Section J Attachment 4 - SOOs.doc

Attachment 4: Statement of Objectives

Service/Operational Activity

(Service Type II)

Patient Appointing Service

Medical Records Service

Medical Coding and Auditing Service

Medical Transcription Service

Referral Management Service

Release of Information Services

After Hours Off-Site Answering Service

PATIENT APPOINTMENT SERVICES

STATEMENT OF OBJECTIVES

1. PROGRAM GOAL: To supply all necessary equipment and labor required to perform appointment services for military medical treatment facilities.

2. CONTRACT OBJECTIVES: Utilize the best commercial practices in conjunction with military directives and parameters to produce efficient appointing services for the Air Force Medical Service.

3. BACKGROUND:

a. Appointing services are currently accomplished by military, DoD civilians or contractors within MTFs or at remote sites.

b. The volume and demand for services varies by facility. The contractor is required to submit a cost per telephone transaction. A transaction includes all steps necessary to make an appointment via telephone. Only calls resulting in either an appointment or documented verification that an appointment is not available are considered to be a transaction. For example, blocked or abandoned calls do not count as a transaction. Specific facility estimates will be provided upon ordering service and will include: current eligible beneficiary population (Active Duty, TRICARE Prime enrollees, TRICARE Plus enrollees, and non-enrollees) as well as historical workload estimates.

c. Hours of Operation/Federal Holidays. The medical encounters occur daily. Services currently are typically provided Monday through Friday from 0730 to 1630, excluding Federal holidays. However, the contractor may propose operational hours in their strategy to create efficiencies, meet high demand, meet customer needs and improve customer satisfaction.

3. MILITARY PARAMETERS:

a. The Composite Health Care System (CHCS) and the newest version, AHLTA, must be utilized for appointment services. Access will be granted by local MTF connectivity and the contractor shall comply with MHS communications and Government IT security standards and policies. The military facility will provide CHCS/AHLTA accounts for contract staff members after required training and security procedures have been completed by the contractor. If the Military Health Service appointing process moves away from CHCS/AHLTA, the government will modify the task order accordingly.

b. Applicable regulations and guidelines are contained in Section C, Paragraph 5.

c. The Contractor must provide a toll free telephone line/number for the appointment services. The contractor shall be responsible for installation, maintenance and costs associated with the 1-800 line. The Contractor shall submit Automated Call Distribution (ACD) system changes, configurations, procedures, scripting, etc., to the COTR for coordination and/or approval. The contractor may use an automated or voice response system provided that patients have the option to speak directly to an appointment clerk.

d. Appointment Types. The Contractor shall make clinical appointments and coordinate appointments with other direct care facilities as required. Appointments shall be made following MTF-provided appointing criteria and comply with MHS access to care standards as required by 32 CFR 199.17. Appointments shall be made using only DoD approved standard appointment types, business rules, and appointment detail codes as detailed in the Appointment Standardization Commander's Guide to Access Success (http://www.tricare.osd.mil/tai/cguide.htm).

(1) The Government will be responsible for the development and updates to MTF provider appointment templates.

(2) The Contractor shall be required to, in addition to making appointments, call patients and reschedule and/or cancel appointments according to need.

e. Hours of Operation/Federal Holidays. The Contractor must provide services Monday through Friday from 0730 to 1630, excluding Federal holidays. However, the contractor may propose operational hours in their strategy to meet high demand, meet customer needs and improve patient satisfaction.

4. QUALITY ASSURANCE AND PRODUCTIVITY MONITORING REQUIREMENTS: In order for a proposal to be properly evaluated, contractors must provide adequate documentation and explanation of their proposed plan and strategy, as well as pricing and specifications of equipment, if applicable. Offerors need to provide a price per telephone transaction as well as internal controls for the following monitoring and quality assurance activities:

a. Call Waiting Time – The time the caller is on hold waiting to speak to an appointment clerk.

b. Call Abandonment – The number of callers whose calls were received by the telephone switchboard, but who disconnected (i.e., hung up) before the appointment clerk could answer the telephone.

c. Blocked Call Rates – Calls that cannot be completed by the caller due to the call capacity of the telephone system (i.e., all telephone lines are busy).

d. Customer Service/Satisfaction of Appointing Services – This information will be received from the DoD customer satisfaction survey. Report shall also separately address complaints from MTF clinic staff listed by contractor staff member and number of complaints from patients listed by contractor staff member.

e. Error Report – Number of incorrect appointing transactions by contractor staff member.

f. Call Volume – Total number of calls received by the appointing contractor’s telephone switch.

g. Call Processing Time – The total length of call to include call waiting time and talk time.

h. Calls That Do Not Result In An Appointment – The contractor will use the CHCS/AHLTA system to identify and report patients that called, but did not get an appointment.

i. All Refused Appointments (Patient is offered same day appointment but refuses) - See paragraph g. above.

j. Access To Care Summary Report - documents when a patient is offered an appointment within standards but refuses and gets an appointment outside standards due to their own preference.

k. Calls Monitored Report - Report shows results of contractor’s internal surveillance process.

l. Utilization/Demand Forecasting. Reports show required performance data on an hourly basis for each business day of the week with an aggregate total for the week.

