SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

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1 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 7. FOR SOLICITATION INFORMATION CALL: 9. ISSUED BY NAVAL MEDICAL LOGISTICS COMMAND 693 NEIMAN STREET FORT DETRICK MD TEL: FAX: 11. DELIVERY FOR FOB DESTINA- TION UNLESS BLOCK IS MARKED SEE SCHEDULE a. NAME ERIK PRZYGOCKI CODE N DISCOUNT TERMS 10. THIS ACQUISITION IS X SMALL BUSINESS HUBZONE SMALL BUSINESS SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS 1. REQUISITION NUMBER 13a. THIS CONTRACT IS A RATED ORDER UNDER DPAS (15 CFR 700) 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE N R-0009 b. TELEPHONE NUMBER UNRESTRICTED OR 13b. RATING (No Collect Calls) X SET ASIDE: WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE UNDER THE WOMEN-OWNED SMALL BUSINESS PROGRAM NAICS: EDWOSB (A) PAGE 1 OF Mar OFFER DUE DATE/LOCAL TIME 01:00 PM 01 Apr % FOR: SIZE STANDARD: $15,000, METHOD OF SOLICITATION RFQ IFB X RFP 15. DELIVER TO CODE N ADMINISTERED BY BUREAU OF MEDICINE & SURGERY 7700 ARLINGTON BOULEVARD FALLS CHURCH VA TEL: FAX: CODE 17a.CONTRACTOR/ CODE FACILITY OFFEROR CODE 18a. PAYMENT WILL BE MADE BY CODE TELEPHONE NO. 17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK BELOW IS CHECKED SEE ADDENDUM ITEM NO. SCHEDULE OF SUPPLIES/ SERVICES QUANTITY UNIT UNIT PRICE AMOUNT SEE SCHEDULE 25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Gov t. Use Only ) 1X 27a. SOLICITATION INCORPORATES BY REFERENCE FAR FAR ARE ATTACHED. ADDENDA X ARE ARE NOT ATTACHED 27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR FAR IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED. 29. AWARD OF CONTRACT: REF. OFFER DATED. YOUR OFFER ON SOLICITATION (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS: 30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) TEL: (TYPE OR PRINT) 31c. DATE SIGNED AUTHORIZED FOR LOCAL REPRODUCTION PREVIOUS EDITION IS NOT USABLE STANDARD FORM 1449 (REV. 2/2012) Prescribed by GSA FAR (48 CFR)

2 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS (CONTINUED) 19. ITEM NO. 20. SCHEDULE OF SUPPLIES/ SERVICES 21. QUANTITY UNIT UNIT PRICE PAGE 2 OF AMOUNT SEE SCHEDULE 32a. QUANTITY IN COLUMN 21 HAS BEEN RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: 32b. SIGNATURE OF AUTHORIZED GOVERNMENT 32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE REPRESENTATIVE 32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32g. OF AUTHORIZED GOVERNMENT REPRESENTATIVE 33. SHIP NUMBER PARTIAL FINAL 34. VOUCHER NUMBER 35. AMOUNT VERIFIED CORRECT FOR 36. PAYMENT COMPLETE PARTIAL FINAL 37. CHECK NUMBER 38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY 41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE 42a. RECEIVED BY (Print) 42b. RECEIVED AT (Location) 42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS AUTHORIZED FOR LOCAL REPRODUCTION PREVIOUS EDITION IS NOT USABLE STANDARD FORM 1449 (REV. 2/2012) BACK Prescribed by GSA FAR (48 CFR)

3 Page 3 of 179 Section SF CONTINUATION SHEET ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,977,363 Data Records Outpatient Coding Services: On-site FFP The contractor shall provide On-Site Medical Outpatient Coding services in accordance with the Performance Work Statement (PWS). Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,684 Data Records Outpatient Coding Services: Remote FFP The contractor shall provide Remote Medical Outpatient Coding services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT

4 Page 4 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,930 Data Records Inpatient Coding Services: On-site FFP The contractor shall provide On-site Medical Inpatient Coding services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,527 Data Records Inpatient Coding Services: Remote FFP The contractor shall provide Remote Medical Inpatient Coding services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT

5 Page 5 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,620 Data Records Outpatient Auditing Services: On-site FFP The contractor shall provide On-site Medical Outpatient Auditing services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,410 Data Records Outpatient Auditing Services: Remote FFP The contractor shall provide Remote Medical Outpatient Auditing services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT

6 Page 6 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,615 Data Records Inpatient Auditing Services: Remote FFP The contractor shall provide Remote Medical Inpatient Auditing services in accordance with the PWS. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,038 Session Coding and Auditing Training Services FFP The contractor shall provide Medical Coding and Auditing services in accordance with the PWS. Each session is equal to one hour. FOB: Destination NET AMT

