DRAFT PWS 2012 08 17 Corrected.pdf

Attachment 1

FA5613-13-R-0001

PERFORMANCE WORK STATEMENT (PWS)

FOR

MEDICAL CODING & TRAINING SUPPORT

AT

UNITED STATES AIR FORCES IN EUROPE (USAFE)

MILITARY TREATMENT FACILITIES

17 August 2012

TABLE OF CONTENTS

SECTION TITLE PAGE

1 DESCRIPTION OF SERVICES 2

2 SERVICES SUMMARY 11

3 GOVERNMENT FURNISHED AND

CONTRACTOR FURNISHED PROPERTY AND SERVICES 13

4 GENERAL INFORMATION 15

5 APPENDICES

A. ACRONYMS 19

B. WORKLOAD ESTIMATE 22

C. SPECIAL CONTRACT REQUIREMENTS 24

D. HEALTH AND IMMUNIZATION REQUIREMENTS 30

E. HEALTH INSURANCE PORTABILITY AND

ACCOUNTABILITY ACT (HIPAA) 32

F. REFERENCES 36

SECTION 1

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, 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 and Lakenheath.

For Ramstein, Geilenkirchen, Spangdahlem, and Incirlik, 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)

1.0.2. Ramstein AB, Germany (Remote)

1.0.3. Geilenkirchen AB, Germany (Remote)

1.0.4. Spangdahlem AB, Germany (Remote)

1.0.5. Incirlik AB, Turkey (Remote)

1.0.6. RAF Lakenheath, UK (On-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)

DoD Mission Essential Services During Crisis: IAW 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, coding auditing specialists, and project operations management staffing requirements within thirty (45) 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 (i.e. resignation, annual/sick leave in excess of 30 calendar days, or termination).

1.1.1. 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.

1.1.2. DELIVERABLE: The Contractor shall provide a list of all personnel (with social security numbers) 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. SPECIFIC TASKS.

1.2.1. SPECIFIC TASKS FOR CODING AND AUDITOR/TRAINING.

1.2.1.1. SPECIFIC TASKS FOR CODING: The Contractor shall:

1.2.1.1.1. 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 Department of Defense (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/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).

1.2.1.1.2. Identify and code the correct diagnosis and procedure based on physician and clinical staff’s recorded documentation, established sequencing rules, and Military Health System

(MHS)/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.

1.2.1.1.3. 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.

1.2.1.1.4. 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 Data Quality 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.

1.2.1.1.5. 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.

1.2.1.1.5.1. 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 will accurately reflect the true nature of what needs to be trained. Submit tracking/training report monthly to the

COR.

1.2.1.1.6. 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.

1.2.1.1.7. 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.

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

1.2.1.1.9. Dispose of any worksheets with personally identifiable information according to MTF guidelines. Comply with the Privacy Act, HIPAA, 38 USC 5701 and 38 USC 7332 in accordance with Federal Acquisition Regulation (FAR) Clauses 52.224-1, Privacy Act

Notification, and 52.224-2, Privacy Act.

1.2.1.2. SPECIFIC TASKS FOR CODING/TRAINING: The Contractor shall:

1.2.1.2.1. Code inpatient and outpatient encounters in accordance with all AF and DoD instructions and guidance. See Appendix F for further reference information.

1.2.1.2.1.1. 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.

1.2.1.2.1.2. Contractor shall follow AFMOA and MHS coding audit guidelines. Conduct audits for MTF specific needs. These needs can be, but are not limited to, the following: Data quality related coding audits, new provider audits, clinical areas of concern regarding coding, or problematic coding noted by the COR.

1.2.1.2.1.3. Conduct audits of the medical records and all other pertinent documents for accuracy and completeness. The Contractor shall be responsible for validating the diagnosis, evaluation and management, procedure, and all other codes required to process the encounter as complete and support the billing office.

1.2.1.2.2. Perform independent audits 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 audit 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. Document and maintain all training in a file plan.

