21-R-0051-0001 Medical Coding.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

See Next Page.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 28

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X W91QVN21R0051

X 9B. DATED (SEE ITEM 11)

14-Apr-2021

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer X is extended, is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION

NO. 0001

5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

22-Apr-2021

CODE

411TH CONTRACTING SUPPORT BRIGADE, KOREA

SERVICES DIV, UNIT #15289

APO AP 96271

UNITED STATES

W91QVN 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

JONES.PERCY.D.JR.10686

71414

Digitally signed by

JONES.PERCY.D.JR.1068671414

Date: 2021.05.04 13:25:50 +09'00'

W91QVN21R0051

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been added by full text:

AMENDMENT 0001

a. The purpose of this amendment is to answer the questions from offerors as follows:

Q1: Based on BetaSam it states that: Original Set Aside: Local Area Set-Aside (FAR 26.2), however its not mentioned in SF 1449. Please confirm if a Total Small Business Set-Aside can submit a bid proposal for this solicitation.

A1: There is no set-aside for this solicitation.

Q2: Can the positions be filled remotely or is onsite required? Can 1 position be performed onsite and the other offsite?

A2: The positions should be filled remotely and services, particularly data quality, are timely and provided prior to the suspense. Performance Work Statmement is revised to reflect this changes.

Q3: If the position can be done remotely should we disregard the War Hazard Loss pricing?

A3: Yes, you can disregard the War Hazard Loss pricing for remote service.

Q4: Are contractors required to use the SCA wage determination for this opportunity? If so, please clarify which job title contractors should use for services required?

A4: We will follow the Service Contract Act (SCA) Wage Determinations (WD) #2015-5659, Occupation Code 12190, Title, Medical Record Technician, Rate $23.13.

Q5: Will the government provide SOFA or Logistical support for this role?

A5: No, Government will not provide the SOFA status.

Q6: Is this a follow-on requirement or a new contract? If it is a follow on contract could you please provide the incumbent contract number and the awarded price?

A6: This is a follow-on requirement and current contract is W91QVN-18-C-0009 with the total amount $606,194.40 for 3 years.

Q7: Under paragraph 3.5. TRAINING: Government will provide training in use of military medical computer software such as AHLTA, CHCS, and ASIMS.

Will there be additional trainings that Contractor shall provide? If so, what are the specific trainings and the location/s?

A7: The contractor will provide training to the customer (e.g. staff members) when required. There are no additional trainings scheduled at this time.

Q8: Under paragraph 1.6.29. Health and Immunization Requirement: See Exhibit 1. Please confirm what page can we find Exhibit 1 in the Solicitation.

A8: Exhibit 1 is uploaded as an attachment in Beta.Sam.

Q9: In paragraph 4.2. The contractor is required to provide contract personnel with all required medical coding books, manuals or other coding reference material. Examples of coding reference material include but are not limited to, ICD-10-CM, APA HCPCS and APA CPT. Coding books should be the most updated version available to ensure medical staff are receiving proper guidance from contract personnel.

Does the government have available aforementioned books that the Contractor can buy?

A9: No books are available for purchase.

Q10: Would you accept a partial bid?

A10: No partial bid would be acceptable.

b. Bid closing date is extended from 14 May 2021, 13:00 hrs. to 21 May 2021, 13:00 hrs.

c. All other terms and conditions remain the same.

SECTION SF 1449 - CONTINUATION SHEET

SOLICITATION/CONTRACT FORM

The required response date/time has changed from 14-May-2021 01:00 PM to 21-May-2021 01:00 PM.

The following have been modified:

BUSINESS ASSOCIATE AGREEMENT

“See Exhibit #1”

PWS

PERFORMANCE WORK STATEMENT (PWS)

Medical Coding Service

51st Medical Group Osan Air Base, Korea

PART 1

GENERAL INFORMATION

1. GENERAL: This is a non-personnel services contract to provide MEDICAL CODING SUPPORT. The Government will not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government. The contractor shall provide the non-personal services of MEDICAL CODING SUPPORT;

including 2 FTE MEDICAL RECORDS CODING AUDITOR, 1 FTEs CODING TECHNICIAN (Outpatient/Inpatient Clinic) at the 51st MEDICAL GROUP, OSAN AIR BASE, REPUBLIC OF KOREA which shall contribute to a stable workforce tasked with providing quality health care services to a diverse population.

Contract personnel providing medical coding support will also be referred to as “coders” throughout the rest of the document. The Contractor shall furnish all management, tools, equipment, supervision, reports, consultation and labor necessary to ensure that the Contractor provides coders & auditors for the 51st Medical Group (MDG). The Contractor shall provide services to the 51st Medical Group, Osan Air Base (AB), also referred to as the “medical treatment facilities” (MTFs) herein. Performance shall be according to the requirements contained in this performance work statement (PWS).

