Tab 12 - PPQ - Area Wide HIM Coding BPAs.docx
DOCX document 21 KB Posted
- Solicitation number
- 75H71026Q00276
About this file
This is a Past Performance Questionnaire (PPQ) template designed for the Indian Health Service (IHS) Navajo Area to evaluate vendor performance on HIM Medical Coding and Data Entry Services under Solicitation No. 75H71026Q00276. The PPQ is completed by references provided by vendors responding to the solicitation and submitted directly to the Contracting Officer by a specified deadline; responses are used to assess the likelihood of successful contract performance and may be shared with vendors during debriefing.
The questionnaire evaluates vendor performance across six key areas: Coding Accuracy (including code assignment accuracy, specificity, and modifier/E/M level/DRG correctness); Timeliness (turnaround timeframe compliance and backlog management); Documentation and Data Quality (deficiency identification and data element accuracy); Workforce and Credential Compliance (appropriate certifications and staffing continuity); Security and Confidentiality (HIPAA/privacy compliance and prevention of unauthorized disclosures); and Communication and Responsiveness (point-of-contact accessibility, report submission timeliness, and proactive issue resolution). References rate performance on a five-point scale from Exceptional to Unsatisfactory, with the ability to note N/A. The questionnaire also collects contract details including company name, contract type, period of performance, place of performance, monthly encounter volume, encounter types coded (outpatient, emergency department, inpatient), and ancillary systems used (RPMS/IHS EHR, Epic, Cerner). References provide an overall performance rating and indicate whether they would award a similar contract again, with space to document any performance deficiencies, corrective actions, or contract modifications.
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PAST PERFORMANCE QUESTIONNAIRE (PPQ)
Indian Health Service — Navajo Area Indian Health Service HIM Medical Coding and Data Entry Services Solicitation No.: [Insert]
Instructions to References This Past Performance Questionnaire (PPQ) has been provided to you by a company that has listed your organization as a reference in response to the above-referenced solicitation. The Government is using this information to assess the likelihood of successful contract performance.
Please complete all sections and submit this form directly to the Contracting Officer at [insert CO email address] no later than [insert due date]. Do not return this form to the company that provided it to you. PPQs submitted by the Quoter on behalf of a reference will not be accepted.
Your responses will be used by the Government in its evaluation of the Quoter's past performance and may be shared with the Quoter during any debriefing. Please be candid and accurate. If you have questions, contact [insert CO name and phone number].
Part I — Reference Information
Your Name:
Your Title:
Organization / Agency:
Address:
Phone:
Email:
| Relationship to Quoter: |
| ☐ Contracting Officer ☐ COR / COTR ☐ Program Manager ☐ Other: __________ |
Part II — Contract Information
Quoter / Company Name:
Contract or Agreement Number:
| Contract Type: |
| ☐ Firm-Fixed-Price ☐ BPA ☐ Time-and-Materials ☐ Other: __________ |
| Period of Performance: |
| Start: _____________ End: _____________ |
Place of Performance:
Brief Description of Services:
Approximate Monthly Encounter Volume:
| Encounter Types Coded: |
| ☐ Outpatient / Ambulatory ☐ Emergency Department ☐ Inpatient ☐ Ancillary |
| Systems Used: |
| ☐ RPMS / IHS EHR ☐ Epic ☐ Cerner ☐ Other: __________ |
Part III — Performance Ratings Please rate the Quoter's performance in each area using the following scale:
| Rating |
| Definition |
| Exceptional |
| Performance significantly exceeded requirements; little or no Government intervention required |
| Very Good |
| Performance exceeded most requirements; minor issues self-corrected |
| Satisfactory |
| Performance met requirements; issues corrected with Government involvement |
| Marginal |
| Performance did not meet some requirements; required significant Government intervention |
| Unsatisfactory |
| Performance failed to meet requirements; serious deficiencies not corrected |
| N/A |
| Not applicable to this contract |
3.1 Coding Accuracy
| Item |
| Rating |
| Comments |
| Codes assigned were accurate and supported by clinical documentation |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
| Coding was performed at the appropriate level of specificity |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
| Modifiers, E/M levels, and DRG assignments were correct |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
Approximate coding accuracy rate achieved (if known): _______%
3.2 Timeliness
| Item |
| Rating |
| Comments |
| Encounters were completed within required turnaround timeframes |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
| Backlogs were managed and resolved without significant Government intervention |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
Approximate on-time completion rate achieved (if known): _______%
3.3 Documentation and Data Quality
| Item |
| Rating |
| Comments |
| Deficiencies were identified and providers notified in a timely manner |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
| Required data elements were fully and accurately entered into the health record system |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
3.4 Workforce and Credential Compliance
| Item |
| Rating |
| Comments |
| Coders held appropriate current certifications throughout the contract period |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
| Staffing was maintained without significant coverage gaps or disruptions |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
3.5 Security and Confidentiality
| Item |
| Rating |
| Comments |
| Patient information (PHI/PII) was handled in accordance with HIPAA and applicable privacy requirements |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
| No unauthorized disclosures, data breaches, or security incidents attributable to the Contractor |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
3.6 Communication and Responsiveness
| Item |
| Rating |
| Comments |
| The Contractor's point of contact was responsive and accessible |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
| Required reports were submitted accurately and on time |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
| Performance issues were communicated proactively and resolved promptly |
| ☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory ☐ N/A |
Part IV — Overall Assessment Overall Performance Rating:
☐ Exceptional ☐ Very Good ☐ Satisfactory ☐ Marginal ☐ Unsatisfactory Would you award a contract to this company again for similar services?
☐ Yes, without reservation ☐ Yes, with minor reservations — please describe below ☐ No — please describe below Comments:
Were there any performance deficiencies, corrective actions, or contract modifications resulting from performance issues during this contract?
☐ No ☐ Yes — please describe the nature of the deficiency, the circumstances, and how it was resolved:
Part V — Signature By signing below, I certify that the information provided in this questionnaire is accurate and complete to the best of my knowledge.
| Signature: |
| __________________________________ |
| Printed Name: |
| __________________________________ |
| Title: |
| __________________________________ |
| Organization: |
| __________________________________ |
| Date: |
| __________________________________ |
Submit this completed form directly to the Contracting Officer at [insert CO email address] by [insert due date]. Do not return to the Quoter. For questions, contact [insert CO name] at [insert phone number].
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