Attachment 1 - PWS for PAD Medical Coders 22Dec2023.pdf

HT001424R0004

PAD Medical Coders and Transciption Services

Attachment 1 – PWS

Department of Defense Defense Health Agency

Performance Work Statement

Management of Medical Records Support & Transcription Services

Medical Records Division of the Patient Administration Department

Walter Reed National Military Medical Center

Solicitation Number: HT001424R0004 Version:1

Date: 12/22/2023

PART 1

1.0 GENERAL INFORMATION

1.1 This is a non-personal services contract to provide Management of Medical Records Support & Transcription Services to support the Medical Records Division of the Patient Administration Department at Walter Reed National Military Medical Center (WRNMMC).

1.2 Description of services/introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform Management of Medical Records Support & Transcription Services as defined in this Performance Work Statement (PWS) except for those items specified as government furnished property and services. The contractor shall perform to the standards in this PWS.

1.3 Background: In September 2011, WRNMMC was formed from the merger of Walter Reed Army Medical Center and the National Naval Medical Center. WRNMMC is a 341-bed Hospital that also houses 75+ outpatient specialty clinics. WRNMMC is the premier DoD MTF where the nation’s wounded warriors come to heal. As such, a portion of the patient population is comprised of acute, poly-trauma, highly complex medical cases. Coding is used as a tool for the monthly Data Quality Report, allowing the command to identify areas needing improvement and ensuring benchmarks are met. In addition, coding drives data quality metrics, tracks productivity of clinical staff, and drives the reimbursement for care provided.

1.4 Objectives: The Contractor shall also provide Medical Record Coding Services through off-site and on-site, electronically Remote Coders, performing Remote Electronic Coding, IAW all requisite information technology (IT) systems, protocols, and procedures in place; provided by the Contractor (except where provided by the Government) submitted for the Government’s verification & validation, as to be in conformance with all applicable DOD regulations.

1.5 Scope: Management of Medical Records Support & Transcription Services WRNMMC.

The contractor shall provide Services include Certified Medical Coder(s), Certified Coding Specialists (CCS), Certified Professional Coding Specialist(s) – Physician Based (CCS-P), Certified Professional Medical Auditors (CPMA), Certified Professional Coder (CPC), Registered Health Information Administrator(s) (RHIA), and/or Registered Health Information Technician(s) (RHIT) to code, abstract, analyze, assemble, and audit medical record data. Coders will assign diagnosis and procedure codes for Inpatient Treatment Records (ITR), Inpatient Rounds (RNDS), Ambulatory Procedure Visits (DAY SURGERYs), and Outpatient Clinical Data (data or encounters), and medical transcription services. The contractor shall accomplish alternate remote/electronic coding systems to code/abstract medical records for off-site coding support to achieve workload requirements via a secure Virtual Private Network (VPN). Also, contractor shall transcribe and type from specific dictated directions and from voice recordings (including both magnetic tape and vendor-owned/leased digital dictation systems).

1.6 Period of Performance (PoP): 12-month Base Period plus 4 option years.

1.6.1 Transition: Transition-in/transition-out period

1.6.1.1.1 Transition-in period: The contractor shall comply with transition-in requirements of the DHA, as listed in paragraph 1.11.1, for contractors needing to be issued Common Access Card (CAC) identification, including Department of Defense (DoD) and DHA-directed training and forms submission, prior to network access.

1.6.1.2 Transition-out period: The transition-out plan shall facilitate the accomplishment of a seamless transition from the incumbent to an incoming contractor/Government personnel at the expiration of the contract.

1.6.1.2.1 The contractor shall comply with transition-out requirements of the DHA for contractors who have been issued a CAC or who generate “records”, as defined by DoD (records manual), including DoD-directed disposition of records, and others displayed on the In/Out (I/O) Processing Portal.

1.7 Administrative specifications

1.7.1. The place of performance is the Washington Metropolitan Area, also defined herein as the National Capital Region (NCR). The primary place of performance for on-site contractors will be at WRNMMC, Bethesda, MD. If the Program Office change to another rlocation in the NCR during the period of performance, the terms and conditions of this PWS remain the same and it shll not result in any additional cost to the Government.

1.7.2 Recognized Federal holidays: The contractor is not required to perform services on the following holidays.

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Juneteenth Day Christmas Day Independence Day

1.7.3 Hours of operation: The contractor is responsible for conducting business Monday thru Friday except Federal holidays. The contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons.