1.2.1.2.2.1. Give training to all new clinical staff members during in-processing 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.

1.2.1.2.2.2. 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) 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, but not limited to, retrieval, copying, scanning and filing of outpatient records, inpatient records and ambulatory procedure records shall be performed by the

Contractor Staffing requirements provided in Appendix B.

1.2.1.2.2.3. Provide training and feedback to providers in order to improve provider knowledge and coding accuracy. 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 seven (7) calendar days from the request date. Identify focused training by the coding validation process, internal audits, AFMOA results or external reviews. 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. 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. For MTFs below the 95% accuracy threshold, training will be increased based upon a Contractor corrective action plan and/or AFMOA approved internal training plans. Training materials developed by the Contractor shall be approved prior to use by the COR and/or AFMOA Coding Program Office.

1.2.1.2.2.4. 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 ADM write-back errors that pertain to coding.

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

1.2.1.2.3. Provide internal monitoring and graphical metrics of audits and training. Provide reports monthly to the COR.

1.2.1.2.4. 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.

1.2.1.2.5. Attend regular data quality meetings and brief staff to provide metric data of coding activities.

1.2.1.2.6. OTHER TASKS FOR CODING/TRAINING. The Contractor shall:

1.2.1.2.6.1. Provide support outside of the clinical setting 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.

1.2.1.2.6.2. AFMOA Audit: AFMOA has an independent, centralized audit cell. The Contractor shall provide assistance as outlined below:

1.2.1.2.6.2.1 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.

1.2.1.2.6.2.2 Complete audit reviews as outlined in the most current audit requirements and guidance from HQ USAFE/SG or HQ AF/SG or AFMOA Coding Program Office.

1.2.1.2.6.2.3. 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). Forward copied documentation (non-AHLTA encounters (Emergency Room, 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.

1.2.1.2.6.2.4. 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 EKG, MRI

• Consultation reports

• Admission notes

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

• Pathology report

• Medication records/reports

• *Emergency Room 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.

1.2.1.2.6.2.5. Submit Emergency Room (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.

1.2.1.2.6.3. 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.

1.2.2. 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 Government.

1.2.2.1. 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 in an electronic format. If requested by the Government, send the report by attaching the file in an e-mail to the Contracting Officer. Send the reports no later than the 5th of each month (for the previous month). The MPSR shall include details and trending of information to include:

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

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

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

1.2.2.4. Auditing Status Report by Clinic. Indicates number of records audited monthly by auditor, by clinic, and by MTF. Report must indicate inaccuracies and a percentage of accuracy for ICD, CPT, and E&M (Evaluation and Management). Due no later than the 10 th calendar day of the following month.

1.2.2.5. Monthly Audit Summary Report as outlined by HQ AFMOA guidance. This report is due monthly by 15th calendar day of the following month to the MTF Data Quality Manager

(contact information will be provided at contract award).

1.2.2.6. 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 10 th calendar day of the following month.

1.2.3. TRAINING CONTROL PLAN: The Contractor shall: Establish and maintain a training plan as outlined in the AFMS Coding Manual. 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. Increase training for MTFs below the 95% accuracy threshold based upon a Contractor corrective action plan with AFMOA approval. Training materials developed by the Contractor must be approved by COR and/or

AFMOA Coding Program Office and maintained in the Quality Control Plan.

1.3. CONDUCT. The Contractor shall:

1.3.1. Not introduce new procedures or services without prior approval of the COR or designated

Government representative. In disagreements or deviations from established guidelines or new protocols, the COR or appointed representative shall be the deciding authority.

1.3.2. Comply with federal and local MTF regulations (as applicable) 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 regulations referenced are available for review from the COR or appointed representative at the MTF. All medical records and reports shall remain the property of the Government.

1.3.3. Comply with MTF bylaws (as applicable), TJC, AAAHC, DoD and Medical Department regulations 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.

1.4. QUALIFICATIONS.

1.4.1. CODING & TRAINING. The Contractor personnel shall:

1.4.1.1. 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.

