Department of Veterans Affairs, Chief, ASC VISN 9/90, Alvin C, York, VA Medical Center, 3410 Lebanon Road, Murfreesboro, TN 37129

R -- CODING VALIDATION AND TRAINING SOL 249-06-99 DUE 032399 POC Sherri-Lyn Teeters, 615-867-6026 This is a combined synopsis/solicitation for commercial services prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued. Solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 97-10. This procurement is processed under the authority of 38 U.S.C. 8153 Sharing of HealthCare Resources with non-VA entities. This procurement is set-aside for small businesses and the SIC Code is 8742 and the small business size standard is $5.0 million. This solicitation is being issued as a Request for Proposal (RFP). All RFP's are due on March 23, 1999, 4:00 p.m. local time. If mailed submit to Acquisition Service Center (VISN 9/90), Alvin C. York VAMC, 3410 Lebanon Pike, Murfreesboro, TN 37129. If hand carried deliver to: Acquisition Service Center, Alvin C. York VAMC, Building 5, 2nd Floor, Room 231. DESCRIPTION, QUANTITY, UNIT, UNIT PRICE, TOTAL: Bid Item 1: Contractor is to provide coding validation and training in strict accordance with the terms conditions and schedules listed herein. 1 JOB $_______ Bid Item 2: OPTIONAL RENEWAL PERIOD ONE: Contractor is to provide coding validation and training in strict accordance with the terms conditions and schedules listed herein.1 JOB $_______ Bid Item 3: OPTIONAL RENEWAL PERIOD TWO: Contractor is to provide coding validation and training in strict accordance with the terms conditions and schedules listed herein.1 JOB $_______. Award will be based on participation of all VISN 9 VA medical centers, however for cost accounting purposes contractors must provide a breakdown for each VA Medical Center. (Huntington, WV; Murfreesboro, TN; Nashville, TN; Lexington, KY; Louisville, KY; Memphis, TN; Mtn. Home, TN). STATEMENT OF WORK: The intent of this solicitation is to furnish validation of the integrity, quality and assignment ofthe codes to the data contained in the outpatient Patient Care Encounter (PCE) and the inpatient Treatment File (PTF) database at each VISN 9 medical center and their satellite outpatient clinics. The purpose of this contract is to evaluate the quality of inpatient and outpatient coding and ambulatory patient care encounter data; to deliver a quantitative assessment of the validity of the diagnostic and procedural code; and evaluate and manage code assignment by facility. The assessment will provide baseline data for the quality of inpatient and outpatient coding at each facility and at a network level. Upon initial review, policy and procedures will be developed to assure accuracy and consistency among VISN 9 medical centers and satellite outpatient clinics. The optional renewal periods (if exercised) require the complete review and training process as outlined for the base year period. VISN 9 Facility Description and Complexity: The following description of each facility is provided to inform the contractor of the complexities and environmental impact of coding reviews: Nashville is a Level One facility for providing primary, secondary, and tertiary care in medicine, surgery, neurology and psychiatry. Nashville VAMC supports an outpatient clinic and a veterans outreach center located in Knoxville, Tennessee. Nashville VAMC currently operates 160 of its 238 authorized beds. Murfreesboro's Alvin C. York VAMC provides primary and secondary care in acute medicine and surgery and a full range of psychiatric and extended care. The Level Three facility has 237 beds and an additional 135 beds in the nursing home care unit. The Alvin C. York VAMC supports a satellite clinic and a veterans outreach center in Chattanooga, Tennessee and community based clinics in Tullahoma and Cookeville, Tennessee. Mountain Home's James H. Quillen VAMC is a Level Two facility providing primary, secondary, and tertiary care in medicine, surgery and psychiatry. The VAMC operates a 120 bed Nursing Home Care Unit, a 348 bed domiciliary and a modern 202 bed hospital. The medical center has established community based outpatient clinics in Rogersville and Mountain City, Tennessee. Memphis provides a full range of primary, secondary, tertiary care to medical, neurological, psychiatric, rehabilitation, spinal cord injury, and surgical patients, including cardiovascular and neurological surgery. Of the 341 operating beds at the Level One VAMC, 202 are acute medical and surgical beds, 30 are psychiatric, 90 are spinal cord injury, and 19 are substance abuse rehabilitation program beds. Louisville is a Level One facility providing primary, secondary, and tertiary care in medicine, surgery, neurology, and psychiatry. The VAMC has 168 beds. Lexington is a two-division, Level One (tertiary) medical center with an operating bed complement of 209 hospital and 198 nursing home care unit beds. Acute medical, neurological, surgical and psychiatric services are provided at the