1.1. DESCRIPTION OF SERVICES: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform non- MEDICAL CODING SUPPORT as defined in this Performance Work Statement except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2. All services shall be provided in accordance with established standards, principles and ethics of the profession and applicable professional specialty organizations, The Joint Commission (JC) standards, AAAHC, Accreditation Association for Ambulatory Health Care, applicable Department of Defense (DoD) and Air Force specific regulations, directives, and policies, and military treatment facilities (MTF) specific policies, procedures, and job descriptions. Contract health care staff (contract personnel) shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association’s Bill of Rights for Patients. The Contractor shall provide non-personal services for varied ancillary healthcare specialties in accordance with established principles and ethics of the medical profession, the national standards established by the JC, the professional standards at the medical treatment facility (MTF), and the American Board of applicable specialty. The Contractor shall be held accountable for compliance to the standards listed in the Comprehensive Accreditation Manual for Hospitals (CAMH) dated 2011 or current version.

1.3. BACKGROUND:

1.3.1. The mission of the military healthcare system (MHS) is to ensure the nation has available at all times a healthy military force supported by a combat ready healthcare system. Health care services for eligible MHS beneficiaries are provided at Military Treatment Facilities (MTF) located on or near military installations or posts.

The military treatment facility may be a clinic, hospital, or medical center. Clinics are outpatient facilities offering primary care or simple specialty care (routine exams, tests, and treatments). The clinic may be stand-alone site or satellite of a larger clinic, hospital, or medical center. The 51st Medical Group mission is to seamlessly transition from community healthcare to contingency operations and respond to a full spectrum of health requirements, prepare medically ready forces, expand medical capabilities, and sustain war reserve materiel in support of 7 Air Force (AF) and United States Forces Korea (USFK). The contractors provides Medical Management services to over 12,000 beneficiaries. The contractors work with other members of the Medical Management Team, all clinical and patient administrative areas of the MTF to provide individualized care and promote a positive outcome for the beneficiaries through collaborative and effective nursing practices.

1.4. OBJECTIVES: Perform the full spectrum of services as a Medical Coding Service Provider to support 51st Medical Group’s mission. The contractor shall provide all labor, materials, tools, equipment, transportation, and materials necessary to recruit, qualify, and retain a contractors throughout the duration of this contract.

1.4.1. All services shall comply with established standards, principles, and ethics of the Medical Coding Management profession and applicable professional specialty organization, the Joint Commission (JC) standards, the professional standards at the MTF, the Accreditation Association for Ambulatory Heath Care (AAAHC), applicable Department of Defense (DoD), Air Force Instructions (AFI)-44-174 & 44-173, AFMAN 41-120, AF Guide to Population Health, DoD Medical Management Guide and Medical Group Instruction (MDGI) 44-106.

These documents are available in the MTF and maintained by the Government. Supplements or amendments to instructions or publications from any organizational level may be issued during the life of the contract. The Contractor shall immediately implement those changes. The contractors shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association’s Bill of Rights for patients. The contractors shall be held accountable for compliance to the standards listed in the Comprehensive Accreditation Manual for Hospitals (CAMH) dated 2011 or current version.

The contractors shall be held accountable for relevant action items in the Defense Health Agency (DHA) Data Quality Management Control (DQMC) User’s Guide or the most recent guidance Data Quality manual.

Physicians, nurse practitioners, physician assistants, registered and licensed practical nurses, and other support personnel. All contact personnel shall perform essentially the same functions, within scope of acceptable practice for the specific specialty or position, as those required by Air Force or Government service health care professionals of similar experience and similar duty assignments. The scope of services provided in military treatment facilities cover the same range of services as those that are provided in civilian treatment facilities of similar size and scope of services.

1.5. SCOPE: The 51MDG/CC is seeking assistance in improving their medical coding support and overall resource management processes and performance, including better positioning for the Assistant Secretary of Defense for Health Affairs’ Perspective Payment System, acceleration of reimbursement enhancement, cost savings initiatives and implementation of comprehensive, commercial best practices based systems. As a result, these MTFs require coding services to be provided in support of these initiatives. The contractor shall provide non-personal services for supplemental staffing for coding personnel to perform outpatient record coding, inpatient record coding, ambulatory procedure coding, and related medical record functions covering a wide range of medical specialties for the Medical Treatment Facilities (MTFs). Outpatient records coding will primarily be a review of the electronic medical record initiated by healthcare provider, but there may be instances where actual coding needs to take place. Inpatient coding will include coding of all documentation from admission to disposition to include any related surgeries and procedures. Ambulatory procedure coding will include coding of all outpatient surgeries and procedures. Auditing, training and feedback tailored to the healthcare providers will be provided by coding auditor. Auditing will be provided for outpatient coding, inpatient coding and ambulatory procedure coding, as required. Training and feedback will be provided primarily to the professional staff. However, it may also include the non-professional staff and the ancillary support staff. Related medical records functions including, but not limited to, pulling, copying, scanning and filing of outpatient records, inpatient records and ambulatory procedure records may be required. The Biometric Data Quality Assurance Service (BDQAS) will need to be utilized by coders as a means to identify encounters in the MTF that could be coded incorrectly and fix as needed. Further encounter coding audits will need to be conducted on any encounters flagged as data quality errors to ensure measures are taken to correct these errors. A COR will perform functional oversight, consultation and analysis for the MTF staff

