Attachment 1 - Teleradiology PWS.pdf

B-1 PURPOSE OF CONTRACT

The purpose of the contract is to obtain interpretation of electronic medical images.

Contractor shall furnish all necessary personnel, supplies, materials, network service and equipment to perform under the terms of this contract. All services supplied by contractor under the terms of the contract shall be performed in compliance with all requirements and regulations of Food and Drug Administration (FDA), Mammography Quality Standards Act (MQSA), the Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) and Health Insurance Portability and Accountability Act of 1996 and Privacy Act

(HIPAA).

Participating facilities may include, but are not limited to:

• Phoenix Indian Medical Center (PIMC), Phoenix, Arizona

• Uintah and Ouray Health Clinic (U&O), Fort Duchesne, Utah

• Colorado River Service Unit, Parker, Arizona

• Hopi Health Care Center, Arizona

• Fort Yuma Health Center, Winterhaven, California

Additional Phoenix Area IHS facilities may be added during the period of performance through bilateral contract modification.

B-2 CONTRACT STRUCTURE/ORDERING

The Contractor shall provide managed teleradiology services in accordance with the requirements of this Performance Work Statement and applicable technical exhibits.

Services will be ordered by participating Service Units through task orders or authorized ordering procedures established under the contract.

The Government may issue site-specific task orders, funding modifications, or workload adjustments based on operational requirements.

Each participating facility may have differing:

• imaging modalities

• service hours

• workload volumes

• turnaround requirements

• interface configurations

Site-specific requirements are identified in Technical Exhibits attached to this Performance Work Statement.

FEE SCHEDULE

Estimated workload volumes and modality requirements vary by participating facility and are identified in the applicable Technical Exhibit. Pricing shall be proposed in accordance with Section B and the site-specific workload estimates provided in the Technical Exhibits.

The quantities identified in the Technical Exhibits are estimates only and are provided for evaluation and planning purposes. Actual quantities may vary based on patient demand, staffing availability, operational requirements, recruitment and retention of Government radiologists, implementation of new imaging modalities, and other mission requirements.

B-3 PERFORMANCE WORK STATEMENT (PWS)

1.0 INTRODUCTION

Phoenix Area Indian Health Service (IHS) facilities provide comprehensive healthcare services to eligible Native American and Alaska Native beneficiaries throughout Arizona, Utah, and California. Participating facilities vary in size, clinical complexity, imaging modalities, service hours, and patient volume. Certain facilities may function as referral centers while others operate as outpatient clinics or ambulatory care centers.

The Phoenix Area Indian Health Service (IHS) has a requirement for teleradiology interpretation services across participating Service Units and healthcare facilities. Services may include interpretation of X-ray (DR), Computed Tomography (CT), Ultrasound (US), Mammography (MM), Magnetic Resonance Imaging (MRI), and Dual Energy X-Ray Absorptiometry (DEXA), depending on the participating facility. Site-specific modality requirements, workload volumes, and operational requirements are identified in the applicable Technical Exhibits.

2.0 DEFINITIONS:

A. Area: A defined geographical region for Indian Health Service administrative purposes.

Each Area Office may administer several Service Units.

B. Customer Evaluation/Input: Written comments made to the Contracting Officer regarding the Contractor’s performance. This is one of the criteria used to evaluate the Contractor’s performance.

C. Facility Point of Contact: A Government employee designated by the facility receiving service, who assists the Authorized Ordering Official in the administration of task orders and payment of invoices issued under this contract. Has limited authority to contact Contractor regarding routine daily service issues and special requests within the scope of the contract. Assists the Contracting Officer’s Representative to monitor the Contractor for performance.

D. Holiday: A day marked by a general suspension of work in commemoration of an event.

E. Performance-Based Matrix: Lists the services to be monitored and the standards to be applied.

F. Quality Assurance Surveillance Plan (QASP): A written document prepared and used by the government for Quality Assurance surveillance of the contractor’s performance.