7 Page 7 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Months CDIS Services FFP The contractor shall provide Clinical Documentation Improvement Specialist (CDIS) services in accordance with the PWS. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Lot Travel COST FOB: Destination ESTIMATED COST ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,845,539 Data Records OPTION Outpatient Coding Services: On-site FFP The contractor shall provide On-Site Medical Outpatient Coding services in accordance with the Performance Work Statement (PWS). Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT

8 Page 8 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,238 Data Records OPTION Outpatient Coding Services: Remote FFP The contractor shall provide Remote Medical Outpatient Coding services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,930 Data Records OPTION Inpatient Coding Services: On-site FFP The contractor shall provide On-site Medical Inpatient Coding services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT

9 Page 9 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,527 Data Records OPTION Inpatient Coding Services: Remote FFP The contractor shall provide Remote Medical Inpatient Coding services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,712 Data Records OPTION Outpatient Auditing Services: On-site FFP The contractor shall provide On-site Medical Outpatient Auditing services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT

10 Page 10 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,316 Data Records OPTION Outpatient Auditing Services: Remote FFP The contractor shall provide Remote Medical Outpatient Auditing services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,615 Data Records OPTION Inpatient Auditing Services: Remote FFP The contractor shall provide Remote Medical Inpatient Auditing services in accordance with the PWS. FOB: Destination NET AMT

11 Page 11 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,379 Session OPTION Coding and Auditing Training Services FFP The contractor shall provide Medical Coding and Auditing services in accordance with the PWS. Each session is equal to one hour. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Months OPTION CDIS Services FFP The contractor shall provide CDIS services in accordance with the PWS. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Lot OPTION Travel COST FOB: Destination ESTIMATED COST

12 Page 12 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,713,715 Data Records OPTION Outpatient Coding Services: On-site FFP The contractor shall provide On-Site Medical Outpatient Coding services in accordance with the Performance Work Statement (PWS). Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,793 Data Records OPTION Outpatient Coding Services: Remote FFP The contractor shall provide Remote Medical Outpatient Coding services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT

13 Page 13 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,930 Data Records OPTION Inpatient Coding Services: On-site FFP The contractor shall provide On-site Medical Inpatient Coding services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,527 Data Records OPTION Inpatient Coding Services: Remote FFP The contractor shall provide Remote Medical Inpatient Coding services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT

14 Page 14 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,804 Data Records OPTION Outpatient Auditing Services: On-site FFP The contractor shall provide On-site Medical Outpatient Auditing services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,222 Data Records OPTION Outpatient Auditing Services: Remote FFP The contractor shall provide Remote Medical Outpatient Auditing services in accordance with the PWS. Data Record is defined by the completion of the record with no errors. FOB: Destination NET AMT

15 Page 15 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,615 Data Records OPTION Inpatient Auditing Services: Remote FFP The contractor shall provide Remote Medical Inpatient Auditing services in accordance with the PWS. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,726 Session OPTION Coding and Auditing Training Services FFP The contractor shall provide Medical Coding and Auditing services in accordance with the PWS. Each session is equal to one hour. FOB: Destination NET AMT

16 Page 16 of 179 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Months OPTION CDIS Services FFP The contractor shall provide CDIS services in accordance with the PWS. FOB: Destination NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Lot OPTION Travel COST FOB: Destination ESTIMATED COST PERFORMANCE WORK STATEMENT Performance Work Statement Medical Coding Services Enterprise-wide SECTION C SECTION 1 - INTRODUCTION 1.1. BACKGROUND In order to improve military health care, it is essential to have a robust coding and auditing program within Navy Medicine. With future International Classification of Disease (ICD) versions becoming more detailed, it is imperative that health care providers learn to improve medical record documentation. The focus of this contract is to augment Navy Medical Treatment Facility (MTF) coding resources and provide education to Navy health care providers to improve documentation and coding accuracy. The ongoing requirement of the contract is improving health care provider documentation, coding and auditing practices and achieving outcomes such as reductions in claims denials and relative values of care SCOPE The scope of this contract includes inpatient and outpatient medical record coding services, inpatient and outpatient medical record auditing services, medical coding and auditing training services, and Clinical Documentation Improvement Specialist (CDIS) services. In this contract, Armed Forces Health Longitudinal Technology Application (AHLTA), Ambulatory Procedure Visit (APV), Emergency Room (ER) and Inpatient Professional Services (IPS) (also referred to as rounds) records are all considered outpatient records. The services incorporated