OUTPATIENT MEDICAL CODING AND AUDITING SERVICES

STATEMENT OF OBJECTIVES

1. PROGRAM GOAL: To supply all necessary equipment and labor required to perform outpatient medical coding and auditing services for military medical treatment facilities.

2. CONTRACT OBJECTIVES: Utilize the best commercial practices in conjunction with military directives and parameters to conduct efficient coding and auditing services for the Air Force Medical Service.

3. BACKGROUND:

a. These services are currently accomplished by military, DoD civilians or contractors within MTFs or at remote sites.

b. The volume and demand for services varies by facility. The contractor is required to submit a price per coded outpatient medical record. The number of outpatient records to be coded per year will be specified on each task order proposal request.

4. MILITARY PARAMETERS:

a. The Composite Health Care System (CHCS) and the newest version, AHLTA, must be utilized for coding and auditing services. Access will be granted by local MTF connectivity and the contractor shall comply with MHS communications and Government IT security standards and policies. The military facility will provide CHCS/AHLTA accounts for contract staff members after required training and security procedures have been completed by the contractor. If the Military Health Service appointing process moves away from CHCS/AHLTA, the government will modify the task order accordingly.

c. Guidelines/Resources for Coding includes, but not limited to:

c.1. EssentrisTM, the client-server version of the Clinical Information System (CIS) c.2. Coding Compliance Editor (CCE) Systems c.3. Biometric Data Quality Assurance Service (BDQAS) - https://bdqas.brooks.af.mil/ c.4. AFMS Internal Coding Audit Methodology - AFMOA Audit Tool c.5. MHS Coding Guidelines http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cfm

d. Hours of Operation/Federal Holidays. The medical encounters occur daily. Services currently are typically provided Monday through Friday from 0730 to 1630, excluding Federal holidays. However, the contractor may propose operational hours in their strategy to create efficiencies, meet high demand, meet customer needs and improve customer satisfaction.

5. DAILY MEDICAL ENCOUNTERS:

a. Reviewing daily medical encounters and determining the appropriate clinics codes (s) and proper documentation requirements.

b. Productivity standards established by the contractor must meet the Air Force’s threshold:

(1) Outpatient visits must be coded within 3 business days from the date of visit.

(2) Ambulatory Procedure Visits must be completed within 15 calendar days from the encounter.

(c) Maintain a 95% coding quality rate as determined by peer reviews and/or other reviews done by Contracted Coding Auditor QAP, or other recognized coding agencies conducting peer and/or coding reviews.

6. QUALITY ASSURANCE REQUIREMENTS: In order for offer to be properly evaluated, contractors must provide adequate documentation and explanation of their proposed plan and strategy, as well as pricing and specifications of equipment, if applicable. Offers must provide a price per coded medical encounter as well as internal controls for the following monitoring and quality assurance activities:

a. The contractor shall provide coding personnel to furnish auditing of coding, report documentation assessments, and data quality statistics. Contractor shall provide Coding Auditors, who shall be responsible for:

(1) Reviewing encounter documentation using Center for Medicare and Medicaid Service (CMS), DoD coding Guidelines and Air Force policy documentation standards

(2) Conducting coding assessments/analysis (peer review) measuring audit outcomes against a goal of 95% correctly coded patient visits submitted to the central Air Force designated data repository (P2R2 – Coding Methodology Report, subject to change). Contract personnel shall provide these findings monthly in writing to the QAP, no later than the 10th of the following month the audit was conducted.

(3) A quarterly report of the coding peer review will be given to the QAP detailing: (a) Clinics that have been coded below an acceptable 95% quality standard and (b) corrective actions initiated to ensure the coding will meet standards and c) the timeframe when QAP can expect clinic(s) to return to acceptable 95% quality standard, which is not to exceed 45 days after receipt of report to QAP.

(4) All incorrectly coded outpatient medical encounters identified during the audit will be corrected before the next month’s report at no additional cost to the Government.

(5) Soliciting input from personnel involved in data collection and data entry for methods to improve quality of data collection and ease of collection on a as needed basis, no less than quarterly. Suggest changes to the sample pick lists and super bills based on feedback from personnel involved in data collection and entry to the QAP.

7. PRODUCTIVITY MEASUREMENT REQUIREMENTS:

a. Monthly reports detailing all work/inservices, etc. accomplished by MASS personnel.

b. Coverage plans for planned/unplanned absences to ensure continuation of services. Notification of absences will be given QAP with a plan of action to cover absences.

c. Problem areas or improvement plans.