G. Quality Control: Those actions taken by the contractor to control quality of services provided.

3.0 CONTRACTOR REQUIREMENTS

A. Facility Data and Images: Except as necessary to provide services under the contract, Contractor shall not share, distribute or publish any facility business data, patient data or information, or patient images without the express written consent of the originating facility and any such data, information or images shared, distributed or published with the express written consent of the originating facility shall be in accordance with all applicable regulations and requirements of Health Insurance Portability and Accountability Act (HIPAA), Privacy Act, The Joint Commission (TJC), Center for Medicaid and Medicare Service (CMS) and other applicable privacy standards.

B. The contractor shall be in compliance with CMS requirements §§482.12(a)

(1) through (a) (7) and §482.12 (e) stated in the written agreement.

C. Contractor’s Equipment and Software: Hardware and software utilized by contractor to provide services under the contract shall be compliant with all regulations and requirements of FDA, ACR, TJC, CMS and HIPAA. Shall be able to receive DICOM images for interpretation of exams.

D. Contractor’s Professional Liability Insurance: Contractor shall maintain, at contractor’s sole expense, Professional Liability Insurance for each of contractor’s radiologists providing services under the contract in the amount of at least Two Million Dollars ($2,000,000) per occurrence, AND General Liability Insurance in an amount at least commensurate with industry standards.

E. All interpretations provided to facilities under the terms of the contract shall be performed by radiologists located in the United States of America.

F. Credentialing of Contractor’s Radiologists: Contractor shall maintain at all times during the contract period certification by TJC (MS 13.01.01 and MS 13.01.03) and CMS, §482.22 (a) (3) and §482.22 (a) (4) including credentialing of contractor’s radiologists providing services to facilities under the terms of the contract.

Contractor shall notify facilities immediately in writing of any limitations on contractor’s TJC and/or CMS certification or restrictions on credentials of any of contractor’s radiologists. Contractor shall provide to Contracting Officer Representative (COR) and subsequently update a list of all radiologists that will be providing interpretations under the terms of the contract, said list including Provider Identification Number (PIN) and other identifying information required by government and private third- party payers. Contractor shall provide facilities with signed billing waivers for each interpreting radiologist as required to facilitate billing of government and private third-party payers by the facility. Contractor shall provide the applicable facility all documentation, information and permissions required by the participating facility to properly complete their credentialing actions as required by TJC and CMS. Contractor shall provide at least five working days (excluding weekends and Federal holidays) notice of any additions to contractor’s interpreting radiologist staff, said notice to be accompanied by all identification, billing, privileging and credentialing documentation specified above this paragraph.

The Contractor shall execute and maintain a Distant Site Telemedicine Entity Credentialing and Privileging Agreement, or successor agreement acceptable to the Government, with each participating facility utilizing credentialing-by-proxy arrangements. The Contractor shall provide all documentation required to support credentialing, privileging, and ongoing provider oversight activities.

Documentation to include:

a) All settled malpractice cases to include court documents along with physician’s summary.

b) All dismissed malpractice cases to include legal documents showing the dismissal date along with a physician’s summary.

c) Doctor’s summary for all open malpractice cases.

d) Court documents for any misdemeanor or felony

e) Explanation for any gaps in practice.

f) Privilege form

g) Documentation that the radiologist is credentialed and privileged and in good standing.

Contractor is to submit these documents when credentialing radiologist.

In addition, participating facilities may request additional documentation related to National Practitioners Data Bank (NPDB) reports, any current or past professional liability claims, current or pending challenges to licensure or registration, voluntary or involuntary relinquishment of such licensure or registration, voluntary or involuntary reduction or limitation or loss of clinical privileges at another institution, and any prior felony or misdemeanor convictions or charges. Contractor to notify applicable facility credentialing and COR of any new physician malpractice cases within 10 days.

The Government has provided Attachment 1.1, Sample Distant Site Telemedicine Entity Credentialing and Privileging Agreement, for informational purposes. The Contractor shall execute and maintain credentialing and privileging agreements required by participating facilities during contract performance.

G. Radiology Staff Quality Assurance (QA) Activities and Requirements: The contractor shall establish and maintain a QA program consistent with all TJC or CMS requirements including quarterly evaluations of interpretations by every interpreting radiologist. These requirements may be amended from time to time to maintain compliance with applicable laws, rules and regulations.

a. QA evaluations shall classify contractor’s radiologist’s imaging examination clinical report as:

1. No Discrepancy: Reviewer fully agreed with initial clinical interpretation.

2. Minor Discrepancy: Reviewer noted or disagreed with one or more findings reported on the initial interpretation that would likely not alter any facility’s patient’s care or clinical course.

