Atch_01_Statement_of_Work.pdf

Statement of Work

MEDICAL BILLING

ELECTRONIC MEDICAL RECORDS (EMR)

AND

PAYMENT MANAGEMENT (PM) SOFTWARE

Yosemite National Park

1.0 Background

The National Park Service (NPS) Visitor Resource Protection (VRP) provides as outlined in the Organic Act of 1916, protecting our visitors and our cultural and natural resources are the heart of the National Park Service. Protecting these resources are the mission of the Visitor and Resource Protection program.

Visitor and Resource Protection division oversees a wide variety of functions, including providing healthcare services for primary care, urgent care, and occupational health services.

2.0 General

This Statement of Work (SOW) encompasses the required need to ensure that a contract vehicle is in place to provide Electronic Medical Records (EMR) and Payment Management (PM) systems with outsourced billing services for Yosemite Medical Clinic (YMC) at Yosemite National Park.

YMC is a remote medical clinic operated by the National Park Service (NPS) in partnership with United States Public Health Service (USPHS). It is in a rural portion of central California within the Sierra Nevada Mountain range. By ground transportation, the closest critical access hospital is approximately 1.25 hours away in Mariposa, California, and the closest trauma centers are approximately 2.5 hours away in either Modesto or Fresno. YMC is staffed by a physician, an advanced practice provider (nurse practitioner or physician assistant), registered nurses, and support staff. Services include, but are not limited to, urgent care, primary care, occupational health, telehealth, and workers compensation (WC).

Over the past five years, YMC averaged approximately 3,500-5,000 patient visits annually.

Patients are primarily residents and park visitors that often include international travelers.

About 50% of patients are residents seeking primary care, 40% urgent care (predominantly visitors), and 10% staff for occupational health (physicals or workers compensation).

Approximately 20% of ambulance transports go to the clinic.

YMC recovers costs as ambulatory office visit - (11), urgent care facility - (20), and Telehealth - (02) classified places of service in addition to WC and occupational health services, and from dispensed medication and durable medical equipment, vaccinations, laboratory and point of care services such as x-ray, urine drug screens.

The Dingell Act (2019) allows for medical services within the NPS to retain and use the revenue generated by medical services. The lack of consistent and reliable internet, efficient EMR and PM systems are barriers to operational efficiency and capacity. YMC requires efficient EMR and PM systems and outsourced professional billing service to support its multi-purpose facility and currently experiences barriers to operational efficiency and capacity due to the lack of consistent and reliable internet and outdated systems. The current systems are Practice Fusion EMR, Kareo EMR, and Kareo PM.

3.0 Scope

The contractor shall provide EMR and PM systems with cost recovery services. The hardware, software, and processes must comply with HIPAA, privacy and security laws and regulations, and industry standards to protect Personal Health Information (PHI) and Personal Information Identification (PII). The Contractor shall be responsible for the maintenance of the software, upgrades, and process improvements.

The Contractor shall work with insurance companies, international travelers’ insurance companies, Medicare, Medicaid, and/or individual patients to conduct the specified scope of work.

4.0 Objectives

4.1 Provide a comprehensive revenue cycle management from coding, billing to analytics to optimize revenue

4.2 Development and maintenance of working and contractual relationships with private and public insurance payors and collection agencies, as needed, with the approval of

YMC.

4.3 Credentialing providers and group practice with payor networks

4.4 Track and implement fee schedules, payor’s policies, and medical billing codes as they update

4.5 Administration of the complete billing and collection process on behalf of YMC, to include both domestic and international accounts.

4.6 Provide reports detailing the status of YMC accounts on a weekly, monthly, and quarterly basis.

4.7 Delivery of collected funds to YMC

4.8 Compliance with:

4.8.1 Health Insurance Portability and Accountability Act of 1996 (HIPAA)

4.8.2 Privacy Act of 1974

4.8.3 Any other applicable federal laws

4.8.4 Industry and government standards and payors’ policies including credentialing, coding, billing and network compliance

4.9 Provide software for the EMR with PM system that are already hosted on a FedRAMP approved platform or select one of the options in section 4.11

5.0 Specifications of the EMR and PM systems

The Contractor shall provide all labor, software, materials, and supplies to meet all requirements and specifications for the EMR and PM systems outlined as follows:

5.1 The government is seeking a Comprehensive Revenue Cycle and Patient Records

Management Platform as a Service (PaaS) and Software as a Service (SaaS). The selection of the Electronic Medical Records (EMR) and Payments Management (PM) off-the-shelf PaaS/SaaS will be determined at time of award.

