Purchasing Department
Addendum #1
Date: March 15, 2018
Title: RFB/RFP #LH-0508 Coding Auditing Services
Subject: Questions and Answers
- For Inpatient Charts:
Will APR-DRG need to be validated for any charts (i.e. Texas Medicaid)?
Will POA codes need to be validated for all Dx codes or just HACs?
Answer: Yes APR-DRG will need to be validated for Texas Medicaid
Yes POS will need to be validated for all Dx codes
- For Outpatient Charts
Will PCS codes need to be validated on any outpatient charts?
Answer: No
- For Emergency Department Charts:
Will E/M (facility and/or profee) codes need to be validated?
Will Injection/Infusion codes need to be validated?
Answer: Yes, E/M facility codes only.
Yes, injection/infusion codes.
- For Observation Charts:
Will Injection/Infusion codes need to be validated?
Answer: Yes
- For Clinic Charts:
Will E/M (facility and/or profee) codes need to be validated?
Answer: Yes, facility only.
- The RFP states the audit frequency will be monthly to include 10 accounts per coder. How many coders will the audit include (i.e. # of Inpatient, ED, OP Surgery, Observation, Ancillary coders)?
Answer: on an average6 inpatient coders, 29 OP clinic coders, 5 ED coders, 2 OP Surgery coders and 2 Observation coders.
- When does the District expect to make a vendor selection?
Answer:mid-May 2018
- When does the District expect the first monthly audit to begin?
Answer: To be determined after selection is made.
- We understand you want per chart pricing. Can we propose separate fee structures for pre bill and post bill charts?
Answer:All pricing structures should be per chart pricing.
- Does Outpatient code ICD10PCS?
Answer: No.
- Can auditing be done remotely?
Answer: Yes
- How many coders to be audited for each type – Inpatient, Emergency, Mothers and Newborns, Same Day Surgery, Observations, Outpatient (clinics, ancillary and diagnostics).
Answer: on an average6 inpatient coders, 29 OP clinic coders, 5 ED coders, 2 OP Surgery coders and 2 Observation coders.
- Are the coders being audit JPS FTEs, vendor consultants or a combination? Can you provide how many of each type of coder?.
Answer: Combination. On an average44coders.
- Can you rank order of important of the evaluation factors - Price, Quality of bidder’s good or services, to the extent the goods and or services meet the needs of JPS, Reputation of the vendor’s goods and or services, Diversity Enterprise Participation.
Answer: No, we cannot rank the order of importance of the evaluation factors. They are all important evaluation factors.
- We are a certified Minority Business Enterprise (MBE). Do we still need to provide a Communication Outreach and Plan of Action to include other HUB/SMWVB enterprises?
Answer: If you are certified MBE you do not need to provide Communication Outreach and a Plan of Action. These are options given if you’re not a certified MBE.
- The RFP stipulates “Continuing education units must be associated with official audit education provided by the vendor and provide Continuing Education Units approved by AHIMA and AAPC.” Our Education Services team offers Continuing Education Units approved by AHIMA and AAPC. Our Education Services team can also craft training that is specifically targeted to JPS’ audit results. However, there may not be time have those specifically targeted programs authorized for CEUs through the professional associations. Would our current authorized CEU program accommodate JPS’ continuous education program?
Answer: Yes, pricing should be inclusive of the rebuttal work and post-audit education preparation and delivery.
- Please confirm that this audit scope relates to MS DRG only and no elements of APR DRG are incorporated (such as SOI, ROM)
Answer: MS DRG and APR DRG should both be audited.
- What is the expected turnaround time for pre-bill audits?
Answer: 2 business days including rebuttal time
- What is the expected chart load/coders for pre-bill audits?
Answer: Determined based on amount and timeframe established for pre-bill audit.
- What is the expected chart load/coders for retrospective audits?
Answer: Productivity standards are: Inpatient – 2 per hour, Day Surgery/Observation – 5 per hour, Emergency – 19 per hour, clinics – 18 per hour
- Are CPT codes to be audited in the surgical range? (10000 – 69000)
Answer:Yes
- Are radiology (70000), labs (80000) or Medicine (90000) to be included in the audit scope?
Answer: CPT codes that include infusion/injection/interventional radiology
- Is code count coding accuracy an acceptable methodology for accuracy scores, or will John Peter Smith Health Network (JPS) in the Tarrant County Hospital District (TCHD) be supplying a weighted scoring preference?
Answer: Code count is acceptable
- Is WebEx training acceptable for audit results education? Or is onsite required
Answer: WebEx is acceptable
- How many inpatient coders will be included?
Answer:on an average 6
- How many outpatient coders will be included?
Answer:on an average 36
- Will the inpatients be MS-DRG and/or APR-DRG?
