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U.S. Citizenship:
Employee must be a U.S. citizen. For the purpose of base and network access, possession of a permanent resident card (“Green Card”) does not equate to U.S. citizenship.
SECURITY:
All contractor personnel require a minimum of a Tier 1 background check (T1)/SF85 for any position that requires access to the internet, use of automated information systems to cover standalone computers or unescorted entry into restricted or controlled areas prior to reporting for duty in support of any requirement. The investigation is not for a security clearance; it is for a position of trust. This is a mandatory requirement set forth in DoDM 5200.02_AFMAN 16-1405, Air Force Personnel Security Program. All documentation required for security certification shall be the responsibility of the contractor.
Point of Contact for Immediate Consideration:
Art Mata
amata@reef-sys.com
Medical Coder
Hines, Illinois · Government/MilitaryMedical Coder
Reef Systems seeks experienced medical coders to support the Edward Hines, Jr. VA Hospital in Hines, Illinois 60141.
Scope of Work:
The purpose of this contract is to obtain services to assign ICD, CPT-4, and HCPCS Level II codes based on medical record documentation of outpatient and inpatient care provided at or under the auspices of Edward Hines Jr. VA Hospital and perform coding audits. The Contractor shall provide all resources necessary to accomplish the deliverables described in this Performance Work Statement, except as may otherwise be specified.
a. Assign ICD, CPT-4, and HCPCS Level II codes based on medical record documentation of outpatient and inpatient care provided at or under the auspices of Edward Hines Jr. VA Hospital.
b. Furnish validation of the integrity, quality, and assignment of codes to the data contained in the outpatient Patient Care Encounter (PCE), inpatient Patient Treatment File (PTF), the Non-VA database, and the integrated billing package.
General Requirements:
a. All written deliverables shall be phrased in layperson language. Statistical and other technical terminology shall not be used without providing a glossary of terms.
b. The latest United States editions of the International Classification of Diseases (ICD), Current Medical Information and Terminology (CMIT) and Current Procedural Terminology (CPT) of the American Medical Association (AMA) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA) shall be used to provide uniform disease and operation terminology which is complete and scientifically accurate.
c. Code assignment shall be in accordance with National Center for Health Statistics (NCHS), Centers for Medicare and Medicaid Services (CMS), American Hospital Association (AHA), AMA and APA guidelines, as appropriate. On those occasions when there is a question, VHA guidelines take precedence. Local policies will direct how coding is accomplished and what quantitative and/or qualitative reviews are performed by the facility. The AHA Coding Clinic and other publications may be used for training and reference purposes.
d. Contractor shall ensure that its staff members providing services under this Performance Work Statement and pursuant agreement use VA encoder software.
e. Contractor shall adhere to all coding guidelines as approved by the Cooperating Parties [The four organizations that make up the Cooperating Parties for the ICD-CM: American Hospital Association (AHA), American Health Information Management Association (AHIMA), Centers of Medicare and Medicaid Services (CMS) and National Center for Health Statistics (NCHS)] and accepted VA regulations, including:
1.The Official Guidelines and Reporting as found in the CPT Assistant, a publication of the American Medical Association for reporting outpatient ambulatory procedures and evaluation and management services;
2.The current Official Guidelines for Coding and Reporting in the Coding Clinic for ICD, a publication of the American Hospital Association; and
3.VHA guidelines for coding as found in the Handbook for Coding Guidelines current edition, Health Information Management, Department of Veterans Affairs. This workbook is updated at least once per year with new codes and guidance. Contractor shall ensure it has the current version and the guidance is followed. Note: While VHA does ask for reimbursement from third party payers, the VHA coding policy is to code only according to coding guidelines. Our own compliance audits use only this definition when determining if any encounter or PTF is correctly coded.
4.The Correct Coding Initiative. The CPT Evaluation and Management codes assure documentation substantiates the code level assigned.