3. Significant Discrepancy: Reviewer noted or disagreed with one or more findings on the initial interpretation that would likely alter applicable facility patient’s care or clinical course. Note that contractor shall take action within one (1) hour to communicate to the applicable facility responsible provider notice of any significant discrepancies found in initial reads.

b. QA evaluations shall include a sufficient number of interpretations for each of contractor’s radiologists providing services under the contract to meet all TJC and CMS requirements for accredited QA programs.

c. QA evaluations shall be conducted by a Board Eligible/Board Certified (BC/BE) radiologist (not currently in residency training) at contractor’s sole expense.

d. QA evaluations must be reported to the COR within thirty calendar days of the end of the quarter or as required by TJC and CMS.

e. Performance Improvement Plans (PI Plans) must be included for any of contractor’s interpreting radiologists with a rate of clinically significant discrepancy greater than 1%.

f. Contractor to review and approve imaging protocols (all modalities) per Joint Commission requirement. This will include the contractors Radiologist to sign protocols at each medical facility, as needed. COR will make this request with the contactor.

H. Final Interpretations: All interpretations will be final once BC/BE radiologist (not currently in residency training) complete the report and transfers the report medical record. All interpretations will be final.

I. Digital Mammography Requirements: Contractor shall provide the following services related to screening and diagnostic mammography programs including support for Mammography Quality Standards Act (MQSA) activities with FDA and ACR. Contractor may be required to provide the following services depending on the needs of individual facilities.

a. Lead Interpreting Physician (LIP), as defined by MQSA.

b. Medical Physicist Survey, as required by MQSA, with all required reporting to COR as required by MQSA. Contractor shall maintain full

MQSA accreditation while performing mammography services under the terms of the contract. Contractor will also provide copies for record maintenance or review by FDA/ACR.

c. Contractor’s Lead Interpreting Physician and Medical Physicist shall consult with the applicable facility and assist with all clinical issues and MQSA accreditation issues as requested by the referring facilities and required by MQSA. Contractor shall be responsible for physician’s portions of MQSA accreditation and annual inspections. Contractor’s LIP shall also assist with the process of ACR certification every three years, including selection of sample images and completion of all supporting documentation required by the ACR. Contractor will also provide copies for record maintenance or review by FDA/ACR.

d. If Contractor provides the sole group of radiologists interpreting mammograms at the facilities, Contractor shall prepare a report for the hospital Peer Review Committee as regards breast biopsies recommended by radiologists interpreting mammograms. The report should indicate the true positive, true negative, false positive, and false negative biopsy results, considering the department collectively and each radiologist’s rates individually. This is one part of the MQSA report.

e. Contractor’s Lead Interpreting Physician and staff Mammographers shall be available to assist clinical providers with clinical consultations related to mammography services performed under the terms of the contract.

f. Contractor will need to submit physician credentials, certifications, exam quantity numbers, physicists reports, continuous medical education for record keeping during FDA and ACR inspection.

J. Contractor’s Customers’ Assistance: Contractor shall provide contacts for assistance for clinical, technical and business-related issues as follows.

a. Contractor shall provide a customer representative to assist staff with business questions during regular business hours Monday through Friday, 0800 – 1700 AZ time.

b. Contractor will maintain an 800 number or equivalent telephone service to permit twenty-four hours per day and seven days per week immediate contact with contractor’s clinical staff by clinical providers at the facility.

c. Contractor will maintain an 800 number or equivalent telephone service to permit twenty-four hours per day and seven days per week immediate contact with contractor’s technical and Information Technology staff by clinical providers or technical support personnel.

d. Contractor shall identify a Medical Director for its services. COR, facility clinical providers and administrators may contact contractor’s Medical Director with clinical issues and concerns, and service requests.

e. Contactor to provide fax number where government technologist can fax technologist sheets to contractor for detailed information on exam to contractor (CT, US, Mammography, DEXA).