Cooper Drive Division. The Leestown Division, five miles from Cooper Drive, providesintermediate medical and psychiatric services as well as nursing home care. Huntington is a fully accredited 80 bed primary care facility providing acute medical, surgical, rehabilitative, and intermediate inpatient care, in addition to primary and specialized outpatient care. The VAMC has Level Two complexity and Level Three ER. Primary care is provided through the medical center-based clinic and community-based clinics located in Prestonsburg, Kentucky and Charleston, West Virginia. The following workload is an estimate for a one year period in the following order: Hospital Name; Inpatient (Discharges); Outpatient Visits; Ambulatory Surgery. Nashville; 6,133; 207,731; 4,264. Murfreesboro; 3,383; 175,176; 1,457. Mtn Home; 6,012; 229,274; 3,463. Memphis; 8,190; 260,884; 3,537. Louisville; 4,975; 223,591; 3,043. Lexington; 6,040; 196,178; 2,858. Huntington; 3,379; 159,680; 1,038. Requirements: Contractor shall provide all labor, materials, transportation, and supervision necessary to perform coding validationreviews for inpatient and outpatient data collection, evaluating the completeness and accuracy of coding diagnoses and procedures in accordance with official coding guidelines (Coding Clinics, CPT Assistant, HFCA/AMA, Ambulatory Patient Classifications (APC) in a simulated Medicare payment environment. All reviews shall be conducted utilizing national guidelines (as stated above) and HCFA regulations. Contractor is to be proficient with and is responsible for providing for their staff all computer equipment, reference material, software/encoder tools for conducting reviews and developing training materials. It is anticipated that this contract will have a primary and an alternate COTR (Contracting Officers Technical Representative) assigned for administrative purposes throughout the base contract period and renewal option periods. It should be understood that any future reference in this solicitation to the COTR includes the primary and alternate. Contractor shall be responsible for developing a sample size by taking 5% of the total discharge volume for inpatient and ambulatory surgery procedures and a sample of 1% of the discharge volume for outpatient visits at each facility. At a minimum the sample size must include a review of the following: inpatient hospitalizations, ambulatory surgery, diagnostic tests, (endoscopy, bronchoscopy, cardiac catheterization, PTCA, pulmonary function, radiology, laboratory, etc.) primary care, mental health, medicine sub-specialty, surgery, observation and neurology. Contractor shall be responsible for developing a comprehensive train the trainer program for HIMS staff so that validation can continue at each facility. Contractor shall conduct the training a minimum of eight hours and provide participants with written training tools. As part of the formal education, submit all eligible HIMS staff attendees to AHIMA for continuing education units. The training is to be located at VA facility within the VISN and the site will be determined at a later time. At a minimum the training shall include the following: Methodology for sample size; Development of validation tool and review of the tool for consistency at each medical center; Frequency of reviews; Analysis techniques to identify areas of improvement; Presentation techniques for physicians; Methods for optimization utilizing the network resources and data available; Recommendations regarding the availability of all appropriate documentation at the time of coding; HCFA coding and documentation requirements. Contractor shall be responsible for developing a training plan for management officials, physicians/clinicians, sub-specialty, if applicable, and health information management (coding) staff based on the findings of the review. Contractor shall be responsible for conducting a minimum of: An exit conference with management officials at the discretion of the medical center Director to be coordinated with the COTR; On-site at each medical center, a minimum of two hour educational session for physicians which will include utilizing actual charts and identified documentation issues specific to the physicians and/or VA facility; On-site at each medical center, a minimum of two hour educational session for coding staff which will include utilizing actual charts and identified documentation issues specific to the coders and/or VA facility. The Government reserves the right to videotape all training classes provided by the Contractor for future training purposes required by each medical center. Contractor shall conduct onsite reviews at each medical center and satellite clinic. All travel costs are at the expense of the contractor. Contractor is required to provide the necessary training for professional and coding staff to confirm the accuracy and consistency of coding among network facilities when coding changes arise during the contract