RFP245-S15-0011_Medical_Coding_Data_Entry_August_05_2015.pdf

MEDICAL CODING/DATA ENTRY SERVICES

NAVAJO AREA INDIAN HEALTH SERVICE

RFP: 245-S15-0011 Page 3

TABLE OF CONTENTS

SECTION A

A-1 SF1449 SOLICITATION/CONTRACT/ORDER FOR COMMERICAL ITEMS………………………………..………………………….1

SECTION B – CONTINUATION BLOCK

B-1 PURPOSE OF CONTRACT………………………………………………………………………………………….………

B-2 FEE SCHEDULE……………………………………………………………………………………………………………….……

B-3 PERFORMANCE WORK STATEMENT…………………………………………………………………………………………..6-16

B-4 TASK ORDERS

B-5 PERIOD OF PERFORMANCE………………………………………………………………………………………….…………….17

B-6 CONTRACTING OFFICER RESPONSIBILITY………………………………………………………………………………..…

B-7 INVOICE SUBMISSION………………………………………………………………………………………………….…………….17

B-8 FACILITY REPRESENTATION………………………………………………………………………………………….…………….18

B-9 CONTRACTING OFFICER’S REPRESENTATIVE (COR)……………………………………………………………

B-10 OFFICIALS AUTHORIZED TO PLACE ORDER AGAINST THE CONTRACT…………………………………….…………….19

B-11 CONTRACTOR’S REPRESENTATIVE…………………………………………………………………………………

SECTION C – CONTRACT CLAUSES

C-1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)………………………………………………….……22 C-2 52.212-4 CONTRACT TERMS AND CONDITIONS (MAY 2015)………………………………………………………… 22-27

C-3 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (MAY 2015)………………………………27-32

C-4 52.216-18 ORDERING (OCT 1995)……………………………………………………………………………………….…

C-5 52.216-19 ORDERING LIMITATIONS (OCT 1995)…………………………………………………………………………...32-33

C-6 52.216-22 INDEFINITE QUANTITY (OCT 1995)…………………………………………………………

C-7 DEPARTMENT OF HEALTH AND HUMAN SERVICES ACQUISITION REGULATION

(HHSAR) (48 CFR CHAPTER 3) CLAUSES…………………………………………………………………………..34

SECTION D – CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENT…………………………………………….………………….35

D-1 U.S. Department of Labor Wage Determination No.: 2005-2361, Revision No.: 16 Dated 12/22/2014(NM);

D-2 U. S. Department of Labor Wage Determination No.:2005-2023; Revision No.: 19, Dated 12/22/2014 (AZ);

D-3 Sample Copy of Appendix: Business Associates Agreement D-4 Sample Copy of Data Exchange Agreement D-5 Sample Copy of Business Partner Interconnection Security Agreement D-6 Contractor Performance Assessment Form (CPAR) https://www.cpars.gov/ D-7 Privacy Act of 1974, Procedures for Indian Health Service (IHS) IHS Records Staff, all other persons who work in IHS or contracted hospitals and clinics and IHS Contractors using IHS medical records incorporated by reference with the same force and effects as if given in full text. http://www.ihs.gov/privacyact/index.cfm??module=dsp_pao_gen_qa.

SECTION E – SOLICITATION PROVISIONS

E-1 52.212-1 INSTRUCTIONS TO OFFERS-COMMERCIAL ITEMS (APR 2014)……………………………………

E-2 52.212-2 EVALUATION-COMMERCIAL ITEMS (OCT 2014)…………………………………………………….…………

E-3 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS COMMERCIAL ITEMS

(MAR 2015)…………………………………………………………………………………..…………….……..42

E-4 52.216-5 TYPE OF CONTRACT (APR 1984)……………………………………………………………………….……………….55

E-5 52.233-2 EVALUATION OF OPTIONS (JULY 1990).…..…………………………………………………………………….…….56

E-6 52.233-2 SERVICE OF PROTEST (SEP 2006………………………………………………………………………………………56

https://www.cpars.gov/ http://www.ihs.gov/privacyact/index.cfm??module=dsp_pao_gen_qa

RFP: 245-S15-0011 Page 4

B-1 Purpose of Contract

The Contractor shall provide Medical Coding Services for outpatient encounters and inpatient hospitalizations, review coding queue, and applying transcodes that will include Facility and Professional fee coding with ICD- CM/PCS, CPT, CDT, DSM, HCPCS Level II and modifiers. Due to the National implementation of ICD-10, NAIHS Service Unit/facilities will require medical coding and data entry to address existing coding backlog with pre and post implementation of this new coding classification system effective October 01, 2015, in accordance with the Task-Orders, which will be issued as “Non-Personal Services Contracts” (NPSC), as defined in Federal Acquisition Regulations Part 37, and as authorized by Public Law 103.332, as implemented by 25 U.S.C. 1638C, Transmittal Notices – Indian Health Service Manual 96-7.

B-2 Fee Schedule: Contractor shall perform work off-site, via dial-in connection to the Resource Patient

Management System (RPMS), Electronic Health Record (EHR) and Patient Care Component (PCC) system located at the following Service Unit/facilities:

ICD-9 entails outpatient encounters to be encoded within 15-21 days after receipt of contract award.

