PWS HICBA VIRR Draft.docx

HICBA VIRR Software Solution

VA-25-00010161

PERFORMANCE WORK STATEMENT (PWS)

DEPARTMENT OF VETERANS AFFAIRS

Office of Information & Technology Development, Security, and Operations (DSO) and Health Informatics (HI)

Health Information Coding, Billing, & Auditing (HICBA) Veterans Health Information Systems and Technology Architecture (VistA) Integration, Revenue, and Reporting (VIRR) software solution

Date: 10/30/24

VA-25-00009154

PWS Version Number: 1.0

Contents

BACKGROUND

The Department of Veterans Affairs (VA), Veterans Health Administration (VHA) physicians, nurses, and health care personnel provide quality medical treatment to more than nine million Veterans and their families per year. VHA personnel practice all medical specialties and provide medical and rehabilitative treatment of all kinds, from acute to long term care to outpatient care.

VHA Directive 1233, “Closeout of Veterans Health Administration Corporate Patient Data Files Including Quarterly Census”, mandates the use of an enterprise-wide Encoder software solution inclusive of reporting and revenue workload management functions. The Health Information Coding, Billing and Auditing (HICBA) solution is comprised of two components which interface: the HICBA Encoder software solution; and the HICBA Veterans Health Information Systems and Technology Architecture (VistA) Integration, Reporting, and Revenue (VIRR) software solution. This Performance Work Statement (PWS) contains requirements for the HICBA VIRR software solution.

VHA’s Health Information Management (HIM) Program Office within VHA’s Office of Health Informatics, Health Information Governance, is the business owner of the HICBA Encoder and VIRR software solutions that assist VHA management, HIM coding, revenue operations, and clinical documentation integrity (CDI) professionals in accurately and consistently coding and billing health care encounters and inpatient stays.

As VHA transitions its Electronic Health Record to a Cerner solution under the leadership of the Office of Electronic Health Record Modernization, it is imperative that the HICBA solution continue to meet the mandates of VHA Directive 1233, to include the full spectrum of enterprise-wide encoder and revenue reporting and to provide for enterprise-wide utilization of a product to expedite coding processes and ensure all patient care services impacting revenue are coded in a timely manner (with at least weekly reporting). Enterprise reporting capabilities must be seamless across Cerner-implemented and VistA legacy sites.

The HICBA VIRR software solution assists VHA HIM and revenue staff in collecting quality health care data and accurately reporting the codes that are used to determine the complexity and level of care provided to our patient population; and it assists VHA management and leadership with ensuring timely coding and revenue cycle activities.

APPLICABLE DOCUMENTS

In the performance of the tasks associated with this Performance Work Statement, the Contractor shall comply with the following:

1. 44 U.S.C. § 3541-3549, “Federal Information Security Management Act (FISMA) of 2002”

2. “Federal Information Security Modernization Act of 2014”

3. Federal Information Processing Standards (FIPS) Publication 140-2, “Security Requirements for Cryptographic Modules”

4. FIPS Pub 199. “Standards for Security Categorization of Federal Information and Information Systems,” February 2004

5. FIPS Pub 200, “Minimum Security Requirements for Federal Information and Information Systems,” March 2006

6. FIPS Pub 201-2, “Personal Identity Verification of Federal Employees and Contractors,” August 2013

7. 10 U.S.C. § 2224, "Defense Information Assurance Program"

8. 5 U.S.C. § 552a, as amended, “The Privacy Act of 1974”

9. Public Law 109-461, Veterans Benefits, Health Care, and Information Technology Act of 2006, Title IX, Information Security Matters

10. 42 U.S.C. § 2000d “Title VI of the Civil Rights Act of 1964”

11. VA Directive 0710, “Personnel Security and Suitability Program,” June 4, 2010, https://www.va.gov/vapubs/index.cfm

12. VA Handbook 0710, “Personnel Security and Suitability Program,” May 2, 2016, https://www.va.gov/vapubs/index.cfm

13. VA Directive and Handbook 6102, “Internet/Intranet Services,” August 5, 2019

14. 36 C.F.R. Part 1194 “Information and Communication Technology Standards and Guidelines,” January 18, 2017

15. Office of Management and Budget (OMB) Circular A-130, “Managing Federal Information as a Strategic Resource,” July 28, 2016

16. 32 C.F.R. Part 199, “Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)”

17. NIST SP 800-66 Rev. 1, “An Introductory Resource Guide for Implementing the Health Insurance Portability and Accountability Act (HIPAA) Security Rule,” October 2008

18. Sections 504 and 508 of the Rehabilitation Act (29 U.S.C. § 794d), as amended, January 18, 2017

19. Homeland Security Presidential Directive (12) (HSPD-12), August 27, 2004

20. VA Directive 6500, “VA Cybersecurity Program,” February 24, 2021

21. VA Handbook 6500, “Risk Management Framework for VA Information Systems VA Information Security Program,” February 24, 2021