17 Page 17 of 179 under this contract are inherently associated with coding and auditing processes. All services provided under this contract shall be provided either on-site or remotely for Navy MTFs as specified in the individual task orders. SECTION 2 - DUTIES 2.1. SPECIFIC DUTIES The contractor shall provide a monthly report of the services rendered during the previous month at each MTF identified in the task order to the task order primary Government Point of Contact (POC), the Regional Patient Administration Department (PAD) Officer and the Contracting Officer Representative (COR) by the 5 th business day of the month. Also, the contractor shall identify any issues regarding the services provided or any government issues that may affect their performance (i.e., inability to gain access to the Automated Information System (AIS) for new employees). The report shall contain a place for the task order primary Government POC to digitally sign to verify receipt of the deliverable and attesting that the information contained within it is accurate. The documents produced in accordance with paragraphs and below shall be embedded into the document. This shall be submitted as an Excel spreadsheet with a separate tab for each MTF, but only one spreadsheet per task order MEDICAL RECORD CODING SERVICES The contractor shall code billable care including Medical Services Accounts (MSA), all Other Health Insurance (OHI) and encounters in clinic specialties requiring expertise in a specific area of medicine The contractor shall research/resolve problematic coding practices identified by the MTFs to include data quality discrepancy items The contractor shall code encounters in clinic specialties where a high level of coding expertise in a particular specialty is required The contractor shall resolve medical record documentation deficiencies through healthcare provider query and provide routine feedback to health care providers to correct future deficiencies The contractor shall work as part of a team interacting with the health care providers, government personnel and contract employees to perform medical record coding and research errors or missing documentation The contractor shall comply with the following turnaround times which begin upon receipt of the record. All outpatient non-apv records shall be coded within 3 business days. APVs shall be coded within 15 calendar days. Inpatient medical records shall be coded within 30 calendar days The contractor shall perform a quality assessment of records, including verification of medical record documentation (both electronic and hand written) and provide the department head and individual health care providers with feedback The contractor shall recode records on the Data Quality (DQ) discrepancy list as stated in the task order. The level of effort associated with these records is approximately 3 times that of a standard Outpatient record. Records on the DQ discrepancy list are records that have a logic error between the provider documentation and the codes in the system such as a pediatric code in an adult record. If the contractor initially coded the record incorrectly, the government will not be charged for recoding the record If the government does not agree with a code assigned to a medical record by the contractor, the MTF will notify the contractor of the discrepancy. The contractor shall respond with the action to be taken within 48 hours of notification. If the contractor and MTF continue to disagree, the Navy Medicine Region (East or West) will review and make the final decision on the appropriate code(s). The Region s decision will be sent to the contractor and the code shall be changed at no cost to the government.

18 Page 18 of The contractor shall obtain physician documentation for any clinical condition or procedure to support the appropriate severity of illness, expected risk of mortality and complexity of care of the patient prior to coding the medical record The contractor shall advise members of the patient care team, to include the attending physicians, allied health practitioners, nurses and case managers, regarding documentation guidelines The contractor shall work with the MTF clinical champions, AHLTA Sustainment Trainers/Consultants, directors and department heads to develop best practices for outpatient and inpatient coding to provide educational services The contractor shall follow the MTF Standard Operating Procedures (SOPs) when the government systems are unavailable due to system issues MEDICAL RECORD AUDIT SERVICES The contractor shall conduct audits of government coded medical records as stated in the individual task orders. The audit shall assess compliance with Department of Defense (DoD) requirements and industry standards, such as the use of modifiers, procedure sequencing and linkage of procedures to diagnosis codes to support medical necessity of services. The contractor shall perform the audits in accordance with the Bureau of Medicine and Surgery Instruction A (BUMEDINST A) (or current version); a copy is provided as PWS Attachment II. In addition, the contractor shall use the government s auditing tool of choice which is currently the Auditing Prototype (an Access database) The contractor s audit shall identify inaccurate/non-specific code assignments, document improvement opportunities and make recommendations for staff training. Improved documentation accurately reflects the patient/health care provider s interaction, the chief complaint/reason for admission (including pertinent patient/family health and social histories) and co-morbidities affecting the specificity of final code assignment. The audit report (See paragraph ) shall describe the gap between the medical record documentation and the required baseline clinical documentation. This information shall be used to improve clinical documentation through provider training For MTFs with on-site services, the contractor shall pull the records for the audit based on the list provided by the task order primary Government POC. For those MTFs purchasing remote services, the government will provide the contractor electronic copies of the patient record and the auditing tool loaded with the data. The quantity and frequency of the audits will be stated in the task order. The task order primary Government POC will coordinate specific audit dates and provide a list of the records to be audited The contractor shall verify patient identification and demographic information, reason for admission, disposition date, assignment of diagnoses, procedure documentation and provider s signature for all inpatient record audits. The inpatient audit includes a comparison of the auditor s coded record against the original coded record and a comparison of Relative Weighted Products (RWPs) The contractor shall verify patient identification and demographic information, chief complaint/reason for visit, encounter date, assignment of diagnoses, procedures documentation and provider s signature for all outpatient record audits. The audit shall include a comparison of the auditor s coded record against the original coded record and a comparison of Relative Value Unit (RVUs) The contractor shall provide random data quality (DQ) audit results to the task order primary Government POC on a monthly basis adhering to the Data Quality Management Control (DQMC) policy (or current version) which can be found at The contractor shall maintain compliance with the due dates consistent with current and future DQMC guidance. The report shall include the process for the audit, aggregate positive and negative trends, comparisons stated in paragraphs and above and recommendations for corrective action, including training topics. The contractor shall be prepared to complete the DQ audit in 5 business days or less once the records have been received from the government. The

