Atch_1_PWS_FA5613-13-R-0001_MC T_Final.docx

PERFORMANCE WORK STATEMENT (PWS)

FOR

MEDICAL CODING & TRAINING SUPPORT

AT

UNITED STATES AIR FORCES IN EUROPE (USAFE)

MILITARY TREATMENT FACILITIES

FA5613-13-R-0001

HQ USAFE/SG

11 February 2013

TABLE OF CONTENTS

ACCOUNTABILITY ACT (HIPAA)

F. REFERENCES 34

1.0. DESCRIPTION OF SERVICES. Headquarters Air Force Medical Operations Agency (HQ AFMOA) is seeking to improve its medical coding support including optimizing the Prospective Payment System reimbursement, acceleration of reimbursement, and cost savings initiatives. As a result, HQ AFMOA requires coding services to be provided in support of these initiatives. The Contractor shall provide non-personal services to perform outpatient record coding, inpatient record coding, ambulatory procedure coding, coding training, and related medical record functions covering a wide range of medical specialties for the specific Medical Treatment Facility (MTF). This shall include 100% of billable encounters, emergency department encounters, ambulatory procedure visit encounters, industry based workload alignment (IBWA) (professional services encounters or inpatient rounds), and inpatient dispositions. Inpatient coding shall include coding of all documentation from admission to disposition to include any related surgeries and procedures. Ambulatory procedure coding shall include coding of all outpatient surgeries and procedures.

The Contractor shall provide non-personal coding services on site at Aviano, Incirlik, and Lakenheath. For Ramstein, Geilenkirchen, and Spangdahlem, remote coding of billable encounters shall be accomplished by the Contractor on-site at Aviano. For Croughton, Menwith Hill, Upwood, and Lajes, remote coding of billable encounters shall be accomplished by the Contractor on-site at Lakenheath. The following is a summary of coding services by location:

1.0.1. Aviano Air Base (AB), Italy (On-Site) (Data Quality Reporting Site)

1.0.2. Ramstein AB, Germany (Remote) (Data Quality Reporting Site)

1.0.3. Geilenkirchen AB, Germany (Remote)

1.0.4. Spangdahlem AB, Germany (Remote) (Data Quality Reporting Site)

1.0.5. Incirlik AB, Turkey (On-Site) (Data Quality Reporting Site)

1.0.6. Royal Air Force (RAF) Lakenheath, United Kingdom (UK) (On-Site) (Data Quality Reporting Site)

1.0.7. RAF Croughton, UK (Remote)

1.0.8. RAF Menwith Hill, UK (Remote)

1.0.9. RAF Upwood (Remote)

1.0.10. Lajes Field, Azores, Portugal (Remote) (Data Quality Reporting Site)

Department of Defense (DoD) Mission Essential Services During Crisis: In accordance with (IAW) DoD Instruction (DoDI) 1100.22, Policy and Procedure for Determining Work Force Mix, paragraph 5b, it is determined the services as stated in this PWS are non-mission essential.

1.1. START-UP AND CONTINUITY OF SERVICES. The Contractor shall provide full coverage for each specific MTF (see paragraph 1.0). The contractor shall identify a minimum of seventy-five percent (75%) of the coding specialists and project operations management staffing requirements within fifteen (15) calendar days of contract award and provide 100% staffing by the contract start date. The contractor shall provide a qualified replacement of contract staff within thirty (30) calendar days of contractor employee resignation, annual/sick leave in excess of 30 calendar days, or termination.

1.1.1. DELIVERABLE: The Contractor shall provide a list of all personnel (with social security numbers if applicable) and all supporting personnel documentation showing initiation of a background investigation, compliance with the Health Insurance Portability and Accountability Act (HIPAA), and compliance with health and immunization requirements for working in a MTF. The documents shall be provided to the COR fifteen (15) calendar days prior to the contract start date and within fifteen (15) calendar days of the hire of new and replacement personnel.

1.2. AVAILABILITY/HOURS OF OPERATIONS. The Contractor shall typically provide services Monday through Friday 7:30 am – 4:30 pm excluding federal holidays but each MTF shall have coverage between the core hours of 9:00 am and 3:00 pm. The Contractor shall coordinate with the Contracting Officer Representative (COR) as soon as possible in the event that Contractor personnel work beyond the specific MTF normal duty hours, arrive late, or in case of absence. The military may designate a weekday as a family day. This may result in the closure of some clinics or departments, negating the need for Contractor services on such days as applicable for each specific MTF. Such closures will be coordinated by the COR.