To meet federal security and privacy mandates, the government’s first priority is a PaaS and SaaS solution where the full cloud stack is FedRAMP authorized. See attachment 02 of Federal Security and Privacy (FedRAMP) requirements. If a full FedRAMP stack solution is not available, the government will consider an equal SaaS solution where the rigors of meeting medical IT Systems standards are equivalent of the following priority order:

5.1.1 An EMR/PM SaaS installed on a FedRAMP IaaS/PaaS space configured with a phishing resistant multi-factor authentication such as login.gov

5.1.2 An EMR/PM SaaS installed within an instance of our Department of Interior private Microsoft Azure tenant. See Attachment 1 of the Department of the Interior Microsoft Azure tenant guidelines.

5.1.3 An EMR/PM SaaS installed at the vendors site of choice and accompanied with security and privacy provision; for example, 3rd party assessment, system, privacy and disaster recovery plans, options for phishing resistant multi-factor authentication such as login.gov.

5.2 The current EMR are Practice Fusion and Kareo and the current PM is Kareo. The Contractor shall propose the new EMR and PM systems to meet our needs and specifications above. Once the accepted EMR and PM become obsolete or no longer perform as they should, the Contractor shall work with YMC to obtain new EMR and PM systems that meet our requirements and specifications.

5.3 The EMR with PM system shall include operating systems such as Android, iOS, iPadOS, tvOS, macOS, Windows, for computers and mobile devices, and Chrome OS and online access

5.4 Comprehensive EMR for a mixed service facility for primary care, urgent care, occupational health service and point of care laboratory and imaging services

5.5 EMR and PM features that capture continuum of patient care to revenue cycle management (RCM) from front office to back-end RCM

5.6 patient portal

5.7 Modifiable patient intakes for different types of visits

5.7.1 Primary care and follow up that meet Medicare’s requirements

5.7.2 Urgent care

5.7.3 Occupational health

5.7.4 Workers’ compensation

5.7.5 Laboratory and diagnostic exams

5.7.6 Nurse visit

5.8 Prescribing of medication, the software shall include:

5.8.1 E-Prescribing feature

5.8.2 Electronic Prescribing for Controlled Substances (EPCS)

5.8.3 E-Prescribing and formulary checking

5.8.4 Reconciliation

5.8.5 Option to connect to direct access to state Prescription Drug Monitoring

Programs

5.9 Option for mobile device app

5.10 Modifiable clinical and non-clinical notes for multiple user roles

5.11 Patient messaging and communication

5.12 Records and document management

5.13 Referral management

5.14 Meaningful use dashboards

5.15 Revenue cycle management dashboard

5.16 Options for patients to pay online and by credit card. The option to include pay.gov is highly desired for various types of payors including self-pay

5.17 Electronic fax using current analogue fax or cloud options

5.18 Scribe and speech recognition

5.19 Kiosk option for patient registration and check in

5.20 Patient education

5.21 Electronic health records such as digital radiographic images

5.22 Telehealth option

5.23 Interoperability with the following:

5.23.1 Quest for laboratory orders outbound and results inbound

5.23.2 Data exchange with major health systems including area, state and nationwide

5.23.3 Referrals process that will be able to attach supportive and required documents such as clinical notes, lab results and copy of insurance information

5.23.4 Secured communications with patients and other system users and any provider/practice that the provider and practice interact with for patient care

5.24 PM and Revenue cycle management (RCM), shall include:

5.24.1 Provide PM software with billing implementation service

5.24.2 Built in industry standards for claims edits and scrubbing including National

Correct Coding Initiative (NCCI) edits

5.24.3 Feature to correct code and manage rejections and denied claims

5.24.4 Business and RCM optimization

5.24.5 Allow for YMC’s third party administrator (TPA)/billing contractor to perform comprehensive billing service

5.25 Reports and reporting tools must include:

5.25.1 Financial reporting dashboards

5.25.1.1 Financial analysis reports with diagnosis and collection information

5.25.1.2 Rejection, denial management, historical days in A/R, and copay reporting

5.25.1.3 Automated process-based reporting for month-end close

5.25.1.4 Fee schedule allowable vs. claim payments including self-pay

5.25.1.5 Business and RCM optimization

5.25.2 Clinical reporting dashboards

5.25.2.1 Diagnoses

5.25.2.2 Medications

5.25.2.3 Lab results analysis and trends

5.25.2.4 Blood pressure and other health metrics trends

5.25.2.5 Visits by types and reasons

5.25.3 Metadata for financial and clinical elements

5.25.3.1 Accounts receivable

5.25.3.2 Claim-level transactions

5.25.3.3 CPT-level transactions

5.25.3.4 Immunizations

5.25.3.5 Vitals

5.25.3.6 Labs

5.25.3.7 Procedure codes

5.25.3.8 Allergies

5.25.3.9 Structured data

5.25.4 Healthcare quality management dashboard and reporting

5.25.4.1 A federally mandated Medicare program, the Quality Payment

Program (QPP): CMS Merit-based Incentive Payment System

(MIPS)