22. VA Handbook 6500.2, “Management of Breaches Involving Sensitive Personal Information (SPI),” March 12, 2019

23. VA Handbook 6500.5, “Incorporating Security and Privacy into the System Development Lifecycle,” March 22, 2010

24. VA Handbook 6500.6, “Contract Security,” March 12, 2010

25. VA Handbook 6500.8, “Information System Contingency Planning,” April 6, 2011

26. VA Handbook 6500.10, “Mobile Device Security Policy,” February 15, 2018

27. VA Handbook 6500.11, “VA Firewall Configuration,” August 22, 2017

28. OIT Process Asset Library (PAL), https://www.va.gov/process/ . Reference Process Maps at https://www.va.gov/process/maps.asp and Artifact templates at https://www.va.gov/process/artifacts.asp

29. One-VA Technical Reference Model (TRM) (reference at https://www.va.gov/trm/TRMHomePage.aspx)

30. VA Directive 6508, “Implementation of Privacy Threshold Analysis and Privacy Impact Assessment,” October 15, 2014

31. VA Handbook 6508.1, “Procedures for Privacy Threshold Analysis and Privacy Impact Assessment,” July 30, 2015

32. VA Handbook 6510, “VA Identity and Access Management,” January 15, 2016

33. VA Directive and Handbook 6513, “Secure External Connections,” October 12, 2017

34. VA Directive 6300, “Records and Information Management,” September 21, 2018

35. VA Handbook, 6300.1, “Records Management Procedures,“ March 24, 2010

36. NIST SP 800-37 Rev 2, “Risk Management Framework for Information Systems and Organizations: A System Life Cycle Approach for Security and Privacy,” December 2018

37. NIST SP 800-53 Rev. 5, “Security and Privacy Controls for Federal Information Systems and Organizations,” September 23, 2020 (includes updates as of 12/10/2020)

38. VA Directive 0735, “Homeland Security Presidential Directive 12 (HSPD-12) Program,” October 26, 2015

39. VA Handbook 0735, “Homeland Security Presidential Directive 12 (HSPD-12) Program,” March 24, 2014

40. OMB Memorandum 05-24, “Implementation of Homeland Security Presidential Directive (HSPD) 12 – Policy for a Common Identification Standard for Federal Employees and Contractors,” August 5, 2005

41. OMB Memorandum M-19-17, “Enabling Mission Delivery Through Improved Identity, Credential, and Access Management,” May 21, 2019

42. OMB Memorandum, “Guidance for Homeland Security Presidential Directive (HSPD) 12 Implementation,” May 23, 2008

43. Federal Identity, Credential, and Access Management (FICAM) Roadmap and Implementation Guidance, December 2, 2011, (NOTE: Part A of the FICAM Roadmap and Implementation Guidance, v2.0, was replaced in 2015 with an updated Architecture (https://arch.idmanagement.gov/#what-is-the-ficam-architecture)

44. NIST SP 800-116 Rev 1, “Guidelines for the Use of Personal Identity Verification (PIV) Credentials in Facility Access,“ June 2018

45. NIST SP 800-63-3, 800-63A, 800-63B, 800-63C, “Digital Identity Guidelines,” updated March 02, 2020

46. NIST SP 800-157, “Guidelines for Derived PIV Credentials,” December 2014

47. NIST SP 800-164, “Guidelines on Hardware-Rooted Security in Mobile Devices (Draft),” October 2012

48. Draft National Institute of Standards and Technology Interagency Report (NISTIR) 7981, “Mobile, PIV, and Authentication,” March 2014

49. VA Memorandum, VAIQ #7100147, “Continued Implementation of Homeland Security Presidential Directive 12 (HSPD-12),” April 29, 2011 (reference https://www.voa.va.gov/documentlistpublic.aspx?NodeID=514)

50. IAM Identity Management Business Requirements Guidance document, May 2013, (reference Enterprise Architecture Section, PIV/IAM (reference https://www.voa.va.gov/documentlistpublic.aspx?NodeID=514)

51. VA Memorandum “Personal Identity Verification (PIV) Logical Access Policy Clarification,” July 17, 2019, https://www.voa.va.gov/DocumentView.aspx?DocumentID=4896

52. Trusted Internet Connections (TIC) 3.0 Core Guidance Documents, https://www.cisa.gov/publication/tic-30-core-guidance-documents

53. OMB Memorandum M-19-26, “Update to the Trusted Internet Connections (TIC) Initiative,” September 12, 2019

54. OMB Memorandum M-08-23, “Securing the Federal Government’s Domain Name System Infrastructure,” August 22, 2008

55. Sections 524 and 525 of the Energy Independence and Security Act of 2007, (Public Law 110–140), December 19, 2007

56. Section 104 of the Energy Policy Act of 2005, (Public Law 109–58), August 8, 2005

57. Executive Order 13834, “Efficient Federal Operations,” dated May 17, 2018

58. Executive Order 13221, “Energy-Efficient Standby Power Devices,” August 2, 2001

59. VA Directive 0058, “VA Green Purchasing Program,” July 19, 2013

60. VA Handbook 0058, “VA Green Purchasing Program,” July 19, 2013

61. Office of Information Security (OIS) VAIQ #7424808 Memorandum, “Remote Access,” January 15, 2014, https://www.voa.va.gov/DocumentListPublic.aspx?NodeId=28