1.5.1 Place of Performance. The services provided under this contract can be performed remotely (off-site) at contractor facilities. For purposes of off-site remove coding, a contractor facility is inclusive of CSP performing services at home.

1.5.2 PERIOD OF PERFORMANCE: The period of performance shall be for one (1) Base Year of 12-months and four (4) 12- month option years.

1.5.3. Type of Contract: The Government contemplates award a Firm-Fixed Price contract.

1.6. PERFORMANCE QUALITY:

1.6.1. Quality Control: See Exhibit 1

1.6.2. Quality Control Plan. See Exhibit 1

1.6.3 Quality Assurance Surveillance Plan: See Exhibit 1

1.6.4. Recognized Holidays: See Exhibit 1

1.6.5. Hours of Operation: See Exhibit 1

1.6.6. Absences and leave: See Exhibit 1

1.6.7. Continuity of Services/Replacement Staff: See Exhibit 1

1.6.8. Scheduled and Unscheduled Absences: See Exhibit 1

1.6.9. Place of Performance: See Exhibit 1

1.6.10. Reserved

1.6.11. National Agency Check: See Exhibit 1

1.6.12. Identification Badge: See Exhibit 1

1.6.13. Vehicle Registration: See Exhibit 1

1.6.14. Safeguarding Government Property/Information:

1.6.15. Contractor’s Qualification.

1.6.15.1. Prime Contractor’s Prior Experience: The Prime Contractor shall have at least two (2) years of experience within the last seven (7) years in providing Medical Record or Medical Staff Services support or Medical Coding management. The experience of a subcontractor cannot be substituted for the Prime Contractor’s experience. The offeror shall provide evidence of prior experience in the following format:

The title and number of the contract/project Description of work completed Length of contract/project (year/month/date – year/month/date) Value of contract/project for total amount Complete point of contact at Client Organization (including name, phone number, email address)

1.6.15.2. The contractor must provide personnel to provide the following service: Personnel for Coding Technician have at least 2 (two) years’ experience in outpatient or inpatient coding

1.6.15.2.1 License: The contract personnel is required to have at least one accreditation from a nationally recognized in the United States accrediting medical coding body to include, Certified Coding Specialist (CCS), Certified Coding Specialist-Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder- Hospital (CPC-H), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA).

1.6.15.2.2. Experience: The contract personnel must have proficient knowledge of medical terminology, anatomy, pharmacology, surgical and medical procedures sufficient to code for optimum billing. This knowledge extends to a number of medical and surgical specialties and human physiological systems. The contract personnel must have knowledge of accepted medical abbreviations and their meanings and interpretation. The contract personnel must have knowledge in the use of specialized references, such as medical nomenclatures, medical dictionaries and texts and medical journals to accurately spell out and use medical terminology. The contract personnel must have knowledge of basic computer functionality.

1.6.15.2.2.1 The contract personnel shall be responsible for verifying and coding of the diagnosis, evaluation and management, admissions, surgeries, procedures or any other codes required for the completeness and accuracy of the record. Supports the Third Party Collection office (as needed) to ensure they have the documentation to submit a claim for reimbursement, to include coding of episode of care if required. Reviews and verifies component parts of medical record to ensure completeness and accuracy of diagnosis, operations, and special therapeutic procedures that must conform to the Center for Medicare and Medicaid Services (CMS) and Department of Defense Coding Guidelines. Codes and/or reviews principal diagnosis, co-morbidities, complications, therapeutic and diagnostic procedures, supplies, materials, injections, and drugs with International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) – all levels, and any other coding classification systems required by the Department of Defense (ICD-10-CM/PCS when available). Inputs codes into applicable coding system made available for each individual MTF. These systems include, but are not limited to: CCE, CHCS (ADM), Essentris, and AHLTA.

1.6.15.3 The contractor must provide personnel to provide the following service: Personnel for Coding Auditors have at least 2 (two) years of medical auditing experience.