1.7.4 Contractor Telework/Telecommuting: Work location other than primarily location in section 1.7.1 is considered telework location. Telework is authorized for continuity of operations to meet the requirements of this PWS. Teleworking allows contractor personnel to perform their contractual requirements outside of the WRNMMC office, typically at a contractor’s residene or a corporate telecommuting office location. Contractor personnel may be permitted to telework on a regular or recurring basis. The Government reserves the right to increase percentage of contractor personnel available on-site. Prior to telework, the contractor shall have a written telecommuting agreement in place with their company and a copy of the telework agreement provided to the COR and the contracting officer at least seven (7) calendar days prior to the proposed start date of the contractor’s personnel telecommuting schedule. Any changes to the telework schedule requires a new telework agreement and must be provided to the COR and KO at least seven (7) days prior to the proposed start date. All telework must be provided in writing via email to the COR, COR, and the CS stating which day a contractor plans on teleworking and must be approved 7 days in advance.

1.8 Contractor travel: Reserved.

1.9 Other Direct Costs (ODC): Reserved.

1.10 Quality

1.10.1 Quality Control (QC): The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure nonrecurrence of defective services. The contractor’s quality control program is the means by which the work complies with stated requirements. Within thirty calendar days after contract award, three copies of a comprehensive written QCP shall be submitted to the COR and within 5 working days when changes are made thereafter. After acceptance of the Quality Control Plan (QCP) the contractor shall receive the contracting officer’s (CO) acceptance in writing of any proposed change to his QC system. See Technical Exhibit 1 - Contract Data Requirements List (CDRL) A001.

1.10.2 Quality assurance (QA): The government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan provides a systematic method for the Government to evaluate performance and to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.11 Contractor personnel

1.11.1 CAC requirements: For all contractors who will work in Government facilities, the Facilities Security Officer (FSO)/Company's Security point of contact (POC) will provide the Government all the required information per the DHA CAC request process current version 2.1, January 2018, or more recent when updated. See process attached at Part 7 Section 7.1.1 of the PWS. A CAC is the standard identification for eligible DoD contractor personnel.

1.11.1.1 The contractor shall return all CACs to the COR upon the departure of the contractor(s).

1.11.2 Contractor onboarding and training. The contractor shall complete all requirements, training, and forms as prescribed in the following requirements:

1.11.2.1 The DHA’s “Onboarding Checklist for Contractor Employees” is located at the DHA Onboarding and Offboarding Portal at https://info.health.mil/cos/admin/hr/IO/SitePages/Home.aspx

1.11.2.2 The DHA’s contractor training instructions embedded at Part 7 Section 7.1.2.

1.11.2.3 The contractor shall comply with onboarding requirements of the DHA for contractors needing to be issued CAC identification, including DoD- and DHA-directed training and forms submission, prior to network access, as displayed in the In/Out-Processing Portal at:

https://info.health.mil/cos/admin/hr/IO/SitePages/home.aspx (note: Public Key Infrastructure (PKI)-restricted, printed versions available).

1.11.2.4 The DHA’s new employee handbook at Part 7 Section 7.1.4.

1.11.3 Physical Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured.

1.11.4 Removing Employees for Misconduct or Security Reasons. The Government may, at its sole discretion (via the Contracting Officer), direct the Contractor to remove any Contractor employee from this contract for misconduct or security reasons. Removal does not relieve the Contractor of the responsibility to continue providing the services required under the contract.

The Contracting Officer will provide the Contractor with a written explanation to support any request to remove an employee.

1.12 Key personnel (Contractor): The Site Manager and the Deputy Site Manager are key personnel identified in this PWS. These individuals shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the Site Manager is absent shall be designated in writing to the KO. The Site Manager and alternate (Deputy Site Manager) shall have full authority to act for the contractor on contract matters relating to daily operation of this contract. The Site Manager or Deputy Site Manager shall be available between 8:00 a.m. to 4:30 p.m., Monday thru Friday except Federal holidays or when the government facility is closed for administrative reasons. Qualifications for key personnel is identified in paragraph 5.2 of this PWS.

1.13 Data rights: Reserved.

1.14 Reporting

1.14.1 Contractor Manpower Reporting (CMR): RESERVED.

1.14.2 Non-Disclosure Agreement (NDA): All contractor personnel who will obtain access to proprietary, classified, or confidential information or any information release of which is protected or governed by law or regulation associated with DHA acquisitions shall be required to complete and sign a DHA contractor NDA (DHA Form 49) prior to beginning work on the https://info.health.mil/cos/admin/hr/IO/SitePages/Home.aspx https://info.health.mil/cos/admin/hr/IO/SitePages/home.aspx subject contract. The contractor shall execute an NDA on behalf of the company and shall ensure that all staff assigned to, including all subcontractors and consultants, or other personnel performing on contract/Task order execute an NDA protecting the procurement sensitive information of the Government and the proprietary information of other contractors. The NDA shall be executed not later than first day of employment and to be renewed upon exercising a contract option period. Assignment of staff who has not executed this statement or failure to adhere to this statement shall constitute default on the part of the contractor. The contractor shall maintain originally signed NDAs of individual employees and provide copy to the COR.