1.2.1. Support Data Quality Management Control Program requirements to include: attending monthly and ad hoc meetings, providing coding metrics and recommended action plans for metrics not meeting published standards

1.2.2. U.S. FEDERAL HOLIDAYS. The following is a list of legal U.S. federal holidays on which contract coding & training 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 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 11th 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. The Government may add additional family days in conjunction with these holidays which may result in MTF closures.

2.0. SPECIFIC TASKS

2.1. SPECIFIC TASKS FOR CODING: The contractor shall:

2.1.1. Code inpatient and outpatient encounters in accordance with all AF and DoD instructions and guidance. See Appendix F for reference material cited herein.

2.1.2. Follow AFMOA and Military Health System (MHS) coding audit guidelines.

2.1.3. Review the medical records and all other pertinent documents for accuracy and completeness in order to validate the diagnosis, evaluation and management, procedure, and all other codes required to process the encounter as complete and support the billing office.

2.1.4. Be responsible for verifying and coding of the diagnosis, evaluation and management, admissions, surgeries, procedures or any other codes required for the completeness and accuracy of the record. Support the Third Party Collection office including Other Health Insurances (OHI), Medical Affirmative Claims (MAC) and Medical Service Accounts (MSA) to ensure they have the proper and correct documentation to submit a claim for reimbursement, to include coding the episode of care. Verify component parts of medical record to ensure completeness and accuracy of diagnosis, operations, and special therapeutic procedures that must conform to the Center for Medicare and Medicaid Services (CMS) and DoD Coding Guidelines. Code principal diagnosis, co-morbidities, complications, therapeutic and diagnostic procedures, supplies, materials, injections, and drugs with International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) – all levels, and any other coding classification systems required by the DoD (ICD-10-CM/Procedure Coding System(PCS) when available). See Appendix F for additional reference information. Input codes into applicable coding system made available for each individual MTF. These systems include: Coding Compliance Editor (CCE), Composite Health Care System (CHCS) Ambulatory Data Module (ADM), Essentris, and Armed Forces Health Longitudinal Technology Application (AHLTA).

2.1.5. Identify and code the correct diagnosis and procedure based on physician and clinical staff’s recorded documentation established sequencing rules, and MHS and AFMOA guidelines. Ensure proper sequencing of all codes to obtain optimal resource allocation. Identify additional diagnoses/procedures to optimize reimbursement; i.e., complications, co-morbidities, therapeutic and diagnostic procedures.

2.1.6. Utilize appropriate data codes and system commands for data entry. Perform edit checks on data entered prior to transmittal and correct errors. Bring computer system concerns to the attention of the COR as quickly as possible to minimize work stoppage. During periods of system downtime, codes shall be reported utilizing the local MTF contingency plans.

2.1.7. Analyze medical record documentation for consistency and completeness for coding purposes using established criteria and regulations. Examine all documents in the record for authorized signature and patient identification to ensure all documents contain sufficient documentation to support the diagnosis and treatment administered, and that results obtained are adequately described. Identify Third Party Billing information per Uniform Business Office Directives and identify lack of proper documentation to clinical and Data Quality staff. Determine who the responsible attending staff physician is according to pertinent and current Air Force (AF) and DoD guidelines.

2.1.8. Interpret and verify the reason for the encounter, including cause(s), diagnosis, procedures(s) performed, and significant related diseases to ensure record contents meet The Joint Commission (TJC), Accreditation Association for Ambulatory Healthcare (AAAHC), and AF and DoD regulation requirements for the highest attainable quality.

2.1.9. Obtain clarification from clinical staff on errors or missing documentation noted. Complete corrections to the documentation and coded entry per the current version of the Air Force Medical Service (AFMS) Coding Manual. Track all errors noted for training and education purposes to ensure the MTF and other Contractor’s training templates accurately reflect the true nature of what needs to be trained. Submit tracking/training report monthly to the COR.

2.1.10. Maintain current reference material. Ensure all updates are posted accurately and as updates are received. Ensure all system pick-lists match current codes, and work with MTF staff when outdated codes are noted.

2.1.11. Conduct coding reviews of professional staff and other contract personnel (if applicable) on a monthly basis and report findings as a deliverable to the COR.