1.6.15.3.1 License: The contract personnel is required to have at least one accreditation from a nationally recognized in the United States accrediting medical coding body to include, Certified Coding Specialist (CCS), Certified Coding Specialist-Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder- Hospital (CPC-H), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA).

1.6.15.3.2 Education: The contract personnel must have associates degree in Healthcare or related field

1.6.15.3.3 Experience: The contract personnel must have extensive knowledge of International Classification of Diseases (ICD) and Healthcare Common Procedure Coding System (HCPCS) (CPT, E&M, etc.) codes and coding practices. The contract personnel must have ability to recognize the correct sequence of diagnoses and procedures.

The contract personnel must have knowledge of DoD coding guidelines, Federal/state compliance regulations. The contract personnel must have knowledge of medical terminology, anatomy and physiology.

1.6.15.3.4 The contract personnel must have knowledge in computer operation including utilization of the Composite Health Care System (CHCS), Ambulatory Data System (ADS), AHLTA, Essentris, word processing, spreadsheets, and other program applications, as necessary. The contract personnel must have skill in oral and written communication sufficient to prepare comprehensive reports, to make presentations of findings and recommend corrective action, and effectively interact with hospital personnel and professional organizations. The contract personnel must have skill in collecting and organizing data sufficient to compile statistical reports, analyze trends, and show differences between related variables to determine accuracy and completeness of records. The contract personnel must have knowledge of data collection methods for basic health care, research information and statistical reporting Analytical ability. The contract personnel must have ability to maintain confidentiality. The contract personnel must have knowledge of laws and regulations on the confidentiality of medical records.

1.6.15.4. English Requirement: The Contractor personnel working on this contract shall be able to communicate in the English language at the intermediate level as exemplified in their written and verbal skills in the performance of their duties under this contract. Government will assess language skills of all Contract employees who are required by terms of this PWS to be proficient at speaking English through performance of services. If the Government, at its sole discretion, determines that the language skills of a Contractor employee does not meet the language proficiency skills required of the position, the Government reserves the right to require the Contractor to provide a new Contract employee that does possess the required language proficiency skills required of the position, at no additional cost to the Government.

1.6.16 Key Personnel: See Exhibit 1

1.6.17. Post Award Conference/Periodic Progress Meetings: See Exhibit 1

1.6.18. Organizational Conflict of Interest: See Exhibit 1

1.6.19. Confidentiality of Information: See Exhibit 1

1.6.20. Communication: See Exhibit 1

1.6.21. Professional Liability: See Exhibit 1

1.6.22. Responsibility and Procedures: See Exhibit 1

1.6.23. Contractor Responsibility: See Exhibit 1

1.6.24. Compliance with Laws and Regulations: See Exhibit 1

1.6.25. Orientation, and Training: See Exhibit 1

1.6.26 In/Out-Processing: See Exhibit 1

1.6.27. Training Requirement: See Exhibit 1

1.6.28. Computer Training: See Exhibit 1

1.6.29. Health and Immunization Requirement: See Exhibit 1

1.6.30. Media and Other Inquires: See Exhibit 1

1.6.31. Appearance: See Exhibit 1

1.6.32. Inspection: See Exhibit 1

1.7. Administrative: See Exhibit 1

1.7.1. Records: See Exhibit 1

1.7.2. Data Rights: See Exhibit 1

1.7.3. Emergency Healthcare for contractors: See Exhibit 1

1.7.4. Monthly Progress Report Meeting: The Contract Manager shall conduct a monthly progress report meeting with the COR and FRED. The meeting can be held physically or via teleconference. The topics of the meeting must at least include PWS Part 5. The Contract Manager shall communicate to the appropriate site managers and track to completion all action items that result from this meeting.

1.7.5. HIPAA Compliance: See Exhibit 1 and Attachment I

1.7.6. Work Roster: The Contract Manager shall provide the COR a list of all employee names providing services in support of this contract. This list shall be provided to the COR by the 20th of the month for the upcoming month.

1.8. Access and General Protection/Security Policy and Procedures: See Exhibit 1

1.9. Contractor Verification System (CVS): See Exhibit 1

1.10. Patient Sensitivity: See Exhibit 1

1.11. Safety Requirement: See Exhibit 1

1.12. Contract management: See Exhibit 1

PART 2 DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS:

2.1. DEFINITIONS

2.1.1. AMBULATORY DATA SYSTEM (ADS). This computer system produces forms on which the providers identify the appropriate billing codes for diagnoses and procedures for each patient.

2.1.2. ARMED FORCES HEALTH LONGITUDINAL TECHNOLOGY APPLICATION (AHLTA) contains the MTF’s appointment scheduling program, pharmacy, lab, and radiology ordering system and is interlinked with other departments in the MTF. In addition, it contains the electronic medical records for MHS beneficiaries.