ICD-10, entails outpatient and inpatient encounters to be encoded on an as needed basis based on the estimated workload below.

Basic Year: 01 October 2015 through 30 September 2016

Estimated

Quantity Unit of Issue

Unit Price

Total

1 Chinle Service Unit

ICD-9 - Outpatient 4,500 ea.

ICD-10 - Outpatient 145,000 ea.

ICD-10 - Inpatient 1,500 ea.

2 Crownpoint Service Unit

ICD-9 - Outpatient 200 ea.

ICD-10 - Outpatient 47,000 ea.

ICD-10 - Inpatient 250 ea.

3 Kayenta Service Unit

ICD-9 - Outpatient 450 ea.

ICD-10 - Outpatient 43,000 ea.

ICD-10 - Inpatient 0 ea.

Basic Year: 01 January 2016 through 30 September 2016

4 Gallup Service Unit

ICD-9 - Outpatient 0 ea.

ICD-10 - Outpatient 150,000 ea.

ICD-10 - Inpatient 1,500 ea.

5 Shiprock Service Unit

ICD-9 - Outpatient 0 ea.

ICD-10 - Outpatient 150,000 ea.

ICD-10 - Inpatient 1,000 ea.

RFP: 245-S15-0011 Page 5

First Option Year: 01 October 2016 through 30 September 2017

Unit of Issue

Unit Price

Total

1 Chinle Service Unit

ICD-10 - Outpatient 70,000 ea.

ICD-10 - Inpatient 700 ea.

2 Crownpoint Service Unit

ICD-10 - Outpatient 20,000 ea.

ICD-10 - Inpatient 100 ea.

3 Kayenta Service Unit

ICD-10 - Outpatient 20,000 ea.

ICD-10 - Inpatient 0 ea.

4 Gallup Service Unit

ICD-10 - Outpatient 100,000 ea.

ICD-10 - Inpatient 700 ea.

5 Shiprock Service Unit

ICD-10 - Outpatient 100,000 ea.

ICD-10 - Inpatient 500 ea.

Second Option Year: 01 October 2017 through 30 September 2018

Unit of Issue

Unit Price

Total

1 Chinle Service Unit

ICD-10 - Outpatient 70,000 ea.

ICD-10 - Inpatient 700 ea.

2 Crownpoint Service Unit

ICD-10 - Outpatient 20,000 ea.

ICD-10 - Inpatient 100 ea.

3 Kayenta Service Unit

ICD-10 - Outpatient 20,000 ea.

ICD-10 - Inpatient 0 ea.

4 Gallup Service Unit

ICD-10 - Outpatient 100,000 ea.

ICD-10 - Inpatient 700 ea.

5 Shiprock Service Unit

ICD-10 - Outpatient 100,000 ea.

ICD-10 - Inpatient 500 ea.

RFP: 245-S15-0011 Page 6

B-3 Performance Work Statement (PWS) Non-Personal Services-Medical Coding/Data Entry Services

1.0 General: This performance work statement describes the requirements for providing off-site outpatient and inpatient medical coding and data entry services to support the mission of the Indian Health Service

(IHS).

1.1 Background: IHS is an agency within the U.S. Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and Indian tribes. The IHS is the principal federal health care provider and health advocate for the Indian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

1.1.1 Navajo Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 201,583 members of the Navajo Nation. The Navajo Nation is the largest Indian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern Paiute Tribe.

1.1.2 Chinle Service Unit.

The Chinle Comprehensive Health Care Facility is a 60 bed hospital which serves as the health care hub for the region and is part of the Chinle Service Unit. The medical staff includes Family Physicians, Internists, Pediatricians, General Surgeons, OB/GYN's, Anesthesiologists, and a Psychiatrist.

In addition to routine outpatient and inpatient primary care, services available to our patients include: Adult Intensive Care, General Surgery (including laparoscopic surgery), routine and operative Obstetrics, and 24-Hour Emergency Room Services. Health care services are provided to approximately 37,000 active users.

1.1.2.1 Pinon Health Center is associated with Chinle Service Unit - Indian Health Service in the Heart of the Navajo Reservation - Northern Az. Pinon Health Center provides care to approximately 11,000 patients. A collegial group of providers offer services in primary care, women's health, counseling, dental, dietary and community nutrition, health promotions, lab, x-ray, native medicine, optometry, pharmacy, physical therapy, speech therapy, podiatry and public health nursing.

1.1.2.2 Tsaile Health Center is located in Northeast Arizona as a part of the Chinle Service Unit. The Tsaile Health Center has 9,031 registered clients. Routine outpatient services are provided to a broad range of patients including prenatal and geriatrics.

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1.1.3 Crownpoint Service Unit serves a population of 20,000 Navajo people. The staff consists of primary care physicians, physician assistants, and nurse practitioners, at a 20 bed hospital. The daily inpatient load is nine; daily outpatient visits are 151; annual OB cases are 275; and annual ER cases number about 5,500.

