Medical_Coder_PWS_v3_4Jan18.pdf

Performance Work Statement

For

Outpatient Medical Coder

14 Medical Group

4 January 2018

Columbus AFB, MS

Table of Contents

1.1. DESCRIPTION OF SERVICES…………………………………………………….….………3

1.2. EDUCATION AND TRAINING REQUIREMENTS……………………………….….……..3

1.3. PERSONNEL REQUIREMENTS………………………………………………………….…..3

1.4. UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES………………………4

1.5. PERFORMANCE OUTCOMES…..……………………………………………………….…..5

1.6. PERSONNEL………………………………..………………………………………………..…5

1.7. EDUCATION/CERTIFICATES DOCUMENTATION…………………….….…………

1.8. NON-PERSONAL SERVICE…………………………………………………….…………

1.9. HEALTH REQUIREMENTS…………………………………………………………………..7

1.10. EMERGENCY HEALTHCARE……………………………………………………..….……..7

1.11. HOURS OF OPERATION………………………………………………………………..…….7

1.12. ON CALL DUTY/AFTER DUTY RESPONSE. Not applicable for this requirement ……..8

1.13. MEDICAL QUALITY ASSURANCE/RISK MANAGEMENT……………………………...8

1.14. ORIENTATION…………………………..…………………………………………..……...…..8

1.15. CONTINUING EDUCATION REQUIREMENTS…………………………………………….8

1.16. GOVERNMENT COMPUTER ACCESS…………………………….………………………..9

1.17. CUSTOMER COMPLAINTS…………………………………….……………………..………9

2.1. SERVICES SUMMARY (SS)…………………………………………..…………….…………9

3.1. GOVERNMENT FURNISHED………………………………………………………….…..….9

4.1. SPECIFIC TASKS……………………………………………...………………………………10

5.1. SECURITY REQUIREMENT………………………………………………………..………..11

6.1. CONTRACT LABOR HOUR REPORTING…………………………………………………12

1.1. DESCRIPTION OF SERVICES

1.1.1. The Contractor shall provide one (1) full-time equivalent (FTE) Outpatient Medical Coder for

Columbus Air Force Base, Mississippi, hereafter referred to as the Medical Treatment Facility (MTF).

The Contractor shall be responsible for assignment of accurate Evaluation and Management (E&M) codes, ICD-9 diagnoses, current procedural terminology (CPT) and Healthcare Common Procedure

Coding System (HCPCS), modifiers and quantities derived from medical record documentation (paper or electronic) for outpatient encounters. Trains and educates MTF staff on coding issues and plays a significant role in coding compliance activities.

1.1.2. Contractor Staffing Plan: The Contractor shall establish and maintain a staffing plan for staffing vacant positions with fully qualified health care workers from outside the Government. A copy of the plan shall be forwarded to the Contracting Officer (CO) prior to contract start date. The plan shall include a timeframe for promptly hiring, credentialing, and, if the employee is terminated or quits, a re-hiring proposal as part of the evaluation criteria prior to contract award.

1.2. EDUCATION AND TRAINING REQUIREMENTS

Contractor may have the following recognized Education/Certifications :

1.2.1 Registered Health Information Technologist (RHIT), Registered Health Information Administrator

(RHIA), Certified Professional Coder (CPC), Certified Coder Specialist – Physician (CCS-P) with the appropriate level of experience.

1.2.2 An accrediting institution recognized by the American Health Information Management

Association (AHIMA) and/or American Academy of Professional Coders (AAPC) must accredit education.

1.3. PERSONNEL REQUIREMENTS

1.3.1. Qualifications

1.3.2. Mandatory knowledge and skills.

1.3.3. Position requires excellent computer/communication skills for provider and staff interactions.

1.3.4. Knowledge of anatomy/physiology and disease process, medical terminology, coding guidelines

(outpatient), documentation requirements, familiarity with medications and reimbursement guidelines, and encoder experience.

1.3.5. Candidate must have ability to handle multiple projects and appropriately prioritize tasks to meet deadlines.

1.3.6. Contractor may have the following recognized Education/Certifications :

1.3.7. Registered Health Information Technologist (RHIT), Registered Health Information

Administrator (RHIA), Certified Professional Coder (CPC), Certified Coder Specialist – Physician

(CCS-P) with the appropriate level of experience.

1.3.8. An accrediting institution recognized by the American Health Information Management

Association (AHIMA) and/or American Academy of Professional Coders (AAPC) must accredit education.

1.3.8.1. Continued Education Requirements :

1.3.8.2. Contract medical coders will obtain the required continued education hours at no expense to the government in order to maintain current and proper national certification(s) required for the position.