2.1.3. COMPOSITE HEALTHCARE COMPUTER SYSTEM (CHCS) is the military’s world-wide automated medical information system interfaces with 40 plus external clinical and administrative systems.

2.1.4. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.5. CONTRACTING OFFICER (KO). A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.6. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.7. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.8. DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

2.1.9. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.9. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.10. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.11. QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.12. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.13. SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.14. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.15. WORK WEEK. Monday through Friday, unless specified otherwise.

2.2. ACRONYMS:

AAAHC Accreditation Association for Ambulatory Health Care ADM Ambulatory Data Module ADP Automated Data Processing ADS Ambulatory Data System AETC Air Education and Training Command AFARS Army Federal Acquisition Regulation Supplement AFI Air Force Instruction AHA American Hospital Association AHLTA Armed Forces Health Longitudinal Technology Application AKO Army Knowledge Online AMA American Medical Association AOD Administrative Officer of the Day AR Army Regulation BAA Business Associate Agreement CAC Common Access Card CAMH Comprehensive Accreditation Manual for Hospitals CDC Centers for Disease Control and Prevention CFR Code of Federal Regulations CHCS Composite Health Care System CLIN Contract Line Item Number CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTR Contracting Officer’s Technical Representative CPT Current Physicians Terminology CVS Contractor Verification System DA Department of the Army DD Department of Defense DEERS Defense Enrollment Eligibility Reporting System DoD Department of Defense DoDI Department of Defense Instruction DFARS Defense Federal Acquisition Regulation Supplement EFT Electronic Funds Transfer FAR Federal Acquisition Regulation FNP Family Nurse Practitioner FRED Functional Requirements Evaluator Designee FSO Facility Security Officer FTE Full Time Equivalent FW Fighter Wing

HCP Health Care Provider MEDCENs Army Medical Centers MEDCOM Medical Command MHA Mental Health Assessment MHS Military Healthcare System HIPAA Health Insurance Portability and Accountability Act of 1996 JC Joint Commission KO Contracting Officer LADS Labor and Delivery Statistics System MDG Medical Group MEDCENs Army Medical Centers MEDCOM Medical Command MHS Military Healthcare System MTF Military Treatment Facility OCONUS Outside Continental United States (includes Alaska and Hawaii) OIC Officer in Charge OSHA Occupational Safety and Health Administration PACAF Pacific Air Forces PAM Pamphlet PAR Performance Assessment Report PHA Preventive Health Assessment POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement PL Public Law QA Quality Assurance QASP Quality Assurance Surveillance Plan QC Quality Control RVU Relative Value Unit SF Standard Form SGP Chief of Aerospace Medicine SGH Chief of Medical Staff TA Trusted Agent TASS Trusted Associate Sponsor System TAMC Tripler Army Medical Center UCAPERS Uniform Charts of Accounts Personnel System

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

3.GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1 The Government will provide access to the following:

3.1.1 DoD Common Access Card (CAC). The government will provide a DoD CAC smart card to each contract service provider performing medical record coding services.

3.1.2 DoD Root Certificates software package located at

https://io.dha.health.mil/fls/fls_avh/InstallRoot_v3-16A.exe or http:iase.disa.mil/pki-pke/Pages/tools.aspx.

3.1.3. Citrix Receiver Client 4.2.100 or newer software package located at https://io.dha.health.mil/fls/fls_avh/CitrixReceiverWeb.exe.

3.1.4. Uniform Resource Location (URL) associated with AVHE application portal specific to the supported MTF.

3.1.5. The Government will provide access credentials for Essentris, Armed Forces Health Longitudinal Technology Application (AHLTA), HAIMS, CHCS, and CCE via the Application Virtualization Hosting Environment (AVHE).

3.2 Government Unique Training

3.2.1 The government will provide unique government training to CSPs who are performing services under this contract. Upon award of task order, each MTF-specific COR and the contractor may coordinate to arrange for unique training of CSPs (to include “train-the-trainer”) in the use of the Ambulatory Data Module (ADM), Essentris, CHCS, AHLTA, CCE, MHS Genesis, and other hosted applications require in conjunction with the performance of the contract.

3.3. Training: Government will provide training in use of military medical computer software such as AHLTA, CHCS, and ASIMS

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4.CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

4.1. General: The Contractor shall furnish all labor, tools, equipment, transportation, and materials necessary to recruit, qualify, and retain three (3) contractors to provide services that are personal in nature for the duration of this contract.