1.14.3 Government’s COR: The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions: assure that the contractor performs the technical requirements of the contract; perform inspections necessary in connection with contract performance; maintain written and oral communications with the contractor concerning technical aspects of the contract; issue written interpretations of technical requirements, including Government drawings, designs, specifications; monitor contractor's performance and notifies both the KO and contractor of any deficiencies; coordinate availability of government furnished property; and provide site entry of contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting contract.

1.14.4 Post award conference/periodic progress meetings: The contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with FAR Subpart 42.5. The KO, COR, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance.

At these meetings the KO will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.14.5 Staff Availability Report. The Site Manager or Deputy Site Manager shall submit to the COR a report that identifies staffs’ availability on a weekly basis. The report shall include the contractor employee names, role (i.e Inpatient Coder, Outpatient Coder, etc.) and their schedule for the week.

1.15 Contractor Identification

1.15.1 Contractor personnel performing services in a contractor capacity in a Government facility are required to possess and wear an identification badge that displays his or her name and the name of their company. All contractor personnel shall identify themselves as contractor support personnel in all forms of communication with all entities with whom DHA/Deputy Assistant Director for Acquisition (DAD-A)/Head of the Contracting Activity (HCA) has business dealings. The contractor shall: Answer all telephone calls and have a personalized voice message with an introductory statement that includes the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting the DAD-A understands that the person is contractor support personnel.

Include a title block in all emails that states the fact that the person is contractor support personnel. Ensure all those with whom the person interacts in any face-to-face dealings while supporting DHA/DAD-A/HCA understands that the person is contractor support personnel.

1.15.2 Contractor personnel will be required to attend meetings or otherwise communicate with Government and/or other contract representatives to meet the requirements of this order.

Contractor personnel shall make their contractor status known during introductions.

1.15.3 Contractor personnel, while performing in a contractor capacity, are prohibited from using their retired or reserve component military rank or title in any written or verbal communications associated with the contracts in which they provide services.

1.16 Contractor Access to Health Affairs (HA)/DHA Network(s)

1.16.1 FSO/Company's Security POC shall notify the DHA Personnel Security Office after being awarded a contract that requires access to a DoD system (If applicable, if not delete 1.16.1 and 1.16.2 and replace to 1.16 Reserved). Contractor personnel requiring access to the HA/DHA networks for performance of their tasks require a background investigation and the security awareness training. The contractor shall be prepared for this process as it could take two (2) or more weeks. The FSO/Security POC shall submit a Standard Form (SF) 85/86 to DHA's Personnel Security Office for a background investigation.

1.16.2 Company's FSO/Security POC must notify the Personnel Security Office when the contractor has submitted the SF-85/86. The FSO/Security POC, or the COR must notify the DHA Personnel Security Office in writing of a contractor's termination from the contract, including the termination date.

1.17 Personnel Security

1.17.1 The contractor shall comply with DoD 8570.01-M, “Information Assurance Workforce Improvement Program, CH4” November 10, 2015 as amended; 8500.01, “Cybersecurity”, dated March 14, 2014; DoD Manual (DoDM) 6025.18, “Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule Compliance in DoD Health Care Programs” dated March 3, 2019, Department of Defense Instruction (DoDI) 6025.18 “HIPAA Privacy Rule Compliance in DoD Health Care Programs”, dated March 13, 2019; and DoDM

5200.02 “Procedures for the DoD Personnel Security Program (PSP),” incorporation change 3, effective September 24, 2020. Contractor responsibilities for ensuring personnel security include, but are not limited to, meeting the following requirements:

1.17.1.1 Follow the DHA Personnel Security Office guidelines for submittal of security clearances. Contact the DHA Personnel Security Office for guidance on the appropriate background investigation required for personnel on the contract. The DHA Personnel Security Office can be reached at (703) 275-6038.

1.17.1.2 Initiate, maintain, and document personnel security investigations appropriate to the individual’s responsibilities and required access to Controlled Unclassified Information (CUI).

1.17.1.3 DHA Personnel Security Office does not deny any access to any automated information system (AIS), network, or Controlled Unclassified Information (CUI). If a contractor receives an unfavorable background investigation, the request for access will be sent back to the FSO for further action. Any unfavorable adjudication will result in DHA Personnel Security Office not signing off on any access request.

PART 2

2.0 DEFINITIONS, ACRONYMS, AND APPLICABLE

PUBLICATIONS/INSTRUCTIONS

2.1 Definitions:

2.1.1 Reserved.

2.1.2 Reserved.

2.1.3 Contracting Officer (CO): A person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.1.4 Contracting Officer’s Representative (COR): An individual, including a contracting officer’s technical representative (COTR), designated and authorized in writing by the CO to perform specific technical or administrative functions. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.5 Nonpersonal services contract: a contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees.

2.1.6 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance. The Government may either prepare the QASP or require the offerors to submit a proposed quality assurance surveillance plan for the Government’s consideration in development of the Government’s plan.