OUTPATIENT MEDICAL RECORD MAINTENANCE SERVICES

STATEMENT OF OBJECTIVES

1. PROGRAM GOAL: To supply all necessary equipment and labor required to perform outpatient medical records maintenance services for military medical treatment facilities.

2. CONTRACT OBJECTIVES: Utilize the best commercial practices in conjunction with military directives and parameters to conduct efficient services for the Air Force Medical Service. Compiles and maintains outpatient medical records of patients within a military health care delivery system to ensure patient condition and treatment documentation is accurate and available.

3. BACKGROUND:

a. These services are currently accomplished by military, DoD civilians or contractors within MTFs.

b. Outpatient records are maintained in both paper and electronic formats depending on where the new CHCS/AHLTA Electronic Medical Record has been implemented. The contractor is responsible for management of both formats and may be requested to convert paper to electronic records when required in the task order.

c. The volume and demand for services varies by facility. The contractor is required to submit a cost per medical record maintained. Specific facility patient population will be provided upon ordering service and will include: current beneficiary population, the number of TRICARE Prime enrollees including TRICARE Plus enrollees, number of current records, as well as historical outpatient visit workload estimates. The volume and demand for services varies by facility. The contractor is required to submit a price per outpatient medical record to be maintained for one year.

a. The Composite Health Care System (CHCS) and the newest version, AHLTA, must be utilized for outpatient medical records ordering, filing and tracking functions. Access will be granted by local MTF connectivity and the contractor shall comply with MHS communications and Government IT security standards and policies. The military facility will provide CHCS/AHLTA accounts for MASS personnel after required training and security procedures have been completed by the contractor. If the Military Health Service medical record maintenance moves away from CHCS/AHLTA, the government will modify the task order accordingly.

c. Hours of Operation/Federal Holidays. Services currently are typically provided Monday through Friday from 0700 to 1630, excluding Federal holidays. However, the contractor may propose operational hours in their strategy to create efficiencies, meet high demand, meet customer needs and improve customer satisfaction.

5. QUALITY ASSURANCE AND PRODUCTIVITY MEASUREMENT REQUIREMENTS: In order for offer to be properly evaluated, contractors must provide adequate documentation and explanation of their proposed management and execution strategies, as well as pricing and specifications of equipment, if applicable. Offerors need to provide internal controls for the following monitoring and quality assurance activities:

a. Productivity standards established by the contractor must meet the Air Force’s threshold:

(1) Loose paperwork must be filed in the beneficiary’s medical record within 24 hours of receipt.

(2) Outpatient medical records are filed as soon as returned to the record room.

(3) Maintains 98 percent of record accountability - knowledge of where the paper record is currently located matches the “signed out” information in CHCS/AHLTA.

(4) Maintains 95 percent record availability (medical record is available at time of patient visit for the provider).

TRANSCRIPTION SERVICES

STATEMENT OF OBJECTIVES

1. PROGRAM GOAL: To supply all necessary equipment and labor required to perform transcription services for the AFMS.

2. CONTRACT OBJECTIVES: Utilize the best commercial practices in conjunction with military directives and parameters to produce efficient inpatient and outpatient transcription services for the Air Force Medical Service. Transcription shall include technical medical terminology for all fields of medicine and surgery. Material requiring transcription in typed form may be dictated or provided in written format (via mail, carrier or facsimile) by physicians, allied health care providers, and paraprofessional staff, requiring transcriptionist adaptation to variations in handwriting, accents, speech, tone, voice volume, delivery, pronunciation, and enunciation. Dictated material may be received from a MTF Dictation System by connecting electronically via dial in telephone lines by the Contractor or the contractor may be required to provide a dictation system. The MTF will specify how the dictation will be sent and how the transcription will be provided by the contractor (in CHCS/AHLTA, by fax, by mail, etc.) in the task order.

3. BACKGROUND:

a. Transcription services are currently accomplished by military providers or DoD civilians within an MTF; however, the majority of transcription services are conducted by contractors at remote sites with the use of a dial-in dictation system and connectivity/access to AFMS computer systems.

b. The volume and demand for services varies by facility. The contractor is required to submit a cost per transcribed lines (65 characters constitute a line). The number of lines to be transcribed per year will be specified on each task order proposal request.

3. MILITARY PARAMETERS:

a. The Composite Health Care System (CHCS) and the newest version, AHLTA, must be utilized for transcription services. Access will be granted by local MTF connectivity and the contractor shall comply with MHS communications and Government IT security standards and policies. The military facility will provide CHCS/AHLTA accounts for MASS personnel after required training and security procedures have been completed by the contractor. If the Military Health Service transcription process moves away from CHCS/AHLTA, the government will modify the task order accordingly.

c. Hours of Operation/Federal Holidays. The medical encounters occur daily. Services currently are typically provided Monday through Friday from 0730 to 1630, excluding Federal holidays. However, the contractor may propose operational hours in their strategy to create efficiencies, meet high demand, meet customer needs and improve customer satisfaction.