4.2 The contractor is required to provide contract personnel with all required medical coding books, manuals or other coding reference material. Examples of coding reference material include but are not limited to, ICD-10-CM, APA HCPCS and APA CPT. Coding books should be the most updated version available to ensure medical staff are receiving proper guidance from contract personnel.

PART 5

SPECIFIC TASKS

5. SPECFIC TASKS:

5.1 Basic Services for the Medical Coding Technician: Contract personnel must review, identify and/or code the correct diagnosis and procedure based on physician and/or clinical staff’s recorded documentation and established sequencing rules and guidelines. Ensure proper sequencing of all codes to obtain optimal resource allocation. Identify additional diagnoses/procedures to optimize reimbursement;

i.e., complications, co-morbidities, therapeutic and diagnostic procedures.

5.2. Tasks: The Medical Coding Technician shall perform the following tasks:

5.2.1. Utilizes appropriate data codes and system commands for data entry. Performs edit checks on data entered prior to transmittal and corrects errors as indicated. Computer system concerns should be brought to the attention of the Quality Assurance Personnel (QAP), DHA Global Service Center, or 51 MDG Medical Information Systems Staff, as quickly as possible to minimize work stoppage. During periods of system downtime, codes shall be captured utilizing the MTF’s contingency plan.

5.2.2. Analyzes medical record documentation for consistency and completeness for coding purposes using established criteria and regulations. Examines all documents in the record for authorized signature and patient identification to ensure all documents contain sufficient documentation to support the diagnosis and treatment administered, and that results obtained are adequately described. Identifies Third Party Billing information per Data Quality Directives and identify lack of proper documentation to on site auditor or clinical and Data Quality staff. Determines who is the responsible attending staff physician according to pertinent and current AF and DoD guidelines.

5.2.3. Interprets and verifies the reason for the encounter, including cause(s), diagnosis, procedures(s), performed and significant related diseases to assure record contents meets JCAHO and AF and DoD regulation requirements for the highest attainable quality.

5.2.4. Obtain clarification as needed from clinical staff on errors or missing documentation noted.

Corrections to the documentation and coded entry shall be completed per MTF and Command guidance and policy. Track all errors noted for training and education purposes to ensure the MTF and other contractor staff’s training templates will accurately reflect the true nature of what needs to be trained.

5.2.5. The contract personnel shall be given system access capabilities applicable to coding functions and at the discretion of the MTF and Command. System access may vary by MTF and be in accordance with DoD and Air Force System upgrades and platform application changes.

5.2.6. Maintains current reference material. Ensures all updates are posted accurately and as updates are received. Ensures all system pick-lists match current codes, and works with MTF staff when outdated codes are noted.

5.2.7. Identifies potential or existing medico-legal problems to supervisor; i.e. malingering cases, therapeutic misadventures, child abuse, and therapeutic abortions. The contract personnel must ensure that all sensitive records be secured due to medical-legal potential. The contract personnel shall be responsible for safeguarding both the record and its informational content against loss, defacement and tampering, and from use by unauthorized individuals while in the contract personnel’s control.

5.2.8. Contract personnel will ensure all records are returned to the appropriate location as defined by the MTF within a timely manner.

5.2.9. The contract personnel shall review and/or code 95% of all outpatient clinic visit records within 3 days post visit, APVs within 15 days, and inpatient visits within 30 days.

5.2.10. Manually coded outpatient visits productivity: 15/hour (depending on acuity of visit) with a 95% accuracy rate (the current Air Force Standard for coding accuracy).

5.2.11. Review of automated outpatient coding productivity: 20/hour (depending on acuity of visit) with a 95% accuracy rate.

5.3. Basic Services for the Medical Records Coding Auditor: Contract personnel shall have technical expertise required to complete all tasks outlined in 5.2. above, and may be solely assigned those tasks as outlined by the MTF or Command and/or in addition to the tasks defined in 5.3.

5.3.1. Tasks: The Medical Records Coding Auditor shall perform the following tasks:

5.3.2. Contract personnel shall review inpatient and outpatient encounters in accordance with all A.F. and DoD instructions and guidance. Examples of such guidance are but not limited to AFI 41-210; Military Health Systems (MHS) Coding Guidelines, or others as defined by A.F. and/or DoD.

5.3.3. Contract personnel are expected to adhere to all policies outlined, as well as any changes provided by the AF. or DoD that may occur during the term of this contract. Command and MTF staff will provide changes to policy to all contracting personnel upon implementation.

5.3.4. Current coding audit methodology is specific and outlines the nature, timeliness, and occurrence of all audits, and the contractor staff is required to follow the specific methodology concerning audits. The contract personnel are required to conduct audits for MTF specific needs. These needs can be, but are not limited to, the following: Data Quality related coding audits, new provider audits, clinical areas of concern regarding coding, problematic coding noted by particular clinical staff, and out-of- rotation audits.

