SOURCES SOUGHT
D -- Request for Information VA-20-00034866 HICBA Replacement Solution
- Notice Date
- 6/12/2020 5:40:37 AM
- Notice Type
- Sources Sought
- NAICS
- 541519
— Other Computer Related Services
- Contracting Office
- TECHNOLOGY ACQUISITION CENTER NJ (36C10B) EATONTOWN NJ 07724 USA
- ZIP Code
- 07724
- Solicitation Number
- 36C10B20Q0373
- Response Due
- 6/26/2020 9:00:00 AM
- Archive Date
- 09/24/2020
- Point of Contact
- Michael.Frank@va.gov, Contract Specialist, Phone: 732 440-9701
- E-Mail Address
-
Michael.Frank@va.gov
(Michael.Frank@va.gov)
- Awardee
- null
- Description
- Department of Veterans Affairs Request for Information Health Information Coding, Billing and Auditing (HICBA) VistA Integration, Revenue, and Reporting (VIRR) 36C10B20Q0373 June 12, 2020 Introduction This Request for Information (RFI) is issued for the purpose of conducting market research. Accordingly, this RFI constitutes neither a Request for Proposal (RFP) nor a guarantee that one will be issued by the Government in the future. Furthermore, it does not commit the Government to contract for any services described herein. Do not submit a Proposal. The Department of Veterans Affairs (VA) is not, at this time, seeking proposals or quotes, and therefore, will not accept, review, or evaluate unsolicited proposals or quotes received in response hereto. This notice is not to be construed as a commitment on the part of the Government to award a contract, nor does the Government intend to pay for any information submitted as a result of this request. The Government does not reimburse respondents for any costs associated with submission of the information being requested or, reimburse expenses incurred for responses to this RFI. The information provided may be used by VA in developing its acquisition strategy and Product Description/Performance Work Statement. Any information submitted by respondents to this RFI is strictly voluntary; however, any information received shall become the property of the Government and will not be returned to the respondent. Interested parties are responsible for adequately marking proprietary, restricted or competition sensitive information contained in their response. This is a request for information and does not obligate the Government in any way, nor does it commit the Government to any specific course of action. Background/Scope: VHA currently consists of 140+ medical centers and seven Consolidated Patient Account Centers (CPACs) located in all 50 states and Puerto Rico. Coding of all inpatient encounters, billable outpatient encounters, and all surgery encounters as well as billing and compliance auditing is performed for the medical services provided at each of these facilities. Billing functions are also performed at the seven CPACs. The Contractor shall provide a VIRR software solution which provides functionality for coding and revenue workflows and communications; facility, Veterans Integrated Service Network (VISN), and enterprise reporting for coding and revenue; and shall also provide the integration with VistA and the HICBA Encoder software solution to enable these functionalities. The Contractor shall provide a Commercial-Off-The-Shelf (COTS) bill scrubbing software suite solution with enterprise level software access and/or licensing. The Contractor shall provide the HICBA VIRR solution to include interfacing with VistA, updates to the application, compliance with International Classification of Diseases (ICD) translations, provision of a centralized reporting module for monitoring productivity, and technical support. Optional tasks are included to provide training and improved reporting features if exercised by the Government. See attached DRAFT PWS for specific requirements. Vendor Responses: Please provide the following information by 12:00PM NOON EST on June 26, 2020 via email to Michael Frank, Contract Specialist, at michael.frank@va.gov and Den-el Opuszynski, Contracting Officer, at Den-el.Opuszynski@va.gov. VA reserves the right to respond to any, all, or select respondents. All VA current requirements identified herein are subject to change at any time. If you experience any problems or have any questions concerning this announcement, please contact Michael Frank at michael.frank@va.gov, 732-440-9701 or Den-el Opuszynski at Den-el.Opuszynski@va.gov, 732-440-9682. VA appreciates your time and anticipated response. Please provide the following in your response: Vendor name DUNS Vendor POC List any federal contracts in which you are a prime contract holder, for example: GSA, NASA SEWP, CIOSP-3, and T4NG. In addition, please provide the following information: General System Requirements Does the COTS VIRR solution provide, without requiring VistA development or changes to VistA (briefly describe how the below requirements shall be met and attach supporting documentation): One consistent VistA-integrated bill scrubbing and revenue workflow application at all VHA facilities that is interfaced with the HICBA encoder solution? The ability to interface with various COTS encoder solutions? Desribe ability to integrate with various