62. Clinger-Cohen Act of 1996, 40 U.S.C. §11101 and §11103

63. “Veteran Focused Integration Process (VIP) Guide 4.0,” January 2021, https://www.voa.va.gov/DocumentView.aspx?DocumentID=4371

64. VA Memorandum “Proper Use of Email and Other Messaging Services,” January 2, 2018, https://www.voa.va.gov/DocumentListPublic.aspx?NodeId=28

65. “DevSecOps Product Line Management Playbook” version 2.0, May 2021, https://www.voa.va.gov/DocumentView.aspx?DocumentID=4946

66. NIST SP 500-267B Revision 1, “USGv6 Profile,” November 2020

67. OMB Memorandum M-21-07, “Completing the Transition to Internet Protocol Version 6 (IPv6),” November 19, 2020

68. Social Security Number (SSN) Fraud Prevention Act of 2017

69. Section 240 of the Consolidated Appropriations Act (CAA) 2018, March 23, 2018

SCOPE OF WORK

VHA currently consists of 140+ medical centers and seven Consolidated Patient Account Centers (CPACs) located in all 50 states and Puerto Rico. Coding of all inpatient encounters, billable outpatient encounters, and all surgery encounters. as well as billing and compliance auditing is performed for the medical services provided at each of these facilities. Billing functions are also performed at the seven CPACs.

The Contractor shall provide a VIRR software solution which provides functionality for coding and revenue workflows and communications facility, Veterans Integrated Service Network (VISN), and enterprise reporting for coding and revenue; and shall also provide the integration with VistA and the current HICBA Encoder software solution to enable these functionalities.

The Contractor shall provide a Commercial-Off-The-Shelf (COTS) bill scrubbing software suite solution with enterprise level software access and/or licensing. The Contractor shall provide the HICBA VIRR solution to include term licensing, interfacing with VistA, updates to the application, compliance with International Classification of Diseases (ICD) translations, provision of a centralized reporting module for monitoring productivity, training, and technical support. An optional task is included for transition out support.

PERFORMANCE DETAILS

PERFORMANCE PERIOD

The period of performance (POP) shall be 8-months, plus two, 12-month option periods, and one 4-month option period and one optional task to be exercised at the Government’s discretion.

Any work at the Government site shall not take place on Federal holidays or weekends unless directed by the Contracting Officer (CO).

There are eleven (11) Federal holidays set by law (USC Title 5 Section 6103) that VA follows:

Under current definitions, four are set by date:

If any of the above falls on a Saturday, then Friday shall be observed as a holiday. Similarly, if one falls on a Sunday, then Monday shall be observed as a holiday.

The other six are set by a day of the week and month:

PLACE OF PERFORMANCE

Tasks under this PWS shall be performed in Contractor facilities.

TRAVEL

The Government anticipates no travel is required under this effort to perform the tasks detailed in this PWS.

SPECIFIC TASKS AND DELIVERABLES

The Contractor shall provide software which consists of an application software suite solution that enables VA coding, HIM, and revenue professionals to accurately and consistently code health care encounters and inpatient stays and provide the full spectrum of enterprise-wide Encoder and revenue reporting. The Contractor shall provide VA with enterprise-wise utilization of a product to expedite the revenue process involving coding and ensure all billable events are coded and provided to revenue operations in a timely manner (with at least weekly reporting).

The Contractor shall provide software which includes an VA enterprise-wide license for an unlimited number of users. No additional costs shall be associated with adding users.

The VIRR solution is critical for operations. The Contractor shall ensure the VIRR software suite solution interfaces with both VistA and the current HICBA Encoder software solution to and enable timely exchange of patient data across all components of HICBA. An optional task is needed if there is a change to the Encoder solution to include the transition of the VIRR to work with a new encoder solution (if applicable). In addition, the Contractor shall provide the capability to set up a Secure File Transfer Protocol (SFTP) connection with VA, or secure alternative, in order to distribute new versions and patches to the VIRR solution suite, in a format compatible with VA.

PROJECT MANAGEMENT

CONTRACTOR PROJECT MANAGEMENT PLAN

The Contractor shall designate a Contractor Project Manager (PM) as the main point of contact (POC) between the VA Program Manager (PM) and Contractor organization on this PWS effort. The PM shall also oversee and manage the schedule and all tasks associated with this PWS.

The Contractor shall:

A. Plan and schedule a kickoff meeting within 10 days following contract award to outline the approach and review the schedule. The meeting shall be held via teleconference.

