Performance Work Statement - Inpatient Transcription.pdf

Performance Work Statement

For

Medical Transcription Service

David Grant Medical Center

23 May 09

Table of Contents

SECTION NO. AND TITLE PAGE NO.

I. Description of Service 3-5

II. Service Delivery Summary 5-6

III. General Information 6-12

IV. Government-Furnished Property and Services 12-13

V. Appendices 14-

A. Historical Data 14

B. Turnaround Time 15

C. Standardized Abbreviations and Acronyms 16

D. Applicable Instructions, Directives and Regulations 17

E. Templates 18-27

PERFORMANCE WORK STATEMENT (PWS)

FOR MEDICAL TRANSCRIPTION SERVICES

DAVID GRANT MEDICAL CENTER

I. Description of Services

1. The 60th Medical Group (60MDG) is a Department of Defense (DoD) TRICARE Regional Medical Center for 82,000 beneficiaries. It provides or arranges comprehensive community and referral health care, readiness, education, research, aeromedical staging and DoD/VA Joint Venture. The objective of this service is to provide David Grant Medical Center, Travis Air Force Base with most accurate, cost-effective, timely, Joint Commission and Health Information Portability and Accountability Act (HIPAA) compliant and acceptable medical transcription services. DGMC reports are comprised of specialized vocabularies and encompass a variety of subjects in the field of medicine and surgery: Vocabularies include but are not limited to:

ambulatory care, anesthesiology, cardiology, dentistry, dermatology, drug and alcohol treatment, endocrinology, general medicine, gastroenterology, general surgery, geriatrics, gynecology, hematology, immunology, internal medicine, neurology, neurosurgery, nuclear medicine, oncology, ophthalmology, oral surgery, orthopedics, otolaryngology, otorhinolaryngology, pathology, psychiatry, psychology, plastic surgery, pulmonary, renal, rheumatology, spinal cord injury, thoracic surgery, transplant and urology

The contractor shall provide the management, supervision, personnel qualifications, skills and abilities, transportation, and other items and services necessary to perform medical transcription services dictated by DGMC healthcare providers as defined in this PWS. The contractor shall conform to the industry standards and follow all applicable instructions and directives as identified by the PWS. The terms, “must”, “shall”, and “will” denote mandatory actions in this

PWS.

2. System: Dictated reports will reside on the Contractor’s dictation system and a verification code will be provided at the time of dictation to retrieve reports. Contractor will ensure reports can be retrieved from a secure and encrypted website. Internet and websites will remain in compliance with HIPAA, DoD, and Air Force standards. The contractor will provide all necessary hardware and software, not currently owned by DGMC, and ensure all hardware and software installed and /or connected to the DGMC network is in compliance with all applicable DoD, Air Force and local directives. Contractor shall pay for all connect/toll charges for dialing any and all DGMC provided phone numbers. The contractor shall notify the Inpatient Records Department, Quality Assurance Personnel (QAP) immediately of any equipment of connections that are not functioning properly and could adversely affect dictation or transcription.

a. Requirements.

1. The contractor shall provide off-site transcription service meeting the 24-clock hour turnaround time (TAT) requirement. Turnaround time is defined as the time between completion of the dictated report by the author and transmission of the report by the contractor.

2. Minimum Qualifications: The expectation is that the contractor has a stable workforce and will employ transcribers with sufficient education and training so that the objective of this PWS is met. The contract should ensure at a minimum that employs have been trained and experience with medical terminology, anatomy and physiology, and completed a certified or approved transcription course.

b. Reports.

1. Report Quality: Each report must be of the highest professional quality to ensure at least 98% accuracy with respect to errors and legible. An error includes, but not limited to, medical word misuse, omitted dictation, misspellings, patient demographic, formatting, capitalization, punctuation, and minor style and grammar errors. Contractor will ensure any extra spaces have been deleted from each report.

2. TAT: TAT is the difference in time between the time the author hangs up at the conclusion of dictating into the dictation system, and the time the contractor’s completed transcribed report are received at DGMC. The contractor shall type all dictated reports within 24-clock hours of the dictated time, including weekends and holidays. If failure to meet the 24-clock hour turnaround is due to circumstances beyond the contractor’s control, the contractor will be expected to resolve backlog within a reasonable time agreed upon by the contractor and DGMC QAP. The contractor should expect to accomplish daily workload and 20% of backlog dictations on a daily basis until backlog dictations have been depleted.

3. Surges. During federal holidays, military deployments, minimal manning days and government system failures, workload may increase and/decrease by approximately 10%.

The contractor will be required to maintain the standard, 24-clock hour TAT for completion of reports during normal workflow fluctuations.

4. Corrected Reports TAT: Incorrect routine reports shall be corrected and retransmitted within four (4) hours of notification by DGMC QAP. STAT reports shall be corrected and retransmitted within one (1) hour of notifications by DGMC QAP. Corrected reports shall be flagged as corrected when transmitted.

