, as follows:

a) Change in audit accuracy comparing pre-training and post training for providers and coders/CDI Staff. Expected increase of 15% or higher in post training audits.

b) Participant survey satisfaction scores of 90% or higher and any concerns will be responded by contractor to the VISN or Station HIMS POC within 1-2 weeks.

E. Performance Metrics / Measurement

QASP is a systematic method used by the Government to evaluate Contractor’s actions and performance based on Performance Work Statement (PWS) requirements. The QASP is designed to provide an effective method of monitoring contractor performance for each listed objective on the PWS. A QASP is based on the premise the Government desires to maintain a quality standard in providing CDI and Coding Training services.

Required Services (Tasks)

Indicator/Performance Standard

Adverse Actions Acceptable Quality Level

Method of Surveillance

In-person training participate surveys conducted Unacceptable performance to be forwarded for action to the WSNC CO – Retraining/refresher

90% 100% Review of Monthly/Quarterly reports

On-line training participate surveys conducted Unacceptable performance to be forwarded for action to the WSNC CO

90% 100% Review of Monthly/Quarterly reports

In-person and on-line training materials and access

Materials delivered timely, meeting training expectations with 95% review/approval, technical issues or downtime resolved in 2 business days.

Unacceptable performance to be forwarded for action to the WSNC CO – including re-work of training materials or updates to on-line systems

90% Management review, Spot Check, Post Training Surveys, and Participant Survey results

In-person training effectiveness

Quality of training and effectiveness of learning when applied to station coding accuracy. New participate review for 15% or higher increase in coder effectiveness

Unacceptable performance to be forwarded for action to the WSNC CO – Retraining/refresher/ revision of training modules

90% Participant Survey results, and Post Training Surveys

On-line training effectiveness

Quality of training and effectiveness of learning when applied to station coding accuracy. New Participant review for 15% or higher increase in coder effectiveness

Unacceptable performance to be forwarded for action to the WSNC CO – retraining/revision of training modules

90% Participant Survey results and Patient Encounter Audits

F. Period of Performance

This will be a 5 Year Contract (1-year Base and 4 1-year options) IDIQ contract. Base period of performance will start after the award of the contract and dates will be outlined in the CLIN structure under the schedule of items. Task Orders will be awarded with no more than a 1-year period of performance.

G. Place of Performance

1) Under this contract, the IDIQ holder shall provide CDI training services for the Western States Network Consortium (WSNC) medical facilities (Interactive US Map - Locations (va.gov)) for list of facilities supporting VISNs 17, 19, 20, 21, 22.). All VHA facilities within the WSNC are authorized to order CDI training listed on the Price-Cost Schedule at the listed price.

a) VISN 17: Texas, Eastern New Mexico.

b) VISN 19: Montana, Wyoming, Eastern Idaho, Eastern Nevada, Utah and Colorado.

c) VISN 20: Oregon, Washington, Idaho and Alaska.

d) VISN 21: Northern California, Nevada, Hawaii Islands, Philippines Islands, Guam and

American Samoa.

e) VISN 22: Southern California, Arizona, New Mexico, Southern Colorado

H. Government-Furnished Property or Services

1) The Contractor will not require GFP. Training platform will be provided by contractor that works with VA system.

Example:

Access to VA Learning Management System (LMS)

Office space and internet access for on-site trainers

I. Workplace Conditions/Security

1) Contractors On-site:

a) Contractors provided under this IDIQ are employees of the Contractor and shall not be considered VA employees. Contractors working on VA property shall be subject to the same rules and regulations as all government employees.

b) Parking is allowed only in areas not designated for patient use. All traffic laws and parking rules on the grounds are strictly enforced. Failure to follow these laws and regulations may result in a citation being issued that will have to be resolved through the Federal Court system.

c) Prior to reporting to work, the Contractor will need to contact the designated point of contact for the ordering facility to arrange an escort to the on-site badging department. VA staff will issue a temporary ID badge to the contracted employee, who will properly display the badge while working onsite. Upon completion of the assignment, the employee will return the badge.

d) The VA reserves the right to refuse any Contractor access to VA property, for any or no reason.

e) Contractors shall comply with all security requirements imposed by the ordering facility.

f) Contractors shall not receive personal telephone calls or texts on their cell phone while rendering services.

g) A VA employee must accompany Contractors who are providing services.

h) The Contractor shall remove and dispose of any waste related to providing the ordered services.