1.4.1.2. 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.

1.5. MISCELLANEOUS REQUIREMENTS.

1.5.1. 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.

1.5.2. TRAVEL. The Government will direct all Contractor travel. Travel is cost reimbursable in accordance with Joint Travel Regulations (JTR).

1.5.2.1. All requests for travel reimbursement must be reviewed by the Government prior to submission.

1.5.2.2. 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.

1.6. Contract Deliverables.

Deliverable (Report, Document, etc.) PWS paragraph

Due Date (Calendar Days)

Personnel Information 1.1.2. Fifteen (15) calendar days prior to contract start date; within fifteen

(15) calendar days of the hire of new and replacement personnel.

Monthly Program Status Report (MPSR) 1.2.2.1. Monthly (NLT fifth (5 th

) of the month (for the previous month)

Outpatient Coding Report 1.2.2.2. Monthly. (NLT tenth (10 th calendar day of the following month)

Inpatient Coding Report 1.2.2.3. Monthly. (NLT tenth (10 th calendar day of the following month)

Auditing Status Report by Clinic 1.2.2.4. Monthly. (NLT tenth (10 th calendar day of the following month)

Monthly Audit Summary Report 1.2.2.5. Monthly. (NLT fifteenth (15 th calendar day of the following month)

Training Summary Report 1.2.2.6. Monthly. (NLT tenth (10 th calendar day of the following month)

SECTION 2

SERVICES SUMMARY

SS # Performance

Objective

PWS PARA Performance Threshold

01 Submit reports/deliverables

1.2.2 Reports/deliverables delivered by the

due date to the Government no more than three (3) consecutive late submittals and no later than three (3) calendar days of the due date.

02 Code and enter applicable data.

1.2.1.1

1.2.1.2

Meet the established AFMS timeliness metrics for coding records:

• 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) consecutive instances of not meeting the timeliness metric per item in a reporting month.

03 Code with accuracy. 1.2.1.1

1.2.1.2

No more than three (3) consecutive monthly instances of not meeting the overall coding accuracy rate of 95% accuracy for ICD, CPT, and E&M codes for the ER, APV, and inpatient dispositions.

Audit per AF and DoD policy and guidance.

1.2.1.2.6.2.2 Complete records identified for audit

by the fifteenth (15 th

) calendar day of the following month. No more than three (3) consecutive instances of not meeting the due date in the reporting month, unless otherwise directed by the Government.

Conduct training. 1.2.1.2.2.1

1.2.1.2.2.2

1.2.1.2.2.3

Conduct recurring training not less than monthly according to the

Government approved schedule. No more than two (2) consecutive refusals by trainer per month.

Retrieve documentation (paper or electronic) for the

AFMOA Audit encounters and forward (through secure electronic transmission or other mechanism) to

AFMOA or designated office for independent review, auditing activities.

1.2.1.2.6.2.1

1.2.1.2.6.2.3

No more than three (3) consecutive instances of not sending in the required (available) documentation

(paper or electronic) retrieved for the

AFMOA Audit encounters (through secure electronic transmission or other mechanism) to AFMOA or designated site by the due date (ten

(10) calendar days of receipt of the pull list).

SECTION 3

3.0. GOVERNMENT FURNISHED AND CONTRACTOR FURNISHED PROPERTY

AND SERVICES

3.1. General. The Government will provide the facilities, equipment, materials, 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.

3.1.1. 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 under this requirement. Each Contractor will have access to a network printer.

3.1.2. Forms. All Government forms required to perform the tasks of this PWS will be provided.

3.1.3. Training.

3.1.3.1. Computer Program Training.

3.1.3.1.1. DoD Unique. 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.

3.1.3.1.2. 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. The Contractor must submit a request to travel to include transportation and lodging costs. The travel request must be submitted to the COR and

Contracting Officer for approval prior to travel. Profit is not authorized.

3.1.4. 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.