4. QUALITY ASSURANCE AND PRODUCTIVITY MONITORING REQUIREMENTS:

a. ACCURACY. The contractor shall ensure all transcribed reports are error-free; medically consistent; contain correct grammar, spelling and medical terminology; and correct formats. The required format will be provided to the contractor by the Government. All discrepancies shall be re-accomplished by the contractor at no additional cost to the government and returned to the MTF within 24 hours of oral or written notification to the contractor for routine reports, and within 2 hours or oral or written notification to the contractor on priority reports.

b. LOG SHEETS. The contractor shall establish log sheets to track all dictation received by MASS transcriptionists. The contractor shall be able to provide specific detailed information, such as date transcribed, line count, and the transcriptionist working the dictation.

c. Record System. The contractor shall maintain a record system that shall ensure dictation can be traced through the process from dictation, to transcription to return to the MTF. The contractor shall maintain a tracking system to ensure a specific report was received as dictated and the date the dictation was transcribed in specified form and the date the final report was transmitted to the MTF. The contractor shall be required by the government to provide this information when a report is identified as missing from the patient’s records. The contractor shall provide the report, at no additional cost, within 24 hours from the time the request is made by the QAP/MTF designee. Contractor will be contacted by e-mail or phone about priority reprints. Higher priority reprints shall be accomplished within the time frames.

d. Storage and Backup. The contractor shall provide appropriate storage media to backup all material in a secured environment for the duration of the task order and 90 days thereafter for retrieval purposes by the MTF if necessary.

e. Disposition - The contractor shall provide all hard copy and electronic material to the MTF at the end of the task order for disposition. The contractor must destroy data in accordance with Government regulations after providing copies to the MTF.

f. AUTHORIZED USERS OF THE MEDICAL TRANSCRIPTION SERVICE. A list of authorized users shall be provided to the Government by the contractor. The Contractor must maintain the list of authorized users by updating it as changes occur. If a name does not appear on the authorized list, the individual may not access to Government systems.

g. TURNAROUND TIMES. Transcription shall be accomplished in the following order of priority and within the specified time frames as stated below:

(1) Priority. The MTF shall identify work as priority and notify the contractor of the priority dictation. Contractor will be contacted via e-mail, telephone, facsimile, or written notification about priority requests. Priority requests shall be processed within four (4) hours from the time the QAP or MTF designee makes an oral or written request to the contractor, taking precedence over all routine work. Information on reports shall include all patient identification (name, social security number, unique identifier, hospital address, transcriber’s initials, ward, page number, and job number); reports shall have accurate dates for date dictated and date transcribed; proper format for each type of dictation according to work type, indicate type report; signature block correctly identifying dictating provider by name, rank, branch of service, corps, specialty, Air Force specialty code.

(2) Routine. Requests shall be processed within twenty-four (24) hours from the time of dictation. Information on reports shall include all patient identification (name, social security number, unique identifier, hospital address, transcriber’s initials, ward, page number, and job number); reports shall have accurate dates for date dictated and date dictated and date transcribed; proper format for each type of dictation according to work type and indicate type report; signature block correctly identifying dictating provider by name, rank, branch of service, corps, specialty, Air Force specialty code.

h. REQUIRED FORMS The following formats are required for each type of transcription:

A. SF 516 – Operation Report

B. SF 502 – Narrative Summary (ROUTINE)

C. SF 502 – Narrative Summary (MEB ROUTINE)

D. SF 502 – Narrative Summary (MEB/TDRL – ROUTINE)

E. SF 504-5-6 History and Physical (H&P)

F. SF 513 – Consult

G. AFMC 6497 Cardiac Catheterization Report & Electrophysiology Study

H. SF 600 - Medical Record – Chronological Record of Medical Care

I SF 558 - Medical Record – Emergency Care and Treatment

NOTE: Copy requirements may differ between requesting locations. However, usually routine narrative summaries & operation reports require four (4) copies. Other reports require 1 – 2 copies, except EEG’s, which require 3 copies.

Samples will be provided by the AFMS Commodity Council if required. If transcribing directly into CHCS/AHLTA, a format is not required.

REFERRAL MANAGEMENT SERVICES

STATEMENT OF OBJECTIVES

1. PROGRAM GOAL: To supply all necessary equipment and labor required to perform referral management services for the AFMS.

2. CONTRACT OBJECTIVES: Utilize the best commercial practices in conjunction with military directives and parameters to produce efficient referral management services for the Air Force Medical Service. These services include customer service, administrative support, appointing, health benefits advice, and referral tracking.