5.3.5. Contract personnel shall be responsible for conducting audits of the medical records and all other pertinent documents for accuracy and completeness. The contractor shall be responsible for validating the diagnosis, evaluation and management, procedure, and all other codes required to process the encounter as complete and support the billing office.

5.3.6. Contract personnel shall be responsible for performing independent audits determining the need for training of its employees and all clinical staff involved in the documentation and coding process. A formal training plan will be developed to address 1) new provider orientation, 2) recurring provider training as a result of monthly coding audit findings, and 3) semi-annually staff training. A formal training plan will be submitted to the government within 30 days of hire. Formal training plans will be reviewed semi-annually. All training must be documented and maintained in a file plan.

5.3.7. Training may be conducted in learning settings determined by each clinic’s needs. Training can be conducted in small or large groups, or one-on-one as needed. Training shall be given to all new clinical staff members prior to them seeing patients. Training should also be delivered to the professional staff with coordination with the Chief of Staff.

5.3.8. The contractor is required to train monthly based off of previous Air Force Medical Operations Agency (AFMOA) and provider audit findings.

5.3.9. Contract personnel are responsible for ensuring all professional staff members are aware of their personal coding errors so corrections can be made. This should be completed at the time the errors are noted.

5.3.10. Contract personnel are required to ensure all professional staff members receive standardized guidance regarding coding on monthly basis.

5.3.11. Contract personnel will provide internal monitoring and graphical metrics of audits and training and provide reports regularly and as requested by the MTF and/or Command.

5.3.12. Contract personnel will be required to conduct coding reviews of professional staff and other contract personnel (if applicable), on a regular basis and report findings as a deliverable to Command.

5.3.13. Contract personnel may be called upon to attend regular data quality meetings and brief staff, provide metric data of coding activities, and provide other coding specific support within the MTF.

5.3.14. Contract personnel may be required to attend training, briefings, clinical Staff Assistance Visits, and other meetings that may require coding expertise.

5.3. OTHER TASKS OF MEDICAL RECORDS CODERS

5.4.1. Contract personnel may be required to assist as necessary within an area outside of the clinical setting with prior coordination and approval with the QAP. Examples of this may be the billing department, command section, or other sections requiring the assistance and expertise of a coding/auditor/trainer specialist.

5.4.2. AFMOA Audit. An independent, centralized audit cell is planned by AFMOA in the near future.

Until that time contract personnel will continue to complete the AFMOA Audit requirements. When the audit cell is stood up, the Coding Technicians/Medical Coding Auditors will be responsible for the following:

5.4.3. AFMOA Audit Documentation Retrieval. Contract personnel shall retrieve, copy, and forward encounter documentation monthly for the AFMOA audit. Detailed pull lists will be available for download on/about the 15th of the month. Transmission of requested records will be completed within 10 days receipt of the pull list.

5.4.4. Documentation for the dates of service to be reviewed will be retrieved from AHLTA and Essentris (to include Inpatient, APV, Obstetrics, and Emergency Room). Copied documentation (non-AHLTA encounters (Emergency Room, Obstetrics, etc), APV, and inpatient records) shall be forwarded (thru secure electronic media transmission or registered/certified mail (if records are sent by mail)) to AFMOA or designated office for independent review, auditing activities. Records are to be treated as protected health information, e.g. appropriate containers for mailing and return receipt for mailed documents.

5.4.5. Submit copied Inpatient and/or APV records to include all documentation relative to the encounter.

This may include:

Summary sheet documenting the codes selected by the MTF personnel Face Sheet or coversheet if different from summary sheet Discharge Summary Anesthesia Record History and Physical exam Transcribed operative report—all pages Report of other procedures Report of any special procedures such as EKG, MRI Consultation reports Admission notes Progress notes from physicians, nurse practitioner, physician assistant or other specialty provider Pathology report Medication records/reports *Emergency Room documentation *Outpatient visit documentation Any documentation referenced during the encounter such as patient, social, or family history from a previous visit.

*Also included when these visits resulted in an admission. Ambulance records or copies of any records from transferring hospital would be included.

5.4.6. Submitted ER, Obstetrics, or Non AHLTA Records**

Emergency Room record Obstetric record Progress notes of the date of service of the encounter Medication records Report of other procedures

**Any other documentation applicable to the encounter should be submitted

5.4.7. On an annual basis, the TRICARE Management Activity performs an audit of coding services.

This audit reviews inpatient, outpatient, and ambulatory procedure services. To meet the requirements of this audit or other AFMOA/DoD directed audits, the MTF is responsible for sending the requested record documentation. The contract Coding Technicians/Medical Coding Auditors are responsible for ensuring the requested records are copied and forwarded (per memo instructions) to the designated point of contact for these audit services.

