MODIFICATION
R -- Billing Clerk Services
- Notice Date
- 1/2/2003
- Notice Type
- Modification
- Contracting Office
- Department of Health and Human Services, Indian Health Service, Billings Area Office, 2900 4th Avenue North PO Box 36600, Billings, MT, 59107
- ZIP Code
- 59107
- Solicitation Number
- RFQ-10-03-013-MTC
- Response Due
- 1/10/2003
- Archive Date
- 1/25/2003
- Point of Contact
- Toni Cuny, Contract Specialist, Phone 406.247.7065, Fax 406.247.7108, - Rita Langager, Contract Specialist, Phone 406.247.7293, Fax 406.247.7108,
- E-Mail Address
-
toni.cuny@mail.ihs.gov, rlangager@mail.ihs.gov
- Description
- The Billings Area Indian Health Service (IHS) is requesting proposals in accordance with the requirements of Request for Quotation (RFQ)-10-03-013 to acquire Billing Clerk Services for the PHS Indian Hospital, Blackfeet Service Unit, Browning, Montana. This procurement is being conducted under Simplified Acquisition procedures pursuant to the authority of Federal Acquisition Regulation (FAR) subpart 13.5 Test Programs for Certain Commercial Items (10 U.S.C. 2304(g) and 2305 and 41 U.S.C. 253(g) and 253a and 253b), FAR Part 12 Commercial Items (Title VIII of the Federal Acquisition Streamlining Act of 1994 (Public Law 103-355)), and FAR 37.1 Personal Services Contract. The solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular (FAC) 10. Preference will be given to Indian applicants pursuant to the Buy Indian Act (25 USC47), HHSAR Clause 352.270-2, Indian Preference. This acquisition has been classified under NAICS 524292 code. This request is for the procurement of the subject services through the awarding of multiple contracts with vendors capable of providing these services. The primary purpose of this position is to abstract and interpret data from the records in preparation and (re)submission of third party claims. The work requires analytical ability, judgment, discretion and knowledge of a substantial body of administration or program principles, concepts, policies and objectives established by the Blackfeet Community Hospital, Billings Area Office, Indian Health Service, and JCAHO. Contractor will be under the direct supervision of the Business Office Manager, Blackfeet Community Hospital. The Business Office Manager provides guidance, advice and suggests techniques for handling unusual or non-recurring situations, which have no clear precedence. Supervisor shall also monitor workload and productivity on a daily basis. Incumbent independently plans and carries out the successive steps and handles problems and minor deviations in the work assignment in accordance with instructions and policies. Period of Performance shall be for a 12-month period. The total amount of hours shall be limited to 40 hours per week. The normal tour of duty shall be Monday through Friday 8:00 am to 5:00 pm. The tour of duty may change during the course of the contract, but only the Supervisor will have the authority to do so. Duties require the following: 1. Responsible for the accurate and timely preparation and submission of claims to third party payers, intermediaries, and responsible parties according to established policy and procedures. 2. Responsible for maintenance and control of unbilled claims for an assigned section of patient receivables. 3. Responsible for verification that all control functions assigned are maintained daily as set forth in hospital policy and procedures. 4. Reviews system generated reports daily to identify claims that are ready for billing. 5. Prepares and submits claims for a variety of third party payers, intermediaries or responsible parties within 24 hours after all information for billing becomes available. 6. Responsible for error correction for all rejected/suspended claims previously submitted to third party payers and intermediaries and patients. 7. Notifies supervisor of all claimed deemed unbillable, along with reason(s) on a daily basis. 8. Documents all activity performed on patient accounts in the patient financial folder such as date billed and to whom. 9. Provides supervisor with an accurate accounting of all claims in the assigned section of patient receivables responsible for. 10. Submits a daily productivity report reflecting the beginning inventory, claims billed and remaining balance at end of shift. Productivity shall be in comparison to the standards as established by the Business Office, Blackfeet Service Unit. 11. Reviews Charge Ticket (Super Bill) and compares it to the PCC Patient Encounter Form to ensure that the visit is complete, accurate and billable. Charge Tickets without the Provider established CPT Code shall be returned to the Medical Records Department. This includes PCC forms with insufficient documentation, proper diagnosis, physician/physician assistant original signature, accurate dates of medical care, and primary care providers not in compliance with Attestation and billing requirements. 12. Contractor must ensure the ICD-9 Code(s) are correct for the diagnosis and service rendered and select the appropriate CPT/HCPC/ADA (services) Codes abstracting from the PCC Patient Encounter Form. 13. Contractor must determine the primary payer for individuals have more than one (1) type of coverage and submit the claims accordingly as well as submitting claims to the secondary payer for any balance. 14. Contractor is to ensure that all applicable forms are submitted and appropriately reflect the services rendered. 15. Contractor must be able to work independently and responsibly for establishing a daily billing practice for productivity. Productivity shall be measured by actions completed in Private Insurance and Medicare Part B. Responds to third party inquiries, requirements on prepayment reviews, exclusions, denials, and appeals. 16. Maintains communication with Business Office Manager to ensure that expenditure of funds collected from third party insurance meet the conditions and requirements as stated in Title IV of P.L. 94-437, ?The Indian Health Care Improvement Act.? 17. Compiles and types letters of correspondence to Federal, State and local agencies regarding third party insurance claims and keeps the Business Office Manager informed. 18. Searches and retrieves individual patient health record(s) to gather and compile information for outpatient services and inpatient hospitalizations. 