3. BACKGROUND:

a. These services are currently accomplished by military, DoD civilians or contractors within an MTF.

b. The volume and demand for services varies by facility. The contractor is required to submit a cost per referral. The number of referrals based from historical workload per year will be specified on each task order proposal request.

a. The Composite Health Care System (CHCS) and the newest version, AHLTA, ERAS, ICD-B programs must be utilized for referral management services. Access will be granted by local MTF connectivity and the contractor shall comply with MHS communications and Government IT security standards and policies. The military facility will provide system accounts for MASS personnel after required training and security procedures have been completed by the contractor. If the Military Health Service processes moves away from specified systems, the government will modify the task order accordingly.

b. Applicable regulations and guidelines are contained in Section C, Paragraph 5. Other references include:

(1) AFMS Referral Management Center User’s Guide is available at https://kx.afms.mil/healthbenefits.

(2) Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Accreditation Manual.

(3) JCAHO Ambulatory Health Care Standards Manual.

(4) TRICARE Operations Manuals.

c. Hours of Operation/Federal Holidays. The medical encounters occur daily. Services currently are typically provided Monday through Friday from 0730 to 1630, excluding Federal holidays. However, the contractor may propose operational hours in their strategy to create efficiencies, meet high demand, meet customer needs and improve customer satisfaction.

5. QUALITY ASSURANCE AND PRODUCTIVITY MONITORING REQUIREMENTS:

a. All referrals are reviewed and dispositioned by the contractor in the appropriate manner (both electronically or manually).

b. Services for appointing were done within the Access to Care standards for 90% of all referrals.

c. Right of First Refusal performance is completed within one (1) business day of the date of the referral.

d. Contractor must follow up on referral results within 72 hours after the patient care visit.

RELEASE OF INFORMATION

STATEMENT OF OBJECTIVES

1. PROGRAM GOAL: To supply all necessary equipment and labor required to perform medical record copying, delivery and tracking in support of the Air Force Release of Information program and to ensure compliance with policy, directives and regulatory guidance to release health care information to DoD beneficiaries, military authorities or other designated officials (insurance companies, social services, etc.) for medical treatment facilities.

2. CONTRACT OBJECTIVES: Utilize the best commercial practices in conjunction with military directives and parameters to conduct efficient release of information services for the Air Force Medical Service. The contractor will be required to retrieve medical records from the Record Room(s), reproduce either on paper or electronically, refile the medical records appropriately, track and deliver the copied documents to the requestor within 10 business days. Packages of copied materials may be picked up at the medical treatment facility by the requestor or may be required to be mailed to the requestor.

3. BACKGROUND:

a. These services are currently accomplished by military, DoD civilians or contractors within MTFs.

b. Outpatient records are maintained in both paper and electronic formats depending on where the new CHCS/AHLTA Electronic Medical Record has been implemented. The contractor is responsible for using both formats if warranted by the release of information request.

c. The volume and demand for services varies by facility. The contractor is required to submit a cost per ONE (1) Release of Information Request DD Form 2870. Specific facility estimates will be provided upon ordering service and will include: current number of outpatient and inpatient medical records maintained by the facility, number of records rooms in the facility, average number of pages in a typical medical record and historical release of information requests (workload estimates).

a. The Composite Health Care System (CHCS) and the newest version, AHLTA, must be utilized for medical records checkout, tracking functions and check in processes. Access will be granted by local MTF connectivity and the contractor shall comply with MHS communications and Government IT security standards and policies. The military facility will provide CHCS/AHLTA accounts for MASS personnel after required training and security procedures have been completed by the contractor. If the Military Health Service medical record system moves away from CHCS/AHLTA, the government will modify the task order accordingly.

(1) Defense Enrollment Eligibility Reporting System (DEERS) is used to validate eligibility and/or locate beneficiaries.

(2) The military has a unique filing system - by sponsor social security number, terminal digit order, color-coded and blocked filing system.

(3) Contents of a military medical record, layout, sections, family member prefix designation, forms used in a MTF, and the medical record tracking procedures are not common to civilian industry.

b. Applicable regulations and guidelines are contained in Section C, Paragraph 5.

c. Personnel used to provide this service must meet the qualifications standards identified in the Release of Information Clerk labor category already in the contract (attached).

d. Hours of Operation/Federal Holidays. Services currently are usually provided Monday through Friday, dayshift, excluding Federal holidays. However, the contractor may propose operational hours in their strategy to create efficiencies, meet high demand, meet customer needs and improve customer satisfaction.

e. All medical records and other documentation is the property of the Department of Defense (DODI 6040.43) and therefore, can not be removed from the facility.

f. Urgent health record copy requests to save a patient’s life, limb, or eyesight, including requests necessary to support or facilitate emergency medical treatment, received from another civilian medical facility, civilian provider, or military medical treatment facility must be processed immediately upon receipt. Because the hours of operation for this release of information service may be limited, the MTF will be responsible for any urgent requests that require immediate attention during non-work hours of the contracted service.

