MTF_TPC_PWS__Oct_18.docx

MILITARY TREATMENT FACILITY THIRD PARTY COLLECTION PROGRAM

BILLING AND COLLECTION SERVICE

PERFORMANCE WORK STATEMENT

OCTOBER 2018

Attachment 1

Attachment 1

DRAFT

TABLE OF CONTENTS

TABLES

TABLE 1 - KEY PERFORMANCE OBJECTIVES 20

APPENDICES:

ATTACHMENTS

1. DESCRIPTION OF SERVICES

1.1. Background: In accordance with U.S. Code 1095 and 1079b, the Code of Federal Regulations, and Department of Defense (DoD) directives, the Government is authorized to recover the cost of providing health care services to covered DoD beneficiaries from third party payers under the Third Party Collection Program (TPCP). Under this program, the Government bills for medical services provided in DoD/Defense Health Agency (DHA) military treatment facilities (MTFs) and professional services rendered by MTF providers at civilian facilities. The Government also bills third party payers for care provided to non-beneficiaries who are authorized care in the facility, foreign nationals, and civilian emergency patients who carry Other Health Insurance (OHI). All patients, excluding active duty, are required to provide information regarding OHI coverage annually or upon a change in coverage status.

1.2. Scope: The purpose of this contract is to perform OHI billing and collection activities for the DHA MTFs, using a Government-provided medical billing program (herein referred to as the Government Billing Solution or “GBS”). Billing and collection activities shall include: identification and verification of OHI provided on the paper or electronic DD2569, as well as update of collected OHI information in the GBS, direct billing of third party payers, ongoing follow-up actions for unpaid claims to include denials management processes, posting payments, conducting valid write-offs and referral of delinquent claims. This contract will not include first party billing to beneficiaries, interagency billing, billing for Elective Cosmetic Surgery procedures, copying charges, or incidental charges (family member rate) for inpatient stays. The contractor shall be required to conduct balance billing for non-beneficiaries only. The successful Offeror shall:

1.2.1. Adhere to all applicable U.S. Codes, the Code of Federal Regulations, DoD Guidance, Air Force Instructions, Centers for Medicare and Medicaid Services guidance, and DHA Policy regarding billing and collection activities (those in effect at the time of contract award and any changes made throughout the contract period of performance).

1.2.2. Adhere to all DoD and DHA published guidance and regulations regarding financial reporting.

1.3. Implementation: This contract shall include all Air Force MTFs identified in Attachment 1 – List of Military Treatment Facilities (MTFs).

2. SUMMARY OF REQUIREMENTS:

2.1. The Contractor shall be paid a negotiated percentage of each dollar collected from third party payers and from the balance-billing of non-beneficiaries that is posted prior to the 151st calendar day after the date of delinquency. A debt becomes delinquent on the 31st day after the date billed; reference paragraph 9.2.1 for more information. Regardless of the location where billing is performed, all data transmission fees, outside of Government locations and established communication lines, will remain the sole responsibility of the contractor (i.e., any services in support of this requirement performed outside of an MTF).

2.2. The Contractor will be required to ensure all services billable to third party payers are identified, billed, and collected or appropriately written off in accordance with COR guidance. The Contracting Officer’s Representative (COR) will provide a listing of DHA-approved reasons for write offs. The Contractor shall provide the MTF with all written documentation received on claims by scanning all hard-copy documents into PDF format and uploading those documents to the GBS. The required documentation includes, but is not limited to copies of checks, verification of electronic payments, explanations of benefits (EOBs), demand letters, non-payment documentation, legal determinations, proof of preauthorization, pre- certifications, notes of phone conversations with insurance company personnel (including the name of the insurance representative, date/time of the phone call, and a brief summary of the discussion), and any other relevant information. The Contractor shall be responsible for shredding all hard copy documents in accordance with AFI 33-332, The Air Force Privacy and Civil Liberties Program, only AFTER the documents are scanned and verified to be successfully uploaded into the GBS. Most billing data will automatically flow from other DoD automated information systems to the GBS. All encounter data that does not automatically flow to the GBS, contractor will contact the MTF to seek correct billing codes from civilian, military or contracted employee (coding is performed under a separate contract) Billing contractor is not responsible for coding encounter. The Contractor shall collect all required data that did not automatically flow into GBS. For newly identified OHI, the Contractor will back-bill encounters, to the extent allowable and specified in each insurance contract or according to the Centers for Medicare and Medicaid Services (CMS) guidelines, within 30 calendar days of OHI discovery. The Contractor will be expected to request authorizations, after the fact, for care provided before back billing is performed.