19 Page 19 of 179 completed DQ audit shall be returned to the task order Government POC in the audit tool no later than 5 business days prior to sending the results to the Region. The contractor shall follow guidance received from the MTF for focused audits. The information from the DQMC Control Review List contains the same information that is used in the audit tool The contractor shall recode records at no additional cost, if the government determines a contractoraudited record is incorrect. The government will assess accuracy by conducting shadow audits of randomly selected contractor-audited records. See PWS Attachment III - Coding Program Management and Training Guidelines regarding government surveillance of performance The contractor shall the task order primary Government POC within three business days of completion of the audit. The shall include the following information: date conducted; dates of services; guidelines used (95 or 97); summary of the audit data including common errors, trends; a compare/contrast of audit results for previously audited providers and recommendations for future training sessions. The Audit Prototype summary report(s) defined in the task order shall be included as an attachment to the report. Other information required will be identified in the task order TRAINING SERVICES The contractor shall provide training as stated in the individual task orders. The task order Government POC is responsible for scheduling and confirming the training session with the providers at least two weeks in advance consistent with the Navy Medicine Training Guidelines (refer to PWS Attachment III, Coding Program Management and Training Guidelines). The primary focus of training is to increase the accuracy of medical encounter coding by improving code assignment and clinical documentation The contractor shall work with the government to develop training that is specific to the clinical services provided by the MTF and shall incorporate standardized Bureau of Medicine and Surgery (BUMED) training guidance provided in the Coding Program Management and Training Guidelines (PWS Attachment III) to facilitate evolving requirements. The contractor shall work with the MTF personnel and the AHLTA sustainment trainers in the performance of these services. Training topics shall include the current ICD version; Current Procedural Terminology (CPT) codes and conventions; inpatient and outpatient documentation; RVU/RWP documentation and coding; residency specific issues (as applicable); use of Healthcare Common Procedural Coding System (HCPCS) and CPT codes; inpatient and outpatient query processes; Medicare Severity-Diagnosis Related Group (MS-DRG) validation and industry coding classification updates The contractor shall ensure training materials are continuously updated to relay the most current and relevant information. The curriculum shall include specific information and examples relevant to the clinical area for which the training is provided The contractor shall not include instruction on how to use the government systems such as AHLTA, Composite Health Care System (CHCS), or Coding Compliance Editor (CCE) in their curriculum. The contractor shall inform the task order Government POC in writing of system related issues brought up during training The contractor shall participate in continuous process improvement with AHLTA sustainment trainer and aid the health care providers in determining the best process for entering information into the system The contractor shall incorporate audit findings and feedback from health care providers (to include residents and interns), clinical staff and government coders into their training The contractor shall provide updates and revisions to any templates or tools used by the health care providers related to coding The contractor shall use a variety of methods to provide training, which may include, group training, oneon-one training, webinars, web-based training, power point presentations, Defense Collaboration Services (DCS) and/or instructional videos. The government reserves the right to record any training session or copy any of the training materials provided by the contractor for educational purposes.