5. QUALITY ASSURANCE AND PRODUCTIVITY MEASUREMENT REQUIREMENTS: In order for offer to be properly evaluated, contractors must provide adequate documentation and explanation of their proposed management and execution strategies, as well as pricing and specifications of equipment, if applicable. Offerors need to provide internal controls for the following monitoring and quality assurance activities:

a. Productivity standards established by the contractor must meet the Air Force’s threshold:

(1) Medical records are properly returned to the appropriate records room within 8 hours of checkout.

(2) Maintains 100 percent of record accountability - knowledge of where the paper record is currently located matches the “signed out” information in CHCS/AHLTA for records retrieved for Release of Information purposes.

(3) Maintains 95 percent record availability (medical record is accessible to other medical staff if the need arises within 24 hours) for records retrieved for Release of Information purposes.

(4) Request of Information Requests are completed (record(s) retrieved, copied and delivered to the requestor) within 14 calendar days (10 business days, excluding holidays).

a. The contractor must ensure tracking, delivery and receipt by the authorized requestor because of the sensitive nature of the documents being copied and distributed.

AFTER-HOURS,OFF-SITE ANSWERING SERVICE

STATEMENT OF OBJECTIVES

1. PROGRAM GOAL: To provide all personnel, labor, materials, equipment, location and phone line(s) to provide an after hours answering service at a non-Government location.

2. TASK ORDER OBJECTIVES: Utilize telephone operators to provide a timely answering service for Defense Enrollment Eligibility Reporting System (DEERS) eligible beneficiaries who are enrolled to the requesting location. In accordance with military directives and privacy regulations, the contractor shall provide efficient guidelines to meet answering service requirements. This includes, but is not limited to, timely answering of incoming call, voice recording, documenting and tracking of calls. The contractor's statement of work shall clearly demonstrate industry standard protocols to answer calls, record/document the calls, a process to contact the on-call provider, recordkeeping for times of calls (incoming, provider contact, provider response), as well as guidelines for unique call transactions (such as flying status, Personal Reliability Program (PRP), mental health contacts).

The Answering Service will be utilized by eligible beneficiaries who have a symptom-based concern and wish to discuss it with an on-call MTF provider during non-duty hours as an alternative to reporting to the Emergency Department or waiting until the next duty day. The telephone operators will answer the after-hour calls, record the patient demographic information and reason for the call/concern and then contact the appropriate on-call provider based on MTF guidelines (i.e., primary care manager enrollment, non-enrollees process or other symptom specific calls for dental, obstetrics, surgery, etc.) The MTF on-call provider will be paged following the Government-published on-call schedules and per the process and time standards outlined below. The operator will provide the call information to the on-call provider. The Government will maintain the documentation requirements for the telephone consultation in the Government computer systems (CHCS/AHLTA). The phone number(s) for after hour provider contact is marketed on clinic answering machines and on the MTF appointing line.

The volume, demand and clinics to use the services vary by facility. Specific facility estimates will be provided upon ordering the service and will include: current eligible beneficiary population (Active Duty, TRICARE Prime enrollees, TRICARE Plus enrollees, and non-enrollees) that may use the service as well as historical workload estimates (see addendum), and clinics utilizing the service.

In the contractor’s Statement of Work/Proposal, the contractor is required to submit a cost per Answering Service Call Transaction. A call transaction includes all steps necessary to receive the call, obtain required information from the caller, dispatch the proper on-call provider, document call times and report to the medical treatment facility in the monthly productivity and quality assurance report (see Paragraph 7). Only calls resulting in a complete transaction are billable to the Government. Any blocked or abandoned calls, wrong numbers, disconnections or informational calls do not count as a transaction. However, the contractor is expected to provide callers with general information to include instructions and accurate telephone numbers to the MTF if requested.

The contractor shall be paid per the estimated call transaction workload provided in the Task Order Proposal Request. Since monthly call transactions vary at times significantly due to seasonal flu and cold patterns, surges in returning military, deployments, etc., invoiced dollars will be of equal amounts. It will be calculated by the offeror’s unit rate per completed call transaction multiplied by the projected units to be purchased divided by 12 to determine the standard monthly invoice amount (per contract H.2.b.(1)(b)). The contractor will be required to reconcile the workload monthly if the call transactions billed is less than actual call transactions.

3. TASK ORDER EMPHASIS:

a. As stated in the MASS contract, Section H.5, the Contractor shall be compliant with all Health Insurance Portability and Accountability Act (HIPAA) rules and regulations. All individuals performing services for the MTFs are required to complete the HIPAA Privacy Rule training and will be held accountable for complying with the MTF’s specific health information privacy policies and procedures.

b. Per Section C, Paragraph 3.18, since protected health information and privacy data is used or transmitted outside the Government facility, the Contractor shall be responsible for following DoD and local directives for physically and operationally safeguarding the information. Under no circumstances may any patient data be transferred or recorded outside the United States.

c. Hours of Operation/Federal Holidays. As a minimum, the after hours on-call answering service shall be available to beneficiaries Monday through Friday, non-duty hours (usually 4:30pm-7:30am) and 24 hours a day on weekends and Federal holidays, military-designated family days, specified training days or other announced down days.