2.1.7: Turnover Rate: The turnover rate is the percentage of FTEs who left the contract over a reporting period. The turnover rate is calculated by dividing the number of active FTEs lost due to termination or resignation to the total number of active FTEs in a reporting period.

2.1.8. Fill Rate: The fill rate is the percentage of FTE positions filled over the total FTEs required in this PWS. The fill rate is calculated by dividing the number of active FTEs to the total FTEs required in a reporting period.

2.2 Acronyms:

CAC Common Access Card CE Computer Environment CDRL Contract Data Requirement List CMR Contractor Manpower Reporting

CNSSI Committee on National Security Systems Instruction KO Contracting Officer(s) CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTR Contracting Officer's Technical Representative CSP Cloud Service Provider CSSP Cyber Security Service Provider CUI Controlled Unclassified Information DAD-A Deputy Assistant Director for Acquisition DBH Department of Behavioral Services DC3 DoD Cyber Crime Center DCS Department of Clinical Services DD Form 254 Department of Defense Contract Security Requirement List (if applicable) DDS Department of Dental Services DFARS Defense Federal Acquisition Regulation Supplement DHA Defense Health Agency DISA Defense Information System Agency DoD Department of Defense DoDD Department of Defense Directive DoDI Department of Defense Instruction DSAs Data Sharing Agreements DSAA Data Sharing Agreement Application DMS Department of Medical Services DMZ Demilitarized Zone DoDM Department of Defense Manual DPCLO DHA Privacy and Civil Liberties Office DSS Department of Surgical Services DUA Data Use Agreement eMSM Enhanced Multi-Service Markets EULA End User License Agreement EVM Earned Value Management FAR Federal Acquisition Regulation FCI Federal contract information FE Facilities Enterprise FedRAMP Federal Risk Authorization and Management Program FISMA Federal Information Security Modernization Act FRCS Facility Related Control Systems FSO Facilities Security Officer HA Health Affairs HIPAA Health Insurance Portability and Accountability Act HCA Head of the Contracting Activity HIT Health Information Technology IGCE Independent Government Cost Estimate IA Information Assurance IO Initial Outfitting

I/O In/Out Processing Portal IPv Internet Protocol Version IS Information System ISP Internet Service Provider IT Information Technology ISCM Information Security Continuous Monitoring IV&V Independent Verification & Validation MedCOI Medical Community of Interest MHS Military Health System MIL-STD Military Standard MTFs Military Treatment Facilities NCR National Capitol Region NDA Non-Disclosure Agreement NIAP National Information Assurance Partnership NIST National Institute of Standards and Technology OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs OPM Office of Personal Management OSD Office of the Secretary of Defense P-ATO Personal Authorization to Operate P&R Personnel and Readiness PGI Procedures, Guidance and Information PDT Project Delivery Team PHI Protected Health Information PII Personally Identifiable Information PIT Platform Information Technology PK Public Key PKI Public Key Infrastructure POA&M Plan of Action and Milestones POC Point of Contact PMO Program Management Office PoP Period of Performance PP Personal Property PPSM Ports, Protocols, and Services Management PRS Performance Requirements Summary PSP Personnel Security Program PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Plan RFP Request for Proposal RFQ Request for Quotation RMF Risk Management Framework

SP Special Publication SPRS Supplier Performance Risk System SRM Sustainment, Restoration and Modernization SRG Security Requirements Guides STIG Security Technical Implementation Guides TOS Terms of Service US United States UFC Unified Facilities Criteria VPN Virtual Private Network XML Extensible Markup Language

2.3 Applicable Publications, DHA Administrative Instructions (AI), etc. Reserved.

PART 3

3.0 GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

The Requiring Activity Authority has assessed the need for Government Furnished Property, Equipment, and Services and determined:

3.1 Services: The Government:

☐ Will NOT provide Government Furnished Services in support of this contract/task order. As a result, this paragraph is Not Applicable.

☒ WILL provide Government Furnished Services required in support of this contract/task orders. These Services are described below:

Provide Staff orientation, annual training, and online Department of Defense courses if needed.

3.2 Facilities: The Government:

☐ Will NOT provide Facilities in support of this contract/task order. As a result, this paragraph is Not Applicable.

☒ WILL provide Facilities in support of this contract/task orders. The Government provided Facilities are described below:

Provide the necessary workspace for the contractor staff to provide the support outlined in the PWS to include work space and equipment/tool storage area. Parking is not guaranteed to be available.______________________________________________________________________

3.3 Utilities: The Government:

☐ Will NOT provide Utilities in support of this contract/task order. As a result, this paragraph is Not Applicable.

☒ WILL provide Utilities in support of this contract/task orders. The Government provided Utilities are described below:

Provide all utilities available in the facility. The Contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions that preclude the waste of utilities.