2.3. The Contractor shall cease collection activity on claims that are more than 150 calendar days delinquent. The Contractor shall abide by COR guidelines pertaining to delinquent debt balances, including writing off all unpaid balances due by 180 days delinquent. If requested by the COR, contractor will provide all correspondence between the Contractor and insurance companies that reflects the Contractor’s efforts to obtain payment. If payment on the delinquent amount is received prior to the 151st day of delinquency, the Contractor shall be compensated the negotiated rate per the contract. However, the Contractor shall not be reimbursed for any payment the Government receives for a claim beginning on the 151st calendar day past the date of delinquency, regardless of prior collection efforts. This stipulation is necessary to ensure the DHA maintains full compliance with laws and regulations pertaining to delinquent debt.

2.4. To facilitate and support the Third Party Collections (TPC) program, the Contractor shall provide all personnel, supervision, training, and services necessary to perform all duties described below:

2.4.1. Claim Generation and Submission:

2.4.1.1 The Contractor shall collect all data necessary to manually bill;

2.4.1.2. The Contractor shall correct data for encounters that error out of the GBS;

2.4.1.3. The Contractor shall perform billing services in accordance with the Defense Health Agency-Procedures Manual 6015.01, Military Treatment Facility (MTF) Uniform Business Office (UBO) Operations, (hereafter referred to as “the UBO Manual”), in its entirety to include future revisions (unless otherwise directed by the COR).

2.4.1.4. The Contractor shall prepare and send inpatient claims to the third-party payer within ten (10) business days following completion of the medical record and coding, measured from the date the encounter enters the GBS.

2.4.1.5. The Contractor shall prepare and transmit/send outpatient claims within ten

(10) business days following completion of the medical record and coding, measured from the date the encounter enters the GBS.

2.4.1.6. For OHI policies discovered after care was rendered, the Contractor shall back bill the insurance companies within thirty (30) calendar days of OHI discovery for all billable encounters that fall within the coverage timeframe.

2.4.1.7. Review additional reports and system notifications in the GBS to stay abreast of any necessary billing/collection actions.

2.4.2. Insurance Verification:

2.4.2.1 Manage the paper and electronic versions of the DD Form 2569, Third Party Collection Program - Record of Other Health Insurance (DD 2569). Update the GBS to reflect the collected OHI (to include updating OHI fields, scanning, and uploading any/all versions of the DD 2569) and update GBS OHI data elements. Entries may include, but not be limited to, updates to family members covered, annual deductibles, copayments, plan restrictions, plan type, medical versus pharmacy or dental carrier, and claim submission instructions.

2.4.2.2. The Contractor shall perform OHI discovery using any means necessary or available to identify any information required to bill a third-party payer that was not captured on the DD 2569.

2.4.2.3. When new OHI is found via receipt of an updated DD 2569 or other means of OHI discovery, this coverage shall be validated as active and billable by the Contractor (to include contacting the insurance company and determining which family members are included in the coverage) and all required data shall be entered into the GBS within five (5) business days of discovery. The Contractor shall retrieve the necessary encounter data, ensure encounters are reviewed by a certified coder employed by the Government as a civilian, military or contracted employee (coding is performed under a separate contract), and submit these documents for back billing. All OHI shall be verified annually before the anniversary of when it was first found (even if a new DD 2569 was not completed by the patient).

2.4.3. Preauthorization and Advance Notification:

2.4.3.1. Preauthorization for care, as required by insurance companies, shall be identified and requested by the Contractor. The Contractor shall request the assistance of a Government employed civilian, military, or contract nurse assigned to the MTF, when required, to provide diagnosis and treatment information. If care was provided on a non-duty day, the Contractor shall be required to request authorization, after the fact, to include sending copies of treatment notes to the insurance company. To perform reauthorizations, the Contractor may require access to GBS or legacy systems.

2.4.3.2. Although the Contractor may not receive advance notification when a high- dollar drug (or a drug requiring precertification) is initially dispensed, they are required to request authorization for all refills dispensed. The billing and denial of the initial dispensing will be considered a valid write-off but all subsequent claims denied for lack of a preauthorization will not be considered valid write-offs.

2.4.4. Encounter Coding/Data Review:

2.4.4.1. Ensure all encounters billable to OHI are reviewed by a certified coder employed by the Government as a civilian, military or contracted employee (coding is performed under a separate contract) prior to sending the bill to the payer. The Contractor shall review coding for encounters rejected due to errors or outpatient visits using the CPT-4 (or later versions, as applicable) for procedures and ICD-10 (or later versions, as applicable) for diagnoses and Evaluation & Management (E&M) codes for the office portion during the normal course of billing. The Contractor shall contact the MTF certified coder to correct the errors and either resubmit or cancel the bill, as appropriate.

2.4.4.2. The Contractor shall collect all data required for billing that does not automatically flow into the GBS. This shall include, but is not limited to, creating bills for inpatient professional charges associated with External Resource Sharing hospital care and the examples listed in paragraph 2.2. All billing, to include outpatient visits and ancillary services, inpatient admissions, trauma care and civilian emergencies, shall be accomplished in the GBS.