K. Contractor’s Communications Network and Interface Requirements

a. Communications Interface: Contractor shall interface with Government furnished PACS (Picture Archiving and Communication System) communications platform(s).

b. Storage and Display of Imaging Examinations: All interpretations shall be performed on FDA, TJC, CMS and HIPAA compliant equipment operating FDA, TJC, CMS and HIPAA compliant software. All equipment and software shall be calibrated and maintained to FDA, TJC, CMS and HIPAA compliant standards.

c. Required Communications and Information Systems Agreements:

Contractor shall work with staff and facility Information Technology (IT) Departments to complete all IHS required Information Systems Agreements. This includes but not limited to Interconnection Security Agreement (ISA)

d. Contractor’s network must have established firewalls and procedures to ensure patient confidentiality and security consistent with HIPAA regulations and American College of Radiology (ACR) guidelines.

e. Contractor shall transmit reports to facilities by electronic means in format acceptable to referring facility.

f. Contractor shall upon request work with applicable facilities to develop: a) bidirectional HL7 and tunnel interface with IHS database to allow direct communications of patient demographic and clinical information, imaging examination information and work orders from facility database to contractor’s information system and bidirectional HL7 and tunnel interface for transmission o f i m a g i n g e x a m i n a t i o n r e p o r t s f r o m contractor’s information system back to facility database. Contractor must also fax reports to applicable facility Emergency Department and Medical Imaging Department.

g. Contractor’s server and telecommunications network must have built in redundancy to allow for 100% receipt and processing of all facility data.

h. Contractor will be responsible for all costs to set up HL7 and tunnel interface on contractor’s side of the HL7 and tunnel interface. The Government will cover all costs on the Government’s side of the H7L and tunnel interface.

i. Contractor systems used in performance of this contract shall comply with applicable IHS, HHS, HIPAA, and Federal information security requirements. The Contractor shall execute and comply with all required Information Systems Agreements (ISA), Business Partner Interconnection Security Agreements (BPISA), and Business Associate Agreements (BAA). Contractor systems shall support integration with Government-furnished systems and utilize non-cloud architectures compatible with existing IHS infrastructure.

L. Contractors providers shall not be mentioned or a party on the OIG (Office of Inspector General) Exclusions List and Excluded Party List.

M. Contractor shall perform quarterly Quality Assurance and Peer Review (QA) including review of all radiologists providing interpretive services under the terms of this contract as defined in section B-3, subsection (3.0) item no. (F) and (G) of this document. Contractor shall report results of all QA performed as part of this

Performance Work Statement (PWS) to the Contracting Officer Representative (COR), as required by section B- 3, subsection (3.0) item no. (F) and (G).

N. The Contractor shall notify the ordering activity upon the appearance of a provider on the National Data Bank with a new event or has a change in license status.

O. Contactor will provide a secure website where Radiologic Technologist, physicians and Radiology Management can access patient reports, monitor receipt of images and completion. Contractor shall list the website:

. The Government may not allow for contractor software application on Government computer systems.

P. Service hours – Service hours and coverage requirements vary by participating facility and are identified in the applicable Technical Exhibit.

Q. Contractor systems and services shall be compatible with Indian Health Service (IHS) information technology, imaging, and security requirements. The Contractor shall support integration with Government-furnished imaging and radiology systems, including VistA Imaging, PACS, HL7 interfaces, and other Government-approved systems utilized by participating facilities. The Contractor shall comply with applicable IHS, HHS, and Federal information security standards, policies, and protocols.

4.0 THIRD PARTY BILLING:

Participating facilities will bill for all third-party insurance for all studies covered in the contract. The contractor shall not bill insurance for services rendered. The contractor shall be required to have all participating radiologist sign billing waiver.

5.0 PROFESSIONAL QUALIFICATIONS

The Contractor physicians shall:

A. Be Board Eligible / Board Certified (BE/BC) in Diagnostic Radiology by the American Board of Radiology (ABR).

B. Contractor physicians shall possess unrestricted licensure in the state in which they are physically located while performing services and shall meet all credentialing and privileging requirements established by participating facilities.

C. Be credentialed by Contractor under The Joint Commission (TJC) or Center for Medicaid/Medicare Services (CMS) accredited methods to provide diagnostic imaging professional services.

D. Provide under the contract only diagnostic imaging professional services within the scope of their credentials as granted by contractor under TJC or CMS accredited methods.