2.1.12. Identify potential or existing medical-legal problems to COR; i.e. malingering cases, therapeutic misadventures, child abuse, and therapeutic abortions. Ensure that all sensitive records be secured due to medical-legal potential. Be responsible for safeguarding both the record and its informational content against loss, defacement and tampering, and from use by unauthorized individuals while in the Contractor’s control.

2.1.13. Return all records to the appropriate location as defined by the MTF within one (1) working day.

2.1.14. Dispose of any worksheets with personally identifiable information according to MTF guidelines. Comply with the Privacy Act, HIPAA, 38 United States Code (USC) 5701 and 38 USC 7332 in accordance with applicable Federal Acquisition Regulation (FAR) Clauses.

2.1.15. Adhere to all policies outlined, as well as any changes provided by the AF or DoD that may occur during the term of this contract. Command and MTF staff will provide changes to policy to all Contractor personnel upon implementation. Provide technical review and input into the MTF Coding Compliance Plan, quarterly.

2.2. SPECIFIC TASKS FOR TRAINING: The Contractor shall:

2.2.1. Establish and maintain a training plan as outlined in the AFMS Coding Manual within 30 days of contract award.

2.2.2. Conduct reviews and training for MTF specific needs, data quality related coding and validation reviews, new provider reviews, clinical areas of concern regarding coding, or problematic coding noted by the COR.

2.2.3. Perform independent reviews, determining the need for training of its employees and all clinical staff involved in the documentation and coding process. Develop a formal training plan to address 1) new provider orientation, 2) recurring provider training as a result of monthly coding review findings, 3) semi-annual contract and MTF staff training, and 4) a corrective action plan when MTF falls below the 95% accuracy rates as outlined in the AFMS Coding Manual. Submit a formal training plan to the Government within thirty (30) calendar days of contract award. Review formal training plans annually, if any changes are made as a result of the annual review, submit the updated plan to the COR. Document and maintain all training in a file plan.

2.2.4. Give training to all new clinical staff members during in-processing (within 30 days) and to the professional staff including coordination with the Chief of the Medical Staff. Training may be conducted in learning settings determined by each clinic’s needs. Training can be conducted in small or large groups, or one-on-one as needed.

2.2.5. Train monthly based off of previous AFMOA and Contractor audit findings. Training and feedback tailored to the healthcare providers shall be provided by coding specialists. Training and feedback shall be provided primarily to the professional staff. Contractor trainers shall conduct telephone consultant and training sessions within three (3) working days of the request. Defense Connect On-line (DCO) training sessions for all covered bases shall be conducted monthly and scheduled to minimize conflicts and maximize attendance. A series of face-to-face training sessions shall be conducted at each remote site once per quarter. Scheduling for the face-to-face trips shall be coordinated with the MTF to minimize conflicts and maximize training attendance. Typically, the face-to-face training at each site will be conducted over a week with sessions scheduled across three (3) working days and travel on Monday and Friday. Training shall also include the non-professional staff and the ancillary support staff. Related medical records functions including, retrieval, copying, scanning and filing of outpatient records, inpatient records and ambulatory procedure records shall be performed by the Contractor.

2.2.6. Provide training and feedback to providers in order to improve provider knowledge and coding accuracy.

2.2.6.1. Initial Training. Initial training shall be provided within thirty (30) calendar days of a new provider’s arrival at the MTF. Thereafter, it can be “provider requested” or “accuracy driven” training sessions. Schedule a provider requested training session as soon as possible, but no later than three (3) working days from receipt of the request. Conduct the training as soon as possible, but no later than five (5) working days from the request date.

2.2.6.2. Focused Training. Identify focused training by the coding validation process, internal audits, AFMOA results or external reviews.

2.2.6.3. Recurring Training. Provide recurring monthly training (i.e., lunch session, clinic staff meetings) and quarterly on-site training at remote locations. Further training may be advisable as dictated by results of the monthly AFMOA audit and errors identified by the on-site coders when performing their workload requirements.

2.2.6.4. Ensure all professional staff members receive standardized guidance regarding coding on a monthly basis.

2.2.7. Maintain training documentation and report monthly to the COR. The supporting documentation shall include the training topics, the materials, list of attendees, and a critique from the providers/coders that were trained.

2.2.8. For MTFs below the 95% accuracy threshold, training will be increased based upon a Contractor corrective action plan.

2.2.9. Training materials developed by the Contractor shall be approved prior to use by the COR and/or AFMOA Coding Program Office.

