Description
STATEMENT OF WORK CODING SERVICES Kansas City VAMC Contractor shall provide ICD-10-CM, ICD-10-PCS and CPT coding services for outpatient/ambulatory cases, inpatient PTF s and ambulatory surgeries. Outpatient encounters include but are not limited to scheduled clinic appointments with physicians, radiology, laboratory and EKGs. Inpatient PTF s include but are not limited to daily physician encounter, consults, radiology, laboratory and EKGs and surgeries Ambulatory surgeries include but not limited to anesthesia, radiology and laboratory/pathology. Contractor shall carefully read and review health information documentation for cases provided by Kansas City VMAC. Contractor shall ensure that all coders working on the contract have appropriate reference materials and use appropriate encoder software. Contractor shall ensure the assignment of ICD-10-CM and ICD-10-PCS and CPT/HCPCS codes at a 95% accuracy rate or greater for all inpatient, observation and outpatient encounters. Contractor shall ensure a 95% or greater on productivity to meet national standards for turn around times of 7 calendar days or less on inpatient, observations and outpatient encounters. Contractor shall ensure complete electronic data entry into the Kansas City VA MEDICAL CENTER Nuance /3M Encoder system. Entry is to include CPT codes, modifiers, diagnostic and procedure codes for the encounter or occasion of service. It is to include associating the provider with the CPT code. Placement of a Case Comment will be assigned to each encounter not satisfactory for billing per established guidelines. The encounter will then file the encounter to PCE. Placement of a Case Comment will be assigned to identity the Referring Physician (RD) to all diagnostic tests, i.e. x-ray, Echocardiograms, EMG s, laboratory etc. Placement of a Case Comment to include admission diagnosis for Emergency Room Encounters. Contractor shall use 1995 Evaluation and Management guidelines. Contractor shall NOT use incident to rules. Contractor shall maintain frequent communication with the Contracting Officer s Technical Representative (COTR) regarding progress, workload status and/or problems. Contractor shall provide annotated list of completed cases to Kansas City VA MEDICAL CENTER. Contractor shall be responsible for providing personnel to perform coding. Upon request of the Contracting Officer, the Contractor shall remove any Contractor staff who do not comply with Kansas City VA MEDICAL CENTER policies or meet the competency requirements for the work being performed. Contractor shall abide by the American Health Information Management Association (AHIMA) Standards for Ethical Coding, Centers for Medicaid and Medicare (CMS) The Joint Commission (TJC), American Hospital Association (AHA) and American Medical Association (AMA). Contractor shall provide all labor and materials to include but not limited to coding books, encoder, training, education and supervision necessary to perform coding requirements under this contract. Contractor shall be required to maintain records that document certification, competency and performance levels for all employees working on this contract in accordance with VHA directives and policies as well as TJC and CMS standards as well as regulatory body requirements. Contractor shall keep abreast of policy and regulation changes affecting coding, including VHA, CMS, OIG information as well as other promulgations as appropriate. Access to Contractor s coding quality reviews can be obtained from Kansas City VA Medical Center. Contractor shall possess all licenses, permits, accreditation and certificates as required by law. Contractor shall be required to validate any order for test procedures in the health information documentation to validate medical necessity. All associated working papers and other material deemed relevant by the VA generated by the Contractor in the performance of this contract are the property of the United States Government. All individually identifiable health information/patient records shall be treated with the strictest confidentiality. Access to records shall be limited to essential personnel only. Documents/records/information shall be secured when not in use. At the conclusion of the contract all copies of individually identifiable health information shall be returned to Kansas City VA MEDICAL CENTER except where it is required to be retained by Contractor to comply with other Federal regulations. Contractor and Medical Center will agree to volume of cases to be coded weekly. Medical Center will provide a list of cases consistent with the volume agreed to. Contractor shall notify the COTR when the to be coded list is complete but no later than seven (7) calendar days after receipt. When the Contractor cannot meet this