2.4.4.3. The Contractor shall ensure both Defense Medical Information System Identification (DMIS ID) and Medical Expense and Performance Reporting System (MEPRS) codes are correct on every claim billed. DMIS IDs and MEPRS codes are vital data elements for the DHA. DMIS IDs represent a specific facility and the MEPRS codes represent the location and type of care within a facility. Questions on this data shall be referred to the COR.

2.4.4.4. Per the UBO Manual, the Contractor shall actively monitor the report of discharged OHI patients for the coding status of their medical record. The Contractor shall coordinate with the Medical Records section at the MTF to ensure that records are complete and coded within forty-five (45) calendar days of the patient’s discharge from the MTF or, in the case of long-term care according to COR guidance. The Contractor shall report to the COR any MTF that is noncompliant with the forty-five (45) day requirement.

2.4.5. Payment Adjudication Monitoring:

2.4.5.1. Claims previously billed for patients and subsequently found to have no valid OHI shall be cancelled within 3 business days of receipt of notification in order to remove the accounts receivable data from the GBS. The Contractor shall immediately contact the insurance company to determine if payments received for service provided after the cancellation date need to be refunded. If a draft refund is required, the Contractor shall process the draft refund within 30 days of notification of cancelled coverage or receipt of the refund request in accordance with COR guidance. Processing refunds includes, but is not limited to, the preparation of all documentation required by the Defense Finance and Accounting Services (DFAS) and the subsequent submission of that documentation to the MTF for review and validation; however, only Government personnel (military or civilian) will transmit the documentation to DFAS. If a refund is not required, the Contractor shall add a note to each claim in the GBS to indicate a payment was received after the cancellation date but a refund was not required.

2.4.5.2. Balance Billing. The Contractor shall not balance bill eligible DoD beneficiaries. For non-beneficiaries with OHI, the Contractor shall pursue all payments due from third party payers and the patient up to 150 calendar days after the date of delinquency. However, prior to the 151st calendar day of delinquency, the Contractor shall write off all claims that have not been paid in full, IAW para 2.3.

2.4.6. Follow-Up/Denials Management:

2.4.6.1. The Contractor shall perform active and aggressive follow-up actions for all unpaid or underpaid claims at least every 30 calendar days. The Contractor shall annotate all follow-up efforts within the GBS including the name of the insurance representative contacted, date/time of the phone call, and a brief summary of the discussion. The annotations shall be clear and convey the cause for delay in payment. The Contractor shall maintain documentation of correspondence with insurance companies (or any other party) to include copies of all demand letters by scanning the documentation into PDF format and uploading all documents into the GBS.

2.4.6.2. The Contractor shall perform denials management for all claims, regardless of amount, to ensure compliance with the timelines referenced in this PWS. To effectively manage this process, the Contractor shall utilize industry best practices in denials management by trending and reporting performance metrics to the COR on monthly basis. The Contractor shall identify industry ratios/indicators they intend to utilize for this contract beyond those outlined within this PWS and shall include this information in their proposal.

2.4.7. Payment Posting and Refund Management:

2.4.7.1. The Contractor shall post TPC program payments and valid write-offs in the GBS.

2.4.7.2. All forms of payment shall only be handled by MTF Government personnel. Typically, all payments and Explanation of Benefits (EOBs) will be received by Government personnel; however, the Contractor shall retrieve all EOBs that are not mailed to the MTF and any missing EOBs. Government personnel will provide a copy of all checks and EOBs received to the Contractor. The Contractor shall then discern the account information associated with the EOB, annotate that account information or patient identification information on the EOB, and post payments and/or valid write- offs in the GBS within 48 hours of receipt or by close of business (COB) the next business day. When the posting of a batch is started, it must be completed the same business day. The Contractor shall reconcile with insurance companies those payments for which no claim could be found within the GBS. Invalid denials shall not be posted in the GBS. The Contractor shall dispute invalid denials with the insurance company to arrive at a resolution. Partial or reduced payments shall be posted in the GBS and the Contractor shall continue collection efforts to recover the full amount due in accordance with insurance policy coverage. Any remaining balances shall be turned over to the Government in accordance with paragraph 2.3.

2.4.7.3. Payments that are posted electronically (i.e., Electronic Remittance Advice) shall be verified to ensure claims were paid properly.

2.4.7.4. MTF Government personnel will maintain the responsibility and accountability for the deposit of collections received. Payments will be deposited as soon as possible after postings are verified, usually by the next business day.

2.4.7.5. The Contractor shall verify refund requests are valid and process the draft refund transaction in the GBS within 30 days of notification of cancelled coverage or receipt of the refund request.

2.4.7.6. Unless otherwise directed by the COR, after the refund is processed in the GBS, electronically transmit all pertinent documents that support the refund and contain the information necessary to disburse the refund (such as payee, amount, reason for refund, EOB, etc.) to DHA MTFs personnel via the GBS for processing through the DFAS.