5.25.4.2 Other quality measures and metrics that will allow YMC to comply with public and private payers and their incentive programs, and accredited agencies such as:

5.25.4.2.1 Healthcare Effectiveness Data and Information Set

(HEDIS®) measures

5.25.4.2.2 Accreditation Association for Ambulatory Health Care

(AAAHC)

5.25.4.2.3 California Medi-Cal

5.25.4.3 MIPS Quality performance category and claims data submission

5.25.5 Administrative Reporting

5.25.5.1 Appointments, referrals, and network affiliation

5.25.5.2 Delinquent patients

5.25.5.3 Dictionary and master data

5.25.5.4 Visit analysis

5.25.5.5 Payer mix

5.25.5.6 Insurance eligibility

5.25.5.7 Productivity

5.26 Addition features shall include:

5.26.1 Scanning and faxing software for documents,

5.26.2 Access to up to date Medical coding such as ICD-10, Current Procedural

Terminology (CPT), Evaluation and management (E/M) codes and fee schedules

5.26.3 Scanning option to capture identification, insurance, and credit cards directly into the EMR

5.27 Clearing house options to select, such as:

5.27.1 TriZetto

5.27.2 Change Healthcare

5.27.3 Waystar

5.28 Compliance with:

5.28.1 Health Insurance Portability and Accountability Act of 1996 (HIPAA)

5.28.2 Privacy Act of 1974

5.28.3 Any other applicable federal laws

5.28.4 CMS MIPS

5.29 Training during implementation and ongoing

5.29.1 Provide in-person training

5.29.2 Access to on-demand training and webinars

5.30 Installation and data migration

5.30.1 Provide installation service on-site

5.30.2 Import data from previous EMR and PM systems from Practice Fusion and

Kareo

5.31 Technical and customer support

5.31.1 Provide 24/7 customer service support

5.31.2 Option for virtual assistance

6.0 Tasks

6.1 Initial Program Establishment

6.1.1 As agreed upon with DOI and NPS IT management, installing the selected software and hardware for EMR and PM systems including importing patient and payment records from current EMRs and billing systems (Kareo EMR and PM, Practice Fusion EMR)

6.1.2 Establish the capability of using electronic extraction of data on-line via selected EMR and PM systems

6.1.3 Review NPS YMC documentation standards and procedures and provide recommendations in order to assure compliance with applicable billing regulations and to achieve an effective and efficient cost recovery workflow.

6.1.4 Establishment of reporting systems that meet the requirements outlined in this

SOW

6.1.5 Training may be completed through a variety of mediums but must provide in-person training during the implementation. Other training options need to be agreed upon by the Contractor and YMC.

6.1.6 Train YMC personnel on front end operation to accurately and timely check benefit eligibility, collect patient and their insurance information and validate each visit. Initiate charges with the right diagnostic, procedure, medication and medical device codes to be sufficient for the coding part of the billing services.

6.1.7 Completion of connection with Clearing house (TPAf), laboratory, and other electronic and/or online connections including electronic data interchange (EDI) with payors with ability to add payors and plans

6.1.8 Establishment of financial information and payments received electronically via methods such as pay.gov, ACH or other identified electronic payment methods.

6.1.9 Migrate data from existing systems into the new EMR and PM system

6.1.10 Completion and submission of approved insurance network provider enrollment applications as provided by YMC

6.1.11 Establishment of, and maintaining of, contract accounts with Insurance providers as designated by YMC.

6.1.12 A lockbox option may be established with direction from DOI NPS

6.2 Cost Recovery – Billing

6.2.1 The Contractor will provide the following services on an ongoing basis for participating units of the NPS EMS program:

6.2.2 Accurately assign medical codes with a good understanding of official coding guidelines, such as the ICD-10-CM Official Guidelines for Coding and Reporting, American Medical Association (AMA) CPT® guidelines for medical services and procedures, and the National Correct Coding Initiative (NCCI) edits and policy manual. It is imperative that facility coders stay abreast of official coding guidelines across all code sets (ICD-10-CM, CPT®, and HCPCS Level II) and review the published updates and changes as they occur.

6.2.3 Submission of HIPAA (Health Insurance Portability and Accountability Act) compliant claim forms to both contracted and non-contracted primary third-party payers on a regular schedule.