1.3.8.3. Must have successfully completed requirements for International Classification of Diseases, Tenth Revision ICD-10-CM/PCS proficiency certification by AHIMA standards or the AAPC ICD-10-

CM proficiency test prior to their start date.

1.3.8.4. Experience: The applicant must have a minimum of three years’ experience in a production coding environment in multiple specialties in the outpatient setting (physician’s office or ambulatory surgery centers) within the last five years, including assignment of E&M, CPT, and HCPCS codes.

Multiple specialties encompass different medical specialties (i.e. Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, and HCPCS codes. Ancillary specialties

(PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience. Additionally, coding, auditing and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience. Coding experience limited to making codes conform to specific payer requirements for the business office

(insurance billing, accounts receivable) is NOT a qualifying factor.

1.3.8.5. Two years of outpatient/ambulatory surgery experience may be qualifying if received in a military medical facility.

1.3.8.6. Work Environment/Physical Requirements. The work is primarily sedentary. Requirements may include prolonged walking, standing, sitting or bending. Carrying or lifting of medical records may be required daily. Use of one or more computer programs and monitors may be required daily.

1.4 UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES:

1.4.1 Armed Forces Health Longitudinal Technology Application (AHLTA)

1.4.2 Composite Health Care Systems (CHCS)

1.4.3 Defense Enrollment Eligibility Reporting System (DEERS)

1.4.4 Military Filing System – by sponsor social security number , terminal digit order, color coded and blocked filing system.

1.4.5 Contents of a military medical record, layout, sections, family member prefix designation, forms used in a MTF, and the medical record tracking procedures.

1.4.6 Essentris TM, the client-server version of the Clinical Information System (CIS)

1.4.7 Coding Compliance Editor (CCE) Systems

1.4.8 Biometric Data Quality Assurance Service (BDQAS) – https://bdqas.afms.mil/index2.htm

1.4.9 AFMS Internal Coding Audit Methodology – AFMOA Audit Tool

1.4.10 MHS Coding Guidelines http://www.tricare.mil/ocfo/bea/ubu/codingguidelines.cfm

1.5 PERFORMANCE OUTCOMES :

1.5.1 Responsible for assignment of accurate E&M, ICD-9, CPT and HCPCS codes and modifiers from medical record documentation.

1.5.2 Identifies and abstracts information from medical records (paper or electronic) for special studies and audits, internal and external.

1.5.3 Interacts with MTF staff to ensure documentation is clear and supports coding assignments.

Educates MTF staff through individual or group in-services and training sessions.

1.5.4 Maintains a delinquency report of missing records in order to facilitate completion of work within the required Air Force thresholds.

1.6. PERSONNEL

1.6.1. Point of Contact. The contractor shall provide a point of contact that shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the operation of this contract. The Contractor shall designate this individual, in writing, to the Contracting Officer’s Representative (COR) before the contract start date.

1.6.2. Availability. The Contractor shall be available for duty five days a week, Monday thru Friday, 7:00 AM until 5:00 PM (defined herein as a “duty day”), excluding Federal Holidays and Family Days.

The Contractor must provide projection of anticipated vacation day(s) or personal matters in a timely manner, unless it is an acute illness, or a personal or family emergency.

1.6.3. Arrange for Replacement Staff. The Contractor shall arrange for pre-credentialed locum tenens coverage when the Contractor will be unable to provide service for two or more consecutive weeks.

Locum tenens personnel will have all credentialed accepted through 14 MDG before any service is performed within the MTF.

1.6.4. Personnel Requirements

1.6.4.1. English Language Requirement. Personnel shall read, understand, speak, and write English well enough to effectively communicate with patients and other healthcare workers.

1.6.4.2 Contractor Personnel shall present a neat appearance and be easily recognized as a contractor employee. A hospital issued nametag will be provided designating “contractor.” Contractor employee shall identify themselves as a contractor personnel by introducing themselves or being introduced as a contractor personnel and displaying distinguishing badges or other visible identification for meetings with Government personnel. Contractor shall appropriately identify themselves as a contractor employee in telephone conversations and in formal and informal written correspondence.

1.6.5. Criminal Background Check Requirement.

1.6.5.1 The Government will conduct criminal background checks on individuals providing childcare services under this contract, using the procedures set forth in DoDI 1402.5, Background Checks on DoD

Individuals in Child Care Services, dated 15 September 2015. Background checks will be based on fingerprints of individuals obtained by a Government law enforcement officer and inquiries conducted through the Federal Bureau of Investigation (FBI) and state criminal history repositories.