period. Contractor shall demonstrate the methodology for resolving coding questions by reviewers and ensuring interviewer consistency and reliability. Contractor shall be responsible for reviewing each facility's HIMS policy and coding procedures prior to commencement of onsite review. Contractor shall be responsible for reviewing encounter forms to offer suggestions for additional codes for more comprehensive forms. Contractor shall be responsible for reviewing each medical center HIMS staff as it relates to the adequacy of coding, reference material, adequate training to assure competent workforce for coding. Contractor shall document in writing all records reviewed and provide such documentation to the COTR at the conclusion of the review. Contractor shall review findings with Chief, HIMS, COTR, management and other designated medical center personnel to review proposed changes prior to final written report for mutually agreed upon changes. Contractor shall provide a written summarization of identified weaknesses in coding and medical record documentation to the COTR. A written report shall be provided to the COTR within 3 weeks of the conclusion of all of the VISN reviews. Report must contain at a minimum the following: Number of records reviewed for both inpatients and outpatients broken down into specialty for inpatients and by clinic for outpatients; Trending and analysis of medical record documentation; ICD-9-CM, and CPT-4, and if possible, of physician profiling; Recommendations for improvement; Strategies to implement for improvement in the capture of workload and accuracy of code assignment. VA Requirements: a. Development of a random sampling by patient social security number to be utilized to retrieve records and encounters for the coding validation reviews. b. Each Medical Center will be required to provide space, actual records, a copy of the PTF abstract, and access to VISTA, for each reviewer. Access to an electrical outlet, telephone, facsimile and photocopier will also be provided. TERM OF THE CONTRACT: a. The overall term of the initial phase of the project will be three (3) months following the award of the contract. The subsequent reviews and training shall be conducted approximately one yearafter the completion of the initial phase if the optional renewal period is exercised. The subsequent reviews and training shall include all of the services included in the initial phase. b. The options will be renewed in accordance with FAR Clause 52.217-9 Option to Extend the Term of the Contract. The contract is subject to the availability of VA funds. No service shall be performed by the contractor after September 30, until the contracting officer authorizes such services in writing. PERSONNEL POLICY: The contractor shall be responsible for protecting the personnel furnishing services under this contract. To carry out this responsibility, the contractor shall provide the following for these personnel: worker's compensation; professional liability insurance; health examinations; income tax withholdings, and Social Security payments. The parties agree that the contractor shall not be considered VA employees for any purpose and shall be considered employees of the contractor. CONFIDENTIALITY AND NON-DISCLOSURE: The contractor shall agree that: All deliverables associated with working papers, and other material deemed relevant by VA generated by the Contractor in the performance of this contract are the property of the United States Government; All individually identifiable health records shall be treated with the strictest confidentiality. Access to records shall be limited to essential personnel only. Records shall be secured when not in use. At the conclusion of the contract all copies of individually identifiable health records shall be destroyed or returned to the VA. The contractor shall comply with the Privacy Act, 38 USC 5701 and 38 USC 7332; Reviewers will be required to sign a confidentiality statement upon arrival at the facility in coordination with the COTR. Due to the complexity of this contract action, subcontracting is not allowed. Provision 52.212-1, Instructions to Offerors -- Commercial, applies to this acquisition. ADDENDUM TO 52.212-1: Proposals should be submitted as follows: Offeror must submit four (4) copies of their proposal in two parts: A Technical Offer and a Cost/Price Offer. The Technical Offer is to be submitted on white bond paper with no identifying marks indicating company name or company identifying products; The proposal shall be typed or legibly handwritten; The offerors cover letter shall include name and address of the organization submitting the proposal, together with the names, addresses, and telephone numbers of the contact person who has the power to bind and make representations for the organization, relative to the proposal and any resultant contract; Information requested under each evaluation factor stated below must be furnished in detail for