SOL_75H70722Q00058 ACLSU Remote-Onsite Coding Billing and AR Services.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

Albuquerque NM 87110 4101 Indian School Rd NE, Suite 225 Albuquerque Indian Health Service

IHSACL CODE 16. ADMINISTERED BYCODE

X

X

X

541219

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR203

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

07/06/2022 1200 MD

06/15/2022

505-256-6752ERIC WRIGHT

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70722Q00058

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 35 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

Pueblo of Acoma New Mexico 87034 80B Veterans Blvd Acoma Canoncito Laguna Service Unit

15. DELIVER TO

Albuquerque NM 87110 4101 Indian School Rd NE, Suite 225

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$22.00

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Albuquerque Indian Health Service

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Solicitation# 75H70722Q00058 is issued to provide Remote-Onsite Coding, Billing and AR Services at the Acoma Canoncito Laguna Service Unit.

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

ERIC K. WRIGHT

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

35 2 of

75H70722Q00058, ACLSU Remote-Onsite Coding, Billing and AR Services

SF-1449 continued, page 3 of 35

SECTION 1 - SUPPLIES OR SERVICES AND PRICES/COSTS

1.1 SERVICES

1.1.1 The Indian Health Service (IHS)/Albuquerque Area Office, Acoma Canoncito Laguna Service Unit has a requirement for on-site and/or remote professional medical coding, billing and accounts receivable/posting services in Acoma, New Mexico.

1.2 PRICE OR COST

This Solicitation is issued with the quantities shown in the Schedule of Charges.

1.3 GENERAL CONTRACT INFORMATION

1.3.1 This is a non-personal health care service contract, as defined in Federal Acquisition Regulation (FAR) 37.401, under which the contractor is an independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment). The contractor indemnifies the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance.

1.3.2 As an independent Contractor; billing and collecting for the federal, state and other local city/county taxes is the burden of the Contractor, this includes the New Mexico Gross Receipt Taxes (NMGRT) for services provided in any county of the State of New Mexico.

1.3.3 The Contractor's price/cost for services under this contract should include all applicable taxes for Internal Revenue Service (IRS), State of New Mexico Taxation and Revenue agency and/or other revenue agencies.

The Indian Health Service will not withhold taxes nor will it issue a W-2 to the contractor.

1.3.4 FINGERPRINTING REQUIREMENTS FOR SECURITY AND SUITABILITY:

"Prior to start of services specified by the contract scope of work, the Contractor must contact Warren Cheromiah, at Telephone No. (505) 256-6749, AAO, Division of Contracts and Grants, to schedule an appointment to complete the fingerprinting process required by the IHS regulations pertinent to security and character background investigations."

1.4 CONTRACT PRICE

1.4.1 Upon delivery and acceptance of the item(s) specified in the DELIVERY Article in SECTION 7 of this contract, the Government shall pay to the Contractor resulting from the awarded contract price.

1.4.2 Upon delivery and acceptance the services described in the Statement of Work and identified in the schedule of charges below, the Government shall pay to the Contractor the total prices set forth below and will be paid from the following Contract Line Item Numbers (CLINs) accordingly:

1.4.3 The Contractor shall be paid upon submission of an invoice and completion and acceptance (if deliverable) or verification (if service) by the Contracting Officer's Representative (COR), of the deliverables and/or services indicated below. Submit invoices in accordance with the instructions contained in FAR clause 52.232-25, Prompt Payment, and Section 10 of this contract.

1.5 OPTION PRICES

1.5.1 Unless the Government exercises its option, pursuant to the option clause referenced in the Contract Clauses section, this contract consists only of the Base Period specified in this contract.

1.5.2 Pursuant to either the FAR Clause 52.217-8, Option to Extend Services or the FAR Clause 52.217-9, Option to Extend the Term of the Contract, set forth in Section 12, Contract Clauses, of this contract, the Government may, a unilateral contract modification, require the Contractor to perform the Option Period(s) as defined in the SOW of this contract. A notice that the Government intends to exercise any of the options will happen prior to the contract’s expiration date. Specific information regarding the timeframe for this notice is set forth in the OPTION PROVISION of this order. When exercising an option period, the fixed price rate of this contract is set forth below.