2.4.8. Program Support:

2.4.8.1 Market the Third Party Collection (TPC) program to patients and train MTF staff annually on their responsibilities in support of the TPC program; contractor must provide to COR, a POP summary report on the contractor’s requirement to train TPC program responsibilities to appropriate MTF staff.

2.4.8.2 In recognition of the upcoming changes in Federal laws and policy pertaining to the healthcare industry, many of which have not been finalized, should there be a need for the Contractor to develop or utilize external databases or software to support any governmental billing services, these additional methods shall first be approved by the COR. The Contractor shall understand that approval is not guaranteed, but if their request is approved by the COR, any database or software utilized by the Contractor shall comply with DoD directed communications and computer systems security requirements in accordance with DoD policies and procedures at Appendix 2 and shall be solely at the expense of the Contractor. The Contractor shall not attempt to replace any function or process available in the GBS with a Contractor-developed (“in-house/home grown”) system.

2.5 All billing and collection information shall remain the property of the U.S. Government. The Government shall retain unlimited use and ownership of all billing information, data, and data/technical rights for any upgrades and/or modifications to government systems, upon completion and/or termination of this contract. All tools developed by the Contractor in support of this requirement, (i.e. GBS ad hoc reports, Microsoft Word, Access, Excel, PowerPoint, or other software developed databases) shall become and remain the property of the Government and shall have no affect or impact on monies owed to the Contractor by the Government. Access to the GBS will be available to the Contractor with the use of a Government-issued Common Access Card (CAC) – reference paragraph 4.2. The Contractor shall collaborate with the COR and any other required personnel (i.e., MTF Systems and Security Officers) to obtain access to the GBS and any other Government applications (such as required existing legacy systems still in place during the period of performance) as required to execute this contract.

2.5.1 The Government shall have the right to audit any data produced, or any function performed by the Contractor at any time and shall have access to any Contractor owned, managed, or otherwise operated facilities where services are performed under this contract without advance notice.

2.5.2 Contractor may be asked to participate in meetings to facilitate discussions providing input as billing and collection subject matter experts on behalf of the Air Force.

2.6 Key Performance Objectives (KPOs). Contractor performance shall be measured against KPOs. A detailed listing of KPOs can be found in Table 1 – Key Performance Objectives.

2.7 Invoices. A monthly invoice listing the total collections, by line of business and by MTF, and the amount due the Contractor, shall be submitted on a Microsoft Excel spreadsheet on 5th business day the following each month (editable version). The invoice will be processed for payment after billed amounts are verified by the COR or other Government UBO personnel - reference paragraph 9.4 for additional information.

2.8 Additional Contract Requirements:

2.8.1 Business Process. The Contractor shall provide their Business Process with their proposal to include an organizational management structure and specific business approach to the requirements listed throughout this PWS. The proposal shall clearly define roles, responsibilities, subcontractors and/or business partners to ensure effective and efficient TPC services. In addition, the Contractor shall demonstrate a comprehensive process for revenue cycle management that specifically details their approach to the medical claims processing continuum. The Contractor shall notify the COR of any significant changes to their business process during the course of the contract. All contractor instruction given to MTFs that change level of effort required of MTF staff to facilitate execution of the requirements of this PWS shall go through COR for process review.

2.8.2 Human Resource Management Plan. The Contractor shall have in place a Human Resource Management Plan to ensure qualified candidates are identified, screened, placed, monitored, trained, and retained to fulfill service requirements and minimize personnel turnover under this contract. The Contractor shall accomplish the assigned work by employing and utilizing qualified personnel with appropriate combinations of education experience, knowledge, training, abilities and skills. The plan shall include quality assurance and productivity measurements that demonstrate internal controls for workload management that directly support attainment of acceptable output standards and the efficient allocation of resources for performance in accordance with this PWS. These systems and controls for recording and monitoring workload shall be capable of providing historical and in- process workload data.

2.8.3 Transition Plan.

2.8.3.1. Phase-in Plan: The Contractor shall include a Phase-in Plan as part of their proposal that describes in detail, what actions the Contractor will take to ensure their employees are prepared to begin performance for all services required under this PWS and the process to minimize disruption in services throughout the transition. The Contractor shall attend a post-award orientation meeting within ten (10) business days after contract award to review requirements and implementation of the Contractor’s transition plan.

2.8.3.2. Transition Phase-out Plan: The Contractor shall include a Phase- out Plan as part of their proposal that describes in detail, what actions the Contractor will take to ensure a smooth and successful transition of operations between this contract and the next contract provider. Assistance shall include but is not limited to detailing current requirements, suggesting milestones and suggesting necessary actions for the last 30 business days of the contract; this may include formal coordination with Government staff or contractor successor staff as needed. The plan should illustrate a process that would allow the Contractor to “turn over government claims data” within 30 calendar days (in a mutually agreed upon format) whereby the Government could continue uninterrupted billing and collections services. It shall also include providing any information pertinent to the daily activities as outlined in the PWS such as duties, responsibilities, data, metrics, or requirements that are critical for ensuring continued operations.