2.2.10. Ensure all professional staff members are aware of their personal coding errors so corrections can be made at the time the errors are noted. These corrections shall include incorrectly coded encounters, monthly coding validation notification reports, and monthly ADM write-back errors (where the provider coded the encounter correctly in AHLTA, but the encounter did not flow to ADM with CHCS) that pertain to coding.

2.2.11. Provide internal monitoring and graphical metrics of reviews, audits, and training. Provide reports monthly to the COR.

2.2.12. The Contractor shall coordinate quarterly training visits with the MTF Commander (or designee) to minimize conflicts and maximize training attendance. Typically, conduct the face-to-face training at each site over a week with sessions scheduled across three (3) days and travel on Monday and Friday.

2.3. ADDITIONAL TASKS: The Contractor shall:

2.3.1. Provide occasional information or expertise on coding and training to executives, management or billing specialists with prior coordination and approval of the COR. Examples of this may be the billing department, command section, or other sections requiring the support and expertise of a coding/auditor/trainer specialist.

2.3.2. AFMOA Audit: AFMOA has an independent, centralized audit cell. The Contractor shall notify and coordinate with the COR regarding all AFMOA Audit requests. The Contractor shall provide assistance as outlined below:

2.3.2.1. AFMOA Audit Documentation Retrieval: Retrieve, copy, and forward encounter documentation monthly for the AFMOA audit. Detailed pull lists will be available from AFMOA for download on the 15th calendar day of the month. Complete transmission of requested records within ten (10) calendar days of receipt of the pull list.

2.3.2.2. Retrieve documentation for the dates of service to be reviewed from AHLTA and Essentris (to include Inpatient, Ambulatory Procedure Visits (APV), Obstetrics, and Emergency Room [ER]). Forward copied documentation (non-AHLTA encounters (ER, Obstetrics, etc), APV, and inpatient records) (through secure electronic media transmission or registered/certified mail [if records are sent by mail]) to AFMOA or designated office for independent review, auditing activities. Treat records as protected health information, e.g. appropriate containers for mailing and return receipt for mailed documents.

2.3.2.3. Submit copied Inpatient and/or APV records to include all documentation relative to the encounter. This may include:

· Summary sheet documenting the codes selected by the MTF personnel

· Face sheet or coversheet if different from summary sheet

· Discharge summary

· Anesthesia record

· History and physical exam

· Transcribed operative report—all pages

· Report of other procedures

· Report of any special procedures such as Electrocardiogram (EKG), Magnetic Resonance Imaging (MRI)

· Consultation reports

· Admission notes

· Progress notes from physicians, nurse practitioner, physician assistant or other specialty provider

· Pathology report

· Medication records/reports

· *ER documentation

· *Outpatient visit documentation

· Any documentation referenced during the encounter such as patient, social, or family history from a previous visit.

*Also included when these visits resulted in an admission. Ambulance records or copies of any records from transferring hospital would be included.

2.3.2.4. Submit ER, Obstetrics, or Non AHLTA Records**

· ER record

· Obstetric record

· Progress notes of the date of service of the encounter

· Medication records

· Report of other procedures **Including any other documentation applicable to the encounter.

2.3.2.5. On an annual basis, the TRICARE Management Activity performs an audit of coding services. This audit reviews inpatient, outpatient, and ambulatory procedure services. To meet the requirements of this audit and other AFMOA Coding Program Office directed audits, the MTF is responsible for sending the requested records. The Contractor shall ensure the requested records are copied and forwarded (per memo instructions) to the designated point of contact for these audit services.

3.0. REPORTS/DELIVERABLES. The Contractor shall submit the following reports to the MTF COR and the AFMOA Coding Program Office (contact information will be provided at contract award). All reports become the property of the United States (US) Government.

3.1. Monthly Program Status Report. Prepare the Monthly Program Status Report (MPSR) for the MTF COR and a courtesy copy for the AFMOA Coding Program Office. The MPSR shall include metrics related to personnel availability, productivity, quality assurance and customer satisfaction referencing the Services Summary and other contract requirements. Submit the report to the AFMOA Coding Program Office and the COR in an electronic format. If requested by the Government, send the report by attaching the file in an e-mail to the Contracting Officer (CO). Send the reports no later than the 5th calendar day of the following month. The MPSR shall include details and trending of information to include:

3.1.1. A current listing of all Contractor personnel under this requirement.

3.1.2. Outpatient Coding Report: Indicates number and type of outpatient visits coded by coder, by clinic, and by MTF. Due no later than the 10th calendar day of the following month.