3.4 Equipment: The Government:

☐ Will NOT provide Equipment in support of this contract/task order. As a result, this paragraph is Not Applicable.

☒ WILL provide Equipment in support of this contract/task orders. The Government provided Equipment is described below:

Provide computers and peripherals, desks, scanners, fax machines, printers, and other equipment for onsite staff that may assist the contractor in performing the services required in this PWS. A government furnished laptop will be provided to remote support staff.

3.4.1 Procurement Integrated Enterprise (PIEE), GFP Module Application: Reserved.

3.5 Materials: The Government:

☒ Will NOT provide Materials in support of this contract/task order. As a result, this paragraph is Not Applicable.

☐ IS providing Materials in support of this contract/task orders. The Government-provided Materials are described below:

PART 4

4.0 CONTRACTOR FURNISHED ITEMS AND SERVICES

4.1 Services: The Contractor:

☐ Will NOT provide Contractor Furnished Services in support of this contract/task order. As a result, this paragraph is Not Applicable.

☒ WILL provide Contractor Furnished Services required in support of this contract/task orders.

These Services are described below: Reserved.

4.2 General: The contractor shall furnish all supplies, equipment, facilities and services required to perform work listed under Section 5 of this PWS.

4.3 Secret Facility Clearance: Reserved.

4.4 Materials: Reserved.

4.5 Equipment: Reserved.

4.6 Facilities: Reserved.

PART 5

5.0 SPECIFIC TASKS

The following services are to be provided on an annual and monthly basis under this contract:

5.1 Coder Requirements: Inpatient / Day Surgery Unit / Outpatient Clinics and Emergency Department.

The Contractor shall perform on-site and/or remote medical record coding and review of Inpatient/Day Surgery/Outpatient Clinics, Recurrent and Emergency Department encounters in support of all clinic and inpatient services as identified by WRNMMC. The contractor shall perform review and coding for an estimated volume of 80,000 encounters per month in support of WRNMMC (see table below for details). The maximum volume of outpatient encounters will in no event, exceed the estimated quantities contained within the Schedule of Services. The Contractor shall perform on-site/remote coding services utilizing only nationally certified, US citizen, medical coding staff with expertise in medical coding; minimum 3 years of experience in coding their designated Clinic/Specialty. National certification shall be from organizations supported by or associated with the American Health Information Management Association (AHIMA) (i.e., Certified Coding Specialist (CCS), Certified Coding Specialist – Physician Based (CCS-P), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), etc. or the American Association of Professional Coders (AAPC) (i.e., Certified Professional Coder (CPC).

Schedule of Services

TYPE

Estimated 12 month Volume

Estimated Monthly Average

FTE

Inpatient Encounters 12,504 1,042 4 Outpatient Encounters 753,996 62,833 44 Day Surgery Coders 12,000 1,000 4

Inpatient Professional Services 59,004 4,917 4

Anesthesia 30,000 2,500 3 ER Encounters 26,508 2209 3

Inpatient Consults 22,704 1892 2

Note: Encounters provided may fluctuate based on bed capacity.

The Contractor shall provide Nationally Certified Medical Coders: Certified Coding Specialists (CCS), Certified Professional Coding Specialist(s) – Physician Based (CCS-P), Certified Professional Medical Auditors (CPMA), Certified Professional Coder (CPC), Registered Health Information Administrator(s) (RHIA), and/or Registered Health Information Technician(s) (RHIT) to review, code, abstract medical records data. Coders will assign diagnosis and procedure codes for Inpatient Treatment Records (ITR), Inpatient Professional Services (IPS), Anesthesiology Encounters, Emergency Room (ER), Inpatient Rounds (RNDS), Day Surgery, and Outpatient Clinical Data. The Contractor shall provide services in Government Medical Treatment Facilities at the WRNMMC. The Contractor shall furnish all labor and materials (such as coding books/references) except as indicated. Performance shall be according to the requirements contained in this work statement. The Contractor shall also provide Medical Record Coding Services through off-site, electronically Remote Coders, performing Remote Electronic Coding, IAW all requisite information technology (IT) systems, protocols, and procedures in place; provided by the Contractor (except where provided by the Government) submitted for the Government’s verification & validation, as to be in conformance with all applicable DOD regulations.

Services required are for certified coding of inpatient medical records, outpatient medical records (clinic visits), inpatient professional services (rounds), anesthesiology encounters, and day surgery visits. Electronic and hard copy documented medical records will be provided and such documentation can include: provider and allied health personnel progress notes, abbreviated medical records (to include brief summary of chief complaint, history and physical exams, diagnoses, procedures, condition on discharge, etc.), operative and procedure reports, consultations including inpatient consultations, history and physical examinations, laboratory, pathology, radiology and nuclear medicine reports.