1.1.3.1 Pueblo Pintado Clinic and Thoreau Clinic are part of Crownpoint Service Unit satellite clinics located approximately forty miles northeast of the Crownpoint Service Unit (IHS) and 25 miles South of. Both clinics operate Monday through Friday and the clinic operates on an appointment system with walk-ins. Thoreau operates Monday through Thursday. Emergencies are stabilized and transferred to Crownpoint Health Care Facility by the Navajo EMS System.

1.1.4 Gallup Service Unit

Gallup Indian Medical Center is a 96-bed hospital in Gallup, New Mexico, on the border of the Navajo Reservation. Clinical specialties at GIMC include Internal Medicine, Cardiology, Anesthesia, OB/GYN, General Surgery, Orthopedics, Ophthalmology, ENT, Radiology, Pathology, Pediatrics, Psychiatry, Emergency Medicine, and Urology. The workload at Gallup is one of the largest in the Indian Health Service with 380,000 outpatient encounters and 3,300 inpatient admissions annually.

1.1.4.1 Tohatchi Health Center (THC) is part of Gallup Service Unit, it is located in the

Southeastern portion of the Navajo Nation approximately 40 miles North of Gallup, New Mexico. Inpatient needs are met by referral to the Gallup Indian Medical Center. Clinical specialties at Tohatchi include pediatrics, internal medicine and family medicine, services provided include pharmacy, physical therapy, x-ray, laboratory, public health nursing, optometry, dental, and health education. The Tohatchi facility provides 40 hour per week ambulatory care for approximately 8,000 nearby residents.

1.1.5 Kayenta Service Unit has a population of 20,000 with Services to approximately 200 patients each day in outpatient setting. Will be opening an inpatient floor in the near future.

1.1.5.1 Inscription House Health Center and Dennehotso Health Station are part of the Kayenta Service Unit in the Western most part of the Navajo Nation. These facilities provide outpatient services.

1.1.6 Shiprock Service Unit.

Northern Navajo Medical Center is one of five facilities located within the Shiprock Service Unit. Northern Navajo Medical Center is a 68 bed facility. Approximately 138,603 Native Americans (mostly Navajo) are enrolled at Northern Navajo Medical Center. The inpatient load is 29 per day and the outpatient volume averages 950 per day. A variety of services are available including internal medicine, family practice, urgent and emergency care, pediatrics, general surgery, women's health, mental health, respiratory therapy, outpatient rehabilitation services, pharmacy, optometry, dental, public health nursing, social services, health promotion/disease prevention, radiology, laboratory and benefits coordination.

Northern Navajo Medical Center also supports two (2) Health Stations in Sanostee and Toadlena, NM, three (3) days a week and Teen-Life Center five (5) days a week.

RFP: 245-S15-0011 Page 8

1.1.6.1 The Dzilth-Na-O-Dith-Hle Health Center (DZHC) is associated with Shiprock Service Unit. Northern Medical Center is the primary referral center located 70 miles northwest of DZHC. The health center provides ambulatory care to patients, primarily Navajo, living in the Eastern Area of the Navajo Nation. Constructed in 1984, the facility in 1999 expanded, currently serves approximately 20,000 patients. The health center is equipped with a two bed urgent care room for the evaluation, treatment and stabilization of patient presenting with urgent/emergent conditions. The DZHC provision of primary care includes the following departments: Outpatient, urgent care, laboratory, radiology, pharmacy, optometry, dental, mental health, social services and public health nursing. The specialty services including internal medicine, women's health and obstetrics and diabetes education are available at scheduled times and staffed with providers from Northern Navajo Medical Center.

1.1.6.2 Four Corners Regional Health Center (FCRHC) is associated with Shiprock Service Unit. FCRHC provides ambulatory care services including family medicine, internal medicine, mental health, physical therapy, optometry, dental, social services, pharmacy, x-ray, laboratory, public health nursing, diabetes education, health promotion/disease prevention. The Health Center serves approximately 7,000 Native Americans.

2.0 Place of Performance: The Contractor shall provide coding and review of coding for encounters in outpatient and inpatient care settings from their place of business to each Service Unit listed above.

Contractor shall perform work off-site, via dial-in connection to the Resource Patient Management System (RPMS), Electronic Health Record (EHR) and PCC system located at each Service Unit/facilities listed above.

2.1 Contractor shall perform work off-site, via dial-in connection to the RPMS EHR & PCC system located at each Service Unit.