(1) The MTF will submit military-designated family or down days to the contractor at the time of task order proposal request or at least 14 days in advance of closure. Historical down days and closures may be requested from the MTF. For unplanned closures due to weather, natural disaster or other significant military contingency, the MTF will notify the contractor as early as possible for coverage.

(2) The contractor shall provide services for the Federal holidays listed below:

New Year’s Day (observed 1 January)

Martin Luther King, Jr. Birthday (observed the third Monday in January)

President’s Day (observed the third Monday in February)

Memorial Day (observed the last Monday in May)

Independence Day (observed 4 July)

Labor Day (observed the first Monday in September)

Columbus Day (observed the second Monday in October)

Veterans Day (observed 11 November)

Thanksgiving Day (observed the fourth Thursday in November)

Christmas Day (observed 25 December)

c. Unique requirements for the MTF will be included in the addendum (if applicable).

4. SPECIFIC REQUIREMENTS:

a. The Contractor must provide an operational location. The Statement of Work shall include a complete address for the location to include square footage as part of their model.

b. The Contractor must provide a toll free telephone line/number(s) to the requesting location. The phone system and the number of available lines will be outlined in detail in the Statement of Work. The Government will either transfer the calls to the phone line or market the toll free telephone number on the MTF after-hours voice message. Each MTF will refer to its policy in the TOPR. The contractor shall be responsible for installation, maintenance and costs associated with their own telephone line(s). Unless noted in the addendum, the contractor may use an automated or voice response system to direct callers according to MTF guidelines. Prior to implementation, the Government must approve any proposed call tree/definition(s). It is the responsibility of the contractor to have a back up system in place for equipment failures and staffing shortfalls.

c. Minimum qualifications of telephone operator personnel are listed below and may be included in the attached addendum:

(1) Must have at least six months experience in a medical office or medical answering and referral service. Experience must be in an administrative capacity and including direct patient contact and customer service.

(2) Must have basic knowledge level to include: principles of customer service for call answering and referral services and HIPAA guidelines for release of medical information.

(3) Medical terminology is desired.

(4) Must possess excellent oral and written communication skills and interpersonal skills.

d. Other Proposed Staff Members. If other staff positions are proposed in the Statement of Work, the contractor shall provide complete education and experience requirements as well as duties to be performed by the employee.

e. The contractor shall provide the title and phone number for a point of contact to receive provider on-call schedules from the MTF and to use whenever a change is needed.

5. GOVERNMENT FURNISHED ITEMS:

a. The Government will be responsible for the development and issuance of On-Call Provider Rosters for each clinic using the service. An on-call roster for the following month for each MTF clinic utilizing the services will be given to the contractor by the 25th of each month. Required updates are expected and will be provided to the contractor as soon as possible. A provider on-call roster shall be made available 15 days prior to start of the contract.

b. The Government will provide a roster of other designated points of contact to reach during normal duty hours so that urgent problems can be immediately addressed. The contracting office representative will provide the roster upon assignment of a performance start date. The listing will include a primary and alternate emergency contact person. Required updates are expected and will be provided to the contractor as necessary.

6. ON CALL ANSWERING SERVICE PROCESS:

a. The contractor personnel (operator) shall:

(1) Use a predetermined personalized answering greeting when answering calls from

MTF patients. For example “Thank you for calling the (MTF Medical Group) Answering Service. If this is an emergency, please hang up and dial 9-1-1 or go to the nearest Emergency Room.”

b. For symptom-based calls, the following information must be obtained from the caller:

(1) Name of caller

(2) Name of patient (if different)

(3) The sponsor’s social security number

(4) Phone number to reach the caller

(5) Provider or clinic to which patient is enrolled (if applicable)

(6) Whether the patient is on flying status

(7) Whether the patient is PRP

(8) A short description of the symptoms to relay to the on-call provider.

c. Inform the caller that the provider should call within 30 minutes; however, if the provider does not call within 1 hour from the initial call, the caller shall be instructed to call the Answering Service again.

d. The telephone operator shall immediately page the proper on-call provider.

(1) CONTACT GUIDELINES:

Enrollees: The first routing for the provider should be the patient’s enrolled clinic. For example, if the patient is enrolled to a Primary Care/Family Practice provider, call that on-call provider. If enrolled to Internal Medicine, call the Internal Medicine on-call provider.

Non-Enrollees: If the patient is not a TRICARE enrollee at the MTF, the caller must be referred to their primary care manager. The MTF on-call provider can not provide them after hour services. A recommended statement may be: “Since you are not enrolled to this MTF, the on-call provider does not have access to your medical information. You will need to call your primary care manager at your enrolled facility or you may utilize the WPMC Emergency Department.”