Contract employees shall apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding, shall resolve medical record documentation deficiencies through healthcare provider query, and shall provide routine feedback to healthcare providers to correct deficiencies. The contract employees shall work as part of a team to perform medical record coding, to research errors or missing documentation, and to interact with the providers, business managers or other Government personnel and contract employees.

Contract employee working under this contract shall be paid only for hours actually worked at the hourly rates established in the contract. Contractor employee will have a one hour or 30 minute unpaid lunch period. Payment to the Contractor will not be made for temporary work stoppage due to circumstances beyond the control of the Medical Treatment Facility, such as acts of god, inclement weather, power outages, or temporary closing of facilities.

Facility Closures. During anticipated closure of the facility due to Command declared training holidays or during unplanned closure of the facility due to natural disasters, military emergencies, severe weather, or otherwise, the contractor shall continue to work remotely since such closures do not affect the availability of records that needs to be coded.

Federal Holidays. The Contractor will not be paid on federal holidays unless Contractor employee is scheduled to work on a holiday and will be paid for hours worked at the hourly rate established in the contract.

5.1.1 Professional Qualifications/ Specific Task/Responsibilities

WRNMMC will require both on-site and remote medical record coding services to be provided in support of management and medical record support services for the Patient Administration Department at WRNMMC, Bethesda, Maryland.

WRNMMC requires a contractor to provide the systems and services addressed in the scope of work and offer the following experience: Coder certification and experienced users of software preferred for Protected Health Information (PHI).

The contractor must also be capable of providing productivity reports, MHS Genesis audits and reviews, statistical reports and training/feedback to the Government/Providers.

5.1.2 To appropriately support MTF’s, the contractor shall provide the necessary services to achieve the following outcomes:

• Enhance the prompt availability of patient information for providers, as well as accelerating the coding process.

• Reduce on-site revenue cycle management related operating expenses.

• Improve data quality and increase coding quality through state-of-the-art systems and best practices recommendation and implementation.

• Implement productivity-based support services for cost effective operations and improved revenue cycle financial operations efficiency and productivity.

• Improve Quality Assurance and centralized reporting capabilities obtained through a software system with at least a 128 bit encrypted (secure, HIPAA compliant) system.

• Reduce human resource and personnel security management issues through access to remote, highly skilled, nationally certified)) medical record coders.

• Access the government’s system, MHS Genesis, JLV and paper charts, and any new medical documentation system deployed by the MTF via secure systems that resides on the government network and allows for centralized data collection, reporting capabilities, Quality Assurance, and Workflow Management.

• Implement solution’s that re-engineer the current government process to accelerate records completion and the entire coding process.

• Focus on improving processes through a combination of coding from paper format health information onsite, and remote access to the MTF information systems. The government will furnish laptops for remote coders. The government will require a certain number of coders to be on site based on clinical and inpatients needs.

• Meet expected turn-around time for medical coding as follows:

Encounter Type Turn-Around-Time Inpatient Encounters 30 days from date of service Outpatient Encounters 3 Days from date of service Day Surgery Coders 15 days from date of service Inpatient Professional Services 3 days from date of service Anesthesia 15 days from date of service

ER Encounters 3 days from date of service Inpatient Consults 30 days from date of service

The Contractor shall demonstrate support for Medical Records Coding Services through provision of off-site electronically Remote Coders, performing Remote Electronic Coding, IAW all requisite information technology.

Contractor shall have an onsite coder embedded in each department (DMS, DSS, DBH, DCS, DDS) within the facility. The embedded coder would be specialized in the coding encounters within that department.

Embedded coder will act as SME for providers within the Department and participate in training sessions within the department in collaboration with government employees.

(IT) systems, protocols, and procedures in place; provided by the Contractor (except where provided by the Government); submitted for the Government’s verification & validation, as to be in conformance with all applicable DOD regulations

5.1.3 Qualifying/Credentialing Packages

5.1.3.1. The Contractor shall submit a qualifying or credentialing package to the COR for each medical coder no later than fourteen (14) days prior to staff start date after contract award or three (3) days prior to staff start date. Packages shall include resumés, qualifying certifications, licensure, professional experience, medical coder assessment exam result, education and training, competency, and references.

5.1.3.2. All certifications and degrees shall be verified by the prime contractor prior to submission for approval.

5.1.3.3. All candidates must complete medical coder assessment exam and receive a 95% or better score to qualify.

5.1.4 Staff Changes

5.1.4.1 The contractor shall notify the COR at least seven (7) days prior to any anticipated staffing changes such as vacancies as a result of contractor employee voluntary or involuntary termination.