5. Preparation and Report Formats.

a) Minute Count: The contractor will provide a total minute’s transcribed for each report to the QAP each month for billing purposes.

b) Report Length: The length of each report shall vary according to the type of medical report required. The text is single spaced with double space between paragraphs and any excess spaces shall be deleted. No report shall include any text other than what was dictated; except for formatting as instructed by DGMC, comments or questions concerning a report must be sent as separate correspondence referencing the dictation system reference number.

c)Formatting Information: The contractor shall ensure all headers and footer information complies with DGMC standards as listed below (Appendix E):

1) Header Information: Each document shall include the specified header conforming to the standard provided by DGMC for specified type of document. This header includes the document type, date of exam, author, dictation date, and attending physician, when dictated. Contractor shall delete any blanks spaces.

2) Footer Information: Each document shall include the specified footer conforming to the standard provided by DGMC for specified type of document (see Appendix E). The footer includes type of report which will be marked by the contractor, patients name, sex, unit, dictation date, and date typed, when dictated.

3) Additional Information: The contractor shall type one-line two spaces below the end of the body the providers signature block. The contractor shall type one-line below the signature block the initials

C. Monthly Workload Reports: Contractor will provide to the DGMC QAP a daily report of transcriptions sent to DGMC. This report will include report identification, number of lines, author, and line count. The contractor will provide to DGMC a monthly report of transcribed reports sent to DGMC for the respected month in which workload was completed.

3. Quality Control Program: The contractor is responsible for the quality of services under the terms of this contract. To ensure that requirements are met, the contractor shall implement an effective, economical quality control program to indentify, prevent, and insure non-recurrence of effective services and satisfactory performance of objectives listed in the Service Delivery Summary (SDS) are achieved. The contactor shall provide a copy of its quality control procedures to the government within 30 days of contract start date.

II. Service Delivery Summary

The service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. The thresholds are critical to mission success and the percentages shown indicate acceptable (satisfactory) performance.

Performance Objective PWS Section/Para #

Performance Threshold

Method of Surveillance

All transcribed reports must meet the quality standard requirements of legibility and accuracy.

Pg 4, Section I, Para 2, b. 1.

98% Review each report that received for legibility and accuracy.

Transcribe reports within 24-hours at the time of dictation.

Pg 4, Section I, Para 2, b.2.

100% Monitor when report was dictated and received.

Provide monthly/calendar year productivity reports.

Pg 5, Section I Para C

100% Review monthly and calendar year productivity reports.

Performance Objective 1 comprises 45% of monthly pricing.

Performance Objective 2 comprises 45% of monthly pricing.

Performance Objective 3 comprises 10% of monthly pricing.

a. Basic computation for reduction in the monthly price will be a function of the percentage of the non-performance/failed service as compared to the amount of the monthly invoice. Amounts reflected below are the methods that will be used to compute reductions. For Example, if the contractor failed to provide 4% of the required monthly services in accordance with the performance objective the following describes how to calculate a price reduction.

Example: Monthly estimated price for all inpatient coding support requirements is $20,000.00 Requirements to provide a performance objective 1 represents 90% of the monthly price $18,000 Contractor failed to perform 4% of the required services, reduce monthly invoice by $720.00 ($18,000 x 4% = 720.00)

III. General Information:

1. Orientation/Training Requirements:

a. Comply with and attend Government provided orientation and annual training which will include topics such as Compliance, Patient Safety, Performance Improvement, Risk Management, infection control, fire protection, security, patient sensitivity training, automation processing, local in-service and safety briefings, CHCS, and Information Awareness. The classes may be scheduled individually throughout the year or scheduled at one time. Duration of classes will vary and required for each individual. Training will need to be accomplished during first available opportunity after beginning employment with DGMC.

b. The contractor shall ensure that the contract personnel are knowledgeable of the policies and procedures of their specific place of duty and of the medical activity. Such training may include instruction on automation processing, quality assurance policies and local in-service and safety briefings.

c. The contractor shall ensure personnel are in processed by submission of National Agency

Check (NAC) check documents, submission of immunization records, obtaining appropriate Identification Card (ID), Computer Access Card (CAC), Information Assurance Awareness (IAA) and Composite Healthcare System (CHCS) training 15 calendar days prior to start of contract.

2. Security Requirements. All personnel employed by the contractor in the performance of this contract, or any representative of the contractor entering the governmental installation, shall abide by all security regulations of the installation.

a. Base Access. The contractor shall obtain personal identification photo passes for all employees and vehicle passes for all contractor and personal vehicles requiring entry onto Travis AFB from Security Forces Pass and Registration, for the duration of the contract.