deadline due to unforeseen circumstances, Contractor shall notify the COTR by the fourth (4) calendar day. Contractor shall ensure that the to be coded list is properly annotated regarding status and that all records on the to be coded list have been coded and complete data entry performed or that the list is properly annotated regarding the reason not coded. This annotation will be performed consistent with the Case Comment requirement. Contractor shall enter complete data entry, including CPT codes, modifiers, service-connected determination when applicable & diagnoses for the encounter of occasion of service when on-line coding is performed into PCE. Associate the provider with the CPT code performed by him/her at the encounter. GUIDELINES Contractor shall adhere to all coding guidelines accepted by VA policy including but not limited to: (1) Official Guidelines and Reporting as found in the CPT Assistant, a publication of the American Medical Association (AMA) (2) Official Guidelines for Coding Reporting in Coding Clinic for ICD-10-CM and ICD-10-PCS. (3) VHA guidelines for coding as found in the Handbook for Coding Guidelines (most recent edition), Health Information Management, Department of Veterans Affairs, which will be provided to Contractor prior to project commencement. (4) CMS Ruling Documentation Requirements for VA Teaching Physicians as signed by Richard A. Stone, MD, Under Secretary for Health AND related documents and guidelines, which will be provided to Contractor prior to project commencement. CONFIDENTIALITY AND SECURITY Contractor shall insure the confidentiality and security of all patient information and shall be held liable in the event of breach of confidentiality. The Contractor shall comply with the provisions of the Privacy Act (5 USC 522a), Confidentiality of Drug Abuse, Alcohol Abuse, Sickle Cell Anemia and HIV/AIDs Treatment Records (38 USC 7332 and 38 USC 4132) and Confidentiality of Medical Quality Assurance Records (38 USC 5705 and 38 USC 3305). The Contractor shall comply with all pertaining confidentiality and security statutes. Contractor shall be HIPPA compliant (Health Insurance Portability and Accountability Act). Failure to comply with statutes regarding confidentiality and security of patient health information/individually identifiably information may result in financial sanctions. Contractor shall certify that all employees performing services under this contract have received required VHA Privacy and Security training. Contractor shall be responsible for ensuring the confidentiality and security of all patient information and shall be held liable in the event of any breach of confidentiality. Access requirements to VA information systems by Contractor personnel shall meet or exceed those requirements established for VA employees as promulgated in VA/VHA administrative issues including directives. Access shall be granted to non-VA users only if the purpose of access is consistent with all privacy and security policies and regulations. Contractor personnel shall be required to sign access agreements before starting work under this contract. These agreements required them to abide by VA computer access security and confidentiality policies. Contractor shall sign a Business Associate Agreement (BAA) between itself and the Department of Veterans Affairs. CODER QUALIFICATIONS Coders performing work shall: (1) Read and interpret health information documentation to identify all diagnoses and procedures that affect the outpatient encounter. (2) Possess formal training in: Anatomy and physiology, medical terminology, pathology and disease processes, pharmacology, health record formats and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD-10-CM, ICD-10-PCS and CPT). (3) Apply knowledge of CPT format, guidelines and notes to locate the correct codes and to sequence properly for services rendered. (4) Apply knowledge of procedural terminology to recognize when an unlisted procedure code is indicated. (5) Code in accordance with CCI Bundling Guidelines. (6) Use the CMS Common Procedural Coding Systems (HCPCS) where appropriate. (7) Clarify conflicting, ambiguous or nonspecific documentation by consulting with supervisor who will be identified to Contractor along with telephone and email address in advance of the project commencement. Supervisor, if necessary, will discuss with Kansas City VA MEDICAL CENTER COTR the identified conflicting, ambiguous or nonspecific documentation. Coders shall be credentialed with one or more of the following: (1) American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P, CCA (2) American Association of Professional Coders (AAPC): CPC, CIC, COC or CPC-A Credentialed coders must have a minimum of two (2) years experience in outpatient coding. Credentialed