Answer: Both MS-DRG and APR-DRG
- Emergency encounters, will these include validation of facility Evaluation and Management?
Answer: Yes
- Emergency encounters, will these include validation of injection and infusions?
Answer: Yes
- Observation encounters, will these include validation of units of service reflecting the hours?
Answer: No
- Observation encounters, will these include validation of injection and infusions?
Answer: Yes
- Clinic encounters, will these include validation of facility Evaluation and Management?
Answer: Yes
- Clinic encounters, will these include validation of injection and infusions?
Answer: Yes
- Outpatient encounters for review, will any charge master assigned CPT codes be included in the validation such as radiology and cardiology services?
Answer: Yes
- On page 10 of the RFP, what is meant by “Perform documentation assessment and review for accurate abstracting of clinical data to meet regulatory and compliance requirements”? Can you please elaborate on clinical data and regulatory and compliance requirements?
Answer: Admission date
Discharge date
Admitting physician/account physician
Attending physician
Admission type designated in the orders
Point of origin – how patient was referred
Discharge disposition
Discharge destination
Admitting Diagnosis/Reason of Visit
Final Diagnosis/Principal diagnosis
Other diagnoses (if applicable)
Principal Procedure (if applicable)
Other Procedures (if applicable)
Performing Provider(s) (if applicable)
Date(s) of Procedure(s) (if applicable)
- Can you confirm these reviews will be all facility based, no professional fee?
Answer: Facility based only.
- Can you confirm which facilities will be included in this service? Just the Hospital, or clinic and physician group as well?
Answer:Hospital and hospital based outpatient clinics.
- Can you give an exact or estimation on the volume to be audited for this RFP?
Answer: A monthly estimate of charts to be audited includes on an average: 60 inpatient accounts, 50 Emergency accounts, 10 Mothers and newborn accounts, 20 Same day surgery accounts, 20 Observation accounts and 290 Outpatient clinic accounts.
- Please provide monthly volumes by chart type for requested audit services:
Chart Type / FY17 Volumes
Inpatient / 27,913
Emergency / 157,995
Mothers and Newborns / 5,528
Same Day Surgery / 9,204
Observations / 7,461
Outpatient (clinics, ancillary and diagnostics) / 1,120,410
- Does JPS Health have a preference for onshore/offshore services? Are offshore services allowed?
Answer: No preference. Offshore services are allowed.
- Can the services be provided from Remote Offsite location? Exhibit “A”, Scope of Work, no page reference.
Answer: Yes
- Can we provide a joint bid along with partner? Can we include sub-contractors in performing the services of the RFP? Exhibit “A”, Scope of Work, no page reference.
Answer: Yes
- Is local presence required for the vendors to bid for this RFP? Do we need to be onsite for meetings? Exhibit “A”, Scope of Work, no page reference.
Answer: No
- Who was the previous vendor performing auditing services to JPS? How many charts were they able to audit per hour, per specialty? Exhibit “A”, Scope of Work, no page reference.
Answer: Not applicable.
- In 2017, how many hours or provider education were provided? Exhibit “A”, Scope of Work, no page reference.
Answer: 2 hours per quarter.
- Can education be given remotely via webinar or must it be provided onsite? Exhibit “A”, Scope of Work, page 10.
Answer: Webinar is acceptable.
- RFP indicates the Systems used are EPIC and 3M. What version do you utilize? Exhibit “A”, Scope of Work, page 10.
Answer:JPS is on Epic 2015 version, 3M 360 Encompass release 2
- How many systems does vender need to access? Exhibit “A”, Scope of Work, no page reference. Exhibit “A”, Scope of Work, page 10.
Answer: Epic and 3M
- Is there an incumbent vendor? If so, why are you seeking alternative vendors? Exhibit “A”, Scope of Work, no page reference.
Answer: Not applicable.
- Who and where are vendors required to report breaches within the 2 day reporting window? Exhibit “D”, Business Associate Insert for Services Agreement, Letter B.
Answer: Compliance
- What is the goal of the audit? What information are you looking to gain from an audit? Exhibit “A”, Scope of Work, no page reference.
Answer: Quality Scores and continuing education for Coding Staff
- Will the Psych ED be included in the audits? Exhibit “A”, Scope of Work, no page reference.
Answer: Yes
- Please define “query opportunities” for the outpatient account. Exhibit “A”, Scope of Work, Page 10
Answer: Query opportunities are missed opportunities ask the providers to clarify conflicting documentation or validate a diagnosis that is lacking appropriate clinical support.
- Is the scope of the audit Facility only or does it include Professional? Exhibit “A”, Scope of Work, no page reference.
Answer: The audit will include only facility.