Vehicle registration, proof of insurance and a valid driver’s license must be presented for all vehicles to be registered. During Force Protection Condition (FPCON) of Normal and Alpha, personnel without base issued identification shall be sponsored onto the installation. During FPCON Bravo, Charlie and Delta, personnel without base issued identification shall be physically escorted onto the installation. Contractor shall require a Department of Justice (DOJ) or equivalent (i.e. Avert) background check for all personnel and subcontracting personnel requiring entry onto Travis AFB in performance of this contract. DOJ background check(s) to be initiated no later than 5 days after the contract start date. Continued employment is contingent upon successful completion of t the background check. The results of the background checks will be submitted to the 60th Security Forces Squadron, 60 SFS/SFOXI, 510 Airlift Drive Bldg. 381, and Mr. 103, Travis AFB, CA 94535, (707) 424-3770 or 3499. During Higher FPCONs (Charlie and Delta) access by non-essential contractors may not be authorized or at least limited.

b. Criminal Convictions. Only criminal convictions will be considered in determining an applicant’s suitability for employment. Detention and/or arrest without conviction do not constitute valid grounds for employment decisions and cannot play a part in the decision-making process. In determining the applicant’s suitability for employment where the applicant has a criminal conviction on their record, consideration will be given to the specific duties of the position, the number of offenses and circumstances of each, the age of the conviction(s), and the accuracy of the explanation on the application. In instances where information is obtained that would appear to make the candidate a poor risk for hire, Security Forces can provide guidance and a recommendation to the hiring authority.

The Fair Credit Reporting Act (FCRA) provides that written notice and the name of the criminal check agency be given to individuals when employment is denied.

3. Contractor Point of Contact:

The contractor shall provide a point of contact (POC) and alternate(s) that shall be responsible for ensuring that the contract services are provided satisfactorily. The POC and alternate(s) shall be designated in writing to the contracting officer within five days of contract award date. The contractor POC and alternate(s) shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The POC will conduct professional monthly meetings with MTF staff members to discuss any issues and concerns. It is preferred to have a POC available during normal duty hours.

4. Contractor Employees:

a. The contractor shall not employ persons for work on this contract if such employee is identified to the contractor by the contracting officer as a potential threat to the health, safety, security, general well being or operational mission of the installation and its population. Contractor personnel shall present a neat appearance and be easily recognized as contractor employees by obtaining an official DGMC hospital personnel badge with their name and picture clearly visible. Contractors must wear badge at all times while on duty in the facility.

b. The contractor shall not employ any person who is an employee of the U.S. Government if employing that person would create a conflict of interest. Additionally, the contractor shall not employ any person who is an employee of the Department of the Air Force, either military or civilian, unless such person seeks and receives approval according to DOD 5500.7-R, the Joint Ethics Regulation (JER). The contractor shall not employ any person who is an employee of the Department of the Air Force if such employment would be contrary to the policies in Air Force Instruction (AFI) 64-106.

c. The contractor is cautioned that off-duty active military personnel hired under this contract may be subject to permanent change of station, exchange in duty hours, or deployment. Military Reservists and National Guard members may be subject to recall to active duty. The abrupt absences of these personnel could adversely affect the contractor’s ability to perform; however, their absence at any time shall not constitute an excuse for nonperformance under this contract.

5. The contractor shall comply with the Privacy Act of 1974 (the Act) and AFI 33-332, the Air Force Privacy Act Program and the agency rules and regulations issued under the Act in the design, development operation of any system of records. Operation of a system means performance of any of the activities associated with maintaining the system of records, including the collection, use and dissemination of personal information. Systems of Records on individuals are defined as a group of any records under the control of an agency from which information is retrieved by the name of the individual or by some identifying number, symbol or other identification unique to the individual.

The contractor shall comply with AFI 33-322, Records Management Program, paragraph 10 and DoD Regulation 5400_7 Air Force Supplement, Freedom of Information Act. Disposition of records shall be in accordance with Air Force Records Information Management System (AFRIMS) schedule found at http://www.my.af.mil/gcss-af61a/afrims/afrims/ or use the Portal A-Z Applications List to locate the AFRIMS link. The Quality Assurance Evaluator (QAE) will review all records, paper and electronic, to ensure requirements of the Records Management Program, Freedom of Information Act Program, and Privacy Act Program, are met.

a. All records generated during the performance of the contract are considered Government records and shall be turned over to the Government upon termination of the contract.

b. Records are considered to be all books, papers, maps, photographs, machine-readable materials or other documentary materials, regardless of physical form or characteristics, made or received by any agency of the Government under federal laws, or in connection with the transactions of public business, and preserved or appropriate for preservation by any agency, or its legitimate successor, as evidence of the organization, functions, policies, decisions, procedures, operations or other activities of the Government or because of the informational value of data in them. This includes all electronic records, which must meet the requirements of DOD STD 5015.2.