5.4.8. The contract personnel shall be monitored and expected to complete audits reviews as outlined in the most current audit requirements and guidance from HQ AFMOA Coding Program Office.

5.4.9. Minimum provider audits: 4/hour with a 95% accuracy rate. Accuracy should be monitored by peer reviews or program manager.

5.4.10. Training: Professional coding staff shall provide training and feedback to providers in order to improve provider knowledge and coding accuracy. This shall begin with initial training within 30 days of a new provider’s arrival at the MTF. Thereafter, it can be “provider requested” or “accuracy driven” training sessions. A provider requested training session shall be scheduled as soon as possible, but no later than 7 calendar days from receipt of the request. The training should be conducted as soon as possible, but no later than 21 calendar days from the request date. Focused training is identified by the coding validation process, internal audits, AFMOA results or external reviews. Recurring monthly training (i.e., lunch session, clinic staff meetings) is encouraged; quarterly training is required. Further training may be advisable as dictated by results of the monthly AFMOA audit and errors identified by the on-site coders when performing their workload requirements. Training documentation must be maintained and reported monthly. The supporting documentation should include the training topics, the materials, list of attendees, and a critique from the providers/coders that were trained. For MTFs below the 95% accuracy threshold, training will be increased based upon a contractor correction action plan and/or AFMOA approved internal training plans. Training materials developed by the contractor must be approved by QAP and/or AFMOA Coding Program Office and maintained in the Quality Control Plan.

5.4.11. REPORT/DELIVERABLES

5.4.12. The contract representative is responsible but not limited to submitting the following reports to the MTF QAP or designated representative at AFMOA Coding Program Office in the performance of this task. All reports are the property of the United States Government.

5.4.13. The Monthly Program Status Report (MPSR) shall be prepared by the contractor for the MTF, the AFMOA Coding Program Office QAP and the Contracting Officer. The MPSR includes metrics related to personnel availability, productivity, quality assurance and customer satisfaction referencing the Service Summary and other contract requirements. The report must be received by the QAP and the Contracting Officer in an electronic format. Contractors will send the report by attaching the Excel file in an e-mail to the Contracting Officer. Reports must be received no later than the 15th of each month (for the previous month) and 10 days prior to submission of the invoice to allow adequate validation of the workload numbers by the QAP.

5.4.14. MPSR spreadsheet may be updated by the Contracting Officer as needed during the life of the contract. The MPSR should include details and trending of information to include, but not limited to:

5.4.15. The Contractor shall maintain a current listing of all personnel

5.4.16. The contract representative is responsible but not limited to submitting the following reports to the QAP or designated representative at AFMOA Coding Program Office in the performance of this task. All reports are the property of the United States Government.

5.4.17. Outpatient Coding Report: Indicates number of visits and the number of records reviewed/coded, and/or changed/corrected monthly by coder, by clinic, and by MTF. Due monthly by the 5th to the QAP.

5.4.18. Inpatient Coding Report: Inpatient Coding Report: Indicates number of admissions and the number of charts coded, the number of Rounds encounters coded, the number ERSA and absent sick records coded by coder, by specialty, and by MTF. Due by the 5th of each month to the QAP

5.4.19. Auditing Status Report by Clinic. Indicates number of records audited monthly by auditor, by clinic, and by MTF. Report must indicate inaccuracies and a percentage of accuracy for ICD, CPT, and E&M. Due monthly by the 5th to the QAP.

5.4.20. Monthly Audit Summary Report as outlined by HQ AF/SG guidance. The Medical Coding team will assess data, fill in data queries, and share responsibilities, along with Data Quality manager to complete the monthly Data Quality report. Due monthly by 15th of the month to the MTF Data Quality Manager.

5.4.21. Monthly report of training agenda and training accomplished. Due monthly by the 5th to the QAP. Training Summary Report. Report monthly the training agenda, type of training accomplished, topics, number of attendees, and names of attendees as outlined in the AFMS Coding Manual. Due by the 5th of each month to the QAP.

5.4.22 The contractors shall be held accountable for relevant action items in the Defense Health Agency (DHA) Data Quality Management Control (DQMC) User’s Guide or the most recent guidance Data Quality manual.

This will include action items that designate the Medical Coding Staff as a primary or alternate (when relevant) process owner. Medical Coding Staff may be asked to assist in other areas related to Data Quality but in an advisory capacity to the process owner. These action items will be sent in conjunction with the Data Quality report within the suspense set by the Resource Management Office or Data Quality Manager.

5.5. CONTRACTOR MANAGEMENT REPORTING (CMR): The Contractor shall report ALL contractor labor hours requires for performance of…