5.VHA Directive 1082 Patient Care Data Capture and Closeout
6.VHA Directive 1401 Billing for Services Provided by Supervising Practitioners and Physician Residents
7.VHA Directive 1400.01 Supervision of Physician, Dental, Optometry, Chiropractic, and Podiatry Residents
8.Other directives that VA may issue from time to time.
f. Upon request of the Contracting Officer, the Contractor shall remove any Contractor staff that do not comply with VHA policies or meet the competency requirements for the work being performed.
g. Contractor shall abide by the American Health Information Management Association established code of ethical principles as stated in the Standards of Ethical Coding, published by AHIMA.
h. All coding and auditing activities shall utilize Edward Hines Jr. VA Hospital's electronic health record.
i. Contractor shall provide all labor, materials, transportation, and supervision necessary to perform coding validation reviews for inpatient, observation, diagnostic tests, ambulatory surgery/medicine procedures and outpatient (clinic) 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.
j. Communication: Contractor shall specify a contact person and phone number who is available for personal contact at a minimum during regular business hours of the facility that owns the work, for the duration of the work. Contractor shall maintain frequent communications with the designated medical center employee (i.e., coding supervisor/team leader) regarding progress, workload status and/or problems. The contractor shall make every effort to ensure that issues raised by the local facility are addressed in a timely manner.
k. Contract coders shall code in accordance with CCI Bundling Guidelines and use the Healthcare Common Procedural Coding Systems (HCPCS), where appropriate. Contract coders must exclude coding information such as symptoms or signs characteristic of the diagnoses, findings from diagnostic studies, or localized conditions, which have no bearing on current management of the patient or as appropriate. Contract coders must clarify conflicting, ambiguous, or non-specific information appearing in the record by consulting with their supervisor who will, if necessary, discuss with the Edward Hines Jr. VA Hospital's contact.
1. Contractor is responsible for becoming familiar with guidelines on billing within the Veterans Health Administration (VHA).
m. The Contractor shall not use "incident to" rules.
n. Contractor shall code using CPT for inpatient professional services or nursing home professional services.
o. The Contractor shall ensure that its staff members providing services under this contract are trained and capable of using VHA encoder software (Nuance).
p. The Contractor shall follow local Standard Operating Procedures (SOPs) as provided to them.
q. Nurse Practitioner (NP), Physician Assistants (PA) and Clinical Nurse Specialists (CNS) are licensed independent practitioners and should be listed as a primary provider when there is no physician involvement — refer to VHA Coding Guidelines and attached directives.
r. Contractor shall ensure primary and secondary providers are properly selected and sequenced. Note- a licensed independent practitioner is always to be listed as primary, refer to Patient Care Data Capture and Closeout, VHA Directive 1082.
s. Contractor shall ensure all diagnosis and procedure codes are properly sequenced and linked.
t. The Contractor shall review, correct, and re-file any rejected encounters. Recoded encounter will be re-filed, and the contractor shall monitor to ensure the Edward Hines Jr. VA Hospital is not charged for recoded encounters. The Contractor shall not validate any encounters already validated by VA staff; unless the encounter is in a reject/recode status indicating review of provider, comments, and/or recoding is necessary.
u. Contractor shall not unbundle codes. When assigning multiple CPT codes verify codes are not components of a larger, more comprehensive procedure that can be described with a single code, refer to CMS/CCI edits.
v. Contractor shall assign code modifiers in accordance with coding guidelines.
w. The Contractor shall assign the VA specific "GR" modifier when a resident is involved in care provided; refer to VHA Directive 1401.
x. Contractor shall identify and thoroughly review all documentation within the electronic medical record including addendums, separate notes, and reports entered by one or more providers to ensure complete capture and coding of services provided for each assigned encounter. VISTA Imaging and/or Remote Data must be reviewed to ensure all areas within CPRS are reviewed. Encounters without documentation will be suspended for further follow up.