20 Page 20 of The contractor shall identify and provide a list of teaching tools/equipment required from the government at least two weeks in advance of training The contractor shall advise the task order Government POC in advance of developing the training schedule if any provider requires immediate training based on the audit results The contractor shall the task order primary Government POC within three (3) business days of each training session. The shall include the following information: date and number of training hours; name of trainee(s) and their specialty area; training location; documentation used for training; number of records reviewed (if applicable); summary of overall findings; recommendations provided to trainees; feedback from trainees; recommended timeframe to meet again (if applicable). Any follow-up training shall not commence prior to COR approval and modification to the contract. Any other information required will be stated in the task order CLINICAL DOCUMENTATION IMPROVEMENT SPECIALIST (CDIS) SERVICES The contractor shall perform initial and follow-up assessments regarding the inpatient provider s documentation skills. With each assessment, inpatient record reviews shall include verification of patient identification and demographics; reason for admission; disposition date; assignment of diagnoses; procedures documentation and health care provider s signature. The contractor shall also identify opportunities for improvement to ensure documentation used for measuring and reporting physician and hospital outcomes is accurate and complete The contractor shall perform a baseline review of all inpatient health care providers to determine if CDIS are impacting documentation. The sample size for the review shall be between 2-5% per health care provider. The review shall start within 30 calendar days of contract startup and the results of the review shall be provided in a report to the Task Order Government POC per the following schedule: Number of Providers Up to 350 Between 350 and 700 Greater than 700 Report Due After Start of Review Within 5 business days Within 10 business days Within 15 business days The contractor shall perform a baseline review of all new health care providers within 30 days of seeing patients to determine the current level of documentation detail. The sample size for the review shall be 2% per provider. A report of findings shall be provided to the Task Order Government POC within 5 business days of starting the review The contractor shall concurrently review all medical records identified in the task order(s) to identify documentation deficiencies. For an inpatient stay, the CDIS shall review the provider documentation daily and recommend an addendum to the record if necessary. If the CDIS determines a provider s documentation is not improving, the CDIS shall recommend to the Task Order Government POC a corrective action plan to identify specific areas of improvement, a remediation plan that includes a timeline in which to achieve positive results and a follow-up plan. The corrective action plan shall be approved by the Task Order Government POC prior to implementation. A summary of all providers placed on a corrective action shall be included in the monthly report of services rendered The contractor shall perform focused inpatient medical record reviews. The initial review is performed within hours of patient admission The contractor shall communicate with physicians, case managers, coders and other health care team members to obtain comprehensive medical record documentation to support the severity of illness, expected risk of mortality, and complexity of care provided to the patient. Documentation obtained shall include clinical treatment and procedures, medical decisions and diagnoses for inpatients.

21 Page 21 of The contractor shall initiate a query to the health care provider to clarify and explain any documentation that does not clearly and consistently describe the patient s medical condition and hospital stay to assign the correct MS-DRG. Clarification includes obtaining accurate and complete documentation based on current clinical findings, prescribed treatment, medical interventions and/or processes. The contractor s medical record review methodology shall comply with BUMEDINST A (or current version) (See PWS Attachment II) The contractor shall conduct routine (non-query) follow-up reviews of the medical record every 3 days until the issue is resolved The contractor shall review outstanding queries daily for provider responses and follow-up as needed to facilitate timely and accurate documentation The contractor shall provide education to physicians and other members of the health care team regarding compliant documentation responsibilities, coding and reimbursement issues and documentation guidelines The contractor shall investigate and analyze documentation issues/questions to generate and recommend solutions to the Task Order Government POC. The contractor shall prepare formal reports for the government with findings and recommendations regarding documentation, revenue and reimbursement issues. Formal reports shall be submitted to the Task Order Government POC by the 5 th business day of each month The contractor shall provide medical record documentation education to residents and interns in the MTFs Family Practice graduate medical education (GME) program The contractor shall implement coding documentation improvement processes and disseminate new/updated information to improve documentation, RWP and Prospective Payment System (PPS) capture within five (5) business days after receiving approval from the government The contractor shall educate the health care provider on the most efficient process for capturing data in the applicable system The contractor shall evaluate Present on Admission (POA) indicators for each diagnosis that could potentially affect the principal diagnosis, quality indicators or MS-DRG assignment The contractor shall validate data using government AIS and identify data capture trends, variations in coding practices and perform management analysis. The contractor shall use this data to provide feedback to taskers or queries from customers such as the MTFs or the Navy Medicine Region (East or West) in a variety of formats The contractor shall monitor compliance with policies and procedures relevant to the clinical data management program, make recommendations to improve compliance, obtain government approval for implementation and take action The contractor shall collect and analyze data to correct identified complex coding deficiencies and improve reimbursement capture The contractor shall utilize enterprise-prescribed tools to monitor the completeness of clinical documentation and accuracy of code assignments The contractor shall make daily rounds and interact with health care team members to ensure consistent documentation practices. The contractor shall work closely with any department impacting admissions to include, Scheduling, Insurance Verification, Operating Room (OR), Post-Anesthesia Care Unit (PACU), Emergency Department (ED) and the Admitting Office for direct admits. The contractor shall seek clarification from physicians regarding proper documentation as it relates to reimbursement The contractor shall achieve minimum departmental productivity standards of reviews per day, inclusive of initial and follow-up reviews.

