Purchasing Department
Addendum # 1
Date: May 11, 2017
Title: RFB/RFP #LH-0421 Coding and Auditing Services
Subject: Questions and Responses
1. The acronym WQ was mentioned. What is the full description of the acronym, WQ. It's mentioned in the scope of work.
Answer: Coding Work Queues in abstracting system
2. Will the vendor have remote access to the software mentioned? 3M, 360, and EPIC, and or any others needed in order to perform coding and auditing services.
Answer: Yes
3. Will you consider partners who respond to only part of the service request, i.e. Pre-bill and post-bill coding audit services and CDI concurrent coding review services only? Streamline Health does not provide production coding services.
Answer: Not at this time
4. Can you specify the volumes of encounters to be audited and concurrently reviewed for CDI, by encounter type, specifying the timeframe for the stated volume as well please? (For example, 100 inpatient discharges/week, 20 ED visits, 25 same day surgery encounters, 25 clinic visits, etc.)
Answer: CDI concurrent coding services will be primarily used as a backup support to manage backlog. This will on an ad-hoc basis
5. In the third section, “Pre-bill and post-bill coding audit services should include, but not limited to:”, bullet 3 “…and review for accurate abstracting of clinical data….” Can you outline the abstracted data elements you would like included in the review please? (For example, admit and discharge dates, discharge disposition, etc.)
Answer: ICD-10-CM/PCS (inpt) ICD-10-CM (outpatient), MSDRG/APR DRG assignment, Present on Admission assignment, Discharge disposition
6. In general, what turnaround times are desired for pre-bill auditing, post-bill auditing and CDI coding reviews each?
Answer: Pre-bill – 48 hrs including rebuttal time, Post-bill – Within the first two week of the first month after quarter reviewed, CDI – 48 hours including rebuttal time
7. Will the organization provide a tool within which auditing is to be completed and reported, or may we use our proprietary tool for all coding reviews? Streamline Health’s CORETM and eValuatorTM tools are routinely used for all coding auditing services provided, pre or post-billing or CDI related.
Answer: Organization will not provide tool for auditing
8. Do you have any standing policy of not doing work offshore?
Answer: No
9. Also is this currently outsourced, I know there have been past coding RFP’s, but I see job openings that look like direct hires for JPS online…
Answer: Yes
10. How many inpatient and outpatient records will be audited during the term of the contract?
Answer: 30 per coder per quarter
11. How many audits will be performed during the term of the contract (i.e. annual, bi-annual, quarterly, monthly, etc.)?
Answer: quarterly
12. What is the anticipated start date of the audits?
Answer: Third quarter of calendar year 2017
13. Is there a particular budget set aside for the audits?
Answer: yes
14. How much was spent on auditing in the previous 12 months?
Answer: Not applicable
15. What outpatient service types will be included in the audit(s) (i.e. outpatient surgery, Observation, Emergency Department, Ancillary, etc.)?
Answer: Clinics, Emergency Department, Observation, Same Day Surgery, Ancillary.
16. Can the audit(s) be performed offsite?
Answer: yes
17. How many vendors will be selected?
Answer: one
18. How many vendors provided auditing services in the previous 12 months?
Answer: two
19. Will vendors that provided services in the previous 12 months be included in the RFP/eligible for consideration? If not, why?
Answer: yes
20. If the responder is able to provide the coding audit-related components, but not the CDI Concurrent review component, would they be eliminated from consideration?
Answer: Yes
21. “Preferred fee structure is per chart and should include rates for various chart types (e.g., inpatient, observations, emergency, etc.).”
Answer: yes
22. To provide accurate pricing, we need to know the District’s productivity expectation. Can you provide productivity standards for each chart type that will be included in the scope?
Answer: Not applicable since billing is requested per chart.
23. Is there a schedule for the retrospective audits (i.e., monthly, quarterly etc.)?
Answer: quarterly
24. What computer systems will be accessed for each audit?
Answer: EPIC / 3M 360
25. Are professional services encounters included in this RFP or is it only IP and OP facility charts?
Answer: need pricing for both
26. If reports should be created for each department, please list the total number of departments that would require a separate audit report?