coders must have a minimum of two (2) years of experience in inpatient coding. QUALITY CONTROL Contractor shall establish and maintain a written quality assurance and control plan to assure that the requirements of the KANSAS CITY VA MEDICAL CENTER are met, and that coding adheres to all rules and regulations. Medical Center shall monitor to ensure that the 95% or greater quality standard is being met on an on-going basis. If monitoring demonstrates that work has fallen below the quality standard, the Contractor shall develop a corrective action plan and include it with the data for each week until standard is met. DEFINITIONS Ancillary Services Those services other than room, board, medical and nursing services, such as laboratory and radiology that are provided to patients in the course of care. An ancillary service does not include the exercise of independent medical judgment in the overall diagnosing, evaluating and/or treating of the patient s conditions. An ancillary service is usually the result of an encounter. CMS Centers for Medicare and Medicaid Services Coding The process of assigning a number (alpha, numeric or a combination of both) from a recognized and approved coding classification system that properly identifies and defines medical services, procedures and diagnoses. COTR Contracting Officer s Technical Representative CPT Current Procedural Terminology, 4th edition, published by the American Medical Association (AMA). A listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians or performed under the supervision of a physician. CMS Centers for Medicare and Medicaid Services HCPCS Healthcare Common Procedural Coding System (HCPCS) is a coding system that was developed by CMS for the purpose of standardizing the coding systems used to process Medicare claims on a national basis. The HCPCS coding system is used to bill primarily for supplies, materials and injections. It is also used to bill for certain procedures and services that are not defined in CPT. ICD-10-CM International Classification of Diseases, 11th revision, Clinical Modification (ICD-10-CM) is a nomenclature developed by the World Health Organization and modified for use within the United States to classify morbidity and mortality information for statistical purposes, and for the indexing of hospital records by disease, diagnosis and operations. ICD-10-PCS- International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-PCS) is an international system of medical classification used for procedural coding. The Centers for Medicare and Medicaid Services, the agency responsible for maintaining the inpatient procedure code set in the U.S TJC The Joint Commission OIG Office of Inspector General PCE Patient Care Encounter is VISTA software, which enables transmission of an ambulatory encounter, inpatient professional fees, or ancillary service data to the National Patient Care Database. VHA Veterans Health Administration VISTA/RESCUE Veterans Health Information Systems and Technology Architecture CPRS Computerized Patient Record System OBLIGATION/PURCHASE ORDER NUMBERS The COTR shall provide the contractor with an Obligation/Purchase Order Number prior to the commencement of work under this contract. The obligation number/task order number is provided for payment purposes and must be referenced on all invoices. EFFECTIVE PERIOD The effective period of this contract shall be mutually agreed to by Contractor and Medical Center. EXTENT OF OBLIGATION The Government is obligated only to the effect of authorized purchases actually made under this contract. PURCHASE LIMITATION Individual purchase dollar limitations shall not exceed the limitations established by each FSS contract. INDIVIDUALS AUTHORIZED TO PURCHASE UNDER THE CONTRACT Individuals (COTRs) acting within the scope of their delegated procurement authority are authorized to purchase under this contract. PAYMENTS/INVOICES Payments shall be made by electronic funds transfer (EFT) or by Government commercial credit card. For purchases made by purchase order, invoices shall be mailed to: Department of Veterans Affairs Financial Services Center PO Box 149971 Austin, TX 78714 Invoices must cite the Obligation/Purchase Order number provided by the ordering facility along with the contract number. MODIFICATIONS Modifications of this agreement shall be in writing and mutually agreed upon by the Contracting Officer and an authorized representative of the contractor. Estimated Quantity CLIN: AA (IP) AC (IP Pro) AE (OP) AG (Surg) AI (IP Audit) AK (IP Pro Audit) AM (OP Audit) Â Â Â Â Â Â Monthly 100 20 4250 20 0 0 0 Yearly 1200 240 51000 240 0 0 0 ***These are estimated quantities that are subject to change. Base Year- CLIN: AA (IP) AC (IP Pro) AE (OP) AG (Surg) AI (IP Audit) AK (IP Pro Audit) AM (OP Audit)