COTS encoder solutions to provide a real time bi-directional interface to VHA s VistA that interacts with all (VA and Non-VA) Patient Treatment File (PTF), Patient Care Encounter (PCE), and Surgery using Remote Procedure Calls (RPC). Support the standards used with VA/VHA as outlined in the PWS? A centralized, customizable enterprise-wide reporting module for use at the medical center, VISN, and enterprise levels? Provide approach for ROM pricing of these elements of the COTS VIRR solution across the enterprise. Pricing approach must be de-scalable to account for VHA s planned EHR transition to Cerner. Billing Does the COTS VIRR solution provide, without requiring VistA development or changes to VistA (briefly describe how the below requirements shall be met and attach supporting documentation): Enforce Correct Coding Initiative (CCI) coding edits at point of entry? Enforce CMS/AHA coding guidelines to ensure correct code is selected and captured? Allow entry and maintenance of customizable third party billing rules and automatically utilize these rules during bill processing? Automatically generate MS-DRG (CMS DRG Grouper) codes for billing and provide a linkage to the Integrated Billing (IB) package through VistA? Utilize logic that automatically sequences codes based on RVU (relative value unit) weights? Enforce medical necessity checks using logic that reflects Medicare Code Edits by CMS that verifies that the diagnosis code(s) supports medical necessity of CPT codes reported? Provide an electronic report that details the daily bill scrubber usage by each user? Provide encounter status codes to indicate that an encounter is not billable? Alert billers if first party copayment charges are 'on hold' when encounter is flagged 'reviewed/not billable'? Provide a bill scrubbing system (integrated to VistA IB module) to include a single claim scrubber that performs claim audit based on requirements of particular claim type or the particular payer prior to filing for payment? Provide a batch claim scrubber to audit health insurance claims for technical and coding accuracy prior to or after claims are submitted to payer? Provide ability to report bill scrubber results? Access patient insurance coverage limitations (integrated to VistA) from the bill scrubbing module, allowing billers to view this data without leaving bill scrubber system to access VistA? Provide various security levels for billers, including an access level to cancel bills? Provide data when bills are cancelled, the 'cancelled date', 'status', 'reason not billable' and 'reason not billable comments' shall be updated in the encounter record for supervisor review? Use the claim scrubber to enforce edits for the National Provider Identifier (NPI) and the Present on Admission (POA) rules? Generate reports that identify encounters with insurance identified retrospectively? Provide a claim review, or scrubbing , component to reduce improperly coded claims? Provide the ability to perform interim and final checks of institutional and professional fee encounters, inpatient stays, and claims prior to being finalized for billing in Veterans Integrated System Technology Architecture (VistA) Integrated Billing? Direct completed encounters/inpatient stays to the claims section and transfer all ICD and CPT codes and Case Comments to the VistA Integrated Billing (IB) package? Provide bill scrubbing software to assist claims reviewers in assessing which bills are billable and/or have special considerations according to third party payers reimbursement rules? Allow the biller to see if there are other billable encounters for the same date of service to include all services on one claim? The system must hold the claim until all of the encounters for a date of service can be billed together. Provide approach for ROM pricing of these elements of the COTS VIRR solution across the enterprise. Pricing approach must be de-scalable to account for VHA s planned EHR transition to Cerner. Compliance Does the COTS VIRR solution provide, without requiring VistA development or changes to VistA (briefly describe how the below requirements shall be met and attach supporting documentation): Incorporate GEMs (General Equivalence Mappings) for ICD-9 to ICD-10 and ICD-10 to ICD-9. For the posting of VA internal policies, coding guidelines and billing guidelines within the products current online references for coder/biller access, including coding guidelines as defined for ancillary services, such as Social Work Services, audiology/speech pathology? The ability to generate data exports using various criteria for selection? All reports (including ad-hoc) with the ability to utilize a special patient identifying column that contains a patient identification other than the SSN? Enhancements to system to support National VHA business process changes/needs? For user data collection capability mandated by CMS and other governing bodies? Updates to all supported code sets according to HIPAA mandated timeframes? Automatic emails generated via the system must in accordance with VHA Privacy and Security protocols? Automatic capturing of an