22 Page 22 of APPLICABLE DIRECTIVES AND REFERENCES The following legal, regulatory, policy, and security documents are relevant to the performance of contract services. The contractor shall comply with all mandatory documents listed below and referenced throughout Section 2.1. Mandatory Compliance Document No./Version/Location Source BUMED memo 6000 Ser M3/ HCO3 AT dtd 2 Feb 12, (See PWS Attachment I) BUMEDINST Department of Defense (DOD) TRICARE Operations A (or current version) (See PWS Attachment II) Administrative Instruction No. 15 (DOD AI-15), May 3, TRICARE Operations Manual M, Chapter 2, dtd Feb 1, =TO08&Change=153&Type=AsOf&Filename=C2TOC.PDF DOD DODI dtd June 6, BUMED Version 2.0 dtd 6 December 2010 (see PWS Attachment III, Coding Program Management and Training Guidelines) Navy Medicine (NAVMED) DOD Policy dtd 06 July Copy.pdf R dtd May 14, Title Subj: Requirement to Correct Codes When Reviewed By Coder/Auditor and Found To Be Inaccurate (or current version) Coding Program Standard Business Practices, Proceses, and Reporting Guidelines OSD Records and Information Management Program Records Management Security of Unclassified DoD Information on Non- DoD Information Systems (or current version) Coding Program Management and Training Guidelines PII Incident Reporting Requirements DoD Privacy Program Department of the Navy (DON) Secretary of the Navy (SECNAV) CIO Message DTG Z FEB 08 SECNAVINST Loss of Personally Identifiable Information Reporting Process DON Computer Network Incident Response and Reporting

23 Page 23 of 179 Military Health System United States Code (USC) United States Code (USC) Code of Federal Regulations (CFR) American Health Information Management Association (AHIMA) Health Topics/Technology/Support Areas/MHS Specific Coding Guidelines?type=Training+Booklets+%26+Toolkits USC Title 41 USC Title 44 title44/html/uscode-2008-title44.htm 36 CFR, Chapter XII, National Archives and Records Administration, Subchapter B vol3/pdf/cfr-2011-title36-vol3-chapxii-subchapb.pdf /bok1_ hcsp?ddocname=bok1_ DOD DOD dtd Nov 29, pdf DOD Department of Defense Instruction (DODI) R dtd Dec 2, DOD Department of Defense Directive (DODD) R dtd October 29, DOD DODI dtd Feb 6, DOD DOD dtd. Aug 12, odi.pdf DOD DODI dtd Jan 23, Joint Travel Regulation SECNAV SECNAV E dtd Dec 28, agement%20security%20and%20safety%20services/05-200%20management%20program%20and%20techniques%20 Requirements MHS Coding Guidelines Public Contracts Public Printing and Documents Records Management American Health Information Management Association Code of Ethics Standards of Conduct Privacy of Individually Identifiable Health Information in DoD Health Care Programs DOD Privacy Program Information Assurance (IA) Implementation Security of Individually Identifiable Health Information in DoD Healthcare Programs Identification (ID) Cards for Members of the Uniformed Services, Their Dependents, and Other Eligible Individuals Per Diem Rates DON Privacy Program

24 Page 24 of 179 BUMED Services/5211.5E.pdf gapiiphiincident.aspx PII Incident Response SECTION 3 HOURS OF OPERATION 3.1. Specific days and hours of operation are defined in the individual task orders for on-site services. The contractor s employees may work outside the duty hours stated in the task order, at no additional cost to the government, to manage any backlog with coordination and written approval from the task order Government POC. Services are not required on the observance of federal holidays at any Navy MTF All closings for severe weather or other emergency shall be at the sole discretion of the government for on-site services. The contractor shall provide services unless notified by the task order primary Government POC that a closing due to weather conditions or other emergency is authorized. The contractor will receive guidance from the Government task order primary Government POC of the MTF protocol for closings Remote services are not bound by defined service hours, however some facilities do not have 24/7 Information Technology (IT) support. It is the contractor s responsibility to ensure that individuals providing remote coding services are informed of the operating hours for the IT department of the MTF they are servicing in the event IT support is required. The hours of operation and contact information for the IT department will be included in the task orders. SECTION 4 DELIVERABLES 4.1. Contract Data Requirements List (PWS Attachment IV) 4.2. Schedule of Deliverables Deliverable Referenced Due Date Quality Control Plan 9.5. No later than the start of the contract and 60 days prior to each option exercise Confidentiality Agreement Prior to start of services Health Examination and Immunization/Screening Requirement Form (on-site services only) days prior to contract performance Random DQ Audit Results Monthly Monthly Report of Services th business day of each month Rendered Audit Report Within 3 business days after completing the audit Training Report Within 3 business days following each training session Baseline Review of Inpatient Healthcare Providers Number of Providers Up to 350 Report Due After Start of Review Within 5 business days Number of Providers Between 350 and 700 Report Due After Start of Review Within 10 business days Number of Providers