1.6.5.2. Contractors shall have the right to obtain a copy of any background check pertaining to them and to challenge the accuracy and completeness of the information contained in the report.

1.6.6. Conflict of Interest. The Contractor shall not be an employee of the United States Government if the employment would create a conflict of interest. The Contractor shall not be a person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval in accordance with DoD Directive 5500.7-R, Joint Ethics Regulation, and Air Force policy.

1.7. EDUCATION/CERTIFICATES DOCUMENTATION

1.7.1. The contractor must provide all required education documents and certificates before the employee can start working under the contract. Required education/certifications are listed in paragraphs

1.2. Education and Training Requirements, and 1.3. Personnel Requirements.

1.7.2. Current BLS. Must be current before the employee can start. Renewal of BLS will be at no cost to the government.

1.7.3. A signed consent for release of information.

1.7.4. A copy of the proposed contractor’s professional resume (curriculum vitae), accompanied by that individuals sworn affidavit of the truthfulness of same, indicating experience, training, and technical expertise in the type of care to be rendered.

1.7.5. A list of all states in which the contractor currently holds or has held a license to practice related services.

1.7.6. The Contractor is required to begin full performance of the contract requirements within 10 days of contract award and provide the proposed start day.

1.8. NON-PERSONAL SERVICE

1.8.1. The services performed under this contract shall be non-personal services and are not inherently governmental. The prime contractor’s staff, including all teaming partners, subcontractors and their staff at the corporate level involved in the company’s or team’s administration of this contract, will hereafter be referred to as “contractor management staff.”

The prime contractor retains responsibility for any teaming partner or subcontractor and shall be accountable for their performance. The contractor management staff shall provide all tools, labor and materials required to recruit, qualify, train, place, manage and retain the medical support services supporting healthcare operations for the Air Force in accordance with the terms and conditions of this contract

1.9. HEATH REQUIREMENTS

1.9.1. Contract employee must have the physical and mental capability to perform the proposed job within the scope of the contract.

1.10. EMERGENCY HEALTH CARE

1.10.1. The MTF will provide emergency health care for the contractor for injuries occurring while on duty in the MTF. These services will be billed to the contractor at the current full reimbursement rate.

1.11. HOURS OF OPERATION

1.11.1. Core patient care hours are 7:00 am – 5:00 pm, Monday thru Friday. The contractor should follow command announcements for reporting to work as it relates to inclement weather or base closures.

1.11.2. Federal Holidays/MTF Closure. The contractor will not provide routine services on federal holidays. The following federal holidays are observed by Columbus Air Force Base:

New Year’s Day 1 January Martin Luther King, Jr’s Day 3rd Monday of January President’s Day 3rd Monday of February Memorial Day Last Monday of May Independence Day 4 July Labor Day 1st Monday of September Columbus Day 2nd Monday of October Veteran’s Day 11 November Thanksgiving Day 4th Thursday of November Christmas Day 25 December

Holidays occurring on Saturday will be observed the proceeding Friday. Those occurring on a Sunday will be observed the following Monday. Additional holidays consist of designated Wing stand down and Presidential appointed down days. All applicable planned closure dates will be incorporated in the contract as non-billable days.

In addition to the days designated as holidays, the Government observes the following days: Any other day designated by Federal Statute and any other day designated by Executive Order.

The Contractor will not provide routine services during Department of Defense (DoD), AF or Wing declared down-days, or events which result in medical facility closure. (Some exceptions may apply as directed by the MDG COR staff).

NOTE: For squadron functions, the contractor will not be reimbursed or paid for these events. However, attendance at alternate duty location directed by the CO or the MTF COR supervisor shall be reimbursed.

1.12. ON CALL DUTY/AFTER DUTY RESPONSE. NOT APPLICABLE FOR THIS

REQUIREMENT.

1.13. MEDICAL QUALITY ASSURANCE/RISK MANAGEMENT (QA/RM)

1.13.1. Health care providers shall participate in QA/RM activities to the extent required by AFI 44-119 and the individual MTF QA/RM plan or regulation. This includes, but is not limited to, peer review at a minimum of 10 encounters per month.

1.13.2. The government will evaluate the contractor’s professional, and differentiated from administrative, performance under this contract using quality assurance standards specified in

AFI 44-119.

1.14. ORIENTATION

1.14.1. The Contractor shall participate in the MTF orientation and service/clinic specific orientation prior to furnishing services under this contract. Clinic orientation must occur within five (5) duty days of employment start date. MTF orientation must occur within 30 days of employment start date.