2.8.4. Contingency Plan. The Contractor shall maintain a contingency plan to ensure continuity of operations for all services required under this PWS. In the event of staffing shortages, equipment or communication failures, or other delays associated with the performance of Third Party Collection services under this contract, on the part of the Contractor, a contingency plan shall be implemented to continue collection and billing services at the MTF. It shall describe how the Contractor will continue to meet production standards during the repair or replacement of faulty equipment. If the contingency plan fails during an actual failure of operations, the Government will require the contractor to modify the plan within five (5) business days, in addition to any other re-performance associated with the failure of the plan.

2.8.5. Medical Expense and Performance Reporting System (MEPRS). MEPRS is the DoD accounting system for financial, personnel, and workload data within MTFs. The Defense Medical Human Resources System-internet (DMHRSi) is the interface used to report hours worked in the MTF. Per DoD Manual 6010.13-M, Medical Expense and Performance Reporting System for Fixed Military Medical and Dental Treatment Facilities, when working within an MTF, the Contractor is required to submit hours worked bi-weekly through DMHRSi to their assigned MTF for entry into the system by the Air Force.

2.8.6. Customer Satisfaction. The Contractor shall have a customer satisfaction system outlining internal controls and procedures to measure Air Force customer satisfaction. The process shall outline methods and frequency of customer interactions, reporting processes, and problem resolution procedures. A satisfaction measurement of patient satisfaction is not required or authorized.

2.9 Quality Control Plan (QCP): The Contractor shall establish and maintain a complete Quality Control Plan. The COR shall review the Quality Control Plan annually. The plan shall include procedures to implement all requirements of the contract to include the in-processing submittals for all contract personnel in paragraph 5 of this PWS and the following:

2.9.1. A compliance plan for third party collections in accordance with DHA Uniform Business Office guidelines;

2.9.2. An inspection system covering all the services required under this contract. The Contractor shall specify the areas to be inspected on either a scheduled or unscheduled basis, how often inspection shall be accomplished and documented, and identify the title of the individual(s) who shall perform the inspection. The Contractor shall maintain a record of all inspections conducted by the Contractor and corrective actions taken. This documentation shall be made available to the Contracting Officer (CO)/COR upon request during the term of the contract. The methods of identifying and preventing defects in the quality of services performed before the level of performance becomes unacceptable;

2.9.3. Written standards (developed by the Contractor) for documentation and fraud prevention for third party collections;

2.9.4. The policy and procedures to ensure all contractor personnel have the required TPC skills and training initially and annually. The plan should also identify the individual(s) performing the assessment;

2.9.5. The Contractor shall establish and maintain an internal policy and procedures checklist for conducting TPC quality control checks to ensure work is free of grammatical, typographical, punctuation, and spelling errors and is properly formatted prior to delivery of products.

3. PERSONNEL

Contractor Representative. Within 10 calendar days following notification of contract award, the Contractor shall provide, in writing to the CO and the COR, the name of the Contractor Representative responsible for coordination and implementation of contract services. Additionally, the representative shall be available telephonically to the CO/COR during normal duty hours to discuss any problem that may arise concerning contractual matters relating to daily operation of the contract.

3.1.1. The Contractor shall notify the CO/COR at least 5 calendar days in advance of any change or replacement actions concerning the individual selected to be the Contractor Representative after the contract period of performance begins. Such notification shall be in writing and shall state the name and telephone number of the new Contractor Representative.

3.1.2. The Contractor Representative shall advise the CO/COR 30 calendar days in advance of any foreseeable event that could affect performance of these contract requirements. Personnel changes, to include scheduled and unscheduled absences of contract personnel shall be reported to the COR as soon as possible. The Contractor Representative shall also provide a plan for continued support until the departing Contractor employee is replaced.

3.2. Conduct. The CO may request that any Contractor employee whose conduct, in the opinion of the CO, interferes with proper order or whose actions fail to meet the level of professionalism expected of a representative of the Government, be removed from any responsibility or service under this contract.

3.2.1. The Contractor shall not employ individuals who are potential threats to health, safety, security, general well-being, or the operational mission of the DoD and its population. This shall include individuals who are a potential threat because of prior felony convictions (reference AUTOMATED INFORMATION SYSTEMS (AIS) III SECURITY

REQUIREMENTS, section 5 below). The Government reserves the right to refuse access to Government facilities and/or operations under this contract to any Contractor employee, or prospective employee, who is identified as a potential threat to the health, safety, security, general well-being, or operational mission of the AF and its population.

3.2.2. The Contractor shall ensure all government-issued identification badges, keys, and equipment (as appropriate) are returned to the COR or MTF Security Manager when an individual leaves employment under this contract and/or upon expiration of this contract.