1.5.3 Upon the delivery and acceptance of the Option Services described in the Statement of Work of the contract and identified in the schedule of charges below, the Government shall pay the Contractor the rate(s) set forth below and will be paid from the following Contract Line Item Numbers (CLINs) accordingly;

1.5.4 If the Government exercises its option pursuant to the OPTION PROVISION of this contract, the Government's total estimated contract amount, represented by the sum of the price of base plus option periods and the period of performance will be as follows:

SF-1449 continued, page 4 of 35

Contract Period Services Estimated # of Actions Onsite Remote

Price Per Action Amount

Price Per Action Amount

Min Max Min Max Min Max

Base Year

Coding 70,200 84,240 $_______ $_______ $_______ $_______ $_______ $_______

Claims Processing 57,143 68,572 $_______ $_______ $_______ $_______ $_______ $_______

Posting 1,350 3,888 $_______ $_______ $_______ $_______ $_______ $_______

Account Review and Follow Up 57,143 68,572 $_______ $_______ $_______ $_______ $_______ $_______

Total Cost Base Year $_______ $_______ $_______ $_______

Option Year #1

Coding 84,240 85,925 $_______ $_______ $_______ $_______ $_______ $_______

Claims Processing 68,572 69,942 $_______ $_______ $_______ $_______ $_______ $_______

Posting 3,888 4,666 $_______ $_______ $_______ $_______ $_______ $_______

Account Review and Follow Up 68,572 69,942 $_______ $_______ $_______ $_______ $_______ $_______

Total Cost First Year Option $_______ $_______ $_______ $_______

Option Year #2

Coding 85,925 87,644 $_______ $_______ $_______ $_______ $_______ $_______

Claims Processing 69,942 71,341 $_______ $_______ $_______ $_______ $_______ $_______

Posting 4,666 5,599 $_______ $_______ $_______ $_______ $_______ $_______

Account Review and Follow Up 69,572 71,341 $_______ $_______ $_______ $_______ $_______ $_______

Total Cost Second Year Option $_______ $_______ $_______ $_______

Option Year #3

Coding 87,644 90,273 $_______ $_______ $_______ $_______ $_______ $_______

Claims Processing 71,341 73,481 $_______ $_______ $_______ $_______ $_______ $_______

Posting 5,599 7,279 $_______ $_______ $_______ $_______ $_______ $_______

Account Review and Follow Up 71,341 73,481 $_______ $_______ $_______ $_______ $_______ $_______

Total Cost Third Year Option $_______ $_______ $_______ $_______

Option Year #4

Coding 90,273 92,981 $_______ $_______ $_______ $_______ $_______ $_______

Claims Processing 73,481 75,685 $_______ $_______ $_______ $_______ $_______ $_______

Posting 7,279 9,463 $_______ $_______ $_______ $_______ $_______ $_______

Account Review and Follow Up 73,481 75,685 $_______ $_______ $_______ $_______ $_______ $_______

Total Cost Fourth Year Option $_______ $_______ $_______ $_______

1.5.5 Note: Unit price shall be an all-inclusive rate of all other fees including travel expenses, per diem, lodging all cities, state, federal, local taxes and miscellaneous cost associated with the above services.

1.5.6 Lunch break of either 1 hour or 30 minutes as determined by the COR is permitted (as non-paid) under the contract; the contractor cannot invoice time as worked if its’ employee chooses not to take a lunch break. The Contractor also cannot invoice travel times to/from the facility site as time worked.

SECTION 2 – DEFINITIONS:

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

2.2 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.

2.3 Area: A defined geographical region for Indian Health Service administrative purposes. Each Area Office may administer several Service Units.

2.4 Blanket Purchase Agreement (BPA): is a simplified method of filling anticipated repetitive needs for supplies or services.

2.5 Business Associate (BA): Any company or person that shown to, handles, or works with the data or medical records of the medical entity.

2.6 Business Associate Agreement (BAA): A BAA is a contract between a HIPAA-covered entity and a HIPAA BA. The contract protects personal health information (PHI) in accordance with HIPAA guidelines.

2.7 Code of Ethics: The Revised American Nurses Association Code of Ethics and Standards of Practice and Care, published in 1996 by the American Nurses Association, which makes explicit primary goals, values and obligations of the nursing profession.

SF-1449 continued, page 5 of 35

2.8 Contract: This is a legal binding document between the Government and the Contractor.

2.9 Contractor: The individual award a legal binding contract to provide supplies and services.

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

2.11 Contracting Officer's Representative (COR): A federal employee who assists the CO in the administration of this contract. The COR is primarily responsible for the technical assistance and day-to-day program management.

2.12 Customer: Patients, staff and visitors of an IHS service unit and health center.

2.13 Customer Evaluation/Input: Written comments made to the COR regarding the Contractors performance. This is one of the criteria used to evaluate the Contractor's performance.

2.14 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.

2.15 Health Clinics/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.

2.16 Indefinite Delivery/Indefinite Quantity: No set delivery time and no set quantity amount (used for recurring purchases with no set delivery time or quantity).

2.17 Non-Personal Health Care Services: A contract under which the personnel rendering the health care services are not subject, either by the contract's terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees, as defined in

FAR 37.401

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

2.19 Orientation: An activity designed to provide basic familiarization of the facility and transition into the IHS Service Unit and/or Health Center.

2.20 Past Performance Information: Relevant information regarding a contractor's actions under previously awarded contracts.