6. Health Requirements.

a. All contractor administrative personnel assigned and working in Bldg 777, Main Hospital and Dental Clinic, must have certification of the following health requirements: Proof of Tuberculin skin testing or history of completion of anti-tuberculosis prophylaxis, Varicella or history of disease, MMR or history of disease or born after 1956.

b. Baseline and annual IPPD (TB) skin testing shall be required and any contract employee found to have a positive skin test on baseline or annual screening shall show proof of treatment with anti-tuberculosis chemoprophylaxis to the MTF’s Public Health Flight upon notification by the QAP. If the contract employee is unable to show proof of treatment with anti-tuberculosis chemoprophylaxis, THE MTF’s Public Health Flight will provide counseling on signs and symptoms of tuberculosis and refer the individual to the infectious disease consultant. The contract employee will then be referred back to the contractor. The contractor will ensure the contract employee receives appropriate medical treatment with anti-tuberculosis chemoprophylaxis under the direction of a private physician at the contractor’s expense. The contract employee will not be required to undergo further skin testing once a positive skin test is documented.

c. During anticipated closure of the facility due to Commander declared training holidays, administrative leave granted to the entire staff or other closures, the Contracted employees shall be treated in the same manner as DoD civilian employees. In the event of unplanned closure of the facility due to natural disasters, military emergency or severe weather, the Contracted employees will be treated in the same manner as DoD employees.

7. FOR OFFICIAL USE ONLY (FOUO). The contractor shall create and Maintain FOUO material IAW DoD 5400-7,R, DoD Freedom of Information Act Program, Chapter 4, AFI 33- 129, Transmission of Information Via the Internet, paragraphs 7.4, 8.23, 16 and 17; and AFI 33- 201, Communications Security (COMSEC), Table 1. Mark all documents meeting the requirements identified in DoD Regulation 5400.7/Air Force Supplement, paragraphs C3.2.1.2 thru C3.2.1.9 as “For Official Use Only” IAW instructions identified in paragraph C4.2.1.

Safeguard all sensitive data IAW DoD Regulation 5400.7/Air Force Supplement, paragraph C4.4. When documents containing FOUO material are authorized for destruction, shred the records so that the pieces cannot be reconstructed. Degauss or overwrite magnetic tapes or other magnetic media. Proper records maintenance and disposition shall be IAW with the Records Disposition Schedule available on the AFRIMS website at https://afrims.amc.af.mil

8. Patient Lists: Patient lists, no matter how developed, shall be treated as privileged information. Add the following to the bottom of all patient lists: “FOR OFFICIAL USE ONLY.” This document contains information exempt from mandatory disclosure under the Freedom of Information Act (FOIA), Title 5 U.S.C 552(b)(2) High and (b)(6) apply.” Lists and/or names of patients shall not be disclosed or revealed in any way for any use outside the MTF without prior written permission by the Chief of Hospital Services.

9. Privacy Act Program: The contractor shall create and maintain Privacy Act data IAW AFI33- 129, Transmission of Information Via the Internet, paragraphs 7.4, 8.2.3, 16 and 17 and supplements; AFI 33-201, Communications security (COMSEC), Table 1; AFI 33-332, Air Force Privacy Act Program, paragraph 3.3.3, Chapter 7, Chapter 9, Chapter 10 and supplements and Privacy Act systems of records notice(s), which are posted on the internet at (http://www.defenselink.mil/privacy/notices/usaf). The contractor shall not create or maintain a Privacy Act system of records prior to public notice. If the contractor receives a Privacy Act request, the contractor shall be responsible for searching for the records and providing those records to the Government official who, as authorized official, will make the decision on releasing Government records.

10. DoD Freedom of Information Act (FOIA) Program: If the contractor receives a FOIA request the contractor shall immediately hand-carry it to the base FOIA manager for processing.

The FOIA manager will task a Government official. When tasked, the contractor shall be responsible for searching for the records and providing those records to a Government official who, as the authorized official, will make the decision on releasing Government records.

11. Functional Requests: A written request for DoD records that does not cite either the FOIA or Privacy Act may be received from any person (including a member of the public), or organization, or a business. The contractor shall be responsible for searching for the records and providing those records to a Government official who, as the authorized official, will make the decision on releasing Government records.

12. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) /

MAINTENANCE OF PATIENT PRIVACY

HIPAA is comprised of several different sections, each to be implemented by the Dept. of Health and Human Services. The medical facilities of the military services and the DOD health plans are specifically listed as covered by HIPAA. Currently, HIPAA Privacy and Security Rules, as set forth in the Code of Federal Regulations, are in effect for all MTFs. The specific implementation of HIPAA Privacy for DOD medical facilities is set forth in DOD 6025.18- R, and for HIPAA Security, the requirements for AF MTFs are contained in DOD 8580.02-R and AFI 41-217, which also contains additional Information Assurance requirements for all AF MTFs. DOD 6025.18-R, DOD 8580.02-R and AFI 41-217 are incorporated herein by reference. MTFs are responsible to insure overall compliance with HIPAA requirements, which includes incorporation of certain requirements in contracts entered or amended after the respective implementation dates.

IAW these regulations, the Contractor and its employees meet the definition of Business Associates. Therefore, a Business Associate Agreement is required by law to comply with both the HIPAA Privacy and Security regulations. This clause serves as that agreement for each MTF, whereby the Contractor and its employees agree to abide by all HIPAA Privacy and Security requirements regarding health information as defined in this clause, DoD 6025-18-R, DOD 8520.02-R and AFI 41-217. Additional HIPAA requirements will be addressed when implemented.

Introduction:

(a) Definitions. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DOD 6025.18-R, DOD 8520.02-R or

AFI 41-217.