5.2 Manager/Auditor/Training Requirements:

• The Contractor shall designate one (1) Site Manager, (1) Deputy Site Manager, one (1) Lead Coder and one (1) Lead Coding Auditor. The Manager, lead coder, and lead auditor shall be responsible for the performance of the following work activities as well as all contracted coding staff:

o Site manager shall have full authority to act on behalf of the vendor on all matters relating to the daily operation of this contract.

o The Site Manager may also be a Lead Contractor Auditor/Coder providing services in accordance with this work statement.

o The Contractor shall designate this individual in writing to the Contracting Officer and Contracting Officer’s Representative (COR) before the contract start date. An alternate may be designated; however, the Contractor shall identify those times when the alternate shall be the primary point of contact.

o The Lead Auditor(s) will be responsible for auditing the contract coders and ensuring their quality of work meets the industry standards in coding.

o The Lead Auditor(s) will respond to all audits conducted by either a Federal Agency or MTF Contracted Auditor.

• Contractor shall provide Coding services and shall work with physicians in all outpatient clinics in the MTF as follows:

o Compare physician documentation with MHS Genesis coding output to determine accuracy level as well as direct training methodology for audited physician or clinic.

o Ensure training of all outpatient contract coders in regard to HIPAA, CBTs, Command trainings and all coding updates, DoD, MHS directives issued.

o Review and assist in the preparation and updating of clinic coding templates.

o Ensure all identified coding errors will be corrected within 3 business days of notification.

o Respond to coding resource inquiries by physicians in regard to number of RVUs captured, workload, etc.

o Attend regularly scheduled clinic meetings as requested by clinic leadership. This will include staff meetings, department meetings, and any other meetings as requested.

o Respond to all email inquiries from clinical and administrative staff within 24 hours of request.

o Attend and participate in all meetings regarding implementation of any command documentation and or coding strategic initiatives.

o Prepare monthly productivity reports and progress reports which detail the results of audits conducted, feedback, and training provided during the month.

5.3 Coder Requirements: Inpatient / Day Surgery / Outpatient Clinics and Emergency Department.

• Contractor provided coders are responsible for completing training on all government systems once assigned to the MTF.

• Contractor provided coders shall review codes for each encounter within 48 business hours of receipt of record/encounter. Business hours are defined as Monday through Friday, 0700 to 1700 hours (local time), exclusive of Federal Holidays.

• Contractor provided coders will be assigned by the MTF to an individual clinic in reasonable space to accommodate the needs of the individual.

• Contractor provided coders shall interact and work with the clinic leadership as well as the MTF coding supervisor on issues pertaining to coding of physician documentation.

• Contractor shall assign an emergency coder each week (in writing) to capture any late appointed day surgery records that are likely to fall out of compliance.

• Contractor is responsible to ensure that their coding staff maintain their certifications and stay current on updates and changes to the International Classification of Disease -10th Edition-Clinical Modification(ICD-10-CM), Current Procedural Terminology (CPT), Military Healthcare System (MHS) Professional and Inpatient Coding Guidelines, and other classification systems utilized within the MHS.

5.4 SITE MANAGER / MANAGEMENT SUPPORT

5.4.1 PROFESSIONAL QUALIFICATIONS / RESPONSIBILITIES.

All Contractors shall meet the qualifications for that specialty and perform essentially the same functions, within the scope acceptable for their technical professional discipline and standard, as those required by government service technical professionals of similar experience and in similar duty assignments. Contractor practices/productivity will be compared to that of other Contractors assigned to the same medical center.

• The Contractor shall provide certified medical record coders for the coding of Inpatient, Inpatient Professional Services, Day Surgery, ER, and Outpatient medical services.

• The Contractor shall designate one (1) Site Manager. The Site Manager shall be responsible for the performance of the work activities of all contracted coding staff. The Site Manager shall have full authority to act on behalf of the contractor on all matters relating to the daily operation of this contract. The Site Manager may also be a lead contractor coder providing services in accordance with this work statement.

• Resolve, on a daily bases, any coding discrepancies, mediating disputes, setting audit assignments, time and attendance, and performance improvement planning.

• Assign work, and create work lists using MHS Genesis

• Provide educational feedback to the Government and Providers addressing inappropriate patterns of documentation of records audited. Maintain records and statistics to include quality control measures, MHS Genesis reporting, accuracy of coding, workload completed, and ad hoc reports as required.

• The Site Manager shall have sufficient experience in the medical coding area with a minimum of five (5) years of supervisory experience with coding, auditing of medical records, and inpatient medical records coding, in addition to the following specific skills:

• Certified Professional Coder (Need to be certified through the American Health Information Management Associations (AHIMA) credentials – RHIA or RHIT, and CCS or through AAPC – Certified Professional Coder.

• Extensive knowledge and understanding of the MHS and CMS official guidelines for coding and reporting.

• Knowledge of medical terminology and usage, including general medical, surgical, pharmaceutical, hospital terms and abbreviations and abstracting techniques

• Knowledge of a broad range of references such as the ICD-10-CM, ICD-10- PCS, CPT, HCPCS, medical dictionaries, manuals relating to coding textbooks and glossaries

• Knowledge of legal and regulatory requirements of medical records

• Knowledge of medical records procedures, regulations and principles to carry out a variety of medical records functions such as analysis, coding, ensuring compliance, and compiling data

• Knowledge of data collection methods for basic health care, research information and statistical reporting

• Knowledge of laws and regulations on the confidentiality of medical records

• Skill in effective oral and written communication

5.4.2 Management Support Workload Data:

• Collect and produce weekly and monthly productivity reports.