2.21 Patient Outcome: End result of nursing care.

2.22 Performance Based Matrix: Lists the services and the standards to determine quality of performance.

2.23 Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological, chemical, and radioactive hazards.

2.24 Point of Contact: Person other than the COR or the Alternate COR

2.25 Quality Assurance Surveillance Plan (QASP): A written document prepared and used by the government for Quality Assurance surveillance of the contractor's performance.

2.26 Service Unit: The local administrative unit of IHS.

2.27 Standards of Practice and Standards of Care: Authoritative statements by which it describes the responsibilities for which its practitioners are accountable.

2.28 Technical Direction: A directive to the Contractor that approves approaches, solutions, designs, or refinements; fills in details or otherwise completes the general description of work or documentation items; shifts emphasis among work areas or tasks; or furnishes similar instruction to the Contractor.

2.29 Solicitation: An order issued in accordance with the terms of a contract (GSA or VA, etc.) that details a specific requirement.

2.30 Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

2.31 Verifiable Emergency: An unexpected/unplanned absence by the contractor requiring valid documentation to confirm the occurrence.

SECTION 3 – GOVERNMENT-FURNISHED PROPERTY AND SERVICES:

3.1 The Government will provide the following item(s) of Government property to the Contractor for use in the performance of this contract. This property used and maintained by the Contractor in accordance with provisions of FAR Clause 52.245-1, Government Property (found in Section 3).

SF-1449 continued, page 6 of 35

Item No

Property Description Property Value Qty. Location Date Available

1 Computer 1 Upon Arrival 2 Telephone 1 Upon Arrival 3 Desk/Chair 1 Upon Arrival 4 PIV Card 1 Upon Arrival 5 PPE Equipment Upon Arrival

3.2 Government Furnished Information / Property and Services

3.2.1 Information: Government unique information related to this requirement, which is necessary for Contractor performance, made available to the Contractor. The COR will be the point of contact for identification of any required information to be supplied by the Government.

3.2.2 Joint Use by the Government and the Contractor: Except for the property and service listed in 10.7.1, the Government will provide, for joint use by the Government and the Contractor, all necessary equipment, supplies, and clinic space to perform the services under this contract.

3.2.3 Contractor Exclusive Use:

3.2.3.1 Personal Protective Equipment (PPE): The Government will furnish the Contractor with appropriate PPE other than specified in the contract. The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.2.3.2 The Government will provide facility specific contractor identification badges for each contractor.

For lost or destroyed badges, there is a minimum charge of $20.00.

3.2.3.3 Training: Facility specific orientation/training necessary for the Contractor to perform the required duties, e.g., IHS information technology (IT) systems and operational procedures. Training provided ONLY if the subject matter is necessary to improve or enhance the quality of services or includes mandates made by the IHS Service Units/Health Centers while the providers are working under this contract. Training not provided for the purpose of continuing education, career development or individual development.

3.3 Contractor Furnished Property

3.3.1 Except for the property specified in paragraph 10.9.3 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following:

3.3.2 Uniforms and Lab Coats: Uniforms and Lab Coats must conform to the requirements of the Indian Health Service Manual, Part 3, and Chapter 4 and meet the approval of the Chief Nurse Executive at each IHS facility.

3.3.3 Other personal medical instruments: "Other personal medical instruments" defined, as Contractor owned items include but not limited to stethoscope, scissors, as appropriate to the work unit. The Contractor must not use unsafe equipment or supplies at any time during performance of this contract. All Contractor furnished equipment and supplies shall be subject to inspection by the Government and must be approved by the COR prior to use by the Contractor. The Government reserves the right to prohibit the use of any materials, supplies, or equipment.

SECTION 4 - CONTRACTOR FURNISHED ITEMS

4.1 Except for the property specified in Section 10.7, Contractor will provide all other items as required to carry out the services.

SECTION 5 – STATEMENT OF WORK

5.1

• CODING

o The contractor will assign and sequence ICD-10 CM/CPT/HCPCS codes to diagnoses and procedures from documented information. Assures the final diagnosis and operative procedures as stated by the physician are valid and complete.

Abstracts all necessary information from the electronic health record to identify secondary complications and co-morbid conditions.

o The contractor will select the correct principal diagnoses and operations/ procedures. When multiple diagnoses and procedures are listed, assures the surgical procedure is related to the proper diagnosis. Assures maximum allocation

SF-1449 continued, page 7 of 35 under the diagnostic related group (DRG), ambulatory patient group (APG), system properly sequencing diagnosis and procedures in order of severity of illness treated.

o The contractor will abstract all necessary information, assigning the appropriate evaluation and management (E&M) levels of service, assigning the correct CPT/HCPCS code that accurately describes each medically documented procedure.

o The contractor will abide by official coding conventions and rules established by the Centers of Medicare and Medicaid

(CMS).

o The contractor will utilize the Coding Que to complete patient visits within he Electronic Health Record (EHR) with no errors.

o The contractor will enter data from the patient visit as needed into RPMS database with no errors.

o The contractor will code visits within four days from Date of Service (DOS).

o The contractor will report to the Supervisory Health System Specialist (HIM Manager) or Contracting Representative

Officer (COR) o The contractor will ensure that the error reports are reviewed and corrected on a daily and or weekly basis.

o The contractor will complete the Incomplete Coding Report; review, research and correct weekly.