3.0 Applicable Documents: Please see the web link listed unless document is listed as an attachment.

3.1 Joint Commission on Accreditation of Healthcare Organizations (TJC) http://www.JAC.org.

3.2 Centers for Medicare and Medicaid Services (CMS) Standards http://www.cms.hhs.gov

3.3 Accreditation Association for Ambulatory Health Care (AAAHC) http://www.aaahc.org

3.4 Section 231 of Public Law 101-647, the Crime Control Act of 1990.

http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml

3.5 Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act.

http://www.nicwa.org/policy/law/protection/index.asp

3.6 Health Insurance Portability and Accountability Act (HIPAA) of 1996.

http://www.cms.gov/HIPAAGenInfo/

3.7 Privacy Act of 1974. http://www.justice.gov/opcl/privacyact1974.htm

3.8 Computer Security Act of 1987. http://csrc.nist.gov/groups/SMA/ispab/documents/csa_87.txt

3.9 Federal Code of Conduct. http://www.ihs.gov

3.10 IHS General Directives. http://www.ihs.gov/index.cfm?module=AtoZ&option=index

3.11 IHS Computer Security Directives. http://security.ihs.gov/index.cfm http://www.jac.org/ http://www.cms.hhs.gov/ http://www.aaahc.org/ http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml http://www.nicwa.org/policy/law/protection/index.asp http://www.cms.gov/HIPAAGenInfo/ http://www.justice.gov/opcl/privacyact1974.htm http://csrc.nist.gov/groups/SMA/ispab/documents/csa_87.txt http://www.ihs.gov/ http://www.ihs.gov/index.cfm?module=AtoZ&option=index http://security.ihs.gov/index.cfm

RFP: 245-S15-0011 Page 9

4.0 Definitions

4.1 Acceptance: Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements, except as provided in FAR subpart 46.5 and subject to other terms and conditions of the contract.

4.2 AAPC: Acronym for American Academy of Professional Coders - a National coder’s organization headquartered in Salt Lake City, Utah who provide medical coding certification credentials in a variety of disciplines.

4.3 AHIMA: Acronym for American Health Information Management Association – is a National professional organization dedicated to helping health care professionals manage personal health information in their effort to provide quality health care to the public.

4.4 Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

4.5 BAA: Business Associate Agreement.

4.6 CMS: Acronym for Centers for Medicare and Medicaid Services.

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

4.8 Contractor: The individual awarded a legal binding contract to provide supplies and services.

4.9 Contracting Officer’s Representative (COR): A federal employee who assists the ordering/issuing activity contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the technical assistance and day-to-day program management of the ordering activity’s task orders.

4.10 Contractor Performance Assessment Report (CPAR): A report that assesses a contractor’s performance and provides a record, both positive and negative, on a given contract for specific period of time.

4.11 CPT: Acronym for Current Procedural Terminology – is a codes set that is used to report medical procedures and services to entities such as physicians, health insurance companies and accreditation organizations.

4.12 Electronic Health Record (EHR): The primary clinical component of RPMS, Patient Care Component

(PCC), was launched in 1984. The RPMS EHR graphical user interface represents the next phase of clinical software development for the IHS.

4.13 Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

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4.14 GPRA: Acronym for Government Performance and Results Act of 1993 – an act implemented by the

Government which requires Federal agencies to demonstrate that they are using their funds effectively toward meeting their missions via various measures and reporting of data.

4.15 HCPCS: Acronym for Healthcare Common Procedure Coding System – official procedural code sets used for CMS and other health insurance programs to ensure healthcare claims are processed in a consistent and orderly manner.

4.16 HIS: Acronym for Health Information System – a system that captures, stores, manages or transmits information related to the health of individuals or the activities of organizations that work within the health sector.

4.17 Health Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

4.18 ICD-10-CM: Acronym for International Classification of Diseases, 10th revision, Clinical Modification -a diagnosis classification system developed by the CMS and the National Center for Health Statistics (NCHS), for coding and reporting in the healthcare environment of the United States.

4.19 IRM: Information Resource Management.

4.20 IT: Information Technology.

4.21 ITAC: Information Technology Access Control.

4.22 Meaningful Use (MU): Using certified electronic health record (EHR) technology to improve quality, safety, efficiency, and reduce health disparities in a healthcare environment.

4.23 NCCI Edits: Acronym for National Correct Coding Initiative Edits.

4.24 ORAP: Acronym for Office of Resource Access & Partnership - An organization within IHS formed to concentrate on supplementing funds provided by the IHS with other Federal, state, and private sector resources and to enhance Federal and Tribal access to those resources.

4.25 Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

4.26 Ordering Activity Contracting Officer: A Government employee of IHS authorized and warranted to issue task orders and to make subsequent task order modification(s) under this contract. The Ordering Activity CO has the authority to make initial determinations on all matters of dispute regarding task orders.

4.27 Past Performance Information: Relevant information regarding a contractor’s actions under previously awarded contracts. This includes the contractor’s record of conformance to specifications and to standards of good workmanship; the contractor’s record of containing and forecasting costs on

RFP: 245-S15-0011 Page 11 any previously performed cost reimbursable contracts; the contractor’s adherence to contract schedules, including the administrative aspects of performance; the contractor’s history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer.

4.28 PCC: Acronym for Patient Care Component – a patient care data system developed by the IHS to support primary care in a multi-site, decentralized, health care organization.

4.29 Performance based Matrix: Lists the services to be monitored and the standards to be applied.

4.30 PHI/PII: Acronyms for Protected Health Information and Personally Identifiable Information - Individually identifiable health information which is subject to state and federal privacy and security rules including, but not limited to, the Health Insurance Portability and Accountability Act (HIPAA) and the Privacy Act of 1974.

