Attachment 1 - Quality Assurance Surveillance Plan.docx

Attachment 1

QUALITY ASSURANCE SURVEILLANCE PLAN

FOR

REMOTE MEDICAL CODING SERVICES

A. OBJECTIVE: This plan provides a quality surveillance strategy for remote medical coding services for USA MEDDAC-AK, Fort Wainwright, AK. The primary purpose of this plan is to provide a basis for the government’s evaluation of the Contractor’s key areas of performance under this contract. The Contracting Officer (KO), in conjunction with input provided by the Contracting Officer’s Representative (COR), will evaluate the Contractor’s performance. Oversight of the Contractor’s performance will assure quality and consistency of contract performance.

B. PERFORMANCE MEASUREMENT OBJECTIVE: The key area(s) of the Contractor’s performance that will be evaluated during the term of the contract. The statement of work reference will be provided for each performance measurement objective.

C. ASSESSMENT METHOD: Contractor performance is inspected and evaluated on key areas of performance monthly. Method of surveillance is random sampling.

D. ACCEPTABLE QUALITY LEVEL (AQL): The degree to which the Government will allow the Contractor’s key areas of performance to vary; the variance from the standard that the Contractor is allowed and the grading/measurement associated with deviation from the specific performance standard.

E. KEY AREAS OF PERFORMANCE (PERFORMANCE REQUIREMENTS SUMMARY):

Paragraph

5.1.4.1 5.1.4.5 5.1.4.2 5.1.4.3 5.1.4.4

Monthly Status Reports

Paragraph 5.1.3.5.2

Monthly Status Reports

Contractor will provide 4 on-site provider documentation/coding trainings, and 6 monthly provider focused audits, with documentation/coding feedback for deficiencies noted to providers and clinical staff weekly, or as required and/or needed.

Paragraph 5.1.4.3 5.1.4.4 COR/Coding Manager – Random Sampling of training materials, as well as attending the training.

Cure Notice and Document Monthly Status Reports

Contractor will review and verify component parts of medical record to ensure completeness and accuracy of diagnosis, operations, and special therapeutic procedures that must conform to Health Care Financing Administration and DHA/MHS Coding Guidelines. Codes principal diagnosis, co- morbidities, complications, therapeutic and diagnostic procedures, supplies, materials, injections, and drugs, etc. with ICD-10-CM/PCS, CPT and HCPCS – all levels, and any other coding classification systems that may be required by the DOD.

Paragraph 5.1.4.2 5.1.4.3 5.1.4.4 5.1.4.9

Document Monthly Status Reports

Paragraph 1.1 5.1.3.3.1 5.1.3.5.2 5.1.4.5

Document Monthly Status Reports

and FAR 22.1703

COR documentation and program review.

Immediately notify KO of any non-compliance.

Cure Notice and Document Monthly Status Reports

Cure Notice and Document Monthly Status Reports

F. CONTRACTOR PERFORMANCE ASSESSMENT REPORT. This report shall be submitted to the KO monthly (unless otherwise agreed upon between the KO and the COR).

G. REPERFORMANCE OF SERVICES. If any of the services do not conform to the contract requirements, the Government will require the contractor to re-perform the services in conformity with contract requirements, at no additional cost to the Government. When the defects in services cannot be corrected, the Government may (1) require the contractor to take necessary action to ensure that future performance conforms to contract requirements and (2) reduce the contract price to reflect the reduced value of the services performed. The KO may exercise appropriate contractual remedy should the contractor fail to promptly take the necessary action to ensure future performance is in conformity with contract requirements.

When apparent non-satisfactory work is identified, the COR shall prepare a Contract Discrepancy Report (CDR) and submit to the KO for review, use DD Form 2772. The Contractor shall then be required to respond to the CDR. The Contractor shall explain reasons for substandard performance, how performance will be returned to acceptable levels, and how recurrence of the same or like problems will be prevented. The KO will evaluate the Contractor's explanation, assess its validity, and determine whether it is acceptable.

The contractor shall be required to correct/eliminate any deficiencies in services in a timely manner. Notification begins when pertinent documents (e.g., Customer Complaint Record or CDR) are issued to the contractor. Time of notification and correction of all applicable deficiencies should be entered on all Government documents and retained in the contract file. The Government may execute a deduction in payment for non-compliance when validated by the KO.

H. PERFORMANCE RATINGS

The Government will rate past performance using the following performance standards.

Evaluation Ratings Definitions

highly effective.

To justify an Exceptional rating, identify multiple significant events and state how they were of benefit to the Government. A singular benefit, however, could be of such magnitude that it alone constitutes an Exceptional rating. Also, there should have been NO significant weaknesses identified.

corrective actions taken by the contractor was effective.

To justify a Very Good rating, identify a significant event and state how it was a benefit to the Government. There should have been no significant weaknesses identified.

of the contract.

To justify Marginal performance, identify a significant event in each category that the contractor had trouble overcoming and state how it impacted the Government. A Marginal rating should be supported by referencing the management tool that notified the contractor of the contractual deficiency (e.g., management, quality, safety, or environmental deficiency report or letter).

should be supported by referencing the management tools used to notify

NOTE 1: Plus or minus signs may be used to indicate an improving (+) or worsening (-) trend insufficient to change the assessment status.

NOTE 2: N/A (not applicable) should be used if the ratings are not going to be applied to a particular area for evaluation.