3.1.3. Inpatient Coding Report: Indicates number of admissions and the number of charts coded, the number of Rounds encounters coded, the number of External Resource Sharing Agreement (ERSA) and absent sick records coded by coder, by specialty, and by MTF. Due no later than the 10th calendar day of the following month.

3.2. Training Control Plan: Maintain and report training documentation monthly. Include the training topics, the materials, list of attendees, and a critique from the providers/coders that were trained in the supporting documentation. Training materials developed by the Contractor shall be approved by COR and/or AFMOA Coding Program Office and maintained in the Quality Control Plan (QCP).

3.2.1. Training Summary Report. Reports the monthly and remote MTF quarterly training agenda, type of training accomplished, topics, number of attendees, and names of attendees as outlined in the AFMS Coding Manual. Due no later than the 10th calendar day of the following month.

3.3. Quality Control Plans: The Contractor shall establish and maintain a complete quality control plan to assure the requirements of the contract are provided as specified. The Contractor shall:

3.3.1. Establish and maintain a Quality Control Plan to ensure the requirements of the contract are provided as specified, describing the inspection system for the requested services. Develop and implement procedures to identify, prevent and ensure non-recurrence of unacceptable services. Update the plan as changes occur and submit changes for review and acceptance by the Contracting Officer. The quality control plan shall contain, as a minimum, the following items:

3.3.2. A description of the inspection system to cover all services, to include specifics as to the areas to be inspected on a scheduled and unscheduled basis, frequency of inspections, and the title and organizational placement of the inspector(s).

3.3.3. A description of the methods to be used for identifying and preventing defects in the quality of service performed.

3.3.4. A description of how the records will be kept. Records must document all inspections and corrective or preventive actions taken.

3.3.5. Contractor records of inspections shall be kept and made available to the Government throughout the contract performance period and for the period after contract completion until final settlement of any claims under this contract.

3.3.6. The Government reserves the right to request copies of all inspection system, internal policies and procedures, and medical protocols. The plan shall include procedures to implement all requirements of the contract.

3.4. Contractor Manpower Reporting. The Contractor shall report ALL Contractor labor hours (including subcontractor labor hours) for performance of services provided under this contract for the Air Force via a secure data collection site. The contractor is required to completely fill in all required data fields at http://www.ecmra.mil.

3.4.1. Reporting inputs will be for the labor executed during the period of performance for each Government fiscal year (FY), which runs 1 October through 30 September. While inputs may be reported at any time during the FY, all data shall be reported not later than 31 October of each calendar year. Contractor may direct questions to the CMRA help desk.

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

3.4.3. User Manuals: Data for the Air Force service requirements must be input at the Air Force CMRA link. However, user manuals for Government personnel and contractors are available at the Army CMRA link at http://www.ecmra.mil.

3.5. Table of Deliverables –

4.0. CONDUCT. The Contractor shall:

4.1. Not introduce new procedures or services without prior approval of the COR or appointed Government representative. In disagreements or deviations from established guidelines or new protocols, the COR or appointed representative shall be the deciding authority.

4.2. Comply with federal and local MTF regulations (identified throughout this PWS) and requirements concerning the nature of limited privileged communication between patients and Contractor personnel as may be necessary for security and personnel reliability programs. Comply with federal and local MTF regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the HIPAA of 1996. All medical records and reports shall remain the property of the Government.

4.3. Comply with MTF bylaws (as applicable), TJC, AAAHC, and DoD with regard to Compliance, Patient Safety, Performance Improvement and Risk Management directives, in-service training, maintenance of records, performance evaluation, and release of medical information.

5.0. QUALIFICATIONS. The Contractor personnel shall:

5.1. Experience. Possess a certification through the American Health Information Management Association or the Academy of American Professional Coders and have a minimum of 2 years coding experience in International Classification of Diseases-Version 9 (ICD-9-CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding Systems (HCPCS) coding in a hospital or healthcare setting.

5.2. Knowledge. Have a working knowledge of ICD-9-CM, CPT, and HCPCS coding and be able to provide medical record coding, auditing, and training as outlined above. Also have the working knowledge of ICD-10-CM/PCS when the coding classification becomes available in MHS.

6.0. TRAVEL. Reimbursement for contractor travel is covered in Appendix C-3.

6.1. The Contractor shall submit a request to travel to include transportation and lodging costs. The travel request shall be submitted to the COR and CO for approval 10 days prior to travel.