2) VA FACILITY HOURS OF OPERATION:

a) Standard operating hours for CBOCs and larger VA facilities are normally 8:00 AM to 4:30

PM Monday through Friday in the time zone of the facility, excluding federal holidays. VA Emergency Departments normally operate with 24-hour coverage.

b) TOs may require services to be available 24/7, 365 days a week to include all Federal Holidays.

i) Federal holidays are:

(1) New Years Day

(2) Martin Luther King Jr Birthday

(3) President’s Day

(4) Memorial Day

(5) Juneteenth Day

(6) Independence Day

(7) Labor Day

(8) Columbus Day

(9) Veterans Day

(10) Thanksgiving Day

(11) Christmas Day

J. Special Requirements

Include any certifications, licenses, or other unique requirements.

Contractor must provide a learning platform that does not require access to Government IT/ Government-Furnished Property or Services

The Contractor must be certified to award Continuing Education Units (CEU) – From nationally accreditation body such as the American Health Information Management Association (AHIMA) or equivalent.

VA attendees will have access to web-based training curriculum.

Trainers/Vendor must have at least 10 years of experience in clinical documentation and coding.

The contractor trainers must be certified medical coding, CDI, Provider instructors, accredited by American Health Information Management Association (AHIMA) certification or other equivalent

1) Ordering

a) TOs will be placed against this IDIQ using VA official email messages.

b) The Terms and conditions included in this IDIQ apply to all purchases made pursuant to it.

In the event of an inconsistency between the provisions of this IDIQ and the Contractor's invoice, the provisions of this IDIQ will take precedence, unless TO variation has been otherwise authorized by the IDIQ.

c) Authorized Users/Ordering Officials

i) All properly warranted Contracting Officers within the WSNC are authorized to place orders under this IDIQ supporting any WSNC location.

2) Task Order/Delivery Order acceptance

a) TO/DO acceptance will be by written verification of the order within 10 calendar days of the order being placed.

3) Purchase Limitations

a) Individual Task Orders (TO) may not exceed $1,200,000 each.

b) The Price Ceiling is $13,500,000 over the life of the IDIQ.

4) Obligation of Funds

a) This IDIQ does not obligate any funds. The Government is only obligated to the extent of authorized Task Orders issued under this IDIQ.

5) National Certification and CEU

a) Requires the American Health Information Management Association (AHIMA) certification or other equivalent nationally accepted certification.

b) Continuing Education Units (CEU) – From nationally accreditation body such as the

American Health Information Management Association (AHIMA) or equivalent.

i) In the context of VA Coding, CEU stands for Continuing Education Units. CEUs represent a standardized measure of participation in approved continuing education programs, typically awarded for every ten contact hours of participation in structured continuing education. Health Care Professionals, including those in medical coding, are required to obtain CEUs to stay current in their profession and ensure they meet the latest coding updates and compliance rules. Recertification Cycle Health informatics and information management (HIIM) is a constantly evolving field, and professionals in this field require the most current knowledge to move the profession forward. Best practices, technology, privacy and security, coding updates, healthcare laws and regulations change frequently. For these reasons, a recertification cycle of two years has been established, during which time certificates will be required to attain a specific number of CEUs to update existing knowledge and skills as well as acquire new knowledge and skills relating to advances in the HIIM field and changing job responsibilities. Continuing Education Unit(CEU) CEUs must be earned within your recertification cycle and must be relevant to the HIIM field as presented in the HIIM domains to be eligible for CEU credit. Eighty (80) percent of required recertification CEUs must be earned within the HIIM domains (see Appendix). A).

The remaining twenty (20) percent can include participation in CEU activities on topics not included in the domains but relevant to the credential holder’s professional position. Beginning January 1, 2025, a minimum of 40% of CEUs are now required to come directly from AHIMA resources (including HCPro products, services, and family of brands) and/or Component Associations. Remaining CEUs can come from the AHIMA Approved Continuing Education Provider Program (ACEP) partners and other third-party education providers (More information can be found here.) • Any AHIMA certified professional whose recertification cycle begins on January 1, 2025, or thereafter, will have a full two years to complete, report, and comply with the 2025 40% CEU requirements. • If a certified professional’s recertification cycle start date occurs BEFORE January 1, 2025, then they will continue to meet/follow the 2024 recertification requirements. Only when they recertify successfully and their next two-year cycle goes into ect, after January 1, 2025, will the 2025 40% CEU requirements apply

6) Records Management:

a) All records management will be in accordance with the national Archives Federal

Records Management (National Archives And Records Administration (NARA) Records Management Language For Contracts Records Management Obligations:)