The Claremore Indian Hospital, DHHS/IHS is issuing this sources sought synopsis as a means of conducting market research to identify parties having an interest in and the resources to support this requirement for Coding Encoder and Reimbursement Software Licenses. The result of this market research will contribute to determining the method of procurement. The applicable North American Industry Classification System (NAICS) code assigned to this procurement is 511210. THERE IS NO SOLICITATION AT THIS TIME. This request for capability information does not constitute a request for proposals; submission of any information in response to this market survey is purely voluntary; the government assumes no financial responsibility for any costs incurred. If your organization has the potential capacity to perform these contract services, please provide the following information: 1) Organization name, address, email address, Web site address, telephone number, and size and type of ownership for the organization; and 2) Tailored capability statements addressing the particulars of this effort, with appropriate documentation supporting claims of organizational and staff capability. If significant subcontracting or teaming is anticipated in order to deliver technical capability, organizations should address the administrative and management structure of such arrangements. The government will evaluate market information to ascertain potential market capacity to 1) provide services consistent in scope and scale with those described in this notice and otherwise anticipated; 2) secure and apply the full range of corporate financial, human capital, and technical resources required to successfully perform similar requirements; 3) implement a successful project management plan that includes: compliance with tight program schedules; cost containment; meeting and tracking performance; hiring and retention of key personnel and risk mitigation; and 4) provide services under a performance based service acquisition contract. BASED ON THE RESPONSES TO THIS SOURCES SOUGHT NOTICE/MARKET RESEARCH, THIS REQUIREMENT MAY BE SET-ASIDE FOR SMALL BUSINESSES OR PROCURED THROUGH FULL AND OPEN COMPETITION. Telephone inquiries will not be accepted or acknowledged, and no feedback or evaluations will be provided to companies regarding their submissions. Submission Instructions: Interested parties who consider themselves qualified to perform the above-listed services are invited to submit a response to this Sources Sought Notice by June 24, 2015, 1:00 pm CST. All responses under this Sources Sought Notice must be emailed to
[email protected] and
[email protected] . APPENDIX 1: Purpose and Objectives STATEMENT OF WORK Claremore Indian Hospital A. PURPOSE OF CONTRACT: The purpose of this contract is to procure Encoding, Grouping, Reimbursement Calculation software, and coding and clinical reference software licenses for the Claremore Indian Hospital, Claremore, Oklahoma. B. STATEMENT OF WORK: Provide software with the following functionality: 1. Encoding software to support ICD-9-CM, CPT and HCPCS coding systems. a. Uses logic based upon mandated rules, coding priniples and guidelines to arrive at the appropriate code selection. Includes ICD-9-CM, ICD-10- CM, CPT and HCPCS search engines. Includes Encoder logic for Inpatient, Outpatient and Ambulatory Surgery Center settings. b. Prompts for Present on Admission identifiers. c. Code specific links to electronic codebook, Coding Clinical references, CCI edits and other references from within the encoding system. d. Ability to enter site and code-specific notes and reference those notes from either the encoder or the electronic codebook. 2. Grouping software to support DRG, MS-DRG, and APC assignments. a. Determines if a code is an MCC or a CC. b. Includes MCE. c. Incorporates inpatient and outpatient prospective payment system regulations for editing, grouping, and reimbursement. d. Includes estimated payment for APCs, fee schedules and beneficiary co-payments. e. Provides APC grouping and reimbursement capabilities for Medicare as well as OCE, and NCCI edits. 3. Clinical analyzer software to provide accurate DRG and MS-DRG. a. Assists coders with coding specificity by providing suggestions for frequently missed codes that impact MS-DRG, severity of illness and other quality measures. b. Analyzes the record and prompting for overlooked diagnoses and procedures. 4. Reimbursement calculation software. a. Calculates the reimbursement based on formulas that use appropriate national formulas and hospital-specific variables including Medicare inpatient and outpatient formulas. b. Ability to accommodate other payer groupers using the same codes. c. Calculates APC weight, payment, wage adjustment, discount, Medicare payment, outlier payment, device pass-through amount, and beneficiary co-payment by line items and total claim payments for Medicare, and fee schedule payments. d. Provides fee schedule payments for clinical laboratory tests, therapies (physical, speech, and occupational); durable medical equipment; and national fee schedule payments as defined by CMS. 5. Coding Reference Software a. ICD-9-CM Integrated Codebook b. ICD-10-CM/PCS Integrated Codebook c. Current Procedural Terminology d. AHA Coding Clinic for ICD-9-CM / ICD-10-CM/PCS e. AMA CPT Assistant f. Clinical pharmacology drug reference g. Medical dictionary h. Anatomy plates i. Coder’s Desk Reference j. AHA Coding Clinic for HCPCS k. Faye Brown’s ICD-9-CM Coding Handbook l. The Merck Manual m. Dictionary of Medical Acronyms and Abbreviations n. Diagnostic and Laboratory Tests Reference o. Anesthesia Crosswalk p. ICD-9 and ICD-10 MS-DRG Definitions Manuals q. ICD-10-CM and ICD-10-PCS Coding Handbook 6. ICD-10 ready a. Smooth transition from ICD-9-CM to ICD-10-CM/PCS coding tools b. Dual coding ability providing simultaneous coding in ICD-9 and ICD-10 c. Run ICD-9/ICD-10 analysis reports to see the difference in grouping and reimbursement d. Identify documentation specificity improvement areas important to ICD- 10 coding 7. Network capability. Must be server based. Cannot be cloud based per IHS regulations. 8. Unlimited user access. C. INSTALLATION AND CUSTOMER SUPPORT: 1. Initial installation, support and training 2. Post-installation support 3. 24-hour telephone, e-mail customer support. 4. Web training for new employees and updates. 