3.3. Basic Life Support Certification. At a minimum, any Contractor personnel working within an MTF must maintain either current certification in the American Heart Association Basic Life Support (BLS) (Course C) or the American Red Cross CPR/BLS (Heart Saver) Course. Initial training must be obtained in the community at no cost to the Government so that Contractor employees arrive in the position fully qualified. The Government may offer refresher training for contract workers on a space available basis. If training is received within the facility, the time will not be billable to the Government. The Government will not pay for recertification training obtained outside the MTF.

3.4. English Language Requirement: Contractor employees shall read, understand, speak, and write English fluently.

3.5. Dress and Appearance: While Contractor employees are working in a Government facility, they shall maintain good personal hygiene and a well-groomed, professional appearance -- business casual dress attire is required.

3.6. Health Requirements:

3.6.1. In accordance with AFI 48-105, all Contractor employees shall follow the methods for controlling and preventing disease as described in the American Public Health Association publication, Control of Communicable Diseases Manual, and the Centers for Disease Control and Prevention (CDC) publication, Morbidity and Mortality Weekly Report (MMWR), and its supplements. Where applicable, the most recent guidelines from these publications are utilized as the standard.

3.6.2. Prior to start of work, Contractor employees working in MTFs shall provide proof of immunization for the following diseases according to CDC guidelines: Hepatitis B, measles, mumps, rubella, varicella, and influenza, and proof of a negative tuberculosis skin test completed within the past 12 months (if positive, proof of negative chest X-ray within the past 12 months is required). After start of work, the Government will provide post blood borne exposure protocols according to applicable regulations.

3.6.3. In those areas where there is a higher risk of transmission of tuberculosis, Contractor employees may be tested as frequently as directed by the MTF policy. This test will be provided by the MTF at no cost to the Contractor.

3.6.4. Immunization information will be tracked in DoD computer systems for all Contractor employees providing services within the MTF under this contract.

3.6.5. No medical tests, procedures, or immunizations required by the contract will be performed by the MTF (with the exception of tuberculosis testing after start of work and in the event of exposure). Expenses for all required tests and/or procedures shall be borne by the Contractor, not the Government.

3.6.6. Contractor employees working in an MTF are strongly encouraged to be immunized annually with the influenza vaccine. This vaccine will not be provided by the Government to Contractor employees. If the vaccine is obtained at other facilities, the cost will be borne by the Contractor, not the Government.

3.6.7. The Contractor shall immediately inform the Government when Contractor employees working in the MTF become pregnant. The Government will notify the Contractor Representative of any work hazards. For the safety of the Contractor’s employee, if work hazards exist, it will be the Government’s decision whether the worker can continue work in the environment.

3.6.8. Proof of subsequent immunizations, required for continued employment at the MTF, must be provided on the anniversary of the employee’s hire date or when the option year is executed, whichever comes first.

3.7. Traffic, Safety and Fire Regulations (only applicable if Contractor employees perform services in a government facility):

3.7.1. The Contractor shall ensure that all Contractor employees comply with installation and MTF requirements, regulations, and procedures. The Contractor Management Staff shall ensure that Contractor employees park vehicles only in the designated parking locations.

3.7.2. While working in the MTF, Contractor employees shall comply with all safety and fire procedures/practices associated with the medical facility and participate in all routine drills if Contractor personnel are present for such drills.

3.8. Travel. All travel will be at the Contractor’s expense.

4. PLACE OF PERFORMANCE:

4.1. Place of Performance. The Contractor shall determine the appropriate staffing and placement of contractor staff necessary to carry out the services under this contract in coordination with the COR.

4.2. Access to the GBS. Access to the GBS will be available to the Contractor remotely (at Government-approved locations) with the use of a Government-issued Common Access Card

(CAC). The Government does not require third party billing and collection services be performed in an MTF. However, to facilitate billing and collection services that require access to the GBS the Government will provide available space in the MTFs in accordance with Attachment 1 – List of Military Treatment Facilities (MTFs). Access to the GBS database for OCONUS MTFs will be provided to Contractor employees assigned to CONUS or other OCONUS MTFs (access to OCONUS GBS databases can typically be provided from any CONUS or OCONUS MTF location). In general, the data within a given GBS database is specific to the MTF location; however, the servers at the bases listed in Attachment 2 – Consolidated Servers, support multiple MTFs. It is important to note that remote access to an MTF’s GBS database requires additional approval and is handled on an individual basis by the Defense Health Clinical Systems, an organization unaffiliated with this contract. As such, no more than eight (8) contract employees per region will be provided remote GBS access.

4.2.1. The Contractor shall only access the GBS from Government-approved locations. At no time will the Contractor or any contract employee perform services under this contract from their personal residence or other public locations without specific written authorization from the COR. The Contractor’s proposal shall include all locations where they intend to perform services under this contract. The locations must be approved by the Government prior to the contract start date to ensure access to the GBS is authorized for the proposed locations. Following contract start, any changes to the locations shall be mutually agreed upon by the CO, COR and the Contractor.