3.1.5. 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 AFMSA website at https://bdqas.afms.mil/index2.htm. Contract personnel shall be responsible for maintaining current reference material and any aforementioned regulations, laws, and/or policies (see

Appendix F).

3.1.6. Equipment. Computers and network access will be provided by the Government. Make use of all appropriate equipment within a MTF, to include supplies and services made available by the Government. Do not dispose of equipment without prior consent from the COR or appointed Government representative. All computer disks and working materials shall remain the property of the Government.

3.1.7. System Access. The contract personnel will be given system access capabilities applicable to coding functions and 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.

3.2. SPECIAL CONTRACT REQUIREMENTS. See Appendix C.

SECTION 4

4.0. GENERAL INFORMATION

4.1. PERSONNEL REQUIREMENTS

4.1.1. 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.

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

4.1.2.1. 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.

4.1.2.2. Not, while performing services under this contract, advice, 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.

4.1.2.3. Not be prohibited by reason of their employment under this contract from conducting private business, provided there is no conflict with the performance of services under this contract

4.1.2.4. Not use Government facilities or other Government property in connection with conducting a business.

4.2. 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.

4.3. 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.

4.4. 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.

4.5. SECURITY. The Contractor shall:

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

4.5.2. Be responsible for any keys issued by the Government to contract 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.

4.5.3 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 employee will be submitted through the Personnel

Security Office, Ramstein AB, Germany. 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. The Government is solely responsible for the cost associated with the initiation, application and completion of the background investigation with exceptions for expenses incurred for Police Checks for “local hire” personnel.

4.6. BACKGROUND CHECK REQUIREMENT.

4.6.1. 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 Questionnaires for Investigations

Processing (eQIP) for Public Trust Positions. This electronic form can be accessed online through the Defense Security Service.

4.6.2. Contractor personnel may perform services under this contract pending completion of the background check, but shall be within line-of-sight supervision of a staff person until the check is completed with no negative findings.

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

4.6.4. Each Contractor employee performing this requirement shall have proof of U.S.

citizenship (certified copy of birth certificate or naturalization papers) or a valid U.S.

Immigration Form 1-151 and Alien Registration Card (“Green Card”).

4.7. 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.

4.7.1. The Contractor shall maintain and dispose of medical information in accordance with

DoD, AF and local requirements.

4.8. 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, 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.

4.9. 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.

4.10. PRIVACY AND CONFIDENTIALITY

4.10.1. 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.

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

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

4.11. 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.

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

SECTION 5

5.0 APPENDICES:

APPENDIX A

ACRONYMS

Acronym Term

AAAHC Accreditation Association for Ambulatory Healthcare

AAFES Army and Air Force Exchange Service

AB Air Base

ADM Ambulatory Data Module

ADP Automated Data Processing

AF Air Force

AFI Air Force Instruction

AFMOA Air Force Medical Operations Agency

AFMS Air Force Medical Service

AFMSA Air Force Medical Support Agency

AHLTA Armed Forces Health Longitudinal Technology Application

APV Ambulatory Procedure Visits

AS Analytical Support

ASSA Analytical Support Status Accreditation

BDQAS Biometric Data Quality Assurance System

CAC Current Common Access Card

CCE Coding Compliance Editor

CDC Centers for Disease Control and Prevention

CEU Continuing Educational Units

CFR Code of Federal Regulations

CHCS Composite Health Care System

CLIN Contract Line Item Number

CMS Center for Medicare and Medicaid Services

CO Contracting Officer

COR Contracting Officer Representative

CPT Current Procedural Terminology

CVS Contractor Verification System

DCO Defense Connect On-line

DOCPER Department of Defense Contractor Personnel Office

DoD Department of Defense

E&M Evaluation and Management

ECG Electrocardiograph

EKG Elektrokardiogramm (same as ECG) eQIP electronic Questionnaires for Investigations Processing