1.15. CONTINUING EDUCATION REQUIREMENTS

1.15.1 Credentialed Providers. Continuing Medical Education (CME): Health care providers registered or certified by national/medical associations shall continue to meet the minimum standards for the CME to remain current as prescribed in AFI 41-117, Medical Service Officer Education. CME shall be obtained at no additional cost to the Government and shall be reported to the COR and MTF Credentials

Committee annually on the first normal duty day in January for the previous calendar year. Periodic

CME may be conducted at the MTF and will be available, at no cost, to any healthcare provider desiring to attend.

1.15.2. Annual Training Requirements: All contract employees must complete any mandatory and annual training required IAW DoD, air Force Instructions, Medical facility training requirements, and regulatory agencies (AAAHC, Health Insurance Portability and Accountability Act (HIPAA), Joint

Commission on Accreditation of Healthcare Organizations (JCAHO), Health Services Inspection (HIS), AF Computer Security Policy, and AF Safety Policy). They must complete any additional training as dictated by facility or work-center.

1.16. GOVERNMENT COMPUTER ACCESS

1.16.1. The contractor will ensure that all Contract employees comply with the requirement to obtain the minimum personnel security investigations as prescribed by DoD 5200.2-R and AFI 31-501, paragraphs

3.27.3.7 to 3.27.3.7.2. The contractor will work with the MTF to ensure that the pre-employment screening process for each employee is classified as ADP I, II, III (as defined in DoD 5200.2-R0 includes the appropriate investigations and that each contract employees have the appropriate questionnaires and forms to be completed. All completed forms will be reviewed by the contractor and forwarded to the MTF for processing. The contractor understands that, while the MTF Commander may allow contractor personnel to temporarily occupy noncritical sensitive positions pending National

Agency Check (NAC), employee will be immediately removed from the position if at any time the NAC receives unfavorable adjudication, or, if other unfavorable information that would affect the NAC becomes known.

1.17. CUSTOMER COMPLAINTS

1.17.1. Any customer complaints will be documented on the Customer Complaint Record (CCR). A copy of the CCR is attached to the PWS as Appendix 3.

2.1. SERVICES SUMMARY (SS)

2.1.1. The contract service requirements are summarized in the objectives that relate to mission essential items. The performance thresholds describe the minimum acceptable levels of service for each requirement. The COR will provide surveillances to inspect delivery of services on a Satisfactory or

Unsatisfactory basis. These thresholds are critical to mission success.

Performance Objective

PWS Para Performance Threshold

Method of Surveillance

Personnel Requirements

1.3 And 1.6. 90% Compliance Periodic

Arrange for Replacement Staff

1.6.3. 100% Compliance 100% verification

Patient Sensitivity 4.1.13. 95% Compliance Customer Complaint Documentation 4.1.10 95% Compliance Periodic

3.1. GOVERNMENT FURNISHED PROPERTY AND SERVICES

3.1.1 Equipment/Officer Furniture. The provider shall have joint use of all available equipment for performing services required by this contract.

3.1.2. Personal Protective Equipment (PPE). The Government will furnish the provider with appropriate PPE. The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.1.3. Forms. The MTF will provide required government forms used in the performance of services.

3.1.4. Supplies. The MTF will provide medical and non-medical supplies commonly used in the facility for the care and management of patients.

4.1. SPECIFIC TASKS

4.1.1. Work Requirement:.

4.1.2. Patient Lists. Patient lists, no matter how developed shall be treated as privileged information.

Lists and/or names of patients shall not be disclosed to or revealed in any way for any use outside the

MTF without prior written permission by the Chief of the Medical Staff.

4.1.3. Patient Sensitivity. Contract personnel shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships. Personnel receiving complaints validated by the COR and Chief of the Medical Staff shall be subject to counseling and, depending on the nature and severity of the complaint, separation from performing services under this contract.

4.1.4. Release of Medical Information. Contract personnel shall only release medical information obtained during the course of this contract to the patient, legal guardian, or other MTF staff involved in the care and treatment of that individual patient.

4.1.5. Judgement and Decisions. Educate and counsel patient/families about their potential risk for diseases or injuries; make appropriate recommendations/referrals; conduct education and counseling in

1:1 or group setting, as appropriate.

4.1.6. Coordination. Coordinate with appropriate individuals/departments regarding delays in service that my impact quality.

4.1.7. Communication. Demonstrate strong customer service skills and foster development of those skills throughout entire MTF.

4.1.7.1. Communicate and collaborate with the appropriate members of the health care team to ensure that needs of assigned patients are met without duplication of effort.