4.31 PCS: Acronym for Procedure Coding System - is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs.

4.32 Quality Assurance Surveillance Plan (QASP): is a Government developed and applied document used to make sure the systematic quality assurance methods are used in the administration of the Performance Based Service Contract (PBSC) standards included in this contract and in subsequent task orders.

4.33 RPMS (Resource Patient Management System): IHS-wide system designed to provide detailed and comprehensive clinical and administrative information to manage individual patients, local facilities, regional and national programs.

4.34 Service Unit: The local administrative unit of IHS.

4.35 Secure Data Transfer System: Secure encrypted email system utilized by the Indian Health Service to transmit PHI/PII.

4.36 SNOMED CT: Acronym for Systematized Nomenclature of Medicine – Clinical Terms

4.37 Supervisor: Government employee authorized to provide verbal and written performance direction to the Contractor that the Contractor must follow without exception.

4.38 Task Order: An order SF-1449 issued in accordance with the terms of the contract that details an ordering activity’s specific requirements. An ordering activities written order to obtain services, at a minimum will include the following where applicable: description of services, price, period of performance, contract number, and the ordering activities task order number.

4.39 TJC: Acronym for The Joint Commission.

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4.40 Transcodes: Medical Transaction code, eight-digit number specific for services allowing for Service Unit Healthcare Common Procedure Coding System, modifiers, revenue codes, and prices to be stored and passed directly to 3P Billing.

5.0 Government Furnished Information

5.1 Government unique information related to this requirement, which is necessary for Contractor performance, will be made available to the Contractor. The Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

5.2 NAIHS SU facility(ies) will provide individual computer access codes for Contractor to access RPMS

EHR & PCC applications via dial-in connection.

5.3 NAIHS SU facility(ies) IT/IRM will designate portals for the Contractor to utilize for dial-in connection.

5.4 NAIHS SU facility(ies) IT/IRM will provide technical assistance, as needed, to trouble-shoot any connection issues/problems that Contractor may have.

6.0 Performance-Based Requirements. The Contractor shall provide services in accordance with the performance-based requirements. The Contractor shall provide Certified Coders to satisfy requirements.

Coding Credentials: All contract coders shall be certified by one of the following: American Health Information Management Association (AHIMA): Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician based (CCS-P); and/or American Academy of Professional Coders (AAPC). Coders are certified as Certified Professional Coder (CPC), Certified Professional Coder-Hospital Outpatient (CPC-H), Certified Professional Coder-Payer (CPC-P), Specialty Medical Coding Certification.

Services shall include data entry/coding and review of coding for encounters in the ambulatory and inpatient care setting (to include, but not limited to): Family Medicine, Internal Medicine, Pediatrics, OB/GYN, Newborn, Dental, Urgent Care, Emergency Room, Intensive Care Unit, and various specialty outpatient services, such as Urology, Ears, Nose, Throat, Operating Room, Podiatry, etc. Specific tasks shall include the following:

6.1 Major Duties:

6.1.1 Contractor’s Certified Coders shall have experience and be knowledgeable in determining which transcodes to be entered for services and in some cases for tracking purposes, entry of all pertinent GPRA, and MU to meet or exceed goals and percentages for each year.

6.1.2 Contractor shall code and analyze ambulatory (outpatient) visits and inpatient stays that are documented on paper and electronically in the Resource and Patient Management System (RPMS) Electronic Health Record (EHR) for each NAIHS, Service Unit/Facility(ies), which include ambulatory visits from Home Care, Nursing Home and School-Based visits.

6.1.3 Contractor shall code ambulatory visits and inpatient stays by applying all applicable coding conventions according to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM/PCS) and International Classification of Disease, Ninth Edition, Clinical Modification (ICD-

RFP: 245-S15-0011 Page 13

9-CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) Level II, Diagnostic and Statistical Manual of Mental Disorders (DSM) and Current Dental Terminology (CDT).

6.1.4 Contractor shall analyze provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT codes Local Coverage Determination (LCD) and applicable modifiers.

6.1.5 Contractor shall evaluate the record for documentation, consistency, accuracy and correlation of recorded data, such as medical necessity and modifier usage. Contractor shall ensure the final diagnosis as stated by the provider is valid, complete and accurately reflects the care and treatment rendered.

6.1.6 Contractor shall apply appropriate Transcodes to optimize reimbursement.

6.1.7 Contractor shall enter GPRA data and patient education topics as appropriate and needed for each visit encounter.

6.1.8 Contractor shall enter MU data and patient education topics as appropriate for each encounter.

6.1.9 Contractor shall review the RPMS coding queue report daily for workload assignment. Weekly reports shall be provided each Tuesday on an excel spreadsheet for utilization on the weekly conference call.

6.1.10 Contractor shall issue a notification to the responsible provider through the RPMS/EHR system any encounters not meeting documentation completeness and to address or correct the deficiency.

Contractor shall maintain or establish a database for deficiencies by provider and provide a weekly report to the SU.

6.1.11 Contractor shall use one of the following to communicate deficiencies: the IHS Secure Data Transfer System (SDTS), EHR notifications or facsimile on a daily basis and respond to billing department within 8 hours of receiving a deficiency.