Answer: HIM only
27. For the retrospective audit, how many total coders will be audited per review period?
Answer: Approximately 48 total coders
28. Will injection and infusion codes need to be validated if present in the observation and ED record samples?
Answer: yes
29. Is each facility involved in this review using the same systems?
Answer: yes
30. Are PCS codes used on OP accounts?
Answer: no
31. Will the auditors have access to your encoder?
Answer: yes
32. Will facility E&M codes need to be validated for the ED record samples?
Answer: no
33. Will profee E&M codes need to be validated for the ED record samples?
Answer: Yes
34. The RFP does not include any education for the coders, would you like for us to price separately?
Answer: Education should be included in audit services
35. My firm is an experienced, small DBE. Is there an incumbent? If so, who is it?
Answer: This question is not pertinent.
36. Is the work required to be done on-site or is it /can it be done remotely?
Answer: remotely
37. Please provide chart volume by record type (IP, OP, SDS, ED, OBSV, CLINIC).
Answer:
NAME / COUNTBehavioral Health Inpatient / 4052
Behavioral Series / 1569
Deceased - Organ Donor / 47
Dental Series / 406
Emergency / 106800
Inmate / 52598
Inpatient / 21432
Newborn Inpatient / 4352
Observation / 16239
Oncology Series / 947
OP Surgical Procedures / 15789
Outpatient / 869891
Outpatient in a Bed / 1644
Post Discharge Care Series / 1445
Skilled Nursing / 235
Surgery Admit / 181
Therapies Series / 8933
38. What are expected sample size and frequency of audits?
Answer: 30 per coder per quarter
39. Is it your expectation for us to staff CDI nurses? If so, how many FTEs do you anticipate?
Answer: CDI concurrent coding services will be primarily used as a backup support to manage backlog. This will on an ad-hoc basis
40. What CDI program are you currently using?
Answer: 3M 360 / Epic
41. For auditing, will we have access to the current encoder?
Answer: no
42. What work does JPS expect to be performed onsite?
Answer: none
43. Page 9, Section 1.: Is the District looking for a vendor to provide coding for its entire patient volume annually, approximately 850,000 patient encounters? If not, what is the anticipated annual coding, auditing and CDI workload?
Answer: CDI concurrent coding services will be primarily used as a backup support to manage backlog. This will on an ad-hoc basis. For auditing 30 per coder per quarter.
44. Page 11, Section 5., Item 2.a., and page 15., section 8., item 2.a.: How will the district make a determination of the vendor’s reputation? What criteria will be used to whether a firm has an acceptable reputation?
Answer: At the District’s discretion references may be contacted.
45. Page 11, Section 5., Item 4.: Would the District like to see resumes?
Answer: yes
46. Page 11, Section 5., Item 6. and page 15., section 8., item 5.: How will points be awarded/deducted if a vendor does/does not have a past relationship with the District?
Answer: Up 20 points can be awarded the Evaluator will determine the number of points.
47. Who is the current vendor(s) providing these services to the District?
Answer: N/A
48. AGS Health will render its services through its service delivery centers located in India and it never sub-contracts its services. In such cases, how do we address the requirements on “communication outreach” or “plan of action’ specified in Table 8 – Disadvantage business enterprise application in page 12 of RFP?
Answer: Please address the requirements by inserting your comments, “AGS Health will render its services through its service delivery centers located in India and it never sub-contracts its services.” in the section labeled Communication Outreach and Plan of Action.”
49. As we will be performing just coding and auditing services, we believe exhibit B “License agreement for operating software” is not applicable to us. Can you please confirm that? (Page 23)
Answer: Exhibit B is required
50. Will we be getting a separate MSA once the RFP process is finalized, for our review, as we will have a few comments and suggested edits in the standard terms and conditions portion of the RFP?
Answer: The Purchase Agreement included in the RFP will be utilized. See Section II.B. Form of Contract.
51. RFP mentions that only per chart pricing will be entertained. Can you please share the expected productivity for “CDI Concurrent coding review services”? (Page 9)
Answer: 11-13 initial reviews per day. A total of 23-24 reviews per day to include initial and follow up.
52. Is there a current vendor providing these services?
Answer: No
53. Are coding support services PRN only? Or needed on a continual basis?
Answer: PRN and Continual
54. Will WBE status be considered? Or is JPS only considering SMWBE?
Answer: Yes, Women Business Enterprises (WBE) will be considered.