B. Provide a Staffing Assignment Worksheet listing all Contractor personnel assigned to this project, their contact information, and their role. If Contractor staff requires background investigations, PIV Badges, and access to the VA email system, the Contractor shall include these requirements in the Staffing Assignment Worksheet. Additional information will be required to accomplish the access requests.

C. Develop and maintain a Project Management Plan (PMP) that describes the technical approach, organizational resources, and management controls to be employed to meet the schedule and performance requirements defined in this PWS. The PMP shall include a Risk Management and Communication Plan.

D. Develop and maintain an Integrated Master Schedule (IMS) using a scheduling tool, such as Microsoft (MS) Project or Excel. The preliminary IMS shall identify phases and milestones (such as the delivery of the licenses, enhancement implementation (to include testing, training, etc.) and provide sufficient detail to identify deliverable dates, and when the Government will be expected to attend meetings, review documentation, provide test resources, and other interactions. The Contractor shall maintain the IMS by keeping it current, as dictated by program events and in coordination with the VA PM. The IMS shall be distributed in a PDF or MS Office format.

E. The Contractor shall provide an Implementation Plan for the Contractor’s approach to provide the HICBA VIRR services at facilities across the VA enterprise. The Implementation Plan shall include a detailed timeline of events to include testing of software, access requirements to VA facilities, VA support requirements, and training.

F. Collaborate with the VA OIT Organization to develop and maintain deliverables, and to perform the tasks specified herein.

G. Collaborate with project stakeholders to identify, prioritize, scope, bound, resource and assess course of actions related to program risks. The Contractor shall inform the VA PM of relevant deliberations and Contractor recommendations.

H. Work to mitigate and resolve program risks as they are identified.

I. Develop and submit Monthly Progress Reports (MPR). The MPR shall report activities completed in the prior month and those planned for the next month. The MPR shall include project status summary, Change Request status (new, open, and closed since last report), Issue/Action Item status (new, open, and closed since last report), Risk items and their disposition, Schedule status and a summarized Trip Report for all travel that occurred in the previous month and trips planned for current month. The Trip Report shall summarize the events and actions that occurred during the trips, identify any issues that arose during the trips, and outline any action items with responsible parties and dates that came about from the trips.

J. Create meeting materials (within five days prior to meeting) for all conference calls and/or meetings held with the VA PM.

K. The Contractor shall notify the VA PM, Contracting Officer’s Representative (COR), and CO, in writing, immediately if problems arise adversely impacting the performance of the tasks of this PWS.

L. Attend monthly conference calls with representatives from the VA HIM Program Office, COR, CPAC, the Office of Integrity and Compliance (OIC) and the Office of Information and Technology (OI&T) at a mutually agreed upon date/time. The calls shall identify upcoming software changes, training activities, policy changes, and issues identified by the field facilities, etc. The issues may occur in software, training, business process, workload, etc. The business partners on the call shall review and implement changes that shall correct the issue. If issues are due to Contractor software, training, work process or Contractor’s Help Desk, Contractor shall present to the COR and CO resolution within seven days following identification of issue.

M. The Contractor shall provide the task order-level Contractor Manpower Report to the COR; and if required, supplement with any element below that may not be delineated currently:

a. Name

b. Certifications held

c. Labor category

d. Site Location

e. Start date

f. Separation date

g. Team assigned

h. In/ Out processing progress status details (to include all aspects)

i. Background investigation progress status and date released

j. VA required training completion dates

k. For GFE, need to provide make, serial# and model info

Deliverables:

A. Staffing Assignment Worksheet B. Project Management Plan C. Integrated Master Schedule D. Implementation Plan E. Monthly Progress Reports F. Quarterly Manpower/GFE Report

SOFTWARE REQUIREMENTS

The Contractor shall provide one VIRR bill scrubbing and revenue reporting software suite solution that is for all VHA facilities, to support health record coding, clinical documentation integrity initiatives, billing compliance, as well as workflow efficiency. The Contractor’s VIRR solution shall have a single user interface from which all information can be accessed. The VIRR solution suite shall interface with VistA and provide the integration necessary for VA’s HICBA Encoder software solution. The Contractor shall ensure seamless integration of its VIRR solution with VA’s HICBA Encoder, as these applications and functionalities are critical for operations and timely exchange of patient data. In addition, the VIRR software suite solution shall allow the use of VA’s PIV card system credentials for granting appropriate access to the VIRR software suite.

The VIRR software suite solution shall include reporting functionality for analyzing data that impacts revenue and VA Equitable Resource Allocation (VERA), and management, clinical documentation integrity (CDI) workflow, and productivity reporting at the facility, VISN, and enterprise levels. Specific reporting requirements will be determined by VHA in coordination with the Contractor, as part of the transition-in support task.