7.0. SERVICES SUMMARY

· Three (3) working days for ER, billable, outpatient encounters

· Fifteen (15) calendar days for APV encounters

· Thirty (30) calendar days for inpatient dispositions

· Daily for Inpatient Rounds No more than three (3) instances of not meeting the timeliness metric per item in a reporting month.

8.0. GOVERNMENT FURNISHED PROPERTY AND SERVICES

8.1. General. The Government will provide the facilities, equipment, forms, services and utilities. Contractor shall use all Government furnished property and facilities provided for performance of this contract only. No equipment shall be disposed of without prior consent from the COR. All equipment and material shall remain the property of the Government.

8.1.1. Workspace. One (1) each desk and chair, with a personal computer, including Government network for email and internet, telephone and utilities for each Contractor employee will be provided; contractor will have access to a network printer.

8.1.2. Forms. All Government forms required to perform the tasks of this PWS.

8.1.3. Equipment. Computers and network access will be provided by the Government. All computer disks and working materials shall remain the property of the Government.

8.1.4. System Access. Contract personnel will be given system access capabilities applicable to coding functions at the discretion of the MTF and Command. System access may vary by MTF and be in accordance with DoD and AF System upgrades and platform application changes. In the event of a delay or interruption in access, the Contractor shall implement the local MTF contingency plan to ensure the contract requirements are met.

8.2. Training.

8.2.1. DoD Unique Computer Program Training. The MTF will provide training on the following: CHCS, AHLTA, CCE, Essentris, super user training on ADM, Biometric Data Quality Assurance System (BDQAS), and other DoD unique computer programs.

8.2.2. Government Provided Courses and Training. Contractor medical coders may be required to attend Government courses and training. Attendance shall be during normal working hours. Any related travel costs associated with such courses and training shall be cost reimbursable to the Contractor; see paragraph 6.0 for travel-related costs and reimbursement.

8.2.3. Orientation. All Contractor employees performing work on the MTF shall attend a briefing provided by the Government within thirty (30) calendar days of commencing work in the MTF, to familiarize Contractor personnel with the policies and procedures of the duty location.

9.0. CONTRACTOR FURNISHED PROPERTY AND SERVICES

9.1. Reference Materials. The Contractor shall be responsible for providing basic coding books for their employees at no cost to the Government for use in the MTF. The Contractor shall be financially responsible for the replacement of any lost coding books and reference material. The Professional Services and Specialty Coding Guidelines and MHS Guidelines for Inpatient Coding are available through the Air Force Medical Support Agency (AFMSA) website. Contractor personnel shall be responsible for maintaining current reference material and any aforementioned regulations, laws, and/or policies (see Appendix F).

9.2. Training Materials. Contractor shall develop training material needed to support training requirements in this performance work statement. AFMOA may provide additional training materials from time to time to augment contractor developed training material.

10.0. SPECIAL CONTRACT REQUIREMENTS. See Appendix C.

11.0. GENERAL INFORMATION

11.1. PERSONNEL REQUIREMENTS

11.1.1. ENGLISH LANGUAGE REQUIREMENT. Contractor employees working directly at the MTFs shall be able to read, write and speak English well enough to communicate effectively with patients, staff, and other personnel.

11.1.2. CONFLICT OF INTEREST. The Contractor and their employees shall:

11.1.2.1. Not bill the patient for services rendered under this contract. Be prohibited from receiving compensation of any kind for patients treated, procedures performed, or any other actions performed, except under the terms and conditions of this contract, at the rate specified.

11.1.2.2. Not, while performing services under this contract, advise, recommend, or suggest to persons eligible to receive medical care at Government expense that such persons should receive care from an outside agency or provider at any place other than as designated under this contract.

11.1.2.3. Not use Government facilities or other Government property in connection with conducting any business other than for the purpose of the performance of work under this contract.

11.1.3. CONFIDENTIALITY OF INFORMATION. Unless otherwise specified, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the Contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. The Contractor shall not release any of the above information without prior written consent of the MTF Commander or appointed representative at the specific MTF.