audit trail on all changes to encounters inpatient, surgeries, and outpatient? Capture the user ID who made each change, the reason for each change and the time/date stamp for each change, as well as maintaining the original entry? Reports must be included in the system to provide this change detail within a given date range (user defined). For posting of VA internal policies, coding guidelines and billing guidelines within the products current online references for coder/biller access, including coding guidelines as defined for ancillary services, such as Social Work Services, audiology/speech pathology? Incorporation of compliance monitor & customized edits (Medicare Code Edits, Relational Code Edits, E-Code Edits, Proprietary Revenue, and Data Quality OIG Selection)? All levels of custom rules shall only be entered/maintained by selected users with specific security key access. For generating data exports using various criteria for selection? For random sampling capabilities when pulling encounters for compliance retrospective or self-reviews? Reporting of bills that are incomplete and include data required for the specific bill type, e.g. CMS 1500 or UB04? Report must support multiple sort criteria. A reporting module that allows VistA-data mining and filtering on all data fields to customize reports for HIM staff, billing staff and compliance staff at facility, VISN, and enterprise levels? Outputs from these reports will be formatted for display on a published monthly VHA dashboard. Provide approach for ROM pricing of these elements of the COTS VIRR solution across the enterprise. Pricing approach must be de-scalable to account for VHA s planned EHR transition to Cerner. Encoder Does the COTS VIRR solution provide VIRR and VistA integration for various COTS encoder solutions to: Enforce the VA standards for coding to ensure correct code is selected and captured? Standards include current editions of International Classification of Diseases (ICD), Clinical Modification (CM) and Procedure Code System (PCS); Current Procedural Terminology (CPT) of the American Medical Association (AMA); and Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA). Provide uniform disease and operation terminology which is complete and scientifically accurate and in accordance with: National Center for Health Statistics (NCHS); Centers for Medicare and Medicaid Services (CMS); American Hospital Association (AHA), AMA and APA guidelines, as appropriate? Adhere to all accepted national rules and regulations? Incorporate an Evaluation & Management (E&M) tool for both 1995 and 1997 guidelines; at the administrative level shall provide ability to set E&M tool by facility, clinical specialty? Contain VERA (Veterans Equitable Resource Allocation) patient classification rules for inpatient PTF coding in a manner that will be maintained/updated? Suggest code sequencing to optimize VERA reimbursement and provide a history and reporting output of VERA edits usage, both accepted and bypassed? Provide an automated inpatient encoder tool which assists coders with capturing/coding applicable inpatient professional services, including appropriate professional service edit checks? Automatically suggest code re-sequencing and alternate principal diagnosis/DRG scenarios to satisfy applicable edits and rules that are enforced in logic. Ensure that the inpatient encoder tool can use a CMS DRG analyzer? Automatically assign the appropriate MS-DRG to discharges based on dates of service (integrated MS-DRG calculation)? Provide an Ambulatory Payment Classification (APC) Grouper integrated with the encoder product to automatically assign the correct APC codes and calculate accurate reimbursement? Allow free-form text entry within inpatient encoder tool for cross-walking ICD procedure codes. Provide ability within the inpatient encoder to code PTF movements on VistA 501 screen? Support ability to dual code in the present, past and future versions of International Classification of Diseases (ICD)? Provide linking of professional services CPT codes to diagnosis codes and maintain those links from entry of the patient care encounter through to the VistA integrated billing module? Automatically suggest code re-sequencing and alternate principal diagnosis/DRG scenarios to satisfy applicable edits and rules that are enforced in logic? Electronically generate a report that identifies billable patient encounters that require coding/validation; report shall have ability to filter data by data elements? Detect and identify service-connected medical conditions as listed in VistA and special eligibility authority related to Agent Orange, Military Sexual Trauma (MST), Southwest Asia, ionizing radiation, combat veteran, Camp Lejeune, Project Shipboard Hazard and Defense (SHAD) and head and neck cancer at the encounter level? Allow entry and maintenance of the ordering and rendering provider for each CPT code on the encounter? Use logic that: automatically checks codes to ensure they are correct for the associated date of service and patient gender and age; validates that modifiers entered for CPT/HCPCS codes are