E. Meet the “Qualifications of Personnel” in the America College of Radiology (ACR) Technical Standard for Teleradiology, Section III, A. Physician (http://www.acr.org/Hidden/Economics/FeaturedCategories/useful_links

/medicare_info/teleradiology/ACRTechnicalStandardsDoc4.aspx).

6.0 POST-AWARD ADMINISTRATION MONITORING:

a) Facility COR or POC shall provide an ongoing method of monitoring and evaluation of the quality and appropriateness of services and of identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable.

b) If a Contractor’s employee fails to maintain required service coverage, the Contractor must provide coverage by another provider. If no coverage is provided, the Contractor shall be required to pay the IHS for the cost incurred for providing that coverage. Not providing coverage on more than one occasion will be reviewed and discussed by the Chief Medical Officer and the Contracting Officer as to whether there was a compromise of patient care. All situations that arise from compromise of patient care by the Contractor shall be referred to the Contracting Officer for action and resolution.

c) CONTRACTOR QUALITY CONTROL PROGRAM:

The Contractor shall have a Quality Control program to assure compliance with contract. Quality Control program shall minimally have the following elements:

(1) A method for identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable.

(2) A file of all quality control inspections, inspection results, and any corrective action required shall be maintained by the Contractor throughout the duration of this contract. This file shall be the property of the Government and shall be available to the COR during normal working hours. The file shall be turned over to the Government within 14 days of completion or termination of the contract.

d) QUALITY ASSURANCE (QA):

The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance plan (QASP). This plan is primarily focused on what the Government must do to ensure that the contract performance is in accordance with the contract performance standards. The QASP defines how the performance standards will be applied, the frequency of surveillance, http://www.acr.org/Hidden/Economics/FeaturedCategories/useful_links and the minimum acceptable defect rate(s).

e) PERIODIC PERFORMANCE EVALUATION MEETINGS:

The Contractor shall meet, via in-person or teleconference meeting, with the

Contracting Officer’s representative (COR) at a participating facility or by teleconference, as determined by the Government at a minimum of every six months according to availability. The purpose of these meetings shall be to review the Contractor’s performance to the critical minimum performance standards set forth in this contract, as documented by the COR’s periodic surveillance of the

Contractor’s performance to these standards.

The issuance of a Contract Discrepancy Report (CDR) may be cause for the scheduling of additional meeting(s) between the Contractor and PO. A mutual effort will be made to resolve all problems identified. The PO will prepare written minutes of these meetings. Should the Contractor not concur with the minutes, a written statement will be presented to the Contracting Officer (CO), and the Contractor will be notified of the decision in writing by the CO.

f) PERFORMANCE STANDARDS:

(a) Introduction – Performance Requirements:

(1) A Quality Assurance Surveillance Plan (QASP) has been developed for in-house operations or to implement a service contract. It is designed to aid the COR in providing effective and systematic surveillance of all aspects of services. This plan provides for monitoring the contract requirements

(b) The objective of this surveillance plan is to evaluate how the Contractor is performing in key areas. The government is primarily interested in the final service being provided and not in the details of accomplishment.

(c) The principal method of surveillance will be daily in some cases or by use or periodic inspections. Appropriate indicators are provided for recording observations in this type of surveillance.

(d) How to Use the Performance-Based Matrix

(i) Each defect observed will be recorded on the tally report. These documents will then become a formal record for later reference. The tally of defects at the end of each clinic or year (dependent on criteria) will be compared to the acceptable number of defects appearing in the surveillance plan. Errors detected by the PO in the course of surveillance will be transmitted to the Contractor or in-house personnel for correction. Notification of errors will take place within five (5) working days. Specifics concerning any errors should be recorded on the tally checklist. The Contractor or in-house personnel, as applicable, should be asked to initial this record.

(ii) COR shall forward a copy of Contractor’s compliance with performance and non- performance compliance reports.

(e) Quality Assurance Surveillance Plan (QASP):

(i) The Government shall monitor the Contractors’ performance through a Quality Assurance Surveillance Plan (QASP). The QASP describes the Government's surveillance methodology and does not alter the Contractor's performance obligations established in the PWS.

(ii) Surveillance systems will include periodic inspection and acceptance of all deliverables as cited in the contract.