25 Page 25 of 179 Greater than 700 Report Due After Start of Review Within 15 business days Baseline Review of All New Healthcare Providers Report due within 5 business days after starting the review CDIS Formal Reports th business day of each month Personnel Roster days prior to performance of services Command Orientation Within 30 days of contract start SECTION 5 QUALITY ASSURANCE SURVEILLENCE PLAN (QASP) 5.1. QASP Matrix Performance Element Performance Reference Surveillance Method Frequency Acceptable Quality Level Coding Turn Inspection Monthly 95% Around Time Coding Accuracy Inspection Monthly 95% Audit Accuracy Inspection Monthly 95% Training Quality Inspection & Random Observation Monthly Inspection: 90% of the reports are accurate. Feedback: 80% of students rated the quality of the training CDIS Reporting Inspection& Observation effective. Bi-annual Inspection: 90% of the reports are accurate. CDIS Productivity Inspection Monthly 95% Contractor Quality Control Plan 9.5. Inspection Annually for overall QC activities; as required for corrective 100% Invoicing Monthly invoices are timely and accurate. SECTION 6 - QUALIFICATIONS Inspection/ Acceptance actions Monthly 100% 6.1. GENERAL QUALIFICATIONS The contractor shall ensure their staff is fully trained to provide services consistent with ICD-10 and future mandated coding changes.

26 Page 26 of Be a U.S. Citizen per PWS Attachment V, Citizenship Requirements CODING, AUDITING, TRAINING AND CODING CONSULTATION SERVICES The contractor s professional staff shall possess and maintain certifications issued by a nationally recognized certifying professional body for coding professionals. An apprenticeship certification is not considered acceptable under this contract The contractor s professional staff shall possess a minimum of 2 years of experience working in their discipline CLINICAL DOCUMENTATION IMPROVEMENT SERVICES Bachelor s degree in a health-related field with a minimum of 5 years clinical experience including but not limited to; acute patient care, health services, public health, long-term care administration, hospital organization and management, strategic planning and health systems Two years in the last five years focused on inpatient coding, healthcare and coding regulations including code structure, clinical documentation, MS-DRG experience, criteria-based chart reviews (ex. Utilization Management or Case Management), and quality improvement experience working with a physician s group. SECTION 7 RESUME 7.1. Thirty (30) days after contract award, the contractor shall submit a resume to the COR for each contract employee. Prior to contract employees providing services under this contract, the COR will verify the compliance of each contract employee with the qualification requirements applicable to the labor category required to perform the work The contractor shall maintain a personnel roster for all individuals who are providing services under this contract. The contractor shall provide a copy of the list to the COR within 30 days prior to performance of services under this contract and as required to maintain currency of the information The contractor shall inform the COR of any terminations of employment within 24 hours of the action. SECTION 8 - GOVERNMENT AND CONTRACTOR FURNISHED ITEMS GOVERNMENT FURNISHED ITEMS The government will provide the auditing tool of choice, which is currently the Auditing Prototype (Access database). This includes the tool, directions for usage and a maximum of 2 training sessions not to exceed a total of 4 hours per year for contractor personnel. The task order primary Government POC or their designee will provide the training on how to use the audit prototype AUTOMATED INFORMATION SYSTEMS (AIS) The government will provide access to the AIS required for the performance of services on the contract and will maintain all hardware and systems. Access to sensitive data will be at a level appropriate to the performance of services ON-SITE SERVICES The government will provide, without cost, the facilities, materials, consumable supplies, equipment and/or services required to perform the on-site duties, with the exception of the services specified under this contract. The government will provide routine scheduled maintenance and repair of government-provided equipment according to MTF Instructions. Upon contractor s request, through the task order Government POC, the government will provide repairs of government provided equipment in accordance with MTF Instructions.