The VIRR software suite solution shall provide bi-directional interface with VHA’s VistA to interact with VistA packages, such as (but not limited to): Patient Treatment File (PTF), Patient Care Encounter (PCE), and Surgery using Remote Procedure Calls (RPC), unless otherwise directed by VA OIT team. All ICD, Current Procedural Terminology (CPT®) codes, and Case Comments that are entered in the VIRR solution shall be transferred to VistA packages such as PCE, PTF, the Integrated Billing (IB). The VIRR software suite solution shall integrate with the HICBA Encoder software solution. The Contractor shall provide Product Documentation for the VIRR software suite solution, including role-based manuals (e.g., User, Administrator) for all VIRR functionality (e.g., Reporting, Bill Scrubbing, etc.).

The following list of reference manuals and resource material is VA standard for coding across the agency. The Contractor shall ensure all products provided as a result of this procurement effort support the current versions of standards used within VA. Additionally, the VA shall maintain appropriate license agreements for use of the Current Procedural Terminology (CPT) of the American Medical Association (AMA),UB-04 data of the American Hospital Association (AHA), and other HIPAA-standard code sets as indicated.

Deliverable:

A. HICBA VIRR Software Suite Solution with Product Documentation

BILLING SOFTWARE REQUIREMENTS

As part of the VIRR solution, the Contractor shall include bill scrubbing software which provides facilities with the ability to perform interim and final checks of institutional and professional fee encounters, inpatient stays, and claims, prior to being finalized for billing in VistA IB.

The bill scrubbing software shall assist claims reviewers in assessing which bills are billable and/or have special considerations, according to third party payers’ reimbursement rules. The Contractor’s bill scrubbing software shall perform the following:

a. System shall contain logic that enforces the Correct Coding Initiative (CCI) coding edits at point of entry (integrated logic in application). The system logic shall also enforce Centers for Medicare and Medicaid Services/American Hospital Association (CMS/AHA) coding guidelines to ensure correct code is selected and captured.

b. System shall contain third party billing rules and shall automatically utilize these rules during bill processing.

c. System shall provide an electronic report that details the daily bill scrubber usage by each user. This report will provide supervisors the ability to see if bill scrubber is being utilized effectively by all billers.

d. System's encounter status codes shall include a status for 'reviewed/not billable' to indicate that an encounter has been determined not to be billable.

e. System shall provide status indication for billers if first party copayment charges are 'on hold' when encounter is flagged 'reviewed/not billable'.

f. Integrated bill scrubbing system (integrated to VistA IB module) must include a single claim scrubber that performs claim audit based on requirements of particular claim type or the particular payer prior to filing for payment.

g. System shall include a claim scrubber to audit health insurance claims for technical and coding accuracy prior to or after claims are submitted to payer.

h. System shall provide ability to report bill scrubber results.

i. System shall electronically access patient insurance coverage limitations (integrated to VistA) from the bill scrubbing module, allowing billers to view this data without leaving bill scrubber system to access VistA.

j. System shall allow various security levels for billers, including an access level to cancel bills. When bills are cancelled, the 'cancelled date', 'status', 'reason not billable' and 'reason not billable comments' shall be updated in the encounter record for supervisor review.

k. Claims scrubber shall enforce edits for the National Provider Identifier (NPI) and the Present on Admission (POA) rules.

l. System shall generate reports that identify encounters with insurance identified retrospectively for billing. When new insurance information is entered about a patient, the system shall automatically check his/her previous encounters from the effective date of the insurance policy to current to determine if billable encounters exist.

m. System shall allow the biller to see if there are other billable encounters for the same date of service to include all services on one claim.

n. System shall include a batch claim scrubber to audit health insurance claims for technical and coding accuracy prior to or after claims are submitted to payer.

o. System shall provide insight into coding edits and billing edit configuration.

p. System shall allow entry and maintenance of customizable third-party billing rules automatically utilized during bill processing. Provision of a dynamic tool for user-defined edit maintenance to create specific edit logic based on data elements found on professional or institutional claims. To include user interface, customizable edit configurations, edit descriptions, and edit messages to proving supporting information on why the edit has occurred.

q. System shall automatically generate Medicare Severity-Diagnosis Related Group (MS-DRG) (CMS DRG Grouper) codes for billing and provide a linkage to the IB package through VistA.

r. System shall contain logic that automatically sequences codes based on Relative Value Unit (RVU) weights.

s. System shall electronically enforce medical necessity checks using logic that reflects Medicare Code Edits by CMS that verifies that the diagnosis code(s) supports medical necessity of CPT codes reported.

t. System shall provide electronic reporting to include a higher frequency of data content updates and to minimize VA infrastructure support.

u. System shall provide ability to view when patients have other encounters on the same date of service and provide information needed to determine where the encounters are within the revenue life cycle.