- What type of audit are you requesting? Comparative, Blind, or Focused? Exhibit “A”, Scope of Work, no page reference.
Answer: Focused
- If professional audits are included in the RFP is provider feedback required? Exhibit “A”, Scope of Work, no page reference.
Answer: No professional audits are included in the RFP.
- What is the expected volume of charts to audit per month? How many coders? Exhibit “A”, Scope of Work, page 10.
Answer:on an average 420 charts.
- Will all payers be included in the scope of these audits? Exhibit “A”, Scope of Work, no page reference.
Answer: Yes
- Do you have a coding manual in place? Will you provide this to the vendor? Exhibit “A”, Scope of Work, no page reference.
Answer: Yes
- Do you have a compliance plan in place? Will you provide this to the vendor? Exhibit “A”, Scope of Work, no page reference.
Answer: Yes
- What coding guidelines will be utilized for the audits? Exhibit “A”, Scope of Work, no page reference.
Answer: Official Coding Guidelines and JPS coding procedure.
- What turnaround time is expected for the audits? Exhibit “A”, Scope of Work, no page reference.
Answer: Pre-bill – 2 days including rebuttal time, Post-bill – Within the first two weeks of the first month after quarter reviewed
- How many coders does JPS currently employee across all areas included in this RFP?
Answer:on an average 42
- What is JPS’ expected annual auditing volume per chart type? We see where JPS requested 10 charts per coder per month to be reviewed. If possible we would like to get an estimate on the total number broken by chart type.
Answer: A monthly estimate of charts to be audited includeson an average: 60 inpatient accounts, 50 Emergency accounts, 10 Mothers and newborn accounts, 20 Same day surgery accounts, 20 Observation accounts and 290 Outpatient clinic accounts.
- Can you share what JPS’ coding methodology is in each area?
- How is JPS currently arriving at their ED levels, diagnosis, and professional?
- When does JPS use EPIC vs 3M?
Answer:
JPS has a calculator built in Epic for assignment of ED facility levels. Diagnosis are assigned by using the 3M encoder. Professional is not in this RFP.
- Please provide chart volume by record type (IP, OP, SDS, ED, OBSV, CLINIC).
Answer: A monthly estimate of charts to be audited includeson an average: 60 inpatient accounts, 50 Emergency accounts, 10 Mothers and newborn accounts, 20 Same day surgery accounts, 20 Observation accounts and 290 Outpatient clinic accounts.
- Please provide the monthly chart volumes to be audited by record type (IP, OP, SDS, ED, OBSV, CLINIC).
Answer: A monthly estimate of charts to be audited includeson an average: 60 inpatient accounts, 50 Emergency accounts, 10 Mothers and newborn accounts, 20 Same day surgery accounts, 20 Observation accounts and 290 Outpatient clinic accounts.
- Are the Coding services currently done in-house? Are the coding Services currently outsourced? If yes, What percentage of volumes are coded by the outsourced vendor?
Answer: Both, approximately 17% is outsourced.
- Can the auditing services be performed from an Offshore location?
Answer: Yes
- What is the auditing tool currently used at JPS health? Can the vendor use their use proprietary tool for auditing services?
Answer: Yes
- There was an RFP rolled out for Coding, CDI and auditing services? Is there an Outsourced vendor currently performing coding services? If No, can we provide the pricing for each of the specialty for coding services for JPS health consideration?
Answer: Yes, an award was made for Coding and Auditing Services.
- What are the current challenges faced on coding and auditing front?
Answer: Obtaining meaningful analytics, report formatting for JPS required variables, response turnaround time, and the rebuttal process.
- How many auditors JPS health has currently employed to perform the auditing?
Answer:Not applicable
- What are the reports that vendor must provide to JPS and at what frequency?
Answer: Vendor should supply examples in RFP response.
- What are the KPI expectations for Audit services?
Answer: 95% Accuracy rate
- Will vendor be receiving random charts for audit? What percentage of charts coded should be audited?
Answer: Yes, vendor will receive random charts. The charts the vendor receives are to be audited.
- Is there a requirement for vendor to be registered in state of Texas to perform the auditing services?
Answer: No
All corrections, changes, additions, revisions, and/or clarifications in this Addendum #1 to the
RFP are hereby made a part of the RFB/RFP for #LH-0508 Coding Auditing Services.
All Respondents to the RFB/RFP shall acknowledge receipt and acceptance of this Addendum #1 by
signing in the space provided and submitting the signed Addendum #1 with the RFB/RFP.
Proposals submitted without an executed copy of this Addendum #1 attached may be considered
informal and may be rejected.
Received, acknowledged, and conditions agreed to on this ______day of ______, 2018, by:
Respondent: ______
Company Name: ______
If there are questions pertaining to this addendum please contact Lizzie Harris at