11.1.4. PROPRIETARY INFORMATION. Performance may require Contractor personnel to access data and information proprietary to a Government agency, another Contractor, or of such a nature that its dissemination or use other than as specified in the contract would be adverse to the interests of the Government or others. Neither the Contractor nor their personnel shall divulge or release data or information developed or obtained under performance of this contract, except to authorized Government personnel or upon written approval of the MTF Commander or designated representative. The Contractor or their personnel shall not use, disclose or reproduce proprietary data that bears a restrictive legend. All generated artifacts shall become the property of the Government and shall be turned over to the COR at the completion of this contract.

11.1.5. PERSONAL APPEARANCE. Contractor employees performing this requirement shall present a professional appearance at all times and wear an MTF identification badge (name tag) visible on the front of their outer clothing.

11.1.6. SECURITY. The Contractor shall:

11.1.6.1. Comply with installation and MTF personnel identification and access requirements.

11.1.6.2. Be responsible for any keys issued by the Government to Contractor personnel for use in the MTF and not duplicate the keys. Reimburse the Government for any cost for the replacement of any lost keys and any associated locks. Report lost keys to the issuing party, Department Director or COR immediately upon recognition of the loss. Not allow unauthorized personnel entry into the locked area. Lock all areas for which they possess a key when they are not using the area and at the close of the work period. Sign a hand receipt for assigned key.

11.1.6.3. Since personnel under this contract will have access to critical Government information and/or process information requiring protection under the Privacy Act of 1974, these positions are considered Public Trust Positions. Compliance with DoD Directive 5200.2-R, Air Force Instruction (AFI) 31-501, AFI 33-200 and Homeland Security Presidential Directive 12 (HSPD-12) is mandatory for these positions. A back-ground investigation consisting of a National Agency Check with Inquiries (NACI) is required for all personnel under this contract. The Contractor shall fully adhere with the provisions of referenced publications by having each of their employees who are performing under this contract initiate and complete a NACI. Background investigation requests for employees will be submitted through the local Information Protection (IP) office, at RAF Lakenheath, England, Incirlik AB Turkey, and/or Aviano AB, Italy. Member will be fingerprinted and required to complete the appropriate forms (Standard Form 85P, Questionnaire for Public Trust Positions and OF 306, Declaration for Federal Employment). The Contractor shall advise employee that a favorable suitability determination is required as a condition of employment under this specific contract. The employee shall apply for the NACI prior to start of performance.

11.1.7. BACKGROUND CHECK REQUIREMENT.

11.1.7.1. The Contractor shall: Submit background checks for each employee performing this requirement prior to them beginning work within a MTF and bear any costs incurred. Individuals shall be fingerprinted and complete the electronic (Standard Form 85P) Questionnaires for Investigations Processing (eQIP) for Public Trust Positions. This electronic form can be accessed online through the local IP office.

11.1.7.2. Contractor personnel may perform services under this contract pending completion of the background check, but shall have their work directly supervised and reviewed by supervision of a staff person until the check is completed with no negative findings.

11.1.7.3. The Contractor shall provide proof of the check if the Contractor employees have previously received a background check. (A new investigation is required if a break in service to the DoD results in a time lapse of more than 2 years).

11.1.8. SAFEGUARDING MATERIAL. The Contractor shall safeguard all Government property provided for Contractor use. The Contractor shall safeguard information of a confidential or sensitive nature. Neither the Contractor nor any of its employees shall disclose or disseminate any information concerning the operation of the MTF that could result in or increase the likelihood of the possibility of breach of security or interrupt the continuity of operations or which breach the requirements of the Federal Privacy Act and HIPAA.

11.1.8.1. The Contractor shall maintain medical information in accordance with DoD, AF and local requirements.

11.1.9. HEALTH REQUIREMENTS. All Contractor employees performing services under this contract within a MTF shall comply with the health and immunization requirements as stated in Appendix D titled "Health and Immunization Requirements," at the start of the contract and annually thereafter. Backup/replacement personnel shall provide equally current certification of health at the start of the contract or the start of their employment, and annually thereafter. The expense for all physical examinations to comply with the health requirements shall be borne by the Contractor at no additional cost to the Government. All Contractor personnel shall have proof of health insurance to gain base access.

11.1.10. AUTOMATED DATA PROCESSING (ADP) SECURITY REQUIREMENTS. Contractor personnel will not be given access to Government computer systems until the Joint Personnel Adjudication System reflects the receipt of a request for a background check on the individual.

11.1.11. PRIVACY AND CONFIDENTIALITY

11.1.11.1. PATIENT LISTS. The Contractor shall treat patient lists, no matter how developed, as privileged information and shall not disclose to or reveal lists and/or names of patients in any way for any use outside the MTF without prior permission by the Chief of Hospital Service, MTF Commander or designated Government representative.