ER Emergency Room

ERSA External Resource Sharing Agreement

FAR Federal Acquisition Regulation

HAAZ Headquarters Azores Air Zone

HIPAA Health Insurance Portability and Accountability Act

HCPCS Healthcare Common Procedure Coding System

HSPD Homeland Security Presidential Directive

HQ Headquarters

IAW In Accordance With

IBWA Industry Based Workload Alignment

ICD-9-CM International Classification of Diseases, 9th Revision, Clinical Modification

JFTR Joint Federal Travel Regulations

LOI Letter of Identification

MAC Medical Affirmative Claim

ME Military Exigency

MHS Military Health System

MMWR Morbidity and Mortality Weekly Report

MP Military Police

MPSR Monthly Program Status Report

MRI Magnetic Resonance Imaging

MSA Medical Service Account

MTF Medical Treatment Facility

NACI National Agency Check with Inquiries

NATO North Atlantic Treaty Organization

OHI Other Health Insurance

PWS Performance Work Statement

QCP Quality Control Plan

RAF Royal Air Force

SA German Supplementary Agreement

SF United States Security Forces

SG Surgeon General

SIT Standard Insurance Table

SOFA Status of Forces Agreement

SRPC Secção de Recrutamento do Pessoal Civil Português - Civilian Personnel Recruitment Section

TA Trusted Agent

TB Tuberculosis

TC Troop Care

TCSA Troop Care Status Accreditation

TDY Temporary Duty

TE Technical Expert

TESA Technical Expert Status Accreditation

TJC The Joint Commission

UK United Kingdom

US United States

USAFE United States Air Forces in Europe

USAREUR United States Army Europe

USSSO United States Sending State Office

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.

MINIMUM NUMBER OF ENCOUNTERS OR VISITS PER YEAR (Does not include random audits other than those required by AFMOA.

Category Total Estimates

Number of patient Records for audit at each site: 19,090

Aviano AB: 2,650 Aviano AB: 360 (in-patient record audits)

Incirlik AB: 2,120 Lajes Field: 1,480

Ramstein AB: 2,015 Geilenkirchen AB: 1,400 Spangdahlem AB: 1,900

RAF Lakenheath: 3,600 RAF Croughton: 1,100 RAF Menwith Hill: 1,100

RAF Upwood: 1,365

Number of Government staff at each site requiring

Contractor initial, periodic and formal training: 1,322

Aviano AB: 177 Incirlik AB: 92 Lajes Field: 80

Ramstein AB: 252 Geilenkirchen AB: 39 Spangdahlem AB: 223

RAF Lakenheath: 397 RAF Croughton: 22 RAF Menwith Hill: 15

RAF Upwood: 25

Annual projected frequency and duration of Government provided training and courses:

Training on the CHCS: 6 hours;

Super user training on ADM: 4 hours

Biostatistics Data Quality Assurance System (BDQAS): 1 hour

IM Cell Portal: 1 hour

P2R2: 1 hour

AHIMA: Maintenance of 24 CEU’s, AAPC: Maintenance of 18 CEU’s

Annual average number of super bills for Contractor audit and review: 23

Annual number of claims for Contractor audit and review: This number would be specific to the denials received at the MTF and the number of pay patient’s seen at the MTF and would vary on a monthly, weekly, and daily basis.

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

1. All OHI/MAC/billable encounters will be coded.

2. All ER encounters will be coded.

3. All APU encounters will be coded.

4. All inpatient dispositions will be coded.

5. All inpatient rounds encounter will be coded.

6. All non-federal/absent sick dispositions will be coded.

7. Estimated workload numbers for coding of encounters at each of the facilities are listed below:

Hub Spoke Annual

ER

Annual

APV

Annual

Billables

Inpt

Disp

IBWA Non-Fed

/Ab Sick

Aviano AB 750 2,500 600 2,400 100

Incirlik AB 150 1,000 25

Ramstein AB 1,500

Geilenkirchen AB 250

Spangdahlem AB 500 500

Total 900 5,750 625 2,400 600

RAF Lakenheath 15,000 1,250 4,000 1,500 6,000 100

RAF Croughton 500

RAF Menwith Hill 750

RAF Upwood 500

Lajes Fields 500

Total 15,000 1,250 6,250 1,500 6,000 100

Records Coded/Day Standard 40 40 80 16 120 120

APPENDIX C

SPECIAL CONTRACT REQUIREMENTS

2-1 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. Lack of availability of any of these services shall not serve as a basis for claims by a Contractor against the Government for increased cost of contract performance.