y. Contractor shall enter all required comments for the encounter into the system. All comments
necessary for claims processing including, but not limited to, (RD) referring or ordering provider, date of injury (DOT), presenting diagnosis for Emergency Department (ED) visit, rehab (PT,OT,ST) visit information, refer to CCM Comments list. "999" will only be utilized when there is not any other appropriate predefined comment available.
z. The Contractor shall use 1995 or 1997 Evaluation and Management guidelines as appropriate, refer to VHA Coding Guidelines.
aa. Contractor shall abide by VHA Office of Academic Affiliations, Resident Supervision guidelines for services provided by resident physicians: The primary provider for all encounters is the attending/supervising practitioner. Four types of documentation of resident supervision are allowed (1) Attending progress note (2) Attending addendum, (3) Co-signature, or (4) Resident documentation of attending supervision/identification of supervising attending. Requirements are based on the visit type and graduated levels of supervision required; refer to VHA Directive 1400.01 Supervision of Physician, Dental, Optometry, Chiropractic, and Podiatry Residents for further details. If resident supervision documentation guidelines are not met, coding is to be completed, the primary provider is listed as the resident, and the CCM Comment of "Resident Supervision Not Met" is to be selected, allowing a facility charge to be billed. Fellows are considered Residents for billing purposes. Residents "Moonlighting" in the ED are independent licensed providers and do not require attending supervision.
bb. Contractor shall review encounters assigned for Combat Veteran status and Service-Connected treatment. Encounters with treatment for a listed service-connected condition will be coded and the CCM Comment of "Needs Service-Connected Determination" is to be selected. Refer to CCM Comments for other eligibility related issues that may affect the claims process.
cc. Contractor shall add the referring or ordering provider in the CCM comment section of Nuance for all ancillary services, procedures, and consults. Contractor shall also indicate in the CCM comments, by adding an "N" or "E", whether the patient is "New" or "Established" within the specialty when coding a Consult, which will be cross- walked to an E/M code by billing when required.
dd. Contractor shall ensure all encounter flags are in an OK or REV status upon completion.
ee. Contractor is required to maintain records that document competence/performance levels of employees working on this contract, as set by The Joint Commission and other regulatory body requirements. Contractor shall provide a current copy of competence assessment checklist and annual performance evaluation to the COR for each employee working on this contract at the end of each year's performance. Contractor must keep abreast of regulation changes that affect required coded information, including Centers for Medicare and Medicaid System (CMS), the Office of Inspector General and others as appropriate.
ff. All deliverables, associated 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. The contactor shall comply with the Privacy Act, 38 USC 5701, 38 USC 7332 and the Health Insurance Portability and Accountability Act (HEPAA) regulations. Contractor must certify that all employees working on this contract have received HIPAA training. Contractor shall be responsible for ensuring the confidentiality of all patient information and shall be held liable in the event of any breach of confidentiality.
gg. The contractor, their personnel, and their subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract.
hh. Information made available to the contractor or subcontractor by Edward Hines Jr. VA Hospital for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the Edward Hines Jr. VA Hospital.
ii. Access requirements to Edward Hines Jr. VA Hospital information system by contractors and contractor personnel shall meet or exceed those requirements as described in VHA Directives. Access shall be granted to non-VA users only if the purpose of access meets criteria of the Privacy Act, HIPAA, and confidentiality regulations.
jj. Contractor's employees shall be required to sign access forms before starting work under this contract that require them to abide by the VA computer access security and confidentiality agreement. Contractor staff must sign-on to system at a minimum of once each 30-day period to maintain access.
kk. Quality Assessment of Health Information Services:
The Contractor shall possess all licenses, permits, accreditation and certificates as required by law. The Contractor shall perform the required work in accordance with The Joint Commission (JC), Veteran Health Administration (VHA), and other regulatory standards. JC standards may be obtained from:
The Joint Commission
One Renaissance Blvd
Oakbrook Terrace, IL 60181
ll. Exclusions and Sanction Certification: The Contractor shall provide annual written certification to the COR which certifies that all employees, subcontractors, and employees have been checked to ensure that all agents providing health care services under this contract have been found not to be listed on the List of Parties Excluded from Federal Programs and the HEIS/OIG Cumulative Sanction Report. The certification shall be provided within three weeks after award and within three weeks of the contract's annual anniversary date for each period the contract remains effective.
