ATTACHMENT 2 - STATEMENT OF WORK.docx

ACCOUNT RECEIVABLE

STATEMENT OF WORK (SOW)

I. Contract Title Account Receivable Duties at Western Oregon Service Unit, Chemawa Indian Health Center II. Background Chemawa Indian Health Center is a Service Unit within the Indian Health Service that bills Medicaid, Medicare, Private Insurance, and Veterans Administration. The Account Receivable technician posts payments from the various billing sources.

III. Scope The Contractor will provide Account Receivable duties which will include posting payments and working with Chemawa’s business office staff to assure proper payment is received as required under IHCIA, at Title 25, U.S.C.162e(a). The Contractor will utilize RPMS (Resource Patient Management System), Easyprint, Adobe, various secure share folders, and various insurer/clearinghouse websites to assist with Accounts Receivable services for Western Oregon Service Unit, Chemawa Indian Health Center.

IV. Specific Tasks (100% REQUIRED)

A - Reviews 3rd Party Remittance Advice (RA) Explanation of Benefits (EOB), posts to Account Receivable System

· Must register at all websites where Chemawa retrieves RA and EOBs immediately upon award of contract. See Exhibit 1 - Insurance Websites.

· Payments are listed daily on Portland Area’s financial spreadsheet. These payments indicate which EOBs and RAs must be retrieved by next business day. See Exhibit 2 – Financial Spreadsheet, column “A” Date.

· Prior to posting review payments from remittances and EOB's for accuracy.

· Place EOB in designated file if it reflects payment is denied or paid lower % due to “out of network". Voucher Examiner will return EOB to you if it is a legal denial. Once returned to you, it must be posted the same day you receive it. See Exhibit 3 – File for low payment.

· Post from RA or EOB within three (3) days from receiving the supporting document.

· Payments must be posted in order received on Financial Excel spreadsheet.

· Messages accounts to reflect to/from credits when credit involves multiple accounts utilizing New Standard Adjustment Reason Codes.

· After posting the payment, notate the date the payment was posted on the financial excel spreadsheet. See Exhibit 2 – Financial Spreadsheet, column “L”.

B – Batching Payments

· Batching payments is required and must be done prior to posting the payment.

· Payments must be batched within two (2) business day of receiving the payment.

· Place batch information on financial excel spreadsheet.

· Non-payments must be batched.

C – Filing Financial Documents – All financial documents must be filed

· Financial documents may include: See Exhibit 4 – Batch document example.

Batch cover sheet if printed 835 file

· EOB Files:

1. Name the financial file by the batch name

2. File by Medicaid, Medicare & Part D, Private Insurance, Veteran Administration, Champ VA and Non-Payment.

3. Then, by Fiscal Year, and month

· 835 Files:

1. Name the financial file by the transaction number and check number.

2. If multiple check dates, file by check dates: Example: 031423_031723_032023

3. If multiple checks with same check date, do not add the date twice.

4. Then file by Insurance name and Fiscal Year

· Non – Payment Files:

1. Name the file by Batch name and file all corresponding documents.

2. File by Fiscal Year

3. Note: EOBs reviewed by Voucher Examiner, deemed legal and returned to Accounts Receivable technician must be batched, posted and filed in non – payment file, daily.

Further direction and training will be provided upon award by the Business Office Manager

D - Maintain Accounts Receivable System

· Monitor previous Batch Statistical List (BSL) Report collection batches for open balances to resolve possible issues.

· Send report to BOM via email by 5th business day of new month indicating which batches are unposted and why.

· Responsible to resolve all un-posted payments.

V. Required Knowledge

· Knowledge of the accounting methods, procedures, and techniques to conduct difficult and responsible analysis and determinations within Resource Patient Management System (RPMS) to validate transactions and to perform research to resolve inconsistencies

· The contractor will have knowledge of automated patient accounting system, point of sale system, and third-party billing system to reconcile errors that require an understanding of nonstandard procedures related to patient accounts. The contractor will have a general working knowledge of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) and Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) coding terms.