(b) An authorized Contractor employee is defined as an employee who has been hired as a consequence of this contract and is employed at least 40 hours per week on this contract. For Italy, procedures must be in accordance with the Memorandum of Understanding between the Ministry of Defense of the Republic of Italy and The Department of Defense of the United States of America Concerning Use of

Installations/Infrastructure by U.S. Forces in Italy, signed 2 February 1995. To qualify for Civilian

Personnel status in Italy, the employee must

(i) not be a stateless person;

(ii) not be a national of any State which is not a Party to the North Atlantic Treaty;

(iii) not be a national of Italy;

(iv) not be ordinarily resident in Italy; and

(v) be certified as a technical representative and issued a NATO SOFA

Identification by the United States Sending State Office (USSSO) for Italy or by a base legal office with delegated authority. The final authority to determine whether an employee qualifies for Civilian Personnel status is USSSO.

(c) United Kingdom (UK) Civilian Component Stamp. The Contractor shall be responsible for ensuring their company is registered with the Office of the Special United States Liaison Officer, American

Embassy London, UK to establish eligibility for Status of Forces Agreement Civilian Component passport stampings, under the terms of the Special Memorandum of Understanding, dated 7 July 1987. If

Civilian Component status is not achieved, the Contractor could be held responsible for payment of

British income tax, British council tax, and import tax on privately owned vehicles. Other taxes could also pertain. Note: Medical Coding Support services are not considered “intelligence work”.

(d) Any logistic support for other than NATO countries must comply with the International Agreement of the host nation.

(e) Abuse of Privileges. The Contractor will include a provision in his employment agreement with his employees to provide for disciplinary action, or discharge for cause, of the employee for any abuse of privileges authorized to herein. The US Government retains the right to withdraw privileges as a result of

Contractor employee abuse at no additional cost to the US Government. This provision in no way will prohibit disciplinary action or legal prosecution by either the US Government or the host country

Government. Services or privileges may be denied an individual basis at the discretion of the Installation

Commander.

(f) The Contractor shall assure that upon termination or transfer of any employee who is granted logistic support, action is taken simultaneous with the termination of employment to assure that said employee ceases to have access to the services granted under logistic support. The Contractor shall assure that identification passes or other documents pertinent to or peculiar to the contract or privileges there under are turned over to the issuing office upon termination or transfer of any employee. The Contractor shall require a written receipt of such return and shall immediately forward a copy to the CO.

2-2 LOGISTIC PRIVILEGES FOR TECHNICAL REPRESENTATIVES IN THE UNITED

KINGDOM, ITALY, AND TURKEY.

The following are typical services available at the various installations. Use of these facilities by

Contractor personnel shall be in accordance with the Status of Forces Agreement (SOFA). Lack of availability of any of these services shall not serve as a basis for claims by the Contractor against the

Government for increased cost of contract performance.

(a) Commissary (including rationed items).

(b) AAFES facilities (includes military exchange, theater, food concessions, etc.). Rationed items

(tobacco and spirits) are subject to controls imposed by USAREUR Regulation 600-702.

(c) Customs exemptions and duty free importation of household goods: Not available.

(d) Local services (morale, welfare, and recreation).

(e) Military banking services.

(e) Military postal services.

(f) Mortuary services: Available on a reimbursable basis.

(g) POV license: Available upon completion of written test and locally established procedures.

(h) POV registration: Available, however, local policy and procedures apply.

(i) Petroleum and oil products (tax free): Available for purchase on US bases. NOTE: This is for use in

POVs, company vehicles supporting this contract are NOT entitled tax free petroleum and oil products.

(j) Transient billets: Available…