Performance

Objective

Performance

Standards

Performance

Threshold

Method of

Surveillance

Incentives and

Disincentive

PRS #1. The contractor will provide quality customer service.

Validated customer complaints by

Medical Staff or Rad

Technologist or

Supervisory

Radiological

Technologist.

No more than one validated customer complaint per 1-month time period.

*Validated customer complaints from

Medical Staff or

Medical Imaging

Staff.

Incentives:

None

Disincentives:

PRS#2. Contractor Submit QA/Peer Submit QA/Peer Review receipt of Incentives:

will submit QA/Peer report every quarter. report every QA/Peer report no None review evaluation reports quarterly.

No later than 30 days after the end of the quarter.

quarter. No later than 30 days after the end of the later that 30 days after the end of the quarter.

Disincentives:

quarter.

PRS#3: Contractor Routine reports 95% of reports are Random review and Incentives:

medical interpterion submitted within 24 submitted timely. provider None reports are submitted timely per the requirements stated in the PWS.

hours.

STAT reports submitted within 60 minutes.

Urgent reports reporting to Medical

Imaging of delayed reports.

Disincentives:

submitted within 4 hours.

PRS#4: Contractor Contactor to call 100% critical Random review and Incentives:

provider to contact provider to findings provider None provider to report critical findings.

report Critical

Findings within 30 minutes.

notification. reporting to Medical

Imaging of delayed findings.

Disincentives:

Non-exercise of option or other contractual remedies

Non-exercise of option or other contractual remedies

Non-exercise of option or other contractual remedies

Non-exercise of option or other contractual remedies

PRS#5: Contractor medical interpterion reports are accurate.

Reports are accurate and corrected within the time stated per the PWS.

99% clinically significant accuracy rate

Random review and provider reporting to Medical Imaging of accuracy.

Incentives:

None

Disincentives:

*Complaints must be validated. Complaints are validated if found to be reasonable and true after an administrative investigation.

B-4 PERIOD OF PERFORMANCE

Services shall be performed during the contract period identified in the contract award document, including any exercised option periods.

B-5 CONTRACTING OFFICER (CO) RESPONSIBILITY

Authority to negotiate changes in terms, conditions and amounts cited in this contract is reserved to the Contracting Officer (CO).

B-6 CONTRACTING OFFICER REPRESENTATIVE (COR):

The COR for this contract shall be:

Name: Brian Numkena, brian.numkena@ihs.gov

The COR is responsible for:

1. Monitoring the Contractor’s technical progress, including surveillance and assessment of performance and recommending to the Contracting Officer changes in requirement(s).

2. Performing technical evaluation as required.

3. Performing technical inspections and acceptance required by this contract; and,

4. Assisting the Contractor in the resolution of problems encountered in performance.

B-7 CUSTOMER POINT OF CONTACT:

Name:

Title:

Phone Number:

Email:

Non-exercise of option or other contractual remedies

B-8 MEDICAL DIRECTOR POINT OF CONTACT:

As stated in section B-3, Contractor Requirements, section J, d:

Name:

B-9 REPORTS

The following are the required timelines for reports sent as ‘routine’, ‘urgent’ and/or ‘stat’:

5. Routine Exams: Interpretations shall be available to the referring facility within twenty-four (24) hours of receipt of the imaging examination. The Contractor shall maintain a minimum ninety-five percent (95%) compliance rate for routine examinations.

6. Urgent: Interpretations shall be called, faxed (if required by the facility), and electronically transmitted to the responsible provider within four (4) hours of receipt of the imaging examination.

The Contractor shall maintain a written or electronic log of all urgent examinations and shall conduct monthly reviews consistent with applicable CMS and TJC requirements.

The results of such reviews shall be provided to the COR within twenty (20) calendar days following the end of the reporting month.

The Contractor shall maintain a minimum ninety-five percent (95%) compliance rate for urgent examinations.

7. Stat Exams: Interpretations shall be called, faxed (if required by the facility), and electronically transmitted to the responsible provider within sixty (60) minutes of receipt of the imaging examination.

The Contractor shall maintain a written or electronic log of all STAT examinations and shall conduct monthly reviews consistent with applicable CMS and TJC requirements.