6.1.12 Contractor shall review all ancillary data and merge into appropriate encounter. Contractor shall make determination if ancillary data is considered a stand-alone encounter and shall complete the visit as such if unable to merge data to appropriate encounter.

6.1.13 Contractor shall assist Service Unit in meeting Office of Resource Access and Partnership (ORAP) requirements under the Internal Control Policy.

6.1.14 Contractor shall communicate with HIM staff if documentation is not found via EHR. Limited documentation is completed via paper PCC forms, i.e.: Emergency room, Anesthesiology.

6.1.15 Contractor shall have the knowledge and skills of accessing images to review data scanned into Vista Imaging for coding purposes.

RFP: 245-S15-0011 Page 14

6.2 Communication: The contractor and SU Medical Records Department will maintain frequent communications on any issues or problems with the work performed, workload status, deadlines, or to assign work priority, via email or by telephone. Weekly conference calls will be established to provide updates or address issues/problems. Contractor shall have a representative available during SU normal business hours (7am-7pm MST) for any coding and billing office issues. The following SU representatives for communication are:

Vivian McThomas, RHIT, Chief, Medical Records Department, Chinle SU Tel: 928-674-6117;

Perry Francis, IT Supervisor Tel: 505-674-7435

Beverly Becenti, RHIT, Chief, Medical Records Department, Crownpoint SU Tel: 505-786-6286;

Jimmy Burbank, IT Supervisor Tel: 505-786-6382

Deanna Stewart, RHIT, Chief, Medical Records Department, Gallup SU Tel: 505-722-1115 Adrian Haven, IT Supervisor Tel: 505-722-1300

Josephine Weston, RHIA, CCS, Chief, Medical Records Department, Kayenta SU Tel: 928-697-4143 Herman Holiday, IT Supervisor Tel: 928-697-4277

Gary Russell-King, Chief, Northern Navajo Medical Center, Shiprock SU Tel: 505-368-6032;

Tina Nelson, IT Supervisor Tel: 505-368-6195

6.3 Contractor Furnished Property: Contractor shall provide all labor, materials (hardware & software), including current coding books to their workforce that is necessary to perform work.

7.0 Management of Medical Information: The Contractor shall manage all patient information in accordance with HIPAA standards, Privacy Act, and IHS Service Unit and/or Health Center specific policies and protocols.

7.1 The Contractor shall ensure adherence to Department of Health and Human Services (DHHS) IT system security policies and procedures. The IT policies and procedures will be made available to the Contractor.

7.2 The Contractor shall immediately report to the Contracting Officer or COR any information or circumstances that may violate any statute, policy, or procedure.

8.0 IHS Information Technology Systems

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8.1 In performance of this contract, the Contractor shall adapt to and successfully utilize IHS information technology systems that are deemed by the COR as necessary for acceptable contractor performance, including use of the EHR and RPMS.

8.2 The Contractor shall ensure that IHS information technology system security policies and procedures are adhered to. The IT policies and procedures will be made available to the Contractor at each IHS facility.

8.3 Contractor shall have all personnel complete the IHS Computer Security Awareness training (on-line) and provided copies of certificate of completion to COR.

8.4 Contractor shall have all personnel complete/update the IHS ITAC form, as required, for access to the

RPMS, EHR, and PCC Systems. This shall include the individual’s date of birth and social security number to set up the account for access.

8.5 Contractor shall be required to establish a current Business Associates Agreement or Data Exchange

Agreement with IHS and security related documents for interconnecting and/or data exchange, as applicable.

9.0 Qualification Requirements:

9.1 All contract coders shall be certified by one of the following: American Health Information Management Association (AHIMA): Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician based (CCS- P); and/or American Academy of Professional Coders (AAPC). Coders are certified as Certified Professional Coder (CPC), Certified Professional Coder-Hospital Outpatient (CPC-H), Certified Professional Coder-Payer (CPC-P), Specialty Medical Coding Certification.

All contract coder shall remain certified throughout the term of the contract. The contractor shall provide copies of certificates for each medical coder assigned to this contract.

9.2 The Contractor’s coding staff shall have the capability to code with the following coding systems:

9.2.1 International Classification of Diseases (ICD)

9.2.2 Current Procedural Terminology (CPT)

9.2.3 Healthcare Common Procedure Coding System (HCPCS)

9.2.4 Diagnostic and Statistical Manual of Mental Disorders (DSM)

9.2.5 Current Dental Terminology (CDT)

9.2.6 Evaluation & Management Code (E&M)

9.2.7 Systematized Nomenclature of Medicine (SNOMED)

9.2.8 Diagnostic Related Groups (DRG)

9.2.9 Local Coverage Determination (LCD)

9.2.10 National Correct Coding Initiatives (NCCI)

9.3 The Contractor’s coding staff shall have the knowledge of data entry with the following:

9.3.1 Government Performance Results Act (GPRA) indicators

9.3.2 Physician Quality Reporting System (PQRS)

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10.0 Performance – Based Matrix

Performance-based Task

Indicator Standard Quality Assurance Incentives

Contractor shall provide off-site outpatient & inpatient medical coding and data entry services for the Navajo Area Indian Health Service.