COMPLIANCE REQUIREMENTS

As part of the VIRR solution, the Contractor shall include a compliance monitoring and reporting module. The Contractor shall ensure the VIRR software suite solution Product Documentation includes the compliance roles. The Contractor’s compliance module shall perform the following:

a. System shall automatically capture an audit trail on all changes to encounters – inpatient, surgeries, and outpatient. The system shall capture the user ID who made each change, the reason for each change and the time date stamp for each change, as well as maintaining the original entry. Reports shall be included in the system to provide this change detail within a given date range (user defined).

b. System shall have integrated compliance monitors and customized edits incorporated in application logic (Medicare Code Edits, Relational Code Edits, E-Code Edits, Proprietary Revenue, Data Quality Office of Inspector General (OIG) Selection). All levels of custom rules shall only be entered/maintained by selected users with specific security key access. System shall provide ability to generate data exports using various criteria for selection, including: provider, clinic, division (Community-Based Outpatient Clinic [CBOC]-level), specific codes (CPT, HCPCS, ICD), stop codes, codes changed by coder (audit trail data), trending reports, and changes in collections and/or billing based on changes in coded data, payer, age, count- and non-count clinics.

c. System shall electronically produce reports of bills that are incomplete. The compliance module shall ensure: CMS 1500 bills include patient demographics, diagnosis and procedure codes, rendering and ordering provider information and basic claim demographics (place of service, modifier, billed dollars, unit values); and, Uniform Bill-04 (UB-04) bills include patient demographics, diagnosis and procedure codes (ICD procedure codes for inpatient, HCPCS procedure codes for outpatient), appropriate revenue codes, rendering and ordering provider information and basic claim demographics (type of bill, condition codes, value codes, date of accident or date treatment first began). The report shall support multiple sort criteria, for example clinic, physician, date, coder, or biller.

d. System shall include a reporting module that allows VistA-data mining and filtering on all data fields to customize reports for HIM staff , CDI, billing staff, and compliance staff at facility, VISN, and enterprise levels. Outputs from these reports shall be formatted for display on a published monthly VHA dashboard.

e. The Contractor shall be able to make enhancements to the compliance module to support National VHA business process changes or needs.

f. Software suite solution shall support user data collection capability mandated by CMS and other governing bodies, such as Present On Admission (POA).

g. The VIRR software suite solution shall enable specific user groups with VistA security key assignments to generate templated form emails from records within the software using MS Outlook in an automated process which enables the user to add standard capability encryption. The VIRR solution shall provide the capability to record the date the e-mail is initially sent and the dates of responses. The solution shall also enable tracking of the status of the e-mail and the impact of the e-mail exchange on the subject record.

h. The system's compliance module shall provide random sampling capabilities when pulling encounters for compliance retrospective or self-reviews.

i. All reports (including ad-hoc) shall have the ability to utilize a special patient identifying column that contains identification other than the Social Security Number (SSN) (to support the SSN Elimination project). This patient-identifying column shall use a VHA-defined algorithm to calculate an appropriate ID for reporting (such as 'first letter of last name' + 'last four digits of SSN').

ENCODER INTEGRATION AND CLAIMS REVIEW (‘SCRUBBING’)

The VIRR software suite solution shall include the VistA integration necessary to enable the HICBA Encoder software solution, revenue operations workflows, and reporting. The VIRR solution shall also include a claim review, or ‘scrubbing’, component to reduce improperly coded claims, reduce the billing cycle for claim reimbursement, and ensure data quality to support compliance auditing and reporting. The VIRR software suite solution shall have the ability to dual-report in the present, past, and future versions of ICD.

The VIRR software suite solution shall assist the health record coding process by directing the correct ICD and CPT codes, used for encounters and inpatient stays, to the claims section, once coded.

The VIRR software solution shall support the below functionalities of the HICBA Encoder software solution, as these requirements involve interfacing with VistA. In addition, the VIRR solution shall provide code lookup capability for direct code entry into the VIRR solution. The VIRR shall enable the Encoder to:

1) Detect and identify service-connected medical conditions as listed in VistA and special eligibility authority for, but not limited to: Agent Orange, Military Sexual Trauma (MST), Southwest Asia, ionizing radiation, combat veteran, Camp Lejeune, Project Shipboard Hazard and Defense (SHAD) and head and neck cancer at the encounter level.

2) Enter and maintain the ordering and rendering provider for each CPT code on the encounter.

3) Have the ability to code PTF movements on VistA 501 screen.

4) Automatically check codes to ensure they are correct for the associated date of service and patient gender and age, including validating that modifiers entered for CPT/HCPCS codes are appropriate, and automatically notify coder if a secondary diagnosis code is required.

5) Maintain a list of nationally defined coder comments for communication between coders, CDI, supervisors, and billers. The comment list shall be selectable from outpatient, inpatient, and surgery coding applications, and have the ability to select comments from the nationally approved list. VistA security key shall only be assigned to someone having authority to maintain comments at the National level.