Title:

Phone Number:

Email:

The results of such reviews shall be provided to the COR within twenty (20) calendar days following the end of the reporting month.

The Contractor shall maintain a minimum ninety-five percent (95%) compliance rate for STAT examinations.

8. Critical Results: The Contractor shall provide verbal notification of critical findings to the responsible provider within thirty (30) minutes of interpretation.

Examples of critical findings include, but are not limited to:

• Tension pneumothorax

• Intracranial hemorrhage

• Ectopic pregnancy

• Unexplained free air within the abdomen

• Other findings that could have an immediate impact on patient care

The written report shall document:

• Time of interpretation

• Time of notification

• Name of the individual notified

The Contractor shall maintain one hundred percent (100%) compliance with critical findings notification requirements.

Facility-specific escalation procedures are identified in the applicable Technical Exhibit.

9. Accuracy of Reports: All reports shall maintain a 99% clinically significant accuracy rate. Any errors found in reports, must be communicated within 12 hours by telephone and fax to the responsible provider at the referring facility.

10. The Contractor shall provide a detailed monthly report of all examinations interpreted under the contract. At a minimum, the report shall include:

• Patient name

• Medical record number

• Date of examination

• Date and time of interpretation

• Examination description

• Accession number

• Imaging modality

• Interpreting radiologist

When applicable, CT reports shall include radiation dose information.

11. Manage the interpretation of suboptimal studies as follows:

If an imaging examination is of insufficient quality to permit interpretation, the Contractor shall immediately notify the originating facility and document the reason for non-interpretation.

If an examination is diagnostically limited but interpretable, the Contractor shall:

• Complete the interpretation

• Document the limitation within the report

• Notify the facility radiology leadership or designated point of contact within two

(2) business days

No patient information shall be transmitted through unsecured electronic mail.

12. The Contractor shall not issue preliminary reports unless specifically authorized by the Government.

Reports transmitted under this contract shall be final interpretations and shall be compatible with the Government's imaging and electronic health record systems.

B-10 DELIVERABLES:

Contractor shall provide the following documents:

1. Interpretation Reports.

2. Critical Result Reports.

3. Monthly Critical Results Reports.

4. Quarterly Quality Assurance (QA) (Peer Review).

5. Quality Assurance Program.

6. Medical Liability Insurance --FAR 52.237-7

7. Executed Distant Site Telemedicine Entity Credentialing and Privileging Agreement(s), as required by participating facilities.

8. Business Partner Interconnection Security Agreement (BPISA)

9. IHS Security Agreement (ISA)

10. Business Associate Agreement (BAA)

11. Invoice Itemization (Show patient name, MRN, accession number and exam) (Send by secure email, monthly. Report will be used to support invoice per month.)

12. Schedule 1 Updates, per the Distant Site Telemedicine Entity Credentialing and Privileging Agreement the contractor is submit new Schedule 1 form when physicians are added or removed.

Technical Exhibits The following Technical Exhibits are incorporated into and made part of this Performance Work Statement:

• Exhibit A – Phoenix Indian Medical Center (PIMC)

• Exhibit B – Uintah and Ouray Health Clinic (U&O)

• Exhibit C – Colorado River Service Unit (CRSU)

• Exhibit D – Fort Yuma Health Center (FYHC)

• Exhibit E – Hopi Health Care Center

In the event of a conflict between the Master PWS and a Technical Exhibit, the Technical Exhibit shall govern only with respect to site-specific operational requirements. The Master PWS shall govern all common contract requirements.

ADDENDUM

ACRONYMS:

A. ACR: American College of Radiology (ACR)

B. CMS: Center for Medicaid and Medicare Services

C. DICOM: Digital Imaging and Communications in Medicine, standard for the communication and management of medical information and related data

D. FDA: Food and Drug Administration

E. HIPAA: Health Insurance Portability and Accountability Act

F. HL7: Health Level 7, Medical informatics standard that facilities communication among different digital systems.

G. MQSA: Mammography Quality Standard Act

H. PIMC: Phoenix Indian Medical Center

I. CRSU – Colorado River Service Unit

J. FYSU – Fort Yuma Service Unit

K. OIG: Office of Inspector General

L. PACS: Picture Archiving and Communications System

M. TJC: The Joint Commission