mm. If the Contractor should find it necessary to reassign a staff member from working for a facility, the contractor shall make arrangements for there to be a minimum of two week overlap when both the old and new staff member shall be working the facility's account, unless there is a mutual agreement between the Contractor and facility that the overlap is not necessary.
nn. Contractor is responsible for the management of its staff, and the Contractor is responsible for training its staff on VA and Edward Hines Jr. VA Hospital policy and procedures.
oo. Contractor staff shall sign confidentiality statements as required. Any person, who knowingly or willingly discloses confidential information from the VA, may be subject to fines.
pp. Moving work outside of the United States border (offshore) is prohibited.
Required Knowledge and Skills of Contract Coders:
Contract Coders shall possess the ability to:
Required Contract Coder Education and Experience:
Reef Systems seeks experienced medical coders to support the Edward Hines, Jr. VA Hospital in Hines, Illinois 60141.
Scope of Work:
The purpose of this contract is to obtain services to assign ICD, CPT-4, and HCPCS Level II codes based on medical record documentation of outpatient and inpatient care provided at or under the auspices of Edward Hines Jr. VA Hospital and perform coding audits. The Contractor shall provide all resources necessary to accomplish the deliverables described in this Performance Work Statement, except as may otherwise be specified.
a. Assign ICD, CPT-4, and HCPCS Level II codes based on medical record documentation of outpatient and inpatient care provided at or under the auspices of Edward Hines Jr. VA Hospital.
b. Furnish validation of the integrity, quality, and assignment of codes to the data contained in the outpatient Patient Care Encounter (PCE), inpatient Patient Treatment File (PTF), the Non-VA database, and the integrated billing package.
General Requirements:
a. All written deliverables shall be phrased in layperson language. Statistical and other technical terminology shall not be used without providing a glossary of terms.
b. The latest United States editions of the International Classification of Diseases (ICD), Current Medical Information and Terminology (CMIT) and Current Procedural Terminology (CPT) of the American Medical Association (AMA) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA) shall be used to provide uniform disease and operation terminology which is complete and scientifically accurate.
c. Code assignment shall be in accordance with National Center for Health Statistics (NCHS), Centers for Medicare and Medicaid Services (CMS), American Hospital Association (AHA), AMA and APA guidelines, as appropriate. On those occasions when there is a question, VHA guidelines take precedence. Local policies will direct how coding is accomplished and what quantitative and/or qualitative reviews are performed by the facility. The AHA Coding Clinic and other publications may be used for training and reference purposes.
d. Contractor shall ensure that its staff members providing services under this Performance Work Statement and pursuant agreement use VA encoder software.
e. Contractor shall adhere to all coding guidelines as approved by the Cooperating Parties [The four organizations that make up the Cooperating Parties for the ICD-CM: American Hospital Association (AHA), American Health Information Management Association (AHIMA), Centers of Medicare and Medicaid Services (CMS) and National Center for Health Statistics (NCHS)] and accepted VA regulations, including:
1.The Official Guidelines and Reporting as found in the CPT Assistant, a publication of the American Medical Association for reporting outpatient ambulatory procedures and evaluation and management services;
2.The current Official Guidelines for Coding and Reporting in the Coding Clinic for ICD, a publication of the American Hospital Association; and
3.VHA guidelines for coding as found in the Handbook for Coding Guidelines current edition, Health Information Management, Department of Veterans Affairs. This workbook is updated at least once per year with new codes and guidance. Contractor shall ensure it has the current version and the guidance is followed. Note: While VHA does ask for reimbursement from third party payers, the VHA coding policy is to code only according to coding guidelines. Our own compliance audits use only this definition when determining if any encounter or PTF is correctly coded.