6) Limit the list of users displayed when assigning encounters (facility, CPAC-level), and be customizable to allow adding/removing users to list. System shall only allow supervisors with appropriate VistA secondary menu option(s) and security key(s) to maintain a role-based user list. This will reduce time required to retrieve reports and assign workload. A security/administrative key shall be given to facility designee for adding or deleting users.

7) Allow coders to complete surgery coding from within the outpatient or inpatient coding tool, including surgery encounters that are 'locked'. The system shall have ability to link codes for 'principal' and 'other' procedures. The system shall also list anesthesia providers’ names while coding a surgery encounter (coder shouldn't have to open VistA Surgery package to look up).

8) Reflect the encounter status for encounter inquiry and update screens. Valid encounter statuses are 'open', 'closed', 'suspended'.

9) Electronically assign, by supervisor or HIM designee, encounters to specific coders to balance department workload and reassign cases.

10) Code and maintain hospital census records, including transmitting these records with PTF records and report inpatient census status based on a given date range.

1.1 REPORTING CAPABILITIES

The VIRR Contractor shall provide, through VIRR applications and Contractor services, functionality to generate the below management reporting (workflow) capabilities at the facility, VISN and enterprise levels.

1.1.1 CUSTOMIZABLE REPORTING

As part of the VIRR solution, the Contractor shall provide a customizable reporting service and product capability which shall include the ability to develop and generate recurring and ad hoc reports drawn from HICBA VIRR and associated VistA data fields to focus on domains related to coding, CDI, and revenue. Examples of reporting include revenue workflows and status.

The VIRR software suite solution shall filter reporting data on multiple items or groups, and sort on any displayed data. The solution shall permit users to easily build customized reports.

Deliverable:

a. Customizable Reporting Software Package

1.1.2 ENTERPRISE CENTRAL REPORTING (ECR)

The Contractor shall ensure the VIRR software solution suite includes the following ECR capabilities:

a. Centralized enterprise-wide reporting, which includes productivity and performance tracking at the Full-Time Equivalent (FTE), medical center and VISN levels for number of encounters and inpatient admissions processed, turnaround time for completing encounter coding, and coding accuracy.

b. Ability to create alerts based on workflow status criteria, such as encounters referred to utilization review (i.e., over seven calendar days).

c. Ability to separate out non-VA PTFs from VA PTFs by FTE.

d. Provides reporting with Microsoft Power BI.

Deliverable:

A. HICBA VIRR Software Suite Solution Product Documentation

1.2 TECHNICAL SUPPORT

1.2.1 TECHNICAL AND ON CALL SUPPORT

The Contractor shall provide technical and Help Desk support for all VIRR capabilities. The Contractor shall provide a designated POC for direct communications from VA to the Contractor’s technical support. The Contractor shall provide live, on-call support, staffed by technical professionals, for VA Monday through Friday between the hours of 8:00 a.m. and 7:00 p.m. Eastern Time except for Federal holidays.

The Contractor shall provide telephone lines with Automatic Call Distributor (ACD) and Service Desk functionality to record call date, time, hold times, and duration information, and electronic interface to all systems for monitoring and reporting. The Contractor’s on-call support shall include a single, toll-free phone number and ticketing system with a seamless customer experience.

Immediately upon receipt of a call from VA, the call shall be logged in the Vendor’s ticketing system, and a tracking number assigned and given to the caller reporting the issue. Hand-off shall be made to an appropriate technician. The Contractor shall work with the callers to resolve issues. The Contractor shall create a ticket, which minimally includes a unique identifier (ticket number), name of service requester, location, priority, description of issue, resolution, and dates/times of the following: received, assigned, resolved, and closed. Resolution shall be defined as: a ticket being opened, resolved, and closed by the same technician during same call. The Contractor shall resolve issues within two hours of receiving request. If resolution cannot be made within two hours, the Contractor shall provide the VA technical POC with an email of the cause of the delay and the estimated time to resolve and courtesy copy the COR.

The Contractor shall provide support if the need arises to the OI&T Technical staff during hours (Weekend, holiday, evening, nights) that are defined as hours outside of the established business hours 8AM – 7PM (EST).

The Contractor shall ensure the VIRR solution responds to user commands and entries in a way that permits users to complete their tasks with minimum disruption. The Contractor shall notify VA COR and VA technical POC within two hours when scheduled and/or unplanned (emergency) interruption of services occur that negatively impacts or severely limits VA workflow and/or business processes, and its planned schedule of repair/maintenance. Once identified, the Contractor shall continue emergency repairs until completed and the Contractor demonstrates normal operation to the VA technical POC and advise the COR. Emergency repairs shall be successfully completed within one business day. The Contractor shall perform routine/preventive maintenance during off business hours, or on weekends. The Contractor shall electronically notify all users at least two hours in advance of any scheduled or planned interruption and expected recovery timeframe. The Contractor shall electronically notify all users immediately of any unscheduled or unplanned interruption and expected recovery timeframe. The Contractor shall notify users immediately upon system availability.