Individual has the same meaning as the term “individual” in 45 CFR 164.50 1 and 164.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.

Protected Health Information has the same meaning as the term “protected health information” in 45 CFR 164.501, limited to the information created or received by The Contractor from or on behalf of the Government.

Electronic Protected Health Information has the same meaning as the term “electronic protected health information” in 45 CFR 160.103.

Required by Law has the same meaning as the term “required by law” in 45 CFR 164.501 and 164.103.

Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160,162 and part 164, subpart C. Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in 45 CFR 160.103, 160.502, 164.103, 164.304 and 164.501.

(b) The Contractor agrees to not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

(c) The Contractor agrees to use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

(d) The Contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

(e) The Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Contract.

(f) The Contractor agrees to report to the Government any security incident involving protected health information of which it becomes aware.

(g) The Contractor agrees to report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract of which the Contractor becomes aware of.

(h) The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Contractor on behalf of the Government agrees to the same restrictions and conditions that apply through this Contract to the Contractor with respect to such information.

(i) The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

(j) The Contractor agrees to provide access, at the request of the Government, and in the time and manner designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

(k) The Contractor agrees to make any amendment(s) to Protected Health Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government or an Individual, and in the time and manner designated by the Government.

(1) The Contractor agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contractor on behalf of, the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner designated by the 'Government or the Secretary, for purposes of the Secretary determining the Government's compliance with the Privacy Rule.

(m) The Contractor agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

(n) The Contractor agrees to provide to the Government or an Individual, in time and manner designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

General Use and Disclosure Provisions:

(a) Except as otherwise limited in this Agreement, the Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, DOD 6025.18-R, the HIPAA Security Rule, or DOD 8580.02- R if done by the Government.

Specific Use and Disclosure Provisions:

(a) Except as otherwise limited in this Agreement, the Contractor may use Protected Health Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

(b) Except as otherwise limited in this Agreement, the Contractor may disclose Protected Health Information for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

(c) Except as otherwise limited in this Agreement, the Contractor may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

(d) Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

Obligations of the Government:

Provisions for the Government to Inform the Contractor of Privacy Practices and Restrictions.

(a) Upon request the Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520, as well as any changes to such notice.

(b) The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Contractor's permitted or required uses and disclosures.

(c) The Government shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

Permissible Requests by the Government:

The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, DOD 6025.18R, the HIPAA Security Rule, or DOD 8580.02-R, if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

Termination:

(a) Termination. A breach by the Contractor of this clause, may subject the Contractor to termination under any applicable default or termination provision of this Contract.

(b) Effect of Termination.

(1) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below.

(2) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government, or created or received by the Contractor on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the Protected Health Information.

(3) If this contract does not have records management provisions and the Contractor determines that returning or destroying the Protected Health Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such Protected Health Information.

Miscellaneous:

(a) Regulatory References. A reference in this Clause to a section in DOD 6025.18-R, HIPAA Privacy Regulation or DOD 8580.02-R, HIPAA Security Regulation, or any CFR or AFI provision means the section as currently in effect or as amended, and for which compliance is required.

(b) Survival. The respective rights and obligations of Business Associate under the "Effect of Termination" provision of this Clause shall survive the termination of this Contract.

(c) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with DOD 6025.18-R, the CFR HIPAA Privacy Rule, DOD 8520.02-R, the CFR HIPAA Security Rule and AFI 41-217.

13. Holidays: The following is a list of legal federal holidays and services are not required.

New Year’s Day, January 1st Martin Luther King's Birthday, 3rd Monday in January President’s Day, 3rd Monday in February Good Friday, Friday before Easter Memorial Day, Last Monday in May Independence Day, July 4th Labor Day, 1st Monday in September Columbus Day, 2nd Monday in October

Veteran's Day, November 10th Thanksgiving Day, 4th Thursday in November Christmas Day, December 25th

NOTE: Any of the above holidays falling on a Saturday will be observed on the preceding Friday; holidays falling on a Sunday will be observed on the following Monday.

IV. Government and Contractor Furnished Property and Services:

a. Property and Services: Government shall provide the facilities, equipment, materials and services listed below. An inventory of government-furnished equipment must be done not later than 5 calendar days before start of the contract, within 10 calendar days of the start of any option periods, and not later than 10 calendar days before completion of the contract period (including any options). The contractor and a government representative (identify by the Contracting Officer) shall conduct a joint inventory of all government-furnished equipment and the contractor shall sign a receipt for all equipment provided by the government. Items of equipment missing or not in working order shall be recorded and the contracting officer notified in writing. The contractor and the government representative shall jointly determine the working order and condition of all equipment and document their findings on the inventory. In the event of disagreement between the contractor and the government representative on the working order and condition of the equipment, the disagreement shall be treated as a dispute under the FAR 52.212-4 (d), Contract Terms and Conditions -- Commercial Items (Sep 2005).:

1. Property: (1) Facilities (Rm. # 2A207; approximately 245 sq. ft).

2. Security Forces and Fire Protection: Phone Numbers: Non-Emergency Fire Department:

4-3683, Non-Emergency Security Police: 4-3293. Emergencies (all): 911.