19. The incumbent is responsible for billing the applicable agency for services provided to a patient on an outpatient basis. The incumbent will complete the UB-92 and/or HCFA 1500, or other required billing forms, and review for accuracy the billing and coding information on the UB-92 and/or HCFA 1500 prior to submission. The incumbent is to ensure that all applicable forms are submitted and adequately reflect the services rendered. Because of the complexity of these billing forms used the incumbent must exercise care in the preparation of these billings. Incumbent is responsible for establishing day to day billing procedures; i.e. tickler files, individual patient files, status files for all third party programs and recommends changes in procedures to supervisor. 20. Incumbent safeguards the contents of the Alternate Resources program health insurance claims and Medical Records as a privileged communication with disclosure of information only within the limits of IHS policy and therefore, at the discretion of the Service Unit Director. Contractors whose duties and responsibilities involve regular contact or control over children are subject to a character investigation as required by P.L. 101-630, the Indian Child Protection and Family Violence Prevention Act. The IHS personnel offices will conduct these investigations following award of a personal service contract. The character investigation may be waived if, in the judgment of the Contracting Officer, in consultation with the Personnel Officer, an investigation has already been conducted and is on file. Until the character investigation has been completed and the Contracting Officer notified of the results, the contractor must not have unsupervised contact with Indian children. During the performance of this contract, the contractor shall provide for the consistent performance of patient care processes according to the standards for the JCAHO who supply accreditation to the Blackfeet Community Hospital, IHS. These standards shall include: The Comprehensive Accreditation Manual for Hospitals, The Laboratory standards, Ambulatory Care Standards as they represent the scope of services of this contract. Contractor shall comply with all IHS facility infection control and safety procedures, practices, and standards. The incumbent utilizes a number of substantive guidelines. The incumbent uses judgment in locating and selecting the most appropriate guidelines, references and procedures for application and in making minor deviations to adapt the guidelines to specific cases. The work consists of duties that involve different and unrelated processes and methods. The complexity of the work involves working with various programs having different benefits, deductibles, and eligibility requirements. The incumbent assists in maintaining the balances, and reconciles the funds collected which are used directly by Service Units and Area Office Programs for projects, and planning purposes, which side in our overall objective to elevate the health status of our Indian beneficiaries. The successful efforts of the incumbent directly affect the funds collected. The incumbent has regular and recurring contacts with patients, employees, in the same agency, State and local Welfare agencies, health insurance carriers, Fiscal Intermediaries, etc. The purpose of these contacts are to plan and coordinate the work of the office, resolving problems regarding billing claims and following up to ensure that required actions are completed and resolving differences in costs in initial awards presented for the hospital services. The work is primarily sedentary with some carrying of computer reports and ledgers. Some walking is required since interaction between all disciplines within IHS facility is required. The work is usually performed in an office setting. The Privacy Act of 1974 mandates that the incumbent shall maintain complete confidentiality of all administrative, medical and personnel records, and all other pertinent information that comes to his/her attention of knowledge. The Privacy Act carries both civil and criminal penalties for unlawful disclosure of records. Violation of such confidentiality shall be cause for adverse action. IHS shall provide training on the Freedom of Information Act (as Amended) and the Privacy Act. All IHS regulations and policies applicable to these Acts shall be enforced. The provision 52.212-2, Evaluation-Commercial Items applies as follows: the Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, Price and other factors considered. They will be based upon the following review criteria as set forth in the solicitation and contained in the Statement of Work. The following factors shall be used to evaluate offers. Vendors are required to submit a resume in reference to the following: a. Prior working history applicable to the performance of this solicitation. B. Knowledge of Medical Records information, medical vocabulary. C. Knowledge of computer applications and software programs applicable to Third Party Billing program. D. Knowledge of IHS Third Party Reimbursement Policies & Procedures and industry practices. Preference will be given to qualified Certified Coders (i.e. AACP, HIMA). Applicant shall have either High School Diploma or GED. Ability to deal effectively with people. Knowledge of routine office procedures. Any resultant contract shall include the clauses applicable to the selected offeror?s organization and type of contract awarded as required by Public Law, Executive Order, or procurement regulations in effect at the time of execution of the proposed contract and not at the time of submission of the RFQ. This RFQ incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will made their full text available. Also, the full text of a clause may be accessed electronically at this/these addresses: http://www.arnet.gov and http://www.gsa.gov.. The following FAR clauses are applicable to this solicitation: 52.212-1, Instructions to Offerors-Commercial, 52.212-2, Evaluation-Commercial Items, 52.212-3, Offeror Representations and Certifications-Commercial Items, 52.212-4 Contract Terms and Conditions-Commercial Items and 52.212-5, Contract Terms and Conditions Required to Implement Statutes or Executive Orders-Commercial Items. Preference shall be given to qualified Indian applicants pursuant to the Buy Indian Act (25 USC 47), HHSAR Clause 352.270-2, Indian Preference, However, if no qualified Indian candidates submit a quote, the Act and Clause do not apply. THE RESPONSE DATE FOR THIS SOLICITATION/SYNOPSIS HAS BEEN EXTENDED FOR JANUARY 10, 2003.
- Place of Performance
- Address: USPHS Indian Health Service, Blackfeet Service Unit Hospital, 760 Hospital Circle/P.O. Box 670, Browning, Montana 59417
- Zip Code: 59417
- Country: United States
- Zip Code: 59417
- Record
- SN00233254-W 20030104/030103081802 (fbodaily.com)
- Source
-
FedBizOpps.gov Link to This Notice
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