3(v)_SOW Certified Medical_Dental Coder.docx

Note: The use of the terms Contractor, Contract Provider and Certified Professional Coder (CPC) refers to the provider of care throughout this document.

1. Scope of Work. The Contractor shall provide an individual to assign ICD-10-CM/PCS, CPT-4 and HCPCS Level II codes based on medical and dental care provided at or under the auspices of a Coast Guard Health Services Facility and perform coding audits.

A. The CPC shall meet or exceed the industry standards in accordance with established principles, practices and ethics of the Coding Profession. The standards of performance for all employees provided by the contractor shall reflect the degree and care, skill and learning expected of a reasonably prudent professional in the state of their practice.

B. The Contractors will provide professional services to U.S. Coast Guard locations specified in the Performance Work Statement (PWS).

2. Qualifications. The provider of coding services shall possess and maintain for the duration of this agreement:

A. Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Coder Specialist- Physician (CCS-P) with 36 months experience within the last 60 months, or, B. Certification from an accrediting institution recognized by the American Health Information Management Association (AHIMA) and/or American Academy of Professional Coders 9AAPC) must accredit education and certification or, C. Contract coders will obtain the required continued education hours at no expense to the government in order to maintain current and proper national certification(s) required for this position.

3. Credential Review. The contractor shall submit the following credentials in order to be evaluated for technical acceptability.

A. A current resume including AT LEAST the following information:

(1) Degrees earned;

(2) Professional Experience;

(3) Social Security Number;

(4) Date of birth (to be used only for the purposes of independent query of the NPDB);

Attachment 3(v

CERTIFIED

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(5) Career history;

(6) Professional Training/Courses attended in the past two years;

(7) Professional organization affiliations and memberships;

(8) Previous work references including name of organization, number of years rendered, address and name of point of contract with telephone number;

(9) Awards and certifications received.

B. Copies of:

(1) A certificate, associate degree, or bachelor’s degree from an accredited school of RHIT, RHIA, CPC, COC, CCS, CCS-P.

(2) A current unrestricted certification from an accredited certifying agency, if applicable;

(3) Evidence of immunity to Hepatitis “A” and “B” and evidence of freedom from chronic communicable disease(s) i.e., HIV, TB and Sexual transmitted diseases;

(4) At least three (3) letters of recommendation from recent employers addressing coding services.

4. Professional Services. The Contractor shall perform a full range of professional coding concepts and practices on site, using Government furnished equipment. All aspects of CPC shall be commensurate with the capabilities of the coder but not limited to the items listed below and in the PWS

A. Industry standard coding guidelines shall be followed;

B. All patient encounters shall be properly coded whether the encounter is billable or not;

C. Code assignment shall be in accordance with National Center for Health Statistics (NCHS), Centers for Medicare and Medicaid Services (CMS), American Hospital Association (AHA), AMA and APA guidelines, as appropriate. ;

D. Code in accordance with CCI Bundling guidelines, and use the Healthcare Common Procedural Coding System 9HCPCS), where appropriate;

E. Identifies and abstracts information from medical records (paper or electronic) for special studies, and audits, internal and external F. Interacts with MTF staff to ensure documentation is clear and supports coding assignments. Educates MTF staff though individual or group in-services and training sessions G. Maintains a delinquency report of missing records in order to facilitate completion of work within the required thresholds;

H. Ensures all required component parts of the medical record that pertain to coding are present, accurate and compile with USCG and DHS requirements.

I. Works with Coding Compliance- Editor software to ensure records are accurately coded;

J. Required to use all Microsoft applications, such as Word, Excel, Access, Outlook, PowerPoint, etc. to track, data, generate reports, and prepare presentations.

5. Hours of Performance. The contractor shall provide all aspects of personal CPC services at the locations in the PWS and hours specified by the Coding Supervisor.