evaluation and rating by the Government, as source selection will result from this evaluation process; Offerors are to propose how they intend to fulfill the requirements of this solicitation and how their total offer will meet the minimum needs of the specifications; Each response shall address each element in the sequence listed and clearly identify which element is being addressed; In addition to providing a written proposal, all contractors may be required to present to the VA evaluation committee in person or via teleconference, at no cost to the VA, their proposal. Provision 52.212-2, Evaluation -- Commercial Items, is applicable. The evaluation of criteria is as follows: A. Quality of Service: Provide evidence from two references demonstrating improvement in accuracy and reimbursement; Provide a description of reporting format/mechanisms for displaying the findings and recommendations for improvement; Provide listing of current coding references utilized in coding/reimbursement reviews; Provide a description of the comprehensive plan for conducting reviews and the ability to meet the timeliness for review. As a minimum the following should be provided in the proposal: Specific timelines for completing review at each medical center; Number of days required at each medical center; Number of reviewers for each medical center. B. Past Performance: Provide recent evidence of services provided to customers with the similar size and configurations as this statement of work; Provide detailed evidence of performance of coding consultation for a minimum of three years in a large tertiary healthcare organization, which includes inpatient, primary care and all sub-specialties; Provide evidence that each review has at least three years of experience in providing physician and staff education in reimbursement, documentation, and coding; Provide company background/composition to include years in coding consultation business, number of employees and number of contracts awarded for projects similar in size as to that described in the statement of work. C. Staffing and Equipment: Provide the curriculum vitae (CV) of all personnel who will be involved directly or indirectly in the coding validation services and each reviewer's credentials. The actual reviewers must have the current credentials of an Accredited Recorder Technician (ART), Registered Record Administrator (RRA), or a Certified Coding Specialist (CCS); Provide evidence of use of an encoder; Provide evidence of the collection tool to be utilized in the coding reviews and the description of the sample size methodology utilized to arrive at the 95% confidence level. D. Pricing: Offerors must submit pricing separate from the technical proposal. Evaluation Factors A through D are of equal value. The lowest evaluated price based on the base year plus two one year option renewals will be given the maximum points available for cost evaluation purposes. All others will receive a percentage of points available for cost evaluation based on the relationship of their costs to the lowest cost. Offerors should submit a completed copy of the provision at 52.212-3, Offeror Representations and Certifications -- Commercial Items, with its quotation. Clause 52.212-4, Contract Terms and Conditions -- Commercial Items, applies to this acquisition and Addendum applies as follows: The following Clausesare applicable VAAR 852.219-70 Veteran Owned Small Business, 852.270-1 Representatives of the Contracting Officers; 852.270-4 Commercial Advertising and FAR Clauses 52.224-1 Privacy Act Notification, 52.224-2 Privacy Act, 52.237-2 Protection of Government Buildings, Equipment, and Vegetation, 52.252-2 Clauses Incorporated by Reference; 52.232-19 Availability of Funds for the Next Fiscal Year; 52.217-8 Option to Extend Services; 52.217-9 Option to extend the term of the contract-(a) is completed as follows "10 calendar days prior to expiration"; (c) is completed as follows "24 months". Clause 52.212-5, Contract Terms and Conditions Required to Implement Statues or Executive Orders Commercial Items, including clauses incorporated by reference under section (b) 1, 5, and 12 through 15. Award will be made as a firm fixed price contract and will be based on a scoring system recognizing quality of services, past performance, staffing and equipment and pricing/fee schedule. After receipt of proposals, a determination shall be made of which proposals are in the competitive range for the purpose of conducting written and/or oral discussions, if necessary. Offerors should note that award may be made on the initial proposal. The offeror(s) with the lowest cost/price alone will not necessarily be awarded the contract. After award, the Government will determine the order in which each of the hospitals in VISN 9 will be reviewed. Also, the Government reserves the right to provide the contractor with a sample r Posted 02/26/99 (W-SN302860). (0057)

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