• CLAIMS PROCESSING

o The contractor will submit claims electronically or manually in a timely manner (not to exceed filing limit) for all payers

(Medicare, Medicaid, PI, BMP, BCCP, WC, FMCRA, Non-Beneficiaries, etc.) or all outpatient visits and according to Internal Controls and department policies.

o The contractor will bill and submit claims within six business days from date of service.

o The contractor will assure claims are mailed or transmitted within one business day from approval and maintain a log and submit to Business Office Manager on a monthly basis.

o The contractor will move forward to 100% for all payers to submit claims electronically. Electronic transmits must be

HIPAA (837) compliant.

o The contractor will complete billing by accessing information, via the third party billing package that was input during the registration, EHR and coding queue process.

o The contractor will assure claims are analyzed and the technician will maintain the total billing operation for third party programs and acts as an advocate for the Indian Health Service in the collection of alternate resources by abiding AAAHC, CMS, State, IHS regulations and standards that govern Business Office department policies.

o The contractor will assure proper signatures are obtained for the Medicare Secondary Payer and Assignments of Benefits.

o The contractor will process the claim and assure that payer information is accurate and sequenced appropriately to guarantee the bill is submitted to the proper payer and includes identifying when employment related or accident related visits would designate a different responsible payer source from the patient’s usual primary payer.

o The contractor will bill clinic type, visit type, bill type, proper mode of export, Release of Information, workman’s compensation or FMCRA (third party injury) information, and referring physician information will be verified, input and/or adjusted whenever necessary.

o The contractor will split claim when appropriate.

o The contractor will assure appropriate providers are indicated and verify and assign proper Revenue codes if necessary.

o The contractor will assure proper dates of service for ancillary services and the E/M services.

o The contractor will assure if an error prompt appears on a particular billing page, the error must be identified and handled appropriately.

o The contractor will chart/visits with identified deficiencies (flagging/tracking process) either in the coding, data entry or the billing process will be compiled or returned to service unit for clarification and/or corrections. After correction, those claims will be re-submitted.

o The contractor will respond to third party requirements on post-payment reviews, exclusions, denials, appeals and submits secondary payer claims as appropriate.

o The contractor will maintain the Electronic Transmit Confirmation Reports, reconcile and errors are corrected on a daily basis and resubmitted if necessary.

o The contractor will maintain diagnosis follow-up procedure and working relationship with Medical Record Technician.

o The contractor will maintain handling of inquiries from third party payers and patients regarding claims and ensure they are addressed correctly and timely.

o The contractor will work and maintain a log for Flagged as Billable Listing on a daily basis and identify reasons for unbilled claims and submit to Business Office Manager on a monthly basis.

o The contractor will maintain confidentiality of medical records in accordance with the Privacy Act, HIPAA, AAAHC, IHS, and Acoma-Canoncito-Laguna Indian Health Center (ACL IHS) manuals.

o The contractor will report possible Risk Management issues to the Albuquerque Area Indian Health Service (AAO IHS)

Compliance Officer when discovered.

o The contractor will close-out all sessions every day.

o The contractor will run and correct the Auto Sync Report weekly.

• POSTING

SF-1449 continued, page 8 of 35 o The contractor will post all payments within 72 hours from the receipt of supporting documentation utilizing the RPMS A/R package. Maintain log which identifies the following; name of batch, date batch received, date batch posted, and comments.

o The contractor will assure HIPAA standard adjustment reason codes are used for all posting transactions.

o The contractor will post all zero pay claims.

o The contractor will attach all EOB’s to reflect the batch posted. Maintain on the shared file folder.

o The contractor will close-out all sessions every day.

• ACCOUNT REVIEW AND FOLLOW-UP

o The contractor will reconcile the account by posted payment, credits, and adjustments within 45 days from date of service.

o The contractor will contact insurer if claim paid incorrectly, rejected claim, denied, or outstanding claims not paid.

o The contractor will review the final adjudication process of open accounts for further review or appeals and submit to insurers following payer guidelines.

o The contractor will utilize the Debt Management process for insurers after 180 Days from DOS.

o The contractor will follow and comply with HIPAA i.e. Standardized Adjustment Categories, Medicare Reason Codes, and Claim Status Codes.

o The contractor will document all account activity, i.e. date, time, representation name, and action/remarks in RPMS

Message field.

o The contractor will adjust claims as necessary, utilize the prompt to roll-over claims for secondary payer etc.

o The contractor will assure to work the Aged Summary Report (ASM) until all claims are resolved with payments or true adjustments to have all accounts current. Work FY18 to current year status.

o The contractor will maintain the Aging Account to be under 20% or until all accounts are current.

o The contractor will close-out all sessions every day.

o The contractor will assure that all applicable forms are submitted and adequately reflect the services rendered.

o The contractor will maintain current documentation and files for all third party utilization review activities in appropriate files, binders, etc.

o The contractor will assure filing of all Explanation of Benefits (EOB’s) in chronological order and by payer electronically.

