R -- ANALYSIS OF MEDICAL RECORD CODING COMPLIANCE

Notice Date

December 28, 2000

Contracting Office

Department of Veterans Affairs, Chief, A&MMS (90C), 1055 Clermont St, Denver, CO 80220

ZIP Code

80220

Solicitation Number

RFQ-VISN19-01-01

Response Due

January 19, 2001

Point of Contact

Ms Stevi B. Stevison, 303-393-4635

Description

This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. Simplified acquisition procedures apply to this procurement in accordance with FAR parts 12 & 13. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued. The VISN 19 solicitation reference number is RFQ-VISN19-01-01 and is issued as a request for quote. The incorporated provisions and clauses are those in effect through Federal Acquisition Circular 97-20. The NAICS is 541611, $5 million. The Veteran Integrated Service Network (VISN 19), in accordance with the Balanced Budget Act of 1997, is required to satisfy current HCFA requirements for medical record documentation, coding and billing. The Act enables our Health Care Systems to retain collection from third-party reimbursement to enhance care to veterans through our Medical Care Cost Recovery (MCCR) program. Our goal is to maximize the recovery of funds in the revenue cycle process for the provision of healthcare services to veterans, dependants and other entities using our health care system. In order to develop and maintain an effective compliance program and conform to industry standards the network has determined it necessary to promote education for accurate medical record documentation, correct coding and precise and accurate submission of bills. The network requires a prospective audit and analysis of Inpatient and Outpatient medical record infrastructures to assist the network facilities in determining the educational needs for coding, billing and clinical staff. The goal of this education will be to ensure accurate and correct medical record documentation, coding and billing which comply with current Medicare standards. The audits will include 100 outpatient records and 25 inpatient records per site and the composition of the records reviewed will be site specific. The network requires coding and medical record audits for Cheyenne and Sheridan, Wyoming, Grand Junction, Southern Colorado Health Care System (Ft Lyon) and Montana Health Care System (Ft Harrison). The audits will be conducted from the identified sites, although, records will be reviewed from multiple clinics within the catchment area for that site. The prices quoted for providing this service will be inclusive of all expenses (professional fees and travel). Line Item No. 1 : Quantity is 5 Jobs. The medical record documentation and coding audit will determine the accuracy of ICD-9-CM diagnosis coding, as well as determine the coding accuracy for inpatient, ambulatory surgery, mental health and physician services. The audit will be performed in accordance with the current documentation and coding guidelines that have been established for the Medicare Program. A data validation audit for each medical record selected in pre-determined sample sizes will be accomplished using current AMA coding conventions, CPT assistant, and AHIMA/AMA publications. The Inpatient record audit will focus on insufficient medical record documentation to support billed code's, inappropriate assignment of ICD-9-CM diagnosis and procedure codes, inaccurate assignment of DRG's and inappropriate billing for ancillary services. The physician services audit will focus on insufficient medical record documentation to support billed codes, inappropriate assignment of ICD-9-CM diagnosis codes and CPT/EM codes, over/undercoding of EM codes, unbundling of CPT procedure codes, billing for services not rendered, billing for services of ancillary staff not meeting "incident to" guidelines, lack of appropriate CPT modifier usage and correct coding conventions for "global surgery". A written, detailed report of the findings and recommendations and site specific educational needs will be provided to each facility identified in the contract. A consolidated report will be provided to the VISN 19 Contracting Officer. Line Item No. 2 : Quantity is 5 Jobs: Upon completion of the audit, the contractor will develop a written educational plan and produce educational materials which define the appropriate processes for medical record documentation, appropriate assignment of primary and secondary diagnosis codes and CPT/EM codes and clearly defines the impact these elements have on the revenue (billing) cycle and reimbursement. Line Item No. 3 : Contractor will submit a quote for conducting the training at each of the five sites and a quote to provide the training at a single site. Upon completion of the audit, the contractor will provide training to the Compliance Advisory Committee, clinical staff, coding /billing staff and other appropriate hospital staff to facilitate compliance awareness. The provision 52.212-1, Instruction to Offerors-Commercial, applies to this acquisition. Addendum to provision 52.212-1 is incorporated in this acquisition and states: The contractor will provide a quote for all three line items, failure to do so will result in removal from consideration for award if it is determined to be in the best interest of the Government to award all three line items. Furthermore, the contractor is advised that it is the intent of the agency to award line item number one to the offeror that submits a quote that is of best value to the Government. At this time, the agency will consider awarding line item number two and/or three if it is determined that funding is available and it is the best value to the Government. The provision 52.212-2, Evaluation-Commercial Items, is applicable to this acquisition. The specific evaluation criteria included in paragraph (a) of this provision is: (1) Price, (2)Technical Qualification to perform this requirement (explain qualifications in detail), (3) Past Performance-Provide three references that you have performed this service for within the last year. Offerors will include a completed copy of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Items, with its offer. The clause at 52.212-4, Contract Terms and Conditions-Commercial Items, applies to this acquisition. The clause at 52.212-5, Contract Terms and Conditions Required to Implement Statutes or Executive Orders-Commercial Items, applies to this acquisition. The additional applicable FAR clauses sited in 52.212-5 are as follows: 52.222-21, 52.222-26, 52.222-35, 52.222-36, 52.222-37, 52.225-1, 52.225-5, 52.225-13, 52.232-34, 52.232-36, 52.232-38, 52.222-41, 52.222-4252.222-44, 52.222-50. Offeror can access the full text Federal Acquisition Regulation (FAR) provisions and clauses on line at http://www.access.gpo.gov/nara/cfr/w or http://www.arnet.gov/far/ Part 52. Offeror's will submit their quotes, representation and certification, technical & past performance evaluation factors to this office no later than 4:30 P.M. mountain time on January 19, 2001. Offerors information will be addressed to Ms. Stevi B. Stevison, Network Acquisition Service Center (NASC), 1055 Clermont Street, Denver, Colorado 80220. Should you have any questions in reference to this acquisition you may contact Ms Stevison at 303-393-4635 or by email at stevi.stevison@med.va.gov

Record

Loren Data Corp. 20010102/RSOL007.HTM (W-363 SN509859)