The Government does not consider resolutions taking longer than 48-hours to be a “prolonged delay” as defined in PWS Section B.2.3.d. if the resolution is not be achievable within 48 hours due to VA policy or mandatory VA procedures concerning software updates or the VA-driven timeframes for software update procedures. VA acknowledges that full resolution of some issues may have dependencies on VA local OIT and ESL (Enterprise Service Line) Support Teams to perform various work to restore full functionality. VA software update procedures for code reviews, documentation, pilot site testing, sign-off, issuance of internal VA bulletins informing end-users of software patches, and other various VA mandates may extend the timeline for resolution to beyond 48 hours. In these infrequent instances, the Contractor shall notify the Government of a need for an extension to the routine 48-hour resolution turn-around time and shall work in good faith to provide a resolution as soon as possible. The Contractor shall continuously communicate with the impacted site(s), the VA technical POC, and other VA stakeholders to provide status updates.

All issue reporting, ticket information, and resolution shall be captured in the Monthly Help Desk Report.

Deliverable:

A. Monthly Help Desk Report

1.2.2 SOFTWARE SUSTAINMENT SUPPORT

The Contractor shall renew any VIRR solution software access and/or licenses for the PoP. The Contractor shall provide sustainment support which shall be thoroughly tested in their own testing environments prior to releasing to the VA to include the categories identified below. The Contractor shall provide the VA PM with the release notes, installation guide and testing/validation checklist. The category of support for each correction, revision, or modification shall be recommended by the Contractor and concurred by VA PM:

1. Corrective Sustainment - The diagnosis and correction of program errors after software release.

2. Adaptive Sustainment - The modification of software to interface with a changing environment or congressional mandates.

3. Preventive Sustainment - The modification of software to improve future maintainability or reliability as a result of a requirement to perform a hardware re-platform or operating system/system software upgrade

1.3 TRAINING

The Contractor shall provide end user and system administrator training for VIRR software updates and changes as indicated by the impact to the user or administrator and determined by VHA and/or VA OIT. The training shall be provided to VHA or VA OIT staff with access to the system, including coders, CDI, billers, utilization review, and information technology. The required training shall be provided synchronously, online, to include recordings, and detailed in the Contractor’s training plan. This training for the VIRR software suite solution shall be provided when upgrades or enhancements are released and prior to any impact to the end user. The Contractor shall have the training updates available within 10 business days prior to release of the update or enhancement to the VA environment, unless coordinated with VA (e.g., emergency software update).

Upon award, the Contractor shall update existing training materials and product documentation to include role-based user guides.

When training is indicated, the Contractor shall prepare a Training Plan, which shall include the Contractor’s methodology and schedule for providing training to ensure the most effective utilization of government personnel training time. The Contractor shall develop and deliver a Training Package and shall deliver the training of this material, virtually, to each of the 140+Medical Center (VAMC) sites and seven CPAC organizations, categorized by the following representative training locations: Central Plains, Florida, Caribbean, Mid-Atlantic, Mid-South, North Central, North East, West, West (Honolulu), and West (Anchorage). The scope of the base End User Training requirement shall only include training for end users on changes to VIRR resulting from integration with the HICBA Encoder product and not a comprehensive training on full VIRR functionality.

Deliverable:

A. VIRR Training Plan B. VIRR Training Package

1.3.1 SYSTEM ADMINISTRATOR TRAINING

The Contractor shall conduct at least one system administrator training session per calendar year. All training shall be provided virtually utilizing electronic manuals, online lab environments and conferencing tools for presentation and communication. The training shall be dedicated to VA staff and shall be customized to be specific to the VIRR solution provided by the Contractor to VA as part of this PWS. The training shall cover the information to allow VA OIT staff to sustain and operate the VIRR solution over the life of the systems, including all elements of the VIRR solution: computer, network, storage, and the applications provided to maintain the systems. The training shall also cover detailed use of the centralized support servers and centralized management tools provided by the solution. The Contractor shall provide training materials to include a training outline, training approach, training curriculum, training schedule, and an end-user summary/cheat sheet.

The training schedule shall include proposed dates for classes to be held and shall be approved by VA prior to execution of each training session. Training shall begin no later than the week prior to the first VIRR solution going live at VA and all training sessions shall be completed no later than 12 months after award.

The VA Implementation Manager (IM) will work with VA OIT to develop an online enrollment methodology for the classes. Two weeks prior to a class being held, the IM will provide to the Contractor a list of class attendee names, phone numbers, and email addresses. The Contractor shall provide any training access documentation, manuals, or lab access keys to the attendees scheduled for the virtual training.

Deliverable:

A. VIRR System Administrator Training Package

5.6 OPTIONAL TASK 1 - TRANSITION OUT SUPPORT

This task may be exercised once during the POP and shall have a POP of 120 calendar days. Performance of this task may extend beyond the period of performance in which it was exercised. Work shall not commence until a formal modification has been issued by the CO.