The contractor will generate correspondence on appeals and denials.

o The contractor will communicate new billing requirements and any issues found on follow up with Patient Registration, visit coding or medical documentation with Business Office Manager and/or Health Information Management Manager.

o The contractor will maintain identified corrective action received from the third party payers to be shared or communicated with the Business Office Manager for review, possible consideration and appeal for payment.

o The contractor will set up EFT and 835 files.

• DELIVERABLES/REPORTING REQUIREMENTS

o The contractor will code visits within four days from DOS.

o Contractor will contact provider if visit is not complete to meet the four days.

o The contractor will address the PPPV and TXER report weekly and provide weekly report to ACL IHS CEO or Business

Office Manager.

o The contractor will bill all visits within 10 days from DOS.

o The contractor will contact facility Patient Registration daily should patient demographics need to be revised. If insurance needs to be added the contractor will contact facility Accounts Receivable staff member.

o The BMP and BCCP claims will be billed on a monthly basis for all claims within the month by the following week of the last day of the month. If visits are denied due to past timely filing or billing error, the contractor will reimburse those monies back to the service unit due to failure of not having the claim billed timely or correctly.

o The contractor will address all Medicaid and Medicare claims and complete within 30 days from DOS and PI and other Insurances will be addressed and completed within 60 days from DOS. Failure to do so will result in contractor reimbursing service unit for loss revenue.

o The contractor will be notified to backfill for the Accounts Receivable Posting/Review/Follow-within two weeks or sooner to staff being out of office. Failure to follow-up on aged claims will result in contractor reimbursing service unit for loss revenue.

• REPORTING REQUIREMENTS

o The contractor will provide a weekly deficiency report which is compiled to communicate to the service unit including specific deficiencies for a particular visit as well as to help demonstrate repeat occurrences of issues. This information can be used to identify problem areas and help develop resolutions to the problem.

o The contractor will participate on a weekly conference call with the Business Office Manager to review the deficiency report and resolve any other issues as needed.

o The contractor will contact the Business Office Manager if unable to work due to technical difficulties or unanticipated events, as soon as possible to, in order to make necessary changes.

o The contractor will submit timecard with hours and staff names on a monthly basis to the Business Office Manager for certification that satisfactory services have been received in accordance with the Scope of Services of the contract.

o The contractor will conduct weekly or bi-weekly calls with the ACL IHS staff via Skype conference call.

o The contractor will respond to requested reports such as PHN billing, Billed/Collected Ratio, etc.

o The contractor will provide training as requested to the appropriate ACL IHS staff.

SF-1449 continued, page 9 of 35

5.2 Work Schedule:

5.2.1 Work Shift:

• The POC at each IHS facility must determine specific tour of duty. The contractor’s employee must work

100% of the contracted hours.

• The Contractor must perform and obtain approval of the department Supervisor or designee prior to any absence from work. If the length of the absence exceeds working hours the Contractor must request from agency approval at least thirty (30) days, (the exception is verifiable emergencies) in advance of the desired absence.

• Approval of leave is contingent upon availability of a qualified replacement.

5.2.3 Scheduling of Shifts: The COR or Alternate COR at the IHS facility will determine specific tour of duty. The scheduler will determine the schedule along with the COR or the Alternate.

5.2.4 Work Flexibility: As directed by the COR, the Contractor's employee must rotate into other duty sections as needed to support patient care.

5.2.5 Work Absence: The Contractor will perform and obtain approval from their agency who will inform the COR and/or Alternate COR prior to any absence from work. If the length of the absence exceeds working hours the Contractor must request from agency approval at least fifteen (15) days, (the exception is verifiable emergencies) in advance of the desired absence.

5.2.6 The Contractor must perform and maintain documentation from a qualified health care provider for absences of three (3) or more consecutive days, due to illness, stating:

5.2.6.1 The cause of the current illness or incapacitation AND

5.2.6.2 Indicating the Contractor as contagious or non-contagious.

5.2.7 Training: Not provided to Contractor employees. The only training provided to the Contractor employees will be in-house at ACL Service Unit.

5.3 Performance Evaluation: In accordance with the standards set forth in the contract and Statement of Work Matrix (Section 6).