55. Please clarify the patient chart types to be coded?
Answer: Acute
NICU
Psych
Observation
ED
OP
SDS
56. Please clarify volume of charts to be coded, per chart type.
Answer: Coding services will be primarily used as a backup support to manage backlog. This will on an ad-hoc basis.
57. Are services needed for hospital/facility coding?
Answer: yes
58. Are services needed for profee/clinic coding?
Answer: yes need quote
59. If ER charts are to be coded, will this include profee E&M, facility E&M and injections/infusions
Answer: yes
60. Please clarify patient types to be reviewed.
Answer: Acute
NICU
Psych
Observation
ED
OP
SDS
61. Can JPS clarify by chart type the number of charts per year wanting to be reviewed?
Answer: 30 per coder per quarter
62. Can JPS provide insight to their desired review schedule?
Answer: Quarterly review with final report in first month after quarter reviewed.
63. Can JPS tell us if you are desiring a certain percentage of discharges to be reviewed and/or a set number per month?
Answer: 30 per coder per quarter
64. For the IP pre-bill and post-bill coding audit services, will all payers be reviewed?
Answer: No
65. Will all DRGs be reviewed or only focused/high risk DRGs be reviewed?
Answer: No reviews will be by coder
66. In the emergency room charts to be reviewed, please clarify if you will be wanting: profee E&M, facility E&M and injections/infusions to be audited as well as the typical diagnosis and CPT codes.
Answer: yes to all, separate facility vs. Professional in response
67. Aside from the potential profee E&M records to be reviewed on the ER records, does JPS desire any other profee E&M coding reviews to be performed?
Answer: provide response for charges by both facility and professional for clinic records
68. Does JPS desire physician office/clinic records to be reviewed? If so, will professional E&M codes be reviewed by vendor?
Answer: provide response for charges by both facility and professional for clinic records
69. Does JPS desire only IP charts to be reviewed?
Answer: no
70. If OP charts are to be reviewed, please clarify the type of charts to be reviewed.
Answer: Observation
ED
OP
SDS
71. The RFP states CPT codes are to be reviewed from a CDI perspective. Is this implying you code CPTs on IP? Please clarify.
Answer: No CPT codes are not coded on IP records. Review of CPT codes that are assigned by HIM.
72. Will vendor be utilizing JPS CDI software? Or shall vendor provide software to support this process.
Answer: JPS system will be used
73. Can JPS give an estimation for number of charts to be reviewed per month by vendor?
Answer: 30 per coder per quarter
74. Will vendor be receiving randomly selected charts for the CDI review? Or will they be pre-selected high risk charts?
Answer: Randomly selected charts based on general assignment to support with the backlog
75. Does the scope of this contract include ONLY facility (UB-04) coding, or will there be professional fee (1500) coding as well?
Answer: potential for both depending on prices submitted in RFP
76. What are all of the patient/account/encounter types/specialties for which the Contractor will assign each type of code (ICD10CM, ICD10PCS, CPT/HCPCS)? (i..e., Inpatient, Observation, Ambulatory Surgery, ED, Clinic, Ancillary/Outpatient Diagnostics (Lab, Radiology, Nuclear Medicine, Cardiac Diagnostics, Pulmonary Diagnostics, Neuro Diagnostics), Therapies, etc.) What are the volumes for each? (This helps to determine the number and types of coders required to support operations.)
Answer: Acute
NICU
Psych
Observation
ED
OP
SDS
77. How are daily discharge, surgery and encounter rosters/registers/indices shared and reconciled?
Answer: Work is distributed via Work Queues in Epic
78. Are there any hardcoded diagnosis or procedure codes attached to chargemaster items, order entry systems, etc. that will require Coder review and/or reassignment at the time of coding? If so, please describe.
Answer: Some CPT codes are hard coded and require review.
79. Will the Contractor code drugs and biologicals in outpatient patient encounters (i.e., ED, Clinics, etc.)? If so, for what service lines/patient types?
Answer: Sherri, can you please answer this? Thanks. No
80. Will coders complete abstracting activities beyond required elements for coding/billing encounters/discharges (i.e., are there special abstracting requirements for certain conditions, quality measures, registries, etc. abstracted during the coding process)? If so, is there a brief description of these requirements by patient/condition/service line for review?