4.2.2. The Contractor is not required to staff the available spaces on a daily basis; however when staffed, it must be within normal hours of operation. MTFs showing more than one space available within Attachment 1 (i.e. those with inpatient services) have historically had a higher volume of billable encounters.

4.2.3. If Contract employees are assigned to work within an MTF or any other Government-provided space, those employees shall only perform services directly supporting the Government requirements under this contract. If Contract employees are assigned to work within an MTF, the employees shall comply with all requirements listed in this PWS.

4.2.4. In all cases, the Contractor shall maintain segregation of duties between the employee who generates bills, and the employee who posts the payment for that bill (i.e., the same person that generates the bill cannot be the person to post payment/write- offs).

4.3. Available Hours of Operation. MTF normal hours of operation are from 7:30 AM through 4:30 PM, Monday through Friday, excluding federal holidays, unless altered by the MTF and approved by the CO.

4.3.1. Planned Closures: Days that Air Force leadership designates as a minimal manning/liberal leave days for government employees and at smaller locations, can result in a planned facility closure.

4.3.2. Unplanned Closures: Closure of a federal facility due to natural disasters, military emergency, severe weather, or any other reason that is not planned.

4.3.3. Scheduled Holidays: New Year’s Day; Dr. Martin Luther King, Jr. Birthday; President’s Day; Memorial Day; Independence Day; Labor Day; Columbus Day; Veteran’s Day; Thanksgiving Day; Christmas Day.

5. AUTOMATED INFORMATION SYSTEMS (AIS) III AND BASE SECURITY REQUIREMENTS:

5.1. Contractor personnel will have access to and/or process information requiring protection under the Privacy Act of 1974 on unclassified Automated Information Systems (AIS) under this contract. Because of this required access, contractor personnel are in non-sensitive public trust positions designated as Automated Information Systems III (formally ADP) positions IAW DoD Directive 5200.2-R. In compliance with DoD Directive 5200.2-R and Air Force Instruction (AFI) 31-501, a National Agency Check with Inquiries (NACI) is required for all AIS III positions. The Contractor shall fully adhere to the provisions in these referenced publications by having all contractor personnel who are performing under this contract submit the appropriate forms and have a favorable outcome from the NACI investigation. All contractor personnel will schedule an appointment with the appropriate Government Unit Security Manager at the installation where services are provided or through the Contractor Human Resource Manager and DHA/AFMS Security Manager. The Contractor shall ensure no employee has access to the information or systems required under this contract without meeting the requirements outlined in this contract and the referenced directives, regulations, and instructions. Contractor personnel shall handle and safeguard any unclassified but sensitive information in accordance with appropriate DoD security regulations. Any security violation shall be reported immediately to the COR. No foreign nationals shall be employed under this contract without prior approval of the Government.

5.2. The Contractor shall appoint a Security Officer to be the sole point of contact for NACI/clearance processing with the COR. The Security Officer shall ensure the following forms reach the appropriate Government Security Manager, prior to the employee’s start date for services under this contract:

5.2.1. SF-85P, Questionnaire for Public Trust Positions. An electronic SF-85P form can be accessed and submitted through the U.S. Office of Personnel Management web site at http://www.opm.gov/e-qip/. The Contractor Management Staff is required to provide the Government Unit Security Manager with two (2) printed and signed (original signatures) hardcopies of the SF-85P. To eliminate possible re-submission of the security information, it is highly recommended that contractor personnel maintain a copy of the completed hardcopy of the SF-85P document.

5.2.2. Two (2) sets of FD-258, FBI Fingerprint Cards for each contract employee.

5.2.3. In some cases, contractor personnel may also be required to submit a Birth or Naturalization Certificate to the appropriate Security Manager.

5.3. The Contractor shall advise contractor personnel that a positive (favorable) NACI report is needed as a condition of employment under this contract. Contractor shall make the appropriate staffing adjustments and plan accordingly for the approval process. While the Government will make every effort to expedite investigations, typical approval from the time all paperwork is received by the Government from a contract employee ranges from 30 to 60 days and may last as long as 180 days.

5.4. At the start of the contract and each option year:

5.4.1. The COR or MTF UBO Managers shall provide the names and phone number of the MTF’s Primary Security Manager and Alternate.

5.4.2. The Contractor’s Security Officer shall be responsible for coordinating the initiation of the background investigation for all contract employees prior to performance. They will inform both the COR and the MTF or DHA/AFMS Security Manager of the new hire.

5.4.3. The Contractor’s Security Officer will be required to submit a copy of the contract and a Visit Authorization Letter (VAL) on the Contractor’s letterhead to the COR and the MTF or DHA/AFMS Security Manager. A VAL shall be submitted to the COR for contractor personnel located at approved non-governmental facilities. VAL letters will also be required no later than 30 calendar days prior to the start of each option year of the contract for all contractor personnel.