5.4 The contractor will perform work with multicultural patients and interpreters as necessary for non-English speaking patients.

5.5 Conduct: The Contractor must perform standards as listed in the Federal Code of Conduct.

5.6 Conditions of Contract Services: All contractors providing service under this contract must attend mandatory orientations specified by the Service Unit.

5.6.1 The contractor must be subject to character investigation as required by Public Law 101-360, the Indian Health Child Protection and Family Violence Prevention Act prior to performance of a contract by utilizing the US Office of Personnel Management (OPM), Electronic Questionnaire for Investigation Processing (eQIP) system and this shall include all fingerprinting procedures and clearances. The contractor must provide all requested information necessary to perform Level I and Level II background checks. The contractor must comply with the requirement to obtain security investigations. The contractor must work with the IHS to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. The contractor will review all completed forms and forward onto the Government personnel.

The contractor will be immediately removed from the position (at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

5.6.2 Identification of Contractor: The Contractor must wear a government issued contractor identification badge during performance of duty. After 120 day’s PIV, cards issued at the Service Unit.

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

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

5.6.4 IHS Information Technology Systems: In performance of this contract, the Contractor must adapt to and successfully utilize IHS information technology systems such as Electronic Health Records (EHR) or RPMS, which the IHS has deemed necessary for acceptable contractor performance. The IT policies and procedures are available to the Contractor at the Service Unit and the Contractor will adhere to the IHS Information Technology System Security Policies and procedures. The Contractor must follow all appropriate federal required information Technology security requirements and will be operating under Health Insurance Portability and Accountability (HIPAA) and Privacy Act regulations.

5.7. CONTRACTOR QUALIFICATION REQUIREMENTS:

SF-1449 continued, page 10 of 35

5.7.1 Professional Development:

• The Contractor shall provide documentation showing at least one certified coder and trained coding/billing/accounts receivable staff with in depth knowledge and skill in the coding and billing guidelines for Medicaid/Medicare and Private Insurance and adhere to all applicable policies, codes, and regulations.

5.7.2 Motor Vehicle Operator's License: Contractors will not operate any Government-Owned vehicles. If required to provide health care services, they are allowed only as passengers in the Government-Owned Vehicle driven by a Federal employee.

5.7.3 Health Requirements of Contracted Healthcare Providers: Furnish documentation that reflects immunity for the indicated vaccine preventable diseases through documented disease, vaccination history, serology results, and/or any documented episodes of adverse events after vaccination. Any contractor’s employee who is allergic to a component of a vaccine and/or have a history of a severe reaction to a vaccine is not required to receive that vaccine with documented proof of contraindication to the vaccination. The following are additional requirements for specific vaccine preventable diseases.

• Measles:

- Vaccinations with 2 doses of live measles or MMR vaccines administered at least 28 days apart,

- Laboratory evidence of immunity,

- Laboratory confirmation of disease, or

- Birth before 1957.

• Mumps:

- Vaccinations with 2 doses of live mumps or MMR vaccines administered at least 28 days apart,

- Laboratory evidence of immunity,

- Laboratory confirmation of disease, or

- Birth before 1957.

• Rubella:

- Vaccinations with 1 dose of live rubella or MMR vaccines administered at least 28 days apart,

- Laboratory evidence of immunity,

- Laboratory confirmation of disease, or

- Birth before 1957

• Hepatitis B:

- Vaccinations with three doses of Hepatitis B vaccines, or

- signed declination of Hepatitis B vaccination series.

• Varicella:

- Vaccinations with two doses of varicella at least 4 weeks apart,

- Laboratory evidence of immunity or confirmation of disease,

- Diagnosis or verification of history of varicella disease by a health care provider, or

- Diagnosis or verification of a history of herpes zoster by a health care provider.

• Influenza:

- Vaccination with one dose of current annual influenza season vaccine.

- Documented proof of the contraindication to the influenza vaccination as outlined by Advisory

Committee on Immunization Practices recommendations, or

- Written statement justifying religious exemption from influenza vaccination.

Note: unvaccinated contract staff with an approved medical or religious exemption must wear an IHS-provided surgical or similar mask when working in patient care areas or other areas frequented by patients in an IHS facility during the influenza season.

• Pertussis -Vaccination with one dose of Tdap vaccine.

• Any additional immunization in accordance with IHS Immunization Policy that is available upon request.

The contract staff must have written documentation of TB test (TST or IGRA) within the last 12 months. If documented Positive TB test:

- Provide chest x-ray report of “No active TB disease” following positive TB test.

- Annual sign and symptoms screen:

• If negative sign and symptom screen, follow up chest x-ray not indicated.

• If signs and symptoms screen positive, contract staff must have written documentation of chest x-ray and health care provider evaluation.

For credentialed provider contract staff they must have documentation from the provider’s physician or chief of staff that confirms they do not have any health problems (including disability, emotional stability, drug, or alcohol dependency) that might impair his/her ability to care for patient at time of application.