6.2.4 Submission of claims to secondary and tertiary insurance companies.

6.2.5 Review of Explanation of Benefits (EOB) forms and electronic fund transfer records (EFRs) and or checks, received from third party payers.

6.2.6 Submission of bills to patients.

6.2.7 Continued processing of billing until payment is received in full or until part or all of the bill is handled through the hardship process, written off, or submitted for federal collections.

6.2.8 Track/post all accounting items, including the following:

6.2.8.1 Initial charges

6.2.8.2 Bills issued

6.2.8.3 Insurance payments and adjustments

6.2.8.4 Patient responsibilities and payments

6.2.8.5 Write-offs (hardship, inability to locate patient for payment, etc.)

6.2.8.6 Accounts forwarded to NPS for Federal Treasury Collections

6.2.8.7 Billed and paid amounts

6.2.8.8 Deducted fees and net deposit or payment to YMC (Department of

Treasury account)

6.2.8.9 Reconciliation of payments from pay.gov, credit card, EFT and all other sources.

6.2.9 The Contractor may be required to obtain insurance information from patients, or from a medical facility that treated the patient.

6.2.10 Document/archive all communications with patient, insurer, YMC and other entities involved in the billing, collection, and reimbursement processes.

6.2.11 Follow-up, appeal and/or re-submit all claims which are pending or inappropriately denied.

6.2.12 Submission of disputed charges and requests for hardship waivers or discounts to originating units for resolution, when disputes require attention beyond the standard procedures, which shall be provided by NPS YMC.

6.2.13 Generation and delivery of financial reports to NPS YMC.

6.2.14 Maintenance of strict confidentiality of all information supplied by YMC or any of its participating units, or any other public or private entities. Release of such information is granted only as needed for reimbursement purposes and as regulated by HIPAA.

6.2.15 All printed and electronic records must be returned to YMC upon completion or termination of the contract in a transferrable format.

6.2.16 For fee-for-service. The contractor shall retain the percentage of collected revenue outlined in the Price Schedule for billing fees prior to remittance to YMC. The contractor will then provide monthly detailed reports of reconciliation demonstrating final collected payment, deducted fees, net payment, refunds, and adjustments with detailed payment records to YMC.

The contractor shall be responsible for correcting any under and over payment received with tracking records. Any overpayment shall be deducted from future payment as aligned with industry standards.

7.0 Government Furnished Property

The Contractor will be responsible for furnishing all software and resources for the project. The Contractor will need to obtain access to the current electronic patient care charting and billing and payment systems to transfer data and records to their proposed systems during the transition period.

8.0 Security

The contractor shall be responsible for handling information in a safe and secure manner including maintaining all imposed restrictions for computer access, security provisions, document safeguards, and proper handling procedures including post performance provisions restricting divulging sensitive/secure information.

8.1 Unclassified. Security clearance is not required.

8.2 EMR and PM software are hosted in FedRAMP approved platform or DOI NPS platforms.

8.3 The contractor will create, and to the extent the records are under their control, maintain, disseminate, store, retain, and dispose of records and data relating to their professional work in order to:

8.3.1 Facilitate provision of services later by them or by other vendors

8.3.2 Allow for authorized replication

8.3.3 Meet institutional requirements

8.3.4 Ensure accuracy of billing and payments

8.3.5 Ensure compliance with laws pertaining to patient confidentiality and cost recovery

8.4 Contractors shall propose the EMR and PM systems that are acceptable to YMC and propose changes if and when the products become unsatisfactory to meet YMC needs.

All configured IT systems must be in compliance with current federal regulations and objectives stated within the Department of the Interior, Security Objectives and Service Level Agreements for all Cloud Information Technology Systems as referred to in section 5.1.

9.0 Place of Performance

The Contractor will conduct all day-to-day operations at the Contractor’s site. There may be irregular need for the Contractor to access YMC.

10.0 Period of Performance

The period of performance will be one base-year, and four one-year option periods anticipated to begin June 1, 2023, or upon award as follows:

Base Year June 1, 2023 – May 31, 2024 Option Year One June 1, 2024 – May 31, 2025 Option Year Two June 1, 2025 – May 31, 2026 Option Year Three June 1, 2026 – May 31, 2027 Option Year Four June 1, 2027 – May 31, 2028

11.0 Data

All communications, written or electronic, to and from the Contractor will be compliant with all HIPAA standards. All supporting documentation, manuals, reports, and other documentation materials produced by the Contractor as part of this contract shall become the property of the Government.