5.4.4. Authorization for renewal CAC cards shall be obtained through the MTF Security Manager for contractor personnel performing services in the MTF and through the COR and DHA/AFMS Security Manager for all other contractor personnel. All CAC cards shall be issued at local RAPIDS sites; the Contractor’s Security Officer is responsible for identifying the nearest RAPIDS location for personnel not assigned to an MTF. All costs associated with travel to and from the RAPIDS site shall be borne by the Contractor, not the Government.

5.4.5. The Contractor Representative will provide the COR with a list of current contract employees, to include last name, first name, SSN, DOB, work location, date favorable NACI was granted, and date data was submitted for new personnel. An updated list will be provided at the start of the contract, at the start of each option year, and every time there is a change in personnel.

5.4.6. The Contractor will provide proof of required annual training for all contract employees working outside an MTF. The required annual training will include training on the protection of Government information systems and confidential patient information. Current requirements for training will be provided at contract award and updated as necessary (i.e. upon contractor personnel turnover).

5.4.7. The Contractor shall identify all contractor employees who require access to the GBS (from within an MTF only) and submit proof the contractor employee has a valid Common Access Card and has completed all required system and security training to the COR. The COR will submit a request to add the contractor employee to the Defense Health Information Management System Field Services list. When the contractor employee is added, the Contractor’s Representative should request a GBS account from the DHA, Service, or MTF GBS administrators, as appropriate. The COR shall provide the names of appropriate GBS administrators.

5.5. Privacy System Notices. DoD and Air Force medical information systems are identified for the purposes of privacy system notices. These medical information systems may be accessed by contractor personnel to execute services as stated in this PWS.

6. CONTRACTOR QUALIFICATIONS:

6.1. Experience and Requirements. The Contractor shall have a demonstrated, in-depth knowledge of best practices associated with Government healthcare and the health insurance industry as they relate to the performance of all services described in this PWS at multiple medical treatment facilities in a government or commercial setting. The Contractor shall have experience performing revenue cycle back-end functions for claims submissions, insurance identification and verification, accounts receivables management, denials and appeals management, and collections follow-up within the healthcare industry. In addition, the Contractor shall:

6.1.1. Contractor personnel shall have a working knowledge of Ambulatory Procedure Groupings (APGs), Diagnosis Related Groupings (DRGs), International Classification of Diseases-Version 9 (ICD-9), ICD-10 (when published), Current Procedural Terminology- Version 4 (CPT-4) coding, and electronic billing and collection procedures (to include future versions as appropriate);

6.1.2. The Contractor shall have legal assistance, a Registered Nurse, and Registered Information Health Care Administrators on staff or immediately available to facilitate and expedite collection processes.

6.2. Personnel Qualifications. The Contractor shall employ a staff able to read and interpret medical documentation, and understand medical terminology to correctly bill both outpatient and inpatient services. In addition, the Contractor shall:

6.2.1. Employ a staff with at least two (2) years of experience in the operation of personal computers and familiarity with common office software to include, but not limited to, Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Microsoft Access, and electronic mail systems;

6.2.2. At a minimum, at any location where services are performed under this contract (MTF and/or external location), there shall be one (1) or more contractor employees who possess either two (2) years of experience in medical billing and collections or have completed a medical biller certification program. The Government considers experience acceptable if it was performed within the DoD or in a commercial healthcare organization; however[, it must be specific to medical billing and collection services at a minimum the Contractor’s management team shall include the following key personnel who meet the requisite experience requirements as identified below:

6.2.2.1. Contractor Representative – The Contractor Representative shall have a minimum of five (5) years’ experience performing all services described in this PWS at multiple medical treatment facilities in a government or commercial setting in addition to the requirements listed in paragraph 6.1.

6.2.2.2. Billing and Collection Manager – The Billing and Collection Manager shall have a minimum of five (5) years’ experience supervising medical billers and support staff at multiple locations. This individual shall also have a minimum of five (5) years’ experience simultaneously dealing with medical insurance companies across multiple markets and the practical application of laws and regulations governing medical billing and collection practices nationwide.

6.2.2.3. Human Resource Manager – The Human Resource Manager shall possess a Senior Professional in Human Resources (SPHR) or similar certification and have a minimum of five (5) years’ experience managing medical administrative personnel.

6.2.2.4. Training Manager – The Training Manager shall have a minimum of five (5) years’ experience training medical administrative personnel engaged in billing and collections operations.

6.2.3. The Contractor must provide a signed certification statement that certifies personnel performing under this PWS meet the requirements within paragraphs 6.2.2. and 6.2.3. The signed certification statement is required within ten (10) calendar days following contract award. Monthly staff rosters shall highlight those employees who possess the qualifications listed under paragraphs 6.2.2. and 6.2.3.

6.3. Government Furnished Training: The Government will provide initial training to the…