appropriate; and automatically notify coder if a secondary diagnosis code is required? Maintain a list of nationally-defined coder comments for communication between coders, supervisors and billers. Security key shall be assigned to someone having authority to maintain comments at the National level only? Only allow supervisors with security key to maintain a role based user list? Be integrated to VistA Surgery package to allow coders to complete surgery coding from within the outpatient or inpatient coding tool, including surgery encounters that are 'locked'? The system must have ability to link codes for 'principal' and 'other' procedures. The system must also list anesthesia providers names while coding a surgery encounter. Present an indicator on HCPCS codes with more than two modifiers? Provide encounter inquiry and update screens reflect the encounter status, e.g. 'open', 'closed', or 'suspended'? Provide ability to code and maintain hospital census records and to transmit these records with PTF records and report inpatient census status based on a given date range? Provide approach for ROM pricing of these elements of the COTS VIRR solution across the enterprise. Pricing approach must be de-scalable to account for VHA s planned EHR transition to Cerner. Clinical Documentation Improvement (CDI) Does the COTS VIRR solution provide, without requiring VistA development or changes to VistA (briefly describe how the below requirements shall be met and attach supporting documentation): Include CDI processes that facilitate collection of pertinent clinical indicators to accurately represent the Veteran s severity, acuity and risk of mortality? Incorporate the VERA patient classification model? Include an electronic means for physician query and tracking? Include a report functionality to provide user defined reports such as: CDI Activity by Provider; Reimbursement Impact Summary; Reimbursement Impact by Provider, Potential VERA Impact; CDI Activity by Provider; Case Mix Index by Provider; and CDI Detail & Summary of Activities? Provide approach for ROM pricing of these elements of the COTS VIRR solution across the enterprise. Pricing approach must be de-scalable to account for VHA s planned EHR transition to Cerner. VERA Analyzer Does the COTS VIRR solution provide, without requiring VistA development or changes to VistA (briefly describe how the below requirements shall be met and attach supporting documentation): Automatically suggest appropriate code sequencing to optimize VERA reimbursement and provide a history and reporting output of VERA edits usage, both accepted and bypassed? Provide VERA patient classification rules for inpatient PTF coding that are maintained/updated? Include a tool for analyzing data that impacts VERA and report functionality? Provide approach for ROM pricing of these elements of the COTS VIRR solution across the enterprise. Pricing approach must be de-scalable to account for VHA s planned EHR transition to Cerner. Reporting Does the COTS VIRR solution provide, without requiring VistA development or changes to VistA (briefly describe how the below requirements shall be met and attach supporting documentation): Provide centralized enterprise-wide reporting to include productivity and performance tracking at the FTE, medical center and VISN levels for number of encounters and inpatient admissions processed, turnaround time for completing encounter coding, and coding accuracy? Support customizable reporting to include ad hoc reports to focus on domains of quality (i.e. mutually exclusive codes), timeliness (i.e. outpatient coding turnaround time), and internal business reporting (i.e. VERA)? Provide the capability to generate management reporting (workflow) at the facility, Veterans Integrated Service Network (VISN) and enterprise levels? Provide a workflow billing aging report to capture number of days delayed. Provide the ability to create alerts based on workflow status criteria, such as encounters referred to utilization review (i.e., over 7 days). Provide the capability to separate out non-VA PTFs from VA PTFs by FTE. Provide approach for ROM pricing of these elements of the COTS VIRR solution across the enterprise. Pricing approach must be de-scalable to account for VHA s planned EHR transition to Cerner. Training Does the COTS VIRR solution provide, without requiring VistA development or changes to VistA (briefly describe how the below requirements shall be met and attach supporting documentation): User training on each module contained within the software suite be provided to every user in the enterprise? Training to VHA staff with access to the system, including but not limited to, coders, billers, utilization review, information technology be provided? Face-to-face and/or interactive online/web-based training as determined by VHA organizational needs be provided to the enterprise? Provide approach for ROM pricing of these elements of the COTS VIRR solution across the enterprise. Pricing approach must be de-scalable to account for VHA s planned EHR transition to Cerner.
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