Notice ID: 36C10B25R0015
Solicitation for the Health Information Coding, Billing, & Auditing (HICBA) Veterans Health Information Systems and Technology Architecture (VistA) Integration, Revenue, and Reporting (VIRR) software solution.
Scope. VHA currently consists of 140+ medical centers and seven Consolidated Patient Account Centers (CPACs) located in all 50 states and Puerto Rico. Coding of all inpatient encounters, billable outpatient encounters, and all surgery encounters as well as billing and compliance auditing is performed for the medical services provided at each of these facilities. Billing functions are also performed at the seven CPACs. The Medical Coding process requires management of large volumes of patient care visit transactions that shall be processed and evaluated by staff using tools and standard processes within VHA to ensure accuracy of coding, claim data and submission. VHA data capture, reporting and tracking shall identify workflow, efficiencies, accuracy, current volume, and opportunities for improvement. Medical Coding is the process of health record documentation review and assignment of the Health Insurance Portability and Accountability Act (HIPAA) standard code set values utilizing governed guidelines, rules, and steps to ensure accuracy of coded data, bill generation, and accurate reimbursement in accordance with VHA policies, laws, regulations, and industry standards. HIM coding professionals at 147 medical centers, and 22 VISNS rely on software to facilitate, record, and store VHA coded data reflective of documented services and reason for care in patient’s electronic health record.
In order to accomplish the coding process and selection, software tools shall provide functionality that enable evaluation of health record documentation real-time integration with HICBA Encoder vendor’s product solution, code selection and validation, and storage in the proper VistA files in alignment with official coding guidelines and VHA policies and guidelines. The tools and functionality utilized shall support management of work including identification, assignment, and tracking of work, integration with real time VistA health record content, to facilitate review of documentation and integration with VHA procedure encoder product to facilitate seamless and real time coding process and communication between staff involved. The software tools shall support functionality to ensure identification of all instructions and guidelines, potential errors based on industry or custom VHA edits as warnings or hard stops to support accuracy in coding and claim generation before proceeding to the next step.
VHA is seeking a contractor to provide a software solution to support management and responsibilities within the coding process, clinical documentation integrity, billing claim edits, reporting capabilities as well as project management, and real time integration with VistA and real time integration with tools such as the HICBA current encoder product. The Contractor shall provide software, which includes a VHA enterprise-wide license for an unlimited number of users. No additional costs shall be associated with adding users. This solution shall provide capabilities supporting standard processes, communication and record updates: HIM including functions of code assignment for diagnosis, services/procedures, rendering and/or ordering providers, service connection or special classification related treatment determination, claim edits, documentation integrity and improvement opportunities in all care settings for coding accuracy and specificity in coding …
The period of performance (POP) shall be a 4-month base period, two 7-month option periods, three 12-month option periods and one 6-month option period and one optional task to be exercised at the Government’s discretion …
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