5.7.6 Criminal History Background Check:

SF-1449 continued, page 11 of 35

Contractor’s employees whose duties and responsibilities involve regular contact or control over children are subject to a character investigation as required by Public Law 101-630, The Indian Child Protection and Family Violence Act. The minimum standards of character shall ensure that none of the individuals described in this order have been found guilty of, or entered a plea of nolo contendere or guilty to, any felonious offense, or any of two or more misdemeanor offenses, under federal, state, or tribal law involving crimes of violence;

sexual assault, molestation, exploitation, contact or prostitution; crimes against persons; or offenses committed against children. These crimes do not hold a time statue and will be evaluated the same under any Child Care “CNACI” investigation with IHS. IHS will conduct these investigations following award of a contract.

Until the character investigation has been completed and the Contracting Officer notified of the results, the Contractor‘s employees must not have unsupervised contact with Indian children. Contractor’s employees are not able to work a scheduled shift until the security check is performed and clearance has been obtained by the appropriate agency. At a minimum, fingerprints are required, and upon clearance of this stage, a contractor’s employee may work a scheduled shift. However, Contractor’s employees are required to complete the detailed background application and the application is to be completed within 30 days once the contractor’s employee has been given physical and logical access. All Contractors’ employees are subject to criminal background check prior to performing services in accordance with Solicitation terms and conditions.

The contractor shall ensure that each of their employees complete the Certification of Criminal History and Background Check Packet. The completed forms are to be returned to the COR. Additional Background Check packets can be obtained through the COR. See HHSAR Clauses 352.237-72 and 352.237-73.

5.7.7 Required Training: Protecting Children from Sexual Abuse as stated in IHM Circular 19-05: Contractor Training Plan for Implementation of Indian Health Manual Part 3, Chapter 20, Protecting Children from Sexual Abuse by Health Care Providers. Each provider must take this training within 30 days from their start date at the service unit. Certificate should be provided to the COR.

5.7.8 Subpoenas/Testimonies: Contractors are mandated to cooperate with the appropriate IHS managers when the contractors' employees are subpoenaed or requested by Tribal, State or Federal Parties to provide testimony as stated in Section 5-27.3(B)(9) of the Indian Health Manual.

5.8 Challenges to Conflicts: For any inconsistency between COR and Contractor's employee, the employee should contact their agency. If this situation needs further remedies, then the Contractor will contact the COR

5.9 When the Contractor demonstrates impaired judgement, they cannot continue working on the Solicitation. The Government reserves the right to remove from the facility any Contractor employee who in the judgment of a licensed healthcare practitioner is impaired.

5.10 APPLICABLE DOCUMENTS:

• Business Associate Agreement

• OF 306 – Addendum to Declaration for Federal Employment – Indian Health Service Child Care & Indian Child Care

Work Positions

SECTION 6 0 QUALITY ASSURANCE SURVEILLANCE PLAN

Performance Requirements Summary (PRS)

Required Service

Performance Indicators

Acceptable Quality

Level (AQL)

Method of Surveillance

Payment % for NOT

Meeting AQL Coding, Claims Processing

Posting

Account Reviews and Follow-Up

All staff must be competent and experienced in GPAIHS third party billing requirements including GPRA.

Ability to accurately assign ICD-10-CM, ADA, CPT, and HCPCS codes to all patient encounters with 95% accuracy.

Provide Coding, Data Entry, Compliance Auditing, and Reporting Services as specified in the Statement of Work and Indian Health Manual Part 5, Chapter 1, “Third-party Revenue Accounts Management and Internal Controls”.

Work is reviewed for accuracy through quality assurance activities performed by ACL IHS HIM staff, observation, and random sampling by ACL IHS HIM or his/her designee.

Provide quarterly reports to the Contracting Officer Representative (COR)

5% deduction from monthly invoice.

Deductions will increase by 1% in subsequent years.

Required Service

Performance Indicators

Acceptable Quality

Method of Surveillance

SF-1449 continued, page 12 of 35

Required Service

Performance Indicators

Acceptable Quality

Level (AQL)

Meeting AQL

Third Party Billing

All staff must be competent and experienced in GPAIHS third party billing requirements including

GPRA.

Ability to accurately assign ICD-10-CM, ADA, CPT, and HCPCS codes to all patient encounters with 95% accuracy.

Provide Third Party Billing Services as specified in the Statement of Work and Indian Health Manual Part 5, Chapter 1, “Third-Party Revenue Accounts Management and Internal Controls”.

Work is reviewed for accuracy through quality assurance activities performed by Area Business Office and/or ACL IHS HIM staff, through direct observation, and random sampling by ALC IHS Business Office Manager or his/her designee. Submit Quarterly Reports to the Project Officer.

5% deduction from monthly invoice.