Competency

Compliance/Delivery Schedule

Reports

1. Perform 98% accuracy of all visits in Phase 1 and Phase 2.

With only 2% allowable for Billing returns (refer to 6.0).

2. Phase 1: Work assigned to

Contractor shall be completed within 10 calendar days of receipt.

3. Phase 2: Be in compliance within 4 days of ambulatory visit and/or inpatient discharge date to meet Internal Control Policy.

4. 100% percent of all reports meets established IHS Medical Facility, The Joint Commission, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession.

Service Quality:

Satisfaction with quality of service is evidenced by valid customer inputs.

See QASP. Surveillance systems will include periodic inspections and customer complaints.

Complaints from the NAIHS Medical Records Coding Department and Business Office.

Payment of contract price for satisfactory service.

Exercise option.

Contractor performance will be evaluated using the Contractor Performance Assessment Reporting System (CPARS). The evaluation will be considered when future IHS contract selections are made.

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B-4 Task Orders

Formal award: Service Unit acquisition personnel will issue individual task order utilizing SF-1449:

Solicitation/Contract/Order for Commercial Items. As a minimum, each Task Order will contain the following information.

1. Reference the Contract Number and the Task Order number.

2. A statement of work which shall be specific to the services required.

3. Workday including work hours/shift.

4. The beginning date and completion date for performance.

5. The total dollar amount of the Task Order.

B-5 Period of Performance

1. The effective date of this contract is from October 01, 2015 through September 30, 2016. This contract is effective for one (1) basic contract year and two (2) one-year option periods.

2. If the Government exercises its option pursuant to 52.217-9: Option to Extend the Term of the Contract, the period of performance will be extended in accordance with the following schedule.

YEAR OPTION PERIOD

FIRST YEAR OPTION October 01, 2016 Through September 30, 2017 SECOND YEAR OPTION October 01, 2017 Through September 30, 2018

B-6 CONTRACTING OFFICER RESPONSIBILITY

Authority to negotiate changes in term, conditions, or amounts cited in this contract is reserved for the Contracting Officer.

B-7 INVOICE SUBMISSION:

1. The Contractor shall submit an original monthly invoice(s) to the attention of the individuals listed in Paragraph B-7 for each medical facility for verification of service rendered. A certified copy shall be forwarded by the individuals listed in Paragraph B-7 to their facility’s authorized ordering official listed in Paragraph B-9. The authorized ordering official will then forward the invoice to the approving official for processing of payment.

2. In accordance with FAR 52.212-4(g), a proper invoice must include the following:

a. Contract Number, Purchase Order Number, Contractor’s name, and invoice date and payment terms;

b. The following certification shall be cited on each order/invoice submitted for payment:

“I certify that all laundry services concerned with this invoice are accurate and complete as of the date of this invoice and that all payments requested are for appropriate purposes and in accordance with the contract terms.”

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c. The Contractor shall include the following citation on each invoice submitted for payment:

“Services have been received and are acceptable in accordance with the terms of the contract.”

Facility Representative’s Signature Date

Authorized Ordering Official: “I hereby approve this invoice for payment”

Authorized Ordering Official’s Signature Date

B-8 FACILITY REPRESENTATIVE

All work (except emergencies) shall be performed during regular working hours, 8:00 AM to 5:00 PM Monday through Friday, as scheduled with the designated facility representative listed below.

Chinle Comprehensive Health Care Facility Chinle, AZ……………………………………………………...Vivian McThomas, RHIT, Supervisor Telephone 928/674-6117

Gallup Indian Medical Center Gallup, NM …………………………………………………….Deanna Stewart, RHIT, Supervisor Telephone 505/722-1115

Kayenta Health Center and Dennehotso Health Station Kayenta, AZ…………………………………………………… Josephine Weston, RHIA, CCS, Supervisor Telephone: 928/697-4143

Inscription House Health Center Shonto, AZ…………………………………………………… Ella Mae Dayzie, HSA Telephone: 928/672-3060

Northern Navajo Medical Center Shiprock, NM………………………………………………… Gary Russell-King, Supervisor Telephone 505/368-6032

Crownpoint Health Care Facility, Pueblo Pintado and Thoreau Health Centers Crownpoint, NM..………………………………………………Beverly Becenti, RHIT, Supervisor Telephone 505/786-6286

Tohatchi Health Center Tohatchi, NM ………………………………………………… Rose McReeves, RHIT, Supervisor

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Telephone: 505/733-8112

Dzilth-Na-O-Dith-Hle Health Center Bloomfield, NM ………………………………………………Theresa Victor, RHIA, Supervisor Telephone: 505/368-8021

Four Corners Regional Health Center Red Mesa, AZ …………………………………………….....Theresa Francisco, RHIT, CCS-P, Supervisor Telephone: 928-656-5183

Pinon Health Center Pinon, AZ…………………………………………………….. Jackie Tsosie, Acting Supervisor Telephone: 928/725-9504

Tsaile Health Center and Rock Point Health Station Tsaile, AZ…………………………………………………….Christina Litzin, Supervisor Telephone: 928/724-3616

B-9 CONTRACTING OFFICER’S REPRESENTATIVE (COR):