27 Page 27 of The contractor shall coordinate with the Material Management Department to order department supplies. The contractor shall research products, make recommendations for purchase, enter new item requests, and create replenishment requests to be submitted by the appropriate government official. The contractor is liable for loss of or damage to supplies and equipment if such loss or damage is due to negligence or willful misuse. The contractor shall ensure efficient and economical use of supplies At no time during the term of this contract shall the contractor remove government furnished supplies or equipment from the MTF for on-site services The contract employees shall comply with the military base policies and instructions for gaining access to the military base for on-site services. The identification badge shall be worn during performance of work and anytime the contractor is on the premises. The contractor shall ensure all government furnished items are returned during a proper check-out with the task order Government POC when the contract employee is no longer providing services under this contract The Government task order primary Government POC will provide written confirmation to the contractor for training sessions, which includes the audit dates, the MTF name and contact information (See ) The government will provide any teaching tools/equipment identified by the contractor as being required for training. The government will notify the contractor if the materials are unavailable (See ) REMOTE SERVICES Unless otherwise stated in the task order, the government will issue laptops to the contractor in support of remote services. The laptops will be issued to the contract employee(s) who shall exchange the laptop at the MTF every 60 days starting from issuance, unless the task order states otherwise. The contractor s employee shall possess and maintain a National Agency Check with Law and Credit (NACLC) security clearance before being eligible to receive and use the government furnished laptop. Persons issued Government Furnished Property shall be within commuting distance of an MTF. Refer to Section 10 for additional information CONTRACTOR FURNISHED ITEMS The contractor shall supply current resources and references (e.g. ICD (current version), CPT, and HCPCS) for each contract employee. Specific requirements will be identified in the individual task orders The contractor s headquarters personnel shall use Microsoft-compatible programs possessing Health Insurance Portability and Accountability Act (HIPAA) compliant encryption capabilities to receive encrypted e- mails from government accounts. SECTION 9 QUALITY CONTROL 9.1. The services specified in this contract and the task orders shall be performed in accordance with established principles and ethics of the medical record coding profession. The quality of services shall meet or exceed the current recognized standards established by American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), the MTF, BUMED, DON, the DoD Health Affairs (HA), and those other professional associations and government agencies which specify standards of performance for the medical record coding profession. The contractor shall adhere to and comply with all DoD, DON, BUMED, and Regional and local MTF instructions, notices, Coding Compliance Plans and Coding SOPs as well as BUMED policy letters, notes/notices and memorandums which may be in effect during the term of the contract The contractor shall comply with applicable laws and DoD regulations for disposing of copies of patient care records that are in the contractor s possession.

28 Page 28 of The contractor shall utilize the BUMED Coding Program Management and Training Guidelines, Military Health Systems (MHS) coding guidelines and MTF processes to monitor and evaluate the completeness of clinical documentation and accuracy of code assignments. For additional information refer to the link in Section The contractor shall become acquainted with and obey all MTF regulations. In addition, the contractor shall comply with DoD and MTF instructions, Standard Operating Procedures (SOPs) and policies applicable to data quality, ethics and services rendered in a federal facility The contractor shall comply with federal, state, local, and Joint Commission health, fire and safety regulations The contractor shall establish, submit for government approval and implement a Quality Control Plan (QCP) that is consistent with the applicable MTFs Quality Improvement Plan at the task order level for the specific MTFs The contractor shall submit a Quality Control Plan to the COR and the Contracting Officer for review no later than the start of the contract. The QCP shall include (a) a plan for providing services by appropriately qualified personnel; (b) a plan to ensure maintenance and enforcement of the other requirements for contractor employees as specified in Section 11.1.; and (c) procedures the contractor shall implement to ensure the successful completion of tasks identified in this Performance Work Statement (PWS) Upon receipt of the contractor's QCP, the COR will review and provide comments to the contractor. If the COR finds deficiencies in any portion of the proposed QCP, the contractor shall have five (5) working days to correct the deficiencies. The COR will provide final approval of the QCP Sixty (60) days prior to exercising any option year under this contract, the contractor shall submit to the COR an updated QCP that is consistent with updated Joint Commission standards and updated MTF Quality Control Program. The revised QCP shall be subject to the same review process as that required at the time of contract award INDEPENDENT CONTRACTOR The services provided by the contractor are provided in the capacity of an independent contractor. The government will evaluate the quality of services for purposes of contract inspection and acceptance. The contractor shall be solely responsible for any and all liability caused by the acts or omissions of its agents or employees. The contractor shall not in any manner represent or infer that it is an instrumentality or agent of the United States Government. The contractor shall recognize that the Commanding Officer maintains administrative and operational responsibility for all activities within the command and may take such actions as necessary to preserve and maintain the integrity of the command, subject to the limitations prescribed by law and U.S. Navy Regulations MODIFICATIONS The Contracting Officer will designate and authorize an individual to act as the Contracting Officer's Representative (COR). Any such representative appointed will be specifically designated by letter from the Contracting Officer. The COR exclusively represents the Contracting Officer in all technical phases of the work, but is not authorized to issue Change Orders, Supplemental Agreements, or direct any contract performance requiring contractual modification or adjustment. Changes in the scope of work can only be made by modification properly executed by the Contracting Officer. All observations made by persons other than the Contracting Officer or the COR are strictly advisory and shall not influence the contractor's operations except for administrative requirements and responsibilities specified herein. SECTION 10 - START OF SERVICES BACKGROUND INVESTIGATION The MTF is responsible for assistance with the security processes involved with on-site services. The COR is responsible for all security processes for remote services The Contractor Appointing Personnel shall report to the COR on the first day of contract performance. The COR shall provide direction for a proper check-in and any additional documentation or instructions that may be