Deductions will increase by 1% in subsequent years.

Required Service

Performance Indicators

Acceptable Quality

Level (AQL)

Meeting AQL Back billing

Third Party Billing;

This will be established prior to assignment of the workload.

All staff must be competent and experienced in GPAIHS third party billing requirements including

GPRA.

Ability to accurately assign ICD-10-CM, ADA, CPT, and HCPCS codes to all patient encounters with 95% accuracy.

Provide Third Party Billing Services as specified in the parameters set in collaboration between the government and contractor but will be completed within 30 calendar days.

Work is reviewed for completion through direct observation by government. Submit weekly reports to the ACL IHS CEO, or designee.

5% deduction from monthly invoice.

Deductions will increase by 1% in subsequent years.

Required Service

Performance Indicators

Acceptable Quality

Level (AQL)

Meeting AQL

Level (AQL) Meeting AQL Backlogs in Coding, Data Entry, Compliance Auditing, and Reporting for ACL IHS HIM/Bus.

Office Staff; this will be established prior to assignment of the workload.

All staff must be competent and experienced in GPAIHS third party billing requirements including GPRA.

Ability to accurately assign ICD-10-CM, ADA, CPT, and HCPCS codes to all patient encounters with 95% accuracy.

Provide Coding, Data Entry, Compliance Auditing, and Reporting Services as specified in the parameters set in collaboration between the government and contractor but will be completed within 30 calendar days.

Work is reviewed for completion through dirct observation by the government. Provide weekly reports to the ACL IHS CEO, or designee.

5% deduction from monthly invoice.

Deductions will increase by 1% in subsequent years.

SF-1449 continued, page 13 of 35

Current Patient Accounts Receivable

All staff providing this service must be competent and experienced in GPAIHS Account Receivable and the RPMS accounts receivable program.

Ability to accurately process account receivable functions with 95% accuracy.

Provide Patient Accounts Receivable Services as specified in the Statement of Work and Indian Health Manual Part 5, Chapter 1, “Third-party Revenue Accounts Management and Internal Controls”.

Work is reviewed for accuracy through quality assurance activities performed by Area BOC and/or Service unit staff, direct observation, and random sampling by ACL IHS HIM/ Business Office Manager or his/her designee. Submit Quarterly Reports to the Project Officer.

5% deduction from monthly invoice.

Deductions will increase by 1% in subsequent years.

Required Service

Performance Indicators

Acceptable Quality

Level (AQL)

Meeting AQL Back log in Patient Accounts Receivable;

this will be established prior to assignment of the workload.

All staff providing this service must be competent and experienced in GPAIHS Account Receivable and the RPMS accounts receivable program.

Ability to accurately process account receivable functions with 95% accuracy.

Provide Patient Accounts Receivable Services as specified in the parameters set in collaboration between the government and contractor but will be completed within 45 calendar days.

Work is reviewed for completion through direct observation by government. Submit weekly reports to the ACL IHS CEO, or designee.

5% deduction from monthly invoice.

Deductions will increase by 1% in subsequent years.

Required Service

Performance Indicators

Acceptable Quality

Level (AQL)

Meeting AQL Consultant Services / Auditing for Revenue Generation Cycle Functions and Processes

All staff providing this function must be competent in the third party billing process and experienced in GPAIHS third party billing requirements and knowledgeable of the Third party Internal control policy for all functions of the billing process.

Ability to perform this function with 97% accuracy.

Provide Consultant/Auditing Services as specified in the Statement of Work and Indian Health Manual Part 5, Chapter 1, “Third-party Revenue Accounts Management and Internal Controls”.

Work is reviewed for accuracy through quality assurance activities performed by Area HIM and/or BOC and/or Service unit staff, direct observation, and random sampling by ACL IHS HIM/BO or his/her designee.

Submit Quarterly Reports to the Contracting Officer.Representative

5% deduction from monthly invoice.

Deductions will increase by 1% in subsequent years.

1. Performance Evaluation – If the contractor fails to perform required services at the acceptable quality level, payment may be withheld until the contractor makes corrections. In the event that the contractor is failing to perform any required services, the COR will provide written notice of such to the Chief of the Contracting Office and the contractor. The Contracting Office will issue the contractor a Contractor Discrepancy Report (CDR). The contractor shall have 14 calendar days to provide the Contracting Office with their response to the CDR. Upon evaluation of the contractor’s response to the CDR for tasks surveilled, the contractor’s payment for the month in which the performance in question occurred will be calculated as outlined below.

2. Contractor Payment – If the contractor fails to perform required services at the acceptable quality level, payment may be withheld until contractor makes corrections. If deviations continue after 6 months, then payment may be reduced an additional 1%. If performance is below numerical standards, details will be recorded on “past performance report card.” If

SF-1449 continued, page 14 of 35 performance is below standard for 2 quarters in a row, Government oversight or…