The COR for this contract will be:

Beverly Becenti, RHIT Crownpoint Healthcare Facility P. O. Box 358 Crownpoint, NM 87313

TELE: (505) 786-6286

Fax: (505) 786-6366 E-mail: Beverly.becenti@ihs.gov

The COR is responsible for:

1. Monitoring the Contractor’s technical progress, including surveillance and assessment of performance and recommending to the Contracting Officer changes in requirement;

2. Performing technical evaluation as required;

3. Performing technical inspections and acceptance required by this contract; and

4. Assisting the Contractor in the resolution of problems encountered in performance.

B-10 OFFICIAL AUTHORIZED TO PLACE ORDERS AGAINST THIS CONTRACT

1. The authorized ordering officials, as listed below, shall represent the Government for the purpose of issuing and signing Individual Task Orders under this agreement.

2. The authority to obligate the Government shall be in accordance with the acquisition delegation of his/her authority.

3. The authorized individuals listed under Navajo Area Indian Health Service (NAIHS) shall issue task orders ONLY in the absence of the medical facilities Acquisition Point of Contacts.

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NAIHS Medical Facilities NAME _____________________

Division of Acquisition Mgmt & Contracts Margaret Shirley-Damon, Contract Specialist Window Rock, AZ Maxine Dineyazhe, Contract Specialist PH: 928/871-1336 Priscilla Duncan, Contract Specialist FAX: 928/871-1447 Thomasina Willie, Business Specialist

Chinle Comprehensive Health Care Facility Tanya Johnson, Contract Specialist

Chinle, AZ 86503 Edith Denny, Purchasing Agent

PH: 928/674-7635 FAX: 928/674-7705

Crownpoint Health Care Facility Priscilla Duncan, Contract Specialist Crownpoint, NM 87313

PH: 505/786-6217 FAX: 505/786-5840

Gallup Indian Medical Center Natasha Chee, Contract Specialist Gallup, NM 87301

PH: 505/722-1546 FAX: 505/722-1554

Northern Navajo Medical Center Linda Conn, Contract Specialist Shiprock, NM 87420 Philoma Singer, Contract Specialist

PH: 505/368-6087 FAX: 505/368-6362

Tohatchi Health Center Natasha Chee, Contract Specialist

Tohatchi, NM 87324

PH: 505/733-8100 FAX: 505/733-8239

Dzilth-Na-O-Dith-Hle Health Center Linda Conn, Contract Specialist 6 Road 7586 Philoma Singer, Contract Specialist Bloomfield, NM 87413

PH: 505/960-1801 FAX: 505/632-6738

Four Corners Regional Health Center Linda Conn, Contract Specialist HCR 6100 Box 30 Philoma Singer, Contract Specialist Teec Nos Pos, AZ 86514

PH: 928/656-5000 FAX: 505/368-6362

Pinon Health Center Edith Denny, Purchasing Agent 2 mi. E of Bashas Store Tanya Begay, Contract Specialist P.O. Box 10 Pinon, Arizona 86510

Tsaile Health Center Tanya Begay, Contract Specialist Navajo Route 64 & 12 P.O. Box 467 Tsaile, Arizona 86556

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B-11 Contractor’s Representative

Designate a person whom we may contract for prompt Contract Administration. In the event your firm receives a contract as a result of this solicitation.

Name: __________________________________________________Title: _________________________

Address: _____________________________ Telephone: __________________

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SECTION C – CONTRACT CLAUSES

C.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): http://www.arnet.gov/far

FAR NUMBER TITLE DATE________________

52.224-1 Privacy Act Notification Apr 1984 52.224-2 Privacy Act Apr 1984 52.243-1 Changes-Fixed Price (Alternate 1) Aug 1987

C-2 52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMS (MAY 2015)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights—

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the Government-wide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public http://www.arnet.gov/far http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t29t32+1665+30++%2831%29%20%20AND%20%28%2831%29%20ADJ%20USC%29%3ACITE%20%20%20%20%20%20%20%20%20 http://uscode.house.gov/ https://acquisition.gov/far/current/html/52_233_240.html#wp1113304 https://acquisition.gov/far/current/html/52_200_206.html#wp1137572

RFP: 245-S15-0011 Page 23 enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the

Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.

(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include—

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, contract line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer—System for Award

Management, or 52.232-34, Payment by Electronic Funds Transfer—Other Than System for Award Management), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of

Management and Budget (OMB) prompt payment regulations at 5 CFR Part 1315.

(h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings.

(i) Payment.—

(1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract.

https://acquisition.gov/far/current/html/52_232.html#wp1153351 https://acquisition.gov/far/current/html/52_232.html#wp1153375 http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t29t32+1665+30++%2831%29%20%20AND%20%28%2831%29%20ADJ%20USC%29%3ACITE%20%20%20%20%20%20%20%20%20

RFP: 245-S15-0011 Page 24

(2) Prompt payment. The Government will make payment in accordance with the Prompt Payment Act (31

U.S.C. 3903) and prompt payment regulations at 5 CFR Part 1315.

(3) Electronic Funds Transfer (EFT).