12.0 Quality Control and Assurance

According to the Inspection of Services clause, Federal Acquisition Regulation (FAR) 52.246-4, dated Aug 1996, the Government will evaluate the Contractor’s performance under this contract.

The contractor shall provide and dynamically maintain a quality control plan (QCP), acceptable to the Government, for measuring, tracking, analyzing, reporting, and implementing preventive and corrective actions required to meet the performance standards. The plan shall emphasize deficiency prevention over deficiency detection and correction. The plan shall detail the contractor’s partnering approach with the Government. The Quality Control Plan shall include:

• Methods to measure actual performance against performance standards.

• Control and audit procedures to identify areas adversely affecting contract performance.

• An approach to continuously improve quality and timeliness.

• Problem identification and resolution process and a method for monitoring corrective action.

Contractor personnel shall observe all internal and Privacy Act regulations which apply to this requirement, the agency, and the Government.

13.0 Quality Assurance Surveillance Plan (QASP)

Contractor Employees: The contractor shall provide highly qualified and motivated individuals who possess the skills, knowledge, and training to perform the services required by this contract.

The personnel shall be capable of working independently and with a demonstrated working knowledge of project management best practices as defined by the Project Management

Institute’s Project Management Book of Knowledge. The contractor’s main project contact and all members of the technical team shall be fluent when both speaking and writing in the English language.

The Contractor is responsible for delivering services in conformance to the task order. The Government inspects tendered services and either accepts or rejects services based on the terms and conditions of the contract/task order. In performing both vital roles, the contractor will jointly plan and coordinate work and associated deliverables, timelines, and deadlines with the Contracting Officer’s Representative (COR) and the Contracting Officer (CO) to establish standards and expectations of the Contractor’s efforts.

13.0 Close-out of Contract

The Contractor shall begin close-out activities 90 days prior to the contract expiration and cease billing activities once the contract expires. The Contractor shall transfer pending claims closeout and services to the new contract during the transition period until contract expiration. Any payments and records received after the closeout shall be delivered to YMC. YMC will not submit any new bills for collection to the Contractor after contract expiration.

14.0 Travel

The Government shall not be charged G&A fees for any travel. Contractors shall be reimbursed only for incurred costs at or below the “not to exceed” amount specified on the contract. Costs for transportation, lodging, meals, and incidental expenses incurred by Contractor personnel on official company business are allowable subject to the limitations contained in FAR 31.205-46 Travel Costs.

Lodging, meals, and incidental expenses claimed shall not exceed the current per diem rates in effect when traveling to and while at the project site and shall be in accordance with the Federal Travel Regulations. M&IE for a partial day are limited to ¾ of the daily rate. Per diem rates can be found at https://www.gsa.gov/travel/plan-book/per-diem-rates

15.0 Invoicing

Invoicing under this contract will occur in accordance with Local Clause Electronic Invoicing and Payment Requirements – Invoice Processing Platform (IPP) (APR 2013) and the requirements in FAR 52.212-4, Contract Terms & Conditions – Commercial Items. The contract will contain a payment schedule that will separate the work into discrete deliverables and identify amounts which may be invoiced for upon Government acceptance.

The Contractor shall be compensated on a monthly basis as per the terms of the resulting contract. Invoices will include supporting documentation of bills processed, collections received, and actual deposits completed. Should the need arise for travel and training, the Contractor will be compensated for actual costs and shall submit full back up information with each invoice.

The Contractor may bill for initial and ongoing subscription services, including fixed fee schedules, utilization by features, and users, for frequencies to be included in the Contractor’s response.

16.0 Points of Contact

16.1 Contractor Project Manager/Account Representative

The Project Manager/Account Representative shall be responsible for the overall management and coordination of this contract and shall act as the central point of contact with the Government. The Project Manager shall have full authority to act for the Contractor in the performance of the required services. The Project Manager, or a designated representative, shall meet with the COR to discuss problem areas as they occur. The Project Manager/Account Representative or designated representative shall respond within twenty-four (24) hours after notification of the existence of a problem.

16.2 Government Contracting Officer’s Representative (COR)

The COR will be identified in a separate letter after contract award. The COR monitors all technical aspects of the contract and assists in contract administration.

The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract; perform inspections necessary in connection with contract performance; maintain written and oral communications with the Contractor concerning technical aspects of the contract; issue written interpretations of technical requirements, including Government drawings, designs, specifications;

monitor Contractor’s performance and notify both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting contract.

17.0 Post Award Conference

The Contractor shall schedule a meeting with the Government COR, and the CO within five (5) working days of contract award, before performance commences under this contract. This meeting will be conducted to identify primary points of contact, scope of efforts, and projected task(s).