4.The Correct Coding Initiative. The CPT Evaluation and Management codes assure documentation substantiates the code level assigned.
5.VHA Directive 1082 Patient Care Data Capture and Closeout
6.VHA Directive 1401 Billing for Services Provided by Supervising Practitioners and Physician Residents
7.VHA Directive 1400.01 Supervision of Physician, Dental, Optometry, Chiropractic, and Podiatry Residents
8.Other directives that VA may issue from time to time.
f. Upon request of the Contracting Officer, the Contractor shall remove any Contractor staff that do not comply with VHA policies or meet the competency requirements for the work being performed.
g. Contractor shall abide by the American Health Information Management Association established code of ethical principles as stated in the Standards of Ethical Coding, published by AHIMA.
h. All coding and auditing activities shall utilize Edward Hines Jr. VA Hospital's electronic health record.
i. Contractor shall provide all labor, materials, transportation, and supervision necessary to perform coding validation reviews for inpatient, observation, diagnostic tests, ambulatory surgery/medicine procedures and outpatient (clinic) 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.
j. Communication: Contractor shall specify a contact person and phone number who is available for personal contact at a minimum during regular business hours of the facility that owns the work, for the duration of the work. Contractor shall maintain frequent communications with the designated medical center employee (i.e., coding supervisor/team leader) regarding progress, workload status and/or problems. The contractor shall make every effort to ensure that issues raised by the local facility are addressed in a timely manner.
k. Contract coders shall code in accordance with CCI Bundling Guidelines and use the Healthcare Common Procedural Coding Systems (HCPCS), where appropriate. Contract coders must exclude coding information such as symptoms or signs characteristic of the diagnoses, findings from diagnostic studies, or localized conditions, which have no bearing on current management of the patient or as appropriate. Contract coders must clarify conflicting, ambiguous, or non-specific information appearing in the record by consulting with their supervisor who will, if necessary, discuss with the Edward Hines Jr. VA Hospital's contact.
1. Contractor is responsible for becoming familiar with guidelines on billing within the Veterans Health Administration (VHA).
m. The Contractor shall not use "incident to" rules.
n. Contractor shall code using CPT for inpatient professional services or nursing home professional services.
o. The Contractor shall ensure that its staff members providing services under this contract are trained and capable of using VHA encoder software (Nuance).
p. The Contractor shall follow local Standard Operating Procedures (SOPs) as provided to them.
q. Nurse Practitioner (NP), Physician Assistants (PA) and Clinical Nurse Specialists (CNS) are licensed independent practitioners and should be listed as a primary provider when there is no physician involvement — refer to VHA Coding Guidelines and attached directives.
r. Contractor shall ensure primary and secondary providers are properly selected and sequenced. Note- a licensed independent practitioner is always to be listed as primary, refer to Patient Care Data Capture and Closeout, VHA Directive 1082.
s. Contractor shall ensure all diagnosis and procedure codes are properly sequenced and linked.
t. The Contractor shall review, correct, and re-file any rejected encounters. Recoded encounter will be re-filed, and the contractor shall monitor to ensure the Edward Hines Jr. VA Hospital is not charged for recoded encounters. The Contractor shall not validate any encounters already validated by VA staff; unless the encounter is in a reject/recode status indicating review of provider, comments, and/or recoding is necessary.
u. Contractor shall not unbundle codes. When assigning multiple CPT codes verify codes are not components of a larger, more comprehensive procedure that can be described with a single code, refer to CMS/CCI edits.
v. Contractor shall assign code modifiers in accordance with coding guidelines.
w. The Contractor shall assign the VA specific "GR" modifier when a resident is involved in care provided; refer to VHA Directive 1401.
