Attachment 1 - Draft Statement of Work.docx

ACCOUNT RECEIVABLE

STATEMENT OF WORK (SOW)

I. Contract Title Account Receivable support services 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 contractor shall post payments from Private Insurance companies, Medicaid, Medicare and Veteran Administration.

Payment data are uploaded daily into our financial excel spreadsheet from PNC bank. PNC receives the payments in two forms: Electronic payment files and paper checks. Payment files can range from one claim to a couple of hundred. Previous Full-time Account Receivable technician was experienced and posted payments within the time allotted by Headquarters. (See required time frames in section Specific Tasks) Because Chemawa is a Federal facility within Indian Health Service, the insurance payments are monitored by IHS Portland Area Finance, IHS Headquarters’ Finance and the United States Treasury department. Chemawa’s business office processes are to assure we are compliant and audit ready.

The Contractor’s work hours do not need to align with Chemawa’s business hours after initial onboarding and training for Chemawa specific processes.

III. Scope The Contractor shall provide Account Receivable services 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), Easy Print, 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. IHCIA, at Title 25, U.S.C. 162e(a)

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’s 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 payment indicates which EOBs and RAs must be retrieved by next business day See Exhibit 2 – Financial Spreadsheet, column “A” Date

· Prior to posting, contractor must 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.

· In Claim message field, document 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 is the process of logging in or recording payments/receipts into the practice management system. Batching provides a more efficient and accurate way of handling the following functions:

· Recording and management all Third Party funds received

· Establishing accountability and responsibility

· Reporting collections/distribution for different facilities

· Depositing and Reconciling

· Managing Accounts

· Quick Reference to Batching:

· All payments must be entered into a collection batch before they can be posted to bills (COL – EN)

· Batches must be finalized before they are available for posting (COL – CR – FL)

Required:

· 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.

· EOBs returned from Voucher Examiner and placed in the “ready to post file” must be batched prior to posting.

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

D - Maintain Accounts Receivable System

· Monitor Batch Statistical List (BSL) Report. This report will reveal all open batches with balances.

· Contractor is responsible to resolve situations which prevent posting of payments.

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

V. Required Qualification

· Minimum Experience of two (2) years utilizing the accounting methods, procedures, and techniques to conduct difficult and responsible analysis and determinations within Indian Health Service’s Resource Patient Management System (RPMS) to validate transactions and to perform research to resolve inconsistencies

· Minimum Experience of two (2) years utilizing Indian Health Service’s 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 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.

IHS Revenue Operations Manual

VI. Performance monitoring

Contracting Officer’s Representative or alternate 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 be from April 1, 2024 through March 31, 2025 (Start date is estimate or time of award).

XI. Contracting Officer’s Representative (COR) The COR shall be appointed by the Contracting Officer after award. 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

HHSAR 352.232-71, Electronic Submission of Payment Requests

(a) Definitions. As used in this clause - Payment request means a bill, voucher, invoice, or request for contract financing payment with associated supporting documentation. The payment request must comply with the requirements identified in FAR 32.905(b), “Content of Invoices” and the applicable Payment clause included in this contract.

(b) Except as provided in paragraph of this clause, the Contractor shall submit payment requests electronically using the Department of Treasury Invoice Processing Platform (IPP) or successor system. Information regarding IPP, including IPP Customer Support contact information, is available at www.ipp.gov or any successor site.

(c) The Contractor may submit payment requests using other than IPP only when the Contracting Officer authorizes alternate procedures in writing in accordance with HHS procedures.

(d) If alternate payment procedures are authorized, the Contractor shall include a copy of the Contracting Officer's written authorization with each payment request.

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, Task order number (if applicable)

· 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.

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. Services are billed on a monthly basis for a flat monthly fee after the invoiced month payments have been posted.

2. 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.

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