· The contractor will have knowledge and experience with Indian Health Service (IHS), Electronic Health Record (EHR) and Resource and Patient Management System (RPMS)

· The Contractor will comply with all Federal Regulations and comply with the Indian Health Services Third Party Resource and Internal Control Policy, The Debt Collection Policy, and the Indian Health Services Statistical and Reporting Systems for all Departments.

· Knowledge of Indian Health Services policies and regulations on alternate resources as they relate to Medicare, Medicare Advantage, Supplement Insurance, Medicaid and other private insurance payers.

VI. Performance monitoring

Business Office Manager will run reports and monitor the accuracy and compliance to time sensitive duties which is mandated by Indian Health Service Revenue Operating Manual (ROM) and a requirement of Western Oregon Service Unit. All stated duties are required.

VII. Security Requirements The Contractor shall comply with industry standards, applicable to Indian Health Service (IHS) Rules and Regulations, State and Federal Law, including but not limited to the OIG (Office of Inspector General) recommendations on compliance programs and HIPAA (Health Information Portability Accountability Act) VIII. Government-Furnished Equipment (GFE)/Government-Furnished Information (GFI).

The Government does not anticipate a need for contractor furnished equipment.

IX. Place of Performance Services under this contract will be performed for:

Western Oregon Service Unit Chemawa Indian Health Center 3750 Chemawa Rd NE Salem, OR 97305-1198

All Accounts Receivable services are to be completed off-site, remotely with VPN network access by the contractor.

X. Period of Performance The period of performance shall include a base year and four (4) option years. Services will not be provided on federally recognized holidays.

Base Year: 12 Months from Issuance of Notice to Proceed Option Year 1: 12 Months from the end of base year Option Year 2: 12 Months from the end Option Year 1 Option Year 3: 12 Months from the end Option Year 2 Option Year 4: 12 Months from the end Option Year 3

The general business hours of Western Oregon’s business office are as follows:

Monday – Friday, 7:30 a.m. to 5 p.m.

Contractor works closely with Western Oregon’s Business Office staff; as a result, Contractor’s work hours must align with Western Oregon’s business hours. The work week is forty (40) hours per week (5 days, 8 hours a day.) Work hours may be adjusted, with prior COR approval.

Contractor will submit the work schedule with days and work hours to business office manager one month in advance.

XI. Contracting Officer’s Representative (COR) The following individual or their designee shall serve as the Project Officer/Supervisor government representative under this contract for the facilities listed:

Name: TBD Address: Western Oregon Service Unit

Phone: TBD E-mail: TBD

The COR’s responsibilities will be to coordinate with the contractor the technical aspects of this service and the review of performance hereunder. The COR does not have the authority to change or alter the order amount, terms or conditions, of the contract.

XII. Invoicing

Invoices shall be uploaded/submitted monthly to Invoice Processing Platform (IPP) for COR’s review and acceptance.

IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the Treasury's Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St. Louis (FRSTL).

The IPP website address is: https://www.ipp.gov

If you require IPP account access, please contact the IPP Helpdesk at (866) 973-3131 (M-F 8AM to 6PM ET), or IPPCustomerSupport@fiscal.treasury.gov

The following information must be included on the invoice as a minimum:

· Purchase Order/Contract Number,

· Contractor’s Name and Address,

· Contractor’s Identification Number,

· Dates of service,

· Quantity of services, unit cost, and total amount due,

· Invoice should align with Contractor’s submitted schedule,

· Final invoice at the end of each period shall be marked final.

Invoices shall be submitted only for services actually completed at time of invoice submission. Payment is also subject to the registration requirements in accordance with clause, 52.204-7 System Award Management (SAM).

XIII. Payment Schedule

1. The unit price awarded is the contract price for services and covers all related costs to provide required services. The unit price paid shall constitute full compensation for providing all services remotely which includes the following cost examples: applicable federal / state / local / sales / income taxes, travel, lodging, training, license requirements. The Service Wage Act applies to this contract.

2. Hourly rates: Payment for services received and approved shall be paid at an hourly rate calculated using the actual number of hours services are accepted by the Government (rounded to the nearest ¼ hour).

3. The Government is obligated only to the extent of authorized purchases actually made and received under this contract.