x. Contractor shall identify and thoroughly review all documentation within the electronic medical record including addendums, separate notes, and reports entered by one or more providers to ensure complete capture and coding of services provided for each assigned encounter. VISTA Imaging and/or Remote Data must be reviewed to ensure all areas within CPRS are reviewed. Encounters without documentation will be suspended for further follow up.
y. Contractor shall enter all required comments for the encounter into the system. All comments
necessary for claims processing including, but not limited to, (RD) referring or ordering provider, date of injury (DOT), presenting diagnosis for Emergency Department (ED) visit, rehab (PT,OT,ST) visit information, refer to CCM Comments list. "999" will only be utilized when there is not any other appropriate predefined comment available.
z. The Contractor shall use 1995 or 1997 Evaluation and Management guidelines as appropriate, refer to VHA Coding Guidelines.
aa. Contractor shall abide by VHA Office of Academic Affiliations, Resident Supervision guidelines for services provided by resident physicians: The primary provider for all encounters is the attending/supervising practitioner. Four types of documentation of resident supervision are allowed (1) Attending progress note (2) Attending addendum, (3) Co-signature, or (4) Resident documentation of attending supervision/identification of supervising attending. Requirements are based on the visit type and graduated levels of supervision required; refer to VHA Directive 1400.01 Supervision of Physician, Dental, Optometry, Chiropractic, and Podiatry Residents for further details. If resident supervision documentation guidelines are not met, coding is to be completed, the primary provider is listed as the resident, and the CCM Comment of "Resident Supervision Not Met" is to be selected, allowing a facility charge to be billed. Fellows are considered Residents for billing purposes. Residents "Moonlighting" in the ED are independent licensed providers and do not require attending supervision.
bb. Contractor shall review encounters assigned for Combat Veteran status and Service-Connected treatment. Encounters with treatment for a listed service-connected condition will be coded and the CCM Comment of "Needs Service-Connected Determination" is to be selected. Refer to CCM Comments for other eligibility related issues that may affect the claims process.
cc. Contractor shall add the referring or ordering provider in the CCM comment section of Nuance for all ancillary services, procedures, and consults. Contractor shall also indicate in the CCM comments, by adding an "N" or "E", whether the patient is "New" or "Established" within the specialty when coding a Consult, which will be cross- walked to an E/M code by billing when required.
dd. Contractor shall ensure all encounter flags are in an OK or REV status upon completion.
ee. Contractor is required to maintain records that document competence/performance levels of employees working on this contract, as set by The Joint Commission and other regulatory body requirements. Contractor shall provide a current copy of competence assessment checklist and annual performance evaluation to the COR for each employee working on this contract at the end of each year's performance. Contractor must keep abreast of regulation changes that affect required coded information, including Centers for Medicare and Medicaid System (CMS), the Office of Inspector General and others as appropriate.
ff. All deliverables, associated 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. The contactor shall comply with the Privacy Act, 38 USC 5701, 38 USC 7332 and the Health Insurance Portability and Accountability Act (HEPAA) regulations. Contractor must certify that all employees working on this contract have received HIPAA training. Contractor shall be responsible for ensuring the confidentiality of all patient information and shall be held liable in the event of any breach of confidentiality.
gg. The contractor, their personnel, and their subcontractors shall be subject to the Federal laws, regulations, standards, and VA Directives and Handbooks regarding information and information system security as delineated in this contract.
hh. Information made available to the contractor or subcontractor by Edward Hines Jr. VA Hospital for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the Edward Hines Jr. VA Hospital.
ii. Access requirements to Edward Hines Jr. VA Hospital information system by contractors and contractor personnel shall meet or exceed those requirements as described in VHA Directives. Access shall be granted to non-VA users only if the purpose of access meets criteria of the Privacy Act, HIPAA, and confidentiality regulations.
jj. Contractor's employees shall be required to sign access forms before starting work under this contract that require them to abide by the VA computer access security and confidentiality agreement. Contractor staff must sign-on to system at a minimum of once each 30-day period to maintain access.