3. Utilities: The government will provide gas, electricity, sewage disposal, and water.

4. Equipment/Computer Software: On site equipment includes one telephone per desk, one desktop computer per workstation, Microsoft Office software, Composite HeathCare System (CHCS), Armed Forces Health Longitudinal Technology Application (AHLTA), and Coding Compliance Editor (CCE) and access to network printer.

5. Installation equipment and services: This will include, but is not limited to, copy machines, fax machines, Defense Switching Network (DSN) lines and a Medical library.

The same restrictions to utilize these items for Government official business apply to the contractor. The Government will provide training on Government equipment and initial facility orientation.

6. Supplies: The MTF will provide commonly used non-medical office supplies to include pens, paper, stapler, calendar, etc.

7. Dining Facilities: The contractor personnel will be allowed to use the hospital dining facility while on duty during times established by the facility.

8. The government will provide training to the contract personnel in CHCS and AHLTA other procedures that the medical activity’s staff is required to use. Access to such patient data systems is an “Automated Data Processing Sensitive” position requiring compliance with Patient Administration AFI 41-210 (Chapter 2) and Air Force Systems Security Instruction (AFSSI) 5027.

9. The Government will provide a briefing to familiarize contract personnel with the policies and procedures of the MTF. Orientation attendance will be mandatory of all contract personnel, which will be attended at the onset of working at the MTF.

10. Contract personnel shall be responsible for maintaining current reference material and any aforementioned regulations, laws, and/or policies. The Contractor will be responsible for providing auditors and trainers with current coding guidelines: CPT, HCPCS, ICD-9 -CM, and any other coding guidelines the firm determines to be necessary to met PWS requirements. The DoD directives, Air Force instructions, Medical Health Services (MHS) Coding guidelines, and local instructions will be provided by the government.

11. The MTF will perform monthly audits IAW Air Force policy/instructions (AFI 41-210, AFMSA Coding Accuracy Audit Methodology, DGMC Coding Compliance Plan), on services provided by the contractor.

V. Appendices

Appendix A

Work Load Estimates (Historic)

A. Contract Workload: Number of reports transcribed per month.

Fiscal Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2006 356 389 448 465 359 385 434 417 373 235 405 356

2007 425 393 429 399 394 339 394 419 399 432 404 370

2008 354 319 250 500 380 607 472 507 434 492 409 442

Line Count

FY06: 847,235

FY07: 845,712

FY08: 834,309

B. Surges/Delays: During federal holidays, military deployments, minimal manning day and Government system failures, workload may fluctuate (decrease or increase) by approximately 10%. If unable to meet standards due to circumstances beyond contractor’s control, contractor is expected to catch up with the workload within a reasonable amount of time as defined by the amount of backlog. Contractor will coordinate with QAP to identify reasonable timeline.

Appendix B

Turnaround Time (TAT)

Health and Physical Summary 24 hours Death Summary 24 hours Progress Note 24 hours Medical Evaluation Board 24 hours Narrative Summary 24 hours Consultations 24 hours Tissue (Radiation Therapy) 24 hours Transfer Summary 24 hours Operation Report 24 hours All STAT dictation 4 hours

Note: Copy of templates will be provided upon approval of contract.

Appendix C

Standard Abbreviations

AFMOA: Air Force Medical Operations Agency AHIMA: American Health Information Management Association BDQAS: Biometric Data Quality Assurance System CHCS: Composite Health Care System: The DOD medical database that tracks patient related information CPT: Current Procedural Terminology Used for coding medical/surgical services.

DoD: Defense of Department DGMC: David Grant Medical Center: Military medical facility at Travis AFB DRG: Diagnosis Related Group HCPCS: Health Care Financing Administration Common Procedural Coding System:

Guidelines for billing and coding HSI: Health Services Inspection ICD-9: International Classification of Diseases: Codes types of illnesses/injuries LAN: Local Area Network NAF: Non-Appropriated Fund PWS: Performance Work Statement QAP: Quality Assurance Personnel

Appendix D

Applicable Instructions, Directives and Regulations

Publications and forms applicable to this PWS are listed below, and are mandatory. The contractor shall follow those publications coded as mandatory to the extent (that is, the specific procedure in a paragraph, section, chapter or volume) specified, to meet requirements in this PWS. Applicable publications are located at http://www.e-publishing.af.mil/pubs. The Government may issue supplements or amendments to listed publications from any organizational level during the life of the contract. The contractor shall keep all issued publications up-to-date. The contractor shall immediately implement those changes in publications that result in a decrease or no change in the contract price. Before implementing any such revision, supplement, or amendment that will result in an increase in contract price, the contractor shall submit to the contracting officer a price proposal for approval. Price proposals shall be submitted within 30 calendar days from the date the contractor receives notice of the revision, supplement, or amendment-giving rise to the increase in cost of performance. The Government and the contractor will negotiate the changes into the contract under provisions of the Changes clause. The Government will continue to supply the Government forms needed for daily operations. Upon completion of the contract, the contractor shall return to the Government all issued publications and unused forms.