Unknown: If the patient does not know who they are enrolled to, the operator shall contact the Primary Care/Family Practice on-call provider.

No On-Call Provider: When there is no on-call Pediatric provider on the roster, the operator shall contact the Primary Care/Family Practice on-call provider.

Flying Status/PRPP: the telephone operator shall call the Flight Medicine on-call provider.

(2) NOTIFICATION PROCESS.

a) The telephone operator shall contact the on-call provider’s pager first. The Government will provide a pager number (and access code) on the on-call rosters.

b) If no response is received in approximately 10 minutes, the provider’s listed home or cell phone number shall be called.

c) If there is no response (do not leave a message on voice mail or phone recorders), call the next person on the call list and repeat the above steps of the process twice. If no on-call provider returns a call to the telephone operator, the operator will document attempts to contact the on-call provider and it will be reported the next duty day to the MTF designee.

When the provider calls the operator, the operator shall provide them with the information given by caller/patient. The telephone operator shall not, under any circumstances, refer or directly connect the patient to the on-call provider.

b. For calls pertaining to appointment times or requests, prescription refills or test results, the recommended statement is: “The on-call provider does not have access to the appointment system, computerized pharmacy or laboratory systems needed to fulfill your request. For this information you will need to call the clinic on the next duty day.”

f. Mental Health Standard Protocols for calls from authorized military personnel (not a patient):

(1) Calls from authorized military personnel (unit commanders and 1st Sergeants), asking for the Mental Health on-call provider to contact them, the contractor shall document the commander’s or 1st Sergeant’s name, unit identification, the name of the military member they are calling about, the specific concern, location of the military member, and a phone number where the commander or 1st Sergeant may be reached.

(2) The telephone operator shall contact the Mental Health on-call provider.

(3) When the Mental Health on-call provider calls the operator, the operator shall convey the information in f.(1) above to them.

(4) The operator shall not, under any circumstances, refer or directly connect the patient to the Mental Health on-call provider.

7. PRODUCTIVITY MONITORING AND QUALITY ASSURANCE REQUIREMENTS: In order for a proposal to be properly evaluated, contractors must provide adequate documentation and explanation of their proposed plan and strategy in their Statement of Work for productivity requirements, technologic considerations for patient privacy and protection of PHI data. Offerors must demonstrate internal controls for the following monitoring and quality assurance activities:

a. The operator shall answer patient calls in the order they are received within 2 minutes of call placement.

b. The contractor shall submit a written monthly productivity report to the MTF designee no later than the 10th working day of each month. The monthly report shall include comprehensive analyses of all activity. For example:

· For Symptom-Based Calls:

· Patient Call Information: name of patient (or the commander or 1st Sergeant); flying status or non-flying status; sponsor’s social security number; and phone number (or the commander’s phone number or 1St Sergeant’s phone number)

· Time of each call from the patient; the time the operator called the on-call provider; and the time the on-call provider responded.

· The Service Requested By the Caller (symptoms and/or concern)

· For Informational or General Calls:

· Patient’s name and question(s) for all calls regarding anything other than a medical symptom(s), such as medical prescription refill request or appointment request, and patient that are not enrolled beneficiaries of the MTF.

· Any unusual events

· Total Minutes of each call

· Total Number of Calls Received (able to be sorted by patient, on-call provider, time data, enrolled clinic, etc.)

c. Operator’s time is the accumulated time an operator is on incoming and outgoing calls. One (1) call is defined as an incoming call from a patient or on-call provider for which an operator records or provides message information. One dispatch (page) is included in the cost of an incoming call from a patient. Any additional dispatches needed because of non-response to the original dispatch will be considered an Answering Service Call Transaction and must be reported separately on the report.

d. The contractor shall have internal controls in place for quality assurance and will be required to provide a quality control program to the MTF. The contractor shall provide routine customer quality assurance checks.

e. In addition to compliance standards in the required performance plan, the contractor shall be allowed 1 verified discrepancy or 4 verified minor discrepancies per month.

(1) Major discrepancy: a) Failure to contact on call provider within 10 minutes after call from patient or failure to contact back up on call provider if no response from first provider was received in 30 minutes. A message was left on the provider’s voice mail systems or answering machines is major discrepancy; b) Violation of HIPAA or privacy rules and regulations.

(2) Minor discrepancy: a) Delay in implementing back up system for staffing shortfalls or equipment failures; b) Patient complaint of rudeness by answering service staff; c) Answering service does not obtain accurate information from caller to relay to provider on call (i.e. correct names, social security numbers, phone number(s), or nature of concern).

Attachment 6: WAGE DETERMINATIONS (current as of 26 April 2009)

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EMBED Word.Document.12 Attachment 7: MINIMUM REQUIRED MHS LEARN TRAINING PLAN (as of 26 April 2009)

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