4.1.7.2. Make the health care and MTF system as responsive to patients’ needs as possible.

4.1.7.3. Establish and maintain good interpersonal relationships with co-workers, families, peers, and other health team members.

4.1.8. Infection Control and Safety. The contractor shall comply with all MTF infection control and safety procedures, practices, and standards.

4.1.9. Health Insurance Portability and Accountability Act (HIPAA): All individuals performing services at the MTF are required to complete HIPAA Act Privacy Rule Training and will be held accountable for complying with the MTF’s specific health information privacy and security policies and procedures.

4.1.10. Documentation.

4.1.11. Support during Military Training. Contract personnel may periodically be required to continue clinical operation while DoD employees attend mandatory training or other DoD specific activities.

4.1.12. Attendance at Meetings. The provider personnel shall attend and participate in meetings, professional staff conferences, and other appropriate professional activities as directed.

4.1.13. Professional Qualities. Participate in professional development activities and maintain professional affiliations. Attend conferences and workshops related to duties. Maintain current knowledge of disease management, preventive screening standards and requirements, and current trends in population-based health management. Actively participate in ongoing improvement projects associated with disease management, prevention, and population-based health management.

4.1.14. The Joint Commission (TJC) and Unit Effectiveness Inspection (UEI). The Contractor shall meet all applicable TJC and UEI standards during the performance of this contract.

4.1.15. Communication.

5.1. SECURITY REQUIREMENTS

5.1.1. Security Requirements for Unclassified Services. The contractor shall fully adhere with the provisions of referenced publications by submitting the appropriate forms to obtain and maintain a suitability determination to perform under this contract. The contractor shall ensure the following is accomplished prior to the required or planned start date in the MTF:

5.1.1.1. Schedule an appointment with the Unit Security Manager at the MTF where services are provided. The appointment shall be scheduled at least 14 calendar days before the required start date and arranged for the contractor’s first day of work at the MTF. The contractor cannot start work earlier than the scheduled appointment date with the Unit Security Manager.

5.1.1.2. Complete the Standard Form 85P (SF-85P), Questionnaire for Public Trust Positions, in a secure website called Electronic Questionnaires for Investigations Processing (e-QIP) or (in some cases) completes the SF-85P from a downloadable form on the Office of Personnel Management (OPM) website when the Unit Security manager establishes an account in e-QIP or provides other directions to the contractor before the scheduled appointment date. The unit Security manager may provide instructions with regard to faxing or emailing signature forms for the SF-85P as well as information on completing the

FD-258, Applicant Fingerprint Card, before the appointment date.

5.1.1.3. Contractor performing for the Government under this contract are in non-sensitive public trust positions designated as Automated Information Systems III positions IAW DoD Directive 5200.2-R. In compliance with DoD Directive 5200.2 and AFI 31-501, a National Agency Check with written Inquiries

(NACI), is required for all AIS III positions.

5.1.2. The Contractor shall have a favorable investigation, verified through the Joint Personnel

Adjudicating System (JPAS) as a condition of employment under this contract. The Contractor understands that, while the MTF commander may allow him/her temporary or interim access to

Government systems in non-sensitive positions pending the outcome of the NACI (usually through a 90 day waiver), this contract requires the immediate removal of a contractor from the position if the NACI returns with unfavorable or denied adjudication. In addition, the Government will immediately suspend the contractor computer access if the NACI is returned with an adjudication of “no determination made.”

The MTF Commander will determine whether to allow the contractor to continue in the public trust position or deny computer access, which requires the contractor to be removed from the position.

5.1.3. The contractor shall comply with all requirements and procedures IAW Air Force Federal

Acquisition Regulation Supplement (AFFARS) Clause 5353.242-9000, Contractor Access to Air Force

Installations, and local clause CAFB 00006, Columbus AFB Installation Security Requirements and

Information; these will be incorporated into the contract.

6.1. CONTRACT LABOR HOUR REPORTING

6.1.1. Contractor Manpower Reporting:

The Contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the Columbus AFB Licensed Practical Nurse

Service via a secure data collection site. The contractor is required to completely fill in all required data fields at http://www.ecmra.mil. Reporting inputs will be for the labor executed during the period of performance for each Government Fiscal year. Contractors may direct questions to the CMRA help desk.

6.1.2. Uses and Safeguarding of Information. Information from the secure web site is considered to be proprietary in nature when the contractor number and contractor identity are associated with the direct labor hours and direct labor dollars. At no time will any data be released to the public with the contractor name and contractor number associated with the data.