kk. Quality Assessment of Health Information Services:
The Contractor shall possess all licenses, permits, accreditation and certificates as required by law. The Contractor shall perform the required work in accordance with The Joint Commission (JC), Veteran Health Administration (VHA), and other regulatory standards. JC standards may be obtained from:
The Joint Commission
One Renaissance Blvd
Oakbrook Terrace, IL 60181
ll. Exclusions and Sanction Certification: The Contractor shall provide annual written certification to the COR which certifies that all employees, subcontractors, and employees have been checked to ensure that all agents providing health care services under this contract have been found not to be listed on the List of Parties Excluded from Federal Programs and the HEIS/OIG Cumulative Sanction Report. The certification shall be provided within three weeks after award and within three weeks of the contract's annual anniversary date for each period the contract remains effective.
mm. If the Contractor should find it necessary to reassign a staff member from working for a facility, the contractor shall make arrangements for there to be a minimum of two week overlap when both the old and new staff member shall be working the facility's account, unless there is a mutual agreement between the Contractor and facility that the overlap is not necessary.
nn. Contractor is responsible for the management of its staff, and the Contractor is responsible for training its staff on VA and Edward Hines Jr. VA Hospital policy and procedures.
oo. Contractor staff shall sign confidentiality statements as required. Any person, who knowingly or willingly discloses confidential information from the VA, may be subject to fines.
pp. Moving work outside of the United States border (offshore) is prohibited.
Required Knowledge and Skills of Contract Coders:
Contract Coders shall possess the ability to:
- Read and interpret health record documentation to identify all diagnoses and procedures that affect the current outpatient encounter visit, ancillary, inpatient professional fees and surgical episodes.
- Apply knowledge of current Diagnostic Coding and Reporting Guidelines for outpatient services.
- Apply knowledge of CPT format, guidelines, and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly.
- Apply knowledge of procedural terminology to recognize when an unlisted procedure code must be used in CPT.
- Code in accordance with CCI Bundling Guidelines.
- Use the Healthcare Common Procedural Coding Systems (HCPCS), where appropriate.
- Exclude from coding information such as symptoms or signs characteristic of the diagnoses, findings from diagnostic studies or localized conditions that have no bearing on current management of the patient.
Required Contract Coder Education and Experience:
- Contract coders must have a minimum of two years' experience in the area that they will be coding.
- Contract coders/validation staff must possess formal training in: anatomy and physiology, medical terminology, pathology and disease processes, pharmacology, health record format and content, reimbursement methodologies and conventions, rules and guidelines for current classification systems (ICD-CM, HCPCS and CPT).
- Coders must be credentialed and have completed an accredited program for coding certification, an accredited health information management or health information technician. For the purpose of this contract, a certified coder is someone with one of the following active credentials. Other credentials shall not be accepted.
- American Health Information Management Association (AHIMA) credentials as a Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHET), Certified Coding Specialist (CCS), and Certified Coding Specialist — Physician (CCS-P), or
- American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) or Certified Professional Coder — Hospital (CPC-H),
- Supervisory Coders must have a minimum of three years' experience in coding.
- Credentialed Coders must have a minimum of two years' experience in coding.
U.S. Citizenship:
Employee must be a U.S. citizen. For the purpose of base and network access, possession of a permanent resident card (“Green Card”) does not equate to U.S. citizenship.
SECURITY:
All contractor personnel require a minimum of a Tier 1 background check (T1)/SF85 for any position that requires access to the internet, use of automated information systems to cover standalone computers or unescorted entry into restricted or controlled areas prior to reporting for duty in support of any requirement. The investigation is not for a security clearance; it is for a position of trust. This is a mandatory requirement set forth in DoDM 5200.02_AFMAN 16-1405, Air Force Personnel Security Program. All documentation required for security certification shall be the responsibility of the contractor.
Point of Contact for Immediate Consideration:
Art Mata
amata@reef-sys.com