• Prepare productivity summaries.

• Ensure accurate coding of medical records.

• Participate in all mandatory Command training.

The Contractor shall assume additional administrative duties as requested or needed to ensure sustainment of normal operations and ensure compliance with Joint Commission standards.

5.5 CODER: INPATIENT / DAY SURGERY MEDICAL RECORDS

5.5.1 PROFESSIONAL QUALIFICATIONS / RESPONSIBILITIES.

All Contractor’s shall meet the qualifications for that specialty and perform essentially the same functions, within the scope acceptable for their technical professional discipline and standard, as those required by government service technical professionals of similar experience and in similar duty assignments. Contractor practices/productivity will be compared to that of other Contractors assigned to the same medical center.

• The Contractor shall provide certified medical record coders for the on-site coding of Inpatient, Inpatient Professional Services, and Day Surgery visits medical services provided to Government beneficiaries. Inpatient coders shall review a minimum number of records based on the productivity rate as indicated in the MHS Coding Guidelines depending on complexity, along with other responsibilities as clinical staff request. This may include providing feedback to providers on coding guidelines or documentation requirements, such as clinical notes documented in Essentris or current medical documentation system, including Inpatient professional services, Emergency Department visits and being available to respond to coding inquiries by providers and clinic staff.

• Provide productivity worksheet reflecting on-going summaries of total number of records coded and submitted for billing.

• Provide educational feedback to coders and physicians addressing inappropriate patterns of documentation and coding.

• Submit Daily Activity Reports to the WRNMMC Patient Administration Department (PAD) Division Officer of Inpatient Administration as requested through the site manager.

• Have sufficient experience in the medical coding area with a minimum of two (2) years of continuous inpatient coding experience required and the following specific skills:

• Present documents of certification through one of the following organizations: American Academy of Professional Coders (AAPC); credentials – CPC, CPC-H, CPC-P, CPMA or American Health Information Management Associations (AHIMA); credentials – RHIA, RHIT, CCS, and CCS- P.

• Understand and apply knowledge from the official coding clinic guidelines.

• Use and apply knowledge of medical terminology, including general medical, surgical, pharmaceutical, hospital terms and abbreviations and abstracting techniques.

• Apply knowledge of a broad range of references such as the ICD-10-CM, ICD-10 -PCS, CPT, HCPCS, medical dictionaries, manuals relating to coding textbooks, and glossaries.

• Apply knowledge of legal and regulatory requirements of medical records.

• Apply knowledge of medical records procedures, regulations and principles to carry out a variety of medical records functions such as analysis, coding, ensuring compliance, and compiling data.

• Apply knowledge of data collection methods for basic health care, research information and statistical reporting.

• Apply knowledge of HIPAA laws and DoD/MHS/WRNMMC regulations on the confidentiality of medical records.

• Employ skills of effective oral and written communication.

5.5.2 Medical Record Coding Workload Data:

• Provide an average of 24,504 Inpatient and Day Surgery coding support actions for the 12 month POP.

• Provide on-site and remote coding services for inpatient medical records, inpatient professional services and day surgery.

• Prepare and submit approximately 48 weekly activity reports per year.

• Participate in all mandatory Command training.

• Provide personnel certified in the field of medical coding. Certification will be through the American Health Information Management Association (AHIMA) as a Certified Coding Specialist-Physician based (CCS-P) or Registered Health Information Technician (RHIT) or through the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC). Proof of current certification is required. Minimum of two (2) years of experience performing similar Inpatient functions in tertiary care medical centers is also required.

• Any Contract personnel found to be unacceptable in administering skills required by the Contract may be released from duty by a Government contracting official. The COR will immediately notify the Contracting Officer.

• The Contractor shall assume additional administrative duties as requested or needed to ensure sustainment of normal operations and ensure compliance with Joint Commission standards.

5.6 CODER : OUTPATIENT /IPSR / INPATIENT CONSULTS / ANESTHESIA /

EMERGENCY

5.6.1 PROFESSIONAL QUALIFICATIONS / RESPONSIBILITIES.

All Contractor’s shall meet the qualifications for that specialty and perform essentially the same functions, within the scope acceptable for their technical professional discipline and standard, as those required by government service technical professionals of similar experience and in similar duty assignments. Contractor practices/productivity will be compared to that of other Contractors assigned to the same medical center.

• The Contractor shall provide on-site and remote certified medical record coders for the coding of medical services provided to Government beneficiaries. Coders will be assigned to remote coding based on the needs of the Department.