5. Software updated timely to ensure compliance with all official coding regulations and requirements, at a minimum – quarterly updates. Updates to include at a minimum: ICD-9-CM, ICD-10-CM/PCS diagnosis and HCPCS/CPT procedure code changes, appropriate APC logic changes, OCE editing enhancements and reimbursement updates reflecting the latest values from CMS. D. EXTENT OF OBLIGATION: The United States Government is obligated only for the authorized services listed in Item A, “Purpose of Contract”. Any modification to this contract will require prior approval by both parties before any additional obligations of the Government is incurred. E. NEGOTIATED AUTHORITY: The appropriate contract authority is 41 USC 25. F. SERVICE RENDERED: The Vendor contract will provide Encoding, Grouping and Reimbursement software to Peggy Shults, Health Information Management, Claremore Indian Hospital, 101 S. Moore Avenue, Claremore, Oklahoma 74017. Ms. Shults will sign off on the services received and provide copy to Acquisition Office at Claremore Indian Hospital for receiving. I. FAR 52.224-2 Privacy Act (Apr 1984) (a) The Contractor agrees to— (1) Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies— (i) The systems of records; and (ii) The design, development, or operation work that the contractor is to perform; (2) Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcontract awarded without a solicitation, when the work statement in the proposed subcontract requires the redesign, development, or operation of a system of records on individuals that is subject to the Act; and (3) Include this clause, including this paragraph (3), in all subcontracts awarded under this contract which requires the design, development, or operation of such a system of records. (b) In the event of violations of the Act, a civil action may be brought against the agency involved when the violation concerns the design, development, or operation of a system of records on individuals to accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of the agency when the violation concerns the operation of a system of records on individuals to accomplish an agency function. For purposes of the Act, when the contract is for the operation of a system of records on individuals to accomplish an agency function, the Contractor is considered to be an employee of the agency. (c)(1) “Operation of a system of records,” as used in this clause, means performance of any of the activities associated with maintaining the system of records, including the collection, use, and dissemination of records. (2) “Record,” as used in this clause, means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, education, financial transactions, medical history, and criminal or employment history and that contains the person’s name, or the identifying number, symbol, or other identifying particular assigned to the individual, such as a fingerprint or voiceprint or a photograph. (3) “System of records on individuals,” as used in this clause, means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual. J. FAR 52.223-6 Drug-Free Workplace (May 2001) (a) Definitions. As used in this clause— “Controlled substance” means a controlled substance in schedules I through V of section 202 of the Controlled Substances Act (21 U.S.C. 812) and as further defined in regulation at 21 CFR 1308.11 - 1308.15. “Conviction” means a finding of guilt (including a plea of nolo contendere) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal or State criminal drug statutes. “Criminal drug statute” means a Federal or non-Federal criminal statute involving the manufacture, distribution, dispensing, possession, or use of any controlled substance. “Drug-free workplace” means the site(s) for the performance of work done by the Contractor in connection with a specific contract where employees of the Contractor are prohibited from engaging in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance. “Employee” means an employee of a Contractor directly engaged in the performance of work under a Government contract. “Directly engaged” is defined to include all direct cost employees and any other Contractor employee who has other than a minimal impact or involvement in contract performance. “Individual” means an offeror/contractor that has no more than one employee including the offeror/contractor. (b) The Contractor, if other than an individual, shall—within 30 days after award (unless a longer period is agreed to in writing for contracts of 30 days or more performance duration), or as soon as possible for contracts of less than 30 days performance duration— (1) Publish a statement notifying its employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the Contractor’s workplace and specifying the actions that will be taken against employees for violations of such prohibition; (2) Establish an ongoing drug-free awareness program to inform such employees about— (i) The dangers of drug abuse in the workplace; (ii) The Contractor’s policy of maintaining a drug-free workplace; (iii) Any available drug counseling, rehabilitation, and employee assistance programs; and (iv) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (3) Provide all employees engaged in performance of the contract with a copy of the statement required by paragraph (b)(1) of this clause; (4) Notify such employees in writing in the statement required by paragraph (b)(1) of this clause that, as a condition of continued employment on this contract, the employee will— (i) Abide by the terms of the statement; and (ii) Notify the employer in writing of the employee’s conviction under a criminal drug statute for a violation occurring in the workplace no later than 5 days after such conviction; (5) Notify the Contracting Officer in writing within 10 days after receiving notice under subdivision (b)(4)(ii) of this clause, from an employee or otherwise receiving actual notice of such conviction. The notice shall include the position title of the employee; (6) Within 30 days after receiving notice under subdivision (b)(4)(ii) of this clause of a conviction, take one of the following actions with respect to any employee who is convicted of a drug abuse violation occurring in the workplace: (i) Taking appropriate personnel action against such employee, up to and including termination; or (ii) Require such employee to satisfactorily participate in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and (7) Make a good faith effort to maintain a drug-free workplace through implementation of paragraphs (b)(1) through (b)(6) of this clause. (c) The Contractor, if an individual, agrees by award of the contract or acceptance of a purchase order, not to engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance while performing this contract. (d) In addition to other remedies available to the Government, the Contractor’s failure to comply with the requirements of paragraph (b) or (c) of this clause may, pursuant to FAR 23.506, render the Contractor subject to suspension of contract payments, termination of the contract or default, and suspension or debarment. J. EQUIPMENT PROVIDED BY THE GOVERNMENT: The vendor will be responsible for ownership, maintenance and support for the software program utilized in this contract. Claremore Indian Hospital will own and maintain the server for running the software. K. EQUIPMENT PROVIDED BY THE CONTRACTOR: N/A