11.1.11.2. PATIENT SENSITIVITY. Contractor employees shall respect and maintain the basic rights of patients, demonstrating concern for personal dignity and human relationships.

11.1.11.3. PROTECTED HEALTH INFORMATION. See Appendix E for additional information and requirements on Privacy of Protected Health Information.

11.1.12. EMERGENCY CONTRACT PERSONNEL HEALTHCARE. The MTF will provide emergency healthcare for injuries occurring while on duty. The Contractor shall reimburse the Government for such services.

11.1.13. CONTINUING EDUCATION. Contractor obtaining required continuing educational units (CEUs) shall be at no additional cost to the Government.

11.1.14. CONFORMANCE WITH ENVIRONMENTAL MANAGEMENT SYSTEMS AND REQUIREMENTS

11.1.14.1. Conformance with Environmental Management Systems: The Contractor shall perform work under this contract consistent with the relevant environmental policy and objectives identified in the installation environmental management system (EMS) applicable for your contract. The Contractor shall perform work in a manner that conserves water, energy and other resources to the maximum extent feasible and ensure minimum production of waste as possible, giving preference to recycling and reutilization opportunities. Furthermore, the Contractor shall give preference to less toxic materials whenever available and still reliable for their work. In the event an environmental nonconformance or noncompliance of host nation and USAF environmental laws and regulations associated with the contracted services is identified, the contractor shall take corrective and/or preventative actions. In the case of a noncompliance, the Contractor shall respond and take corrective action immediately. In the case of a nonconformance, the Contractor shall respond and take corrective action based on the time schedule established by the EMS Coordinator. In addition, the Contractor shall ensure that their employees are aware of the environmental management system on base and how these requirements affect their work performed under this contract. All on-site contractor personnel shall receive the installation EMS awareness level information.

11.1.14.2. Conformance with Environmental Requirements: The contractor shall perform all work in accordance with applicable host nation and US Air Force environmental laws, regulations and operating standards. The contractor shall be immediately capable of understanding and addressing environmental laws and regulations as they pertain to work performed under this contract. Environmental laws & requirements applicable for all contractors working on base will be made available upon request.

12.0. APPENDICES

APPENDIX A

ACRONYMS

APPENDIX B

WORKLOAD ESTIMATE

For the purposes of indicating scope of work only, the Government estimate for the work to be performed in this PWS is included below. This estimate is the Government’s interpretation of the requirement and is not intended to be binding on either party or to be the only possible solution to the requirement in terms of estimating staffing.

The quantities, as stated herein, are estimates and, as such, are subject to variations. These estimates are not conclusive. These estimates are provided for the contractor to understand the full scope of workload to be performed; complete requirement descriptions are outlined further throughout the PWS. There are an estimated 1322 customers requiring support.

The table below lists overall functions and the tasks. The quantities in the table represent the estimated number of patient care encounters that require coding per year. The contractor shall be responsible for providing feedback to the Government if these workload estimates are found to have a range variation, plus or minus, of 15%. Negotiations for an equitable estimated cost adjustment may be initiated by either party if a variation, plus or minus, of 15% is found to exist. These figures are based on historical data and are not intended to alter the firm fixed priced nature of performing this work.

The type of encounters to be coded will differ at each of the facilities. The coder workload requirements are as follows:

Aviano AB

Ramstein AB

1,500

Geilenkirchen AB

Spangdahlem AB

Total

Incirlik AB

RAF Lakenheath

RAF Croughton

RAF Menwith Hill

RAF Upwood

Lajes Fields

Total

Data Quality meetings are expected to be 12-15 per year.

Estimated medical records support for the AFMOA audits is 20-30 records per month at Aviano, 10 records per month at Incirlik, and 30-40 records per month at Lakenheath.

Estimated number of Government staff at each site requiring Contractor initial, periodic and formal training:

1,322

APPENDIX C

SPECIAL CONTRACT REQUIREMENTS

C-1 LOGISTICS SUPPORT FOR COUNTRIES OTHER THAN GERMANY

(a) Logistics support as defined in the performance work statement will be provided to authorized Contractor employees and their dependents to the extent these services are available at the location where the contract is to be performed and as authorized by current applicable Air Force and European theater regulations, by current applicable international agreements and arrangements, by current policies, and the local installation commander.