DEPARTMENT OF DEFENSE and AIR FORCE PUBLICATIONS:

Number Title of Directive Para/Chapter

DoD 5400.7-R/AF SUP DoD Freedom of Information Act Chapter 4, Para,C.4.4, 3.2.1.2 DoDI 3020.37 Continuation of Essential DOD All Contractor Services During Crises Air Force Sup DoD Freedom of Information Act All DoDR 6025.18-R Health Information Privacy Regulation All DOD 5200.2-12 Personnel Security Program All DODD 6040.41 Medical Records Retention and All

Coding at Military Treatment Facilities AFI 33-332 Air Force Privacy Act Information All AFI 41-210 Patient Administration Functions All Air Force Systems Security Instruction (AFSSI) 5027 All

OTHER DIRECTIVES:

Military Health Service Coding Accuracy Audit Methodology All MDGI 48-10 Employee Health Program All MDGI 44-96 Standard Abbreviations, Acronyms, and Symbols All Privacy Act Systems of Records Notice(s) at http://www.defenselink.mil/privacy/notices/usaf

Appendix E

Example Templates

Continued on pages 19-27

Note: Original templates will be forwarded as separate documents.

EXAMPLE EXAMPLE EXAMPLE EXAMPLE EXAMPLE

MEDICAL RECORD HISTORY AND PHYSICAL (CLINICAL RESUME)

Date of Pre-op

Date of Operation Dictated by:

CHIEF COMPLAINT:

HISTORY AND PRESENT ILLNESS:

PAST MEDICAL HISTORY:

PAST SURGICAL HISTORY:

ALLERGIES:

MEDICINES:

SOCIAL HISTORY:

PHYSICAL EXAMINATION:

GENERAL:

IMAGING:

IMPRESSION:

PLAN:

Physician Information

XXX-XXXX-XX-XX-XXXXXX-XXX

(Example:XXX (Patient Initials: Last, First, Middle-Last 4 of SSN-PAT CAT-Report Type-Month, Day, Year-Transcribers Initials: AAA-1234-20-HP-010109-BBB)

HISTORY & PHYSICAL EXAMINATION

(SF 504, SF 505 & SF 506)

OPERATION REPORT

(SF 516)

NAME:

CONSULTATION SHEET

(SF 513)

NARRATIVE SUMMARY

(SF 502)

REGISTER NO.

CHRON RECORD OF MEDICAL CARE (SF 600)

DAVID GRANT USAF MEDICAL CENTER TRAVIS

AUTOPSY PROTOCOL

(SF 503)

UNIT

PROGRESS NOTE (SF 509)

DATE DICT DATE TYPED

5-275-102

MEDICAL RECORD REPORT

Computer Generated Form

OPTIONAL FORMS 275 (12-77)

Prescribed by GSA and 1CMR

MEDICAL RECORD DEATH SUMMARY (CLINICAL RESUME)

Date of Admission

Date of Death

Dictated by:

DATE OF BIRTH:

ATTENDING PHYSICIAN:

ADMITTING DIAGNOSIS:

CAUSE OF DEATH:

ADMITTING HISTORY AND PHYSICAL:

PAST MEDICAL HISTORY:

PAST SURGICAL HISTORY:

SOCIAL HISTORY:

ALLERGIES:

ADMISSION MEDICATIONS:

ADMISSION PHYSICAL EXAMINATION:

ADMISSION LABS:

ADMISSION STUDIES:

ASSESSMENT AND PLAN:

HOSPITAL COURSE:

PROCEDURES:

DISPOSITION:

FINAL DIAGNOSIS:

Physician Information

XXX-XXXX-XX-XX-XXXXXX-XXX

OPERATION REPORT

(SF 516)

NAME:

CONSULTATION SHEET

(SF 513)

NARRATIVE SUMMARY

(SF 502)

REGISTER NO.

CHRON RECORD OF MEDICAL CARE (SF 600)

DAVID GRANT USAF MEDICAL CENTER TRAVIS AFB,

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AUTOPSY PROTOCOL

DATE DICT

DATE TYPED

MEDICAL RECORD PROGRESS NOTE (CLINICAL RESUME)

Date of Visit

Physician Information

XXX-XXXX-XX-XX-XXXXXX-XXX

OPERATION REPORT

NARRATIVE SUMMARY

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AUTOPSY PROTOCOL

MEDICAL RECORD MEDICAL EVALUATION BOARD SUMMARY (CLINICAL RESUME)

HISTORY OF PRESENT ILLNESS:

PAST MEDICAL HISTORY:

REVIEW OF SYMPTOMS:

PERTINENT FAMILY HISTORY:

PHYSICAL EXAMINATION:

LABORATORY:

OFFICE NOTE:

RADIOLOGY:

HOSPITAL COURSE:

CONSULTATIONS:

OPEATIONS AND PROCEDURES:

WORLD‐WIDE QUALIFIED:

LINE OF DUTY:

FINAL DIAGNOSIS:

RECOMMENDATIONS:

DUTY AFSC:

LENGTH OF SERVICE:

Physician Signature Block

XXX‐XXXX‐XX‐XX‐XXXXXX‐XXX

Example:XXX (Patient Initials: Last, First, Middle‐Last 4 of SSN‐PAT CAT‐Report Type‐Month, Day, Year‐

Transcribers Initials: AAA‐1234‐20‐HP‐010109‐BBB)

OPERATION REPORT

NARRATIVE SUMMARY

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AUTOPSY PROTOCOL

MEDICAL RECORD NARRATIVE SUMMARY (CLINICAL RESUME)

Date of Admission

Date of Discharge

PREADMISSION DIAGNOSIS:

PROCEDURES/OPERATIONS:

PHYSICIANS:

HISTORY OF THE PRESENT ILLNESS:

PERTTINENT LABORATORY/RADIOLOGY:

PAST MEDICAL HISTORY:

PAST SURGICAL HISTORY:

SOCIAL HISTORY:

ALLERGIES:

MEDICATIONS:

HOSPITAL COURSE:

FOLLOW‐UP:

DISCHARGE DIAGNOSES:

DISCHARGE INSTRUCTIONS:

DISCHARGE MEDICATIONS:

(Example:XXX (Patient Initials: Last, First, Middle‐Last 4 of SSN‐PAT CAT‐Report Type‐Month, Day, Year‐

OPERATION REPORT

NARRATIVE SUMMARY

CA 94535 5300

AUTOPSY PROTOCOL

MEDICAL RECORD CONSULTATION SHEET

TO:

FROM: DATE OF REQUEST:

REASON FOR REQUEST:

PROVISIONAL DIAGNOSIS:

REFERRING PROVIDER: APPROVED: PLACE OF CONSULTATION:

HISTORY AND PRESENT ILLNESS:

PAST MEDICAL HISTORY:

PAST SURGICAL HISTORY:

MEDICATIONS:

ALLERGIES:

SOCIAL HISTORY/HABITS:

PHYSICAL EXAMINATION:

IMPRESSION:

PLAN:

(Example:XXX (Patient Initials: Last, First, Middle‐Last 4 of SSN‐PAT CAT‐Report Type‐Month, Day, Year‐

OPERATION REPORT

NARRATIVE SUMMARY

CA 94535 5300

AUTOPSY PROTOCOL

DIAGNOSIS:

STAGE:

BRIEF CLINICAL HISTORY:

PLAN OF TREATMENT:

DATES OF TREATMENT:

TUMOR DOSE SUMMARY:

RESPONSE:

TOLERANCE:

DISPOSITION:

(Example:XXX (Patient Initials: Last, First, Middle‐Last 4 of SSN‐PAT CAT‐Report Type‐Month, Day, Year‐

OPERATION REPORT

NARRATIVE SUMMARY

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AUTOPSY PROTOCOL

MEDICAL RECORD RADIATION THERAPY SUMMARY

DIAGNOSIS: SEX: RACE: AGE: DATE OF REQUEST:

MEDICAL RECORD TRANSFER SUMMARY (CLINICAL RESUME)

Date of Admission: Date of Transfer: Dictated by:

ATTENDING PHYSICIAN:

RESIDENT:

INTERNS:

PROCEDURES/STUDIES:

HISTORY AND PRESENT ILLNESS:

PAST MEDICAL HISTORY:

PHYSICAL EXAMINATION:

DIAGNOSTIC STUDIES:

HOSPITAL COURSE:

CONDITION ON DISCHARGE:

DISCHARGE MEDICATION:

DICHARGE INSTRUCTIONS:

Physician Information

XXX-XXXX-XX-XX-XXXXXX-XXX

(Example:XXX (Patient Initials: Last, First, Middle-Last 4 of SSN-PAT CAT-Report Type- Month, Day, Year-Transcribers Initials: AAA-1234-20-HP-010109-BBB)

OPERATION REPORT

NARRATIVE SUMMARY

CA 94535 5300

AUTOPSY PROTOCOL

MEDICAL RECORD OPERATION REPORT

Preoperative Diagnosis:

Surgeon: First Assistant: Second Assistant:

Anesthetist: Anesthesia: See AF Form 1864

Circulating Nurse: Instrument Nurse: See AF Form 1864 for surgery beginning and ending time

Operative Diagnosis: Drains: (Kind & NO.) Sponge Count Verified Correct

Material Forwarded to Laboratory for Examination:

Operation Performed:

Major: Minor: Date of Operation:

DESCRIPTION OF DIAGNOSIS:

STAFF:

EBL:

INDICATIONS:

SPECIMENS:

PROCEDURE IN DETAIL:

Physician Information

XXX‐XXXX‐XX‐XX‐XXXXXX‐XXX

(Example:XXX (Patient Initials: Last, First, Middle‐Last 4 of SSN‐PAT CAT‐Report Type‐Month, Day, Year‐

OPERATION REPORT

NARRATIVE SUMMARY

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AUTOPSY PROTOCOL