Pilot Study Recommendations



PlanetGov/HTSI Standard Technical Proposal for Coding Services

Provided for Requirements under BPA N62645-02-A-0011

[pic]

Last Edited August 13, 2002

TABLE OF CONTENTS

1 Introduction: 4

2 Problem Statement: 5

3 PlanetGov/HTSI Goals For MHS Coding Projects: 8

4 PlanetGov/HTSI Services to Meet Objectives 8

4.1 Process Reengineering: 8

4.1.1 Gap Analysis: 8

4.1.2 Process Reengineering Business Case: 9

4.1.3 HTSI ClickBill Application: 9

4.2 Purpose of Coding Services: 9

4.3 Coding Services 9

4.3.1 Coding Round Table Sessions: 10

4.3.2 Coding Credentials: 10

4.3.3 Coding Tests: 10

4.3.4 Assignment of CPT and Diagnosis Codes: 10

4.3.5 Coding Reviews: 10

4.4 Data Entry: 11

5 Education: 12

5.1 Purpose of Provider Education: 12

5.2 Provider Education Services: 12

5.2.1 General Education Requirements: 13

5.2.2 Classroom Sessions: 13

5.2.3 Small Group Training: 13

5.2.4 Individual Provider Training: 13

6 Data Base Application: 14

6.1 Purpose of Data Base: 14

7 Data Analysis: 15

7.1 Purpose of Data Analysis: 15

7.2 Data Analysis Services: 15

7.2.1 Data Analysis Software: 16

8 Reporting: 16

8.1 Reporting: 16

8.1.1 Standard Reports: 16

8.1.2 Ad Hoc Reports: 17

9 Records management 18

10 Data Entry: 19

11 Security and Confidentiality: 19

11.1 Security - Staffing: 19

11.2 Computer Security: 19

11.3 Confidentiality and Non-Disclosure: 19

12 Compliance Plan 20

12.1 Information Definitions and Principles: 20

12.1.1 Definition of Information: 20

12.1.2 Guiding Principles for Quality Improvement: 21

12.1.3 Data Collection As By-Product Of Work Performed: 21

12.1.4 Use of Statistical Process Control Software: 21

12.1.5 Use of Existing Data From Existing Data Repositories: 21

12.1.6 Collection and Analyzing Data on the WWW: 21

12.1.7 Aggregation of Information: 22

12.1.8 Ensure Front-Line Activities Get First Chance at Problem Solving: 22

12.1.9 Control Causes of the Problem Instead of the Symptoms: 22

12.1.10 Fail-Safing – Preventing Problems Before They Occur: 22

12.1.11 Self Inspection: 22

12.1.12 Process Improvement Training: 22

12.1.13 Process Orientation: 22

12.2 Factors Considered in Selecting Coding Metrics: 22

12.3 Metric Descriptions: 23

12.3.1 Records – 95% Coding Accuracy: 23

12.3.2 Responsive – Filing Claims Within 14 Days of Service Date: 23

12.3.3 Service – Rating of 4.0 on a Scale of 5.0 23

12.3.4 Claim Identification – 90%: 23

12.3.5 Consistency Among Coders < 5%: 23

12.3.6 Outpatient TPC Revenue – > 100% Increase: 23

12.3.7 Compliance – 98%: 23

12.3.8 Data Quality - < 5% Error Rate: 24

12.3.9 Data < 5% Variance Between Systems: 24

12.3.10 Denials < 10% of Claims Submissions: 24

12.3.11 Provider Documentation Completion < 7 Days: 24

12.4 Quality Process: 24

13 Data Analysis and Reporting: 26

13.1 HTSI CLICKBILL APPLICATION: 26

13.2 Sample HTSI ClickBill Reports and Queries; 31

13.2.1 Sample Clinic Report: 31

13.2.2 Sample Report ER Visits: 33

13.2.3 Example Provider Report: 33

13.2.4 Sample Queries: 34

14 Key Personnel: 35

14.1 Continuity and Quality of New Hires: Revise to make MHS specific 36

15 references: 37

15.1 Wilkes-Barre DVAMC: 37

15.2 Assistant Secretary of Defense, Health Affairs: 39

15.3 Integrated Outcomes: 39

15.4 Wilford Hall Medical Center: 39

15.5 Wilford Hall Medical Center: 40

15.6 Electronic Paper Solutions 40

16 Sequence of Events: 40

17 point of Contact for Technical Proposal: 40

INtroduction:

Please refer to the attached pricing proposal if you are receiving this technical proposal in response to your task order under the PlanetGov BPA for coding services BPA# N62645-02-A-0011. If you are reviewing this technical proposal, and it is not in response to a request for proposal, then you may request pricing from Healthcare Technology Solutions International (PlanetGov/HTSI) at

This technical proposal is based on providing coding services and products to evaluate and improve information common to the revenue process for most MHS facilities. The revenue process and the data collected are detailed at appendix A. A sample study using PlanetGov/HTSI coding services and products are to improve third party revenue is provided at Appendix B. The study and HTSI ClickBill application come as value adds to our coding services. As a result we are able to address the main objectives of any MHS facility to: (1) increase third party revenue; (2) improve coding accuracy and compliance, and (3) documenting the actual complexity and quality of patient care. Specifically, our total coding solution allows the MHS customer to accurately predict and measure the revenue and compliance percentage gains in seven components of the revenue cycle where we will increase the revenue of an MHS facility. These components include:

• Registration;

• Appointment Scheduling and Admission;

• Patient Encounter and Provider Documentation;

• Coding;

• Billing and Claims Follow-Up;

• Data Analysis and Decision Support System; and

• Process Improvements

Please refer to Appendix A for the details on the methods we use to evaluate the entire revenue process as part of our coding services.

In addition to the main objective of improving revenue, our team adds the following value:

• CME accredited education for providers and other staff members associated with the MHS revenue process. This allows providers to get CME credits on a quarterly basis. Based on the size and attendance at a MHS facility this could be $20,000 to $200,000 in savings. As you will see later, this also has a dramatic effect by improving the quality and completeness of documentation required for a billable claim.

• Within the cost of the contract, we provide16 hours of ad hoc report development per month to the MHS facility staff to customize the HTSI ClickBill application and Provider application described under the reporting section of this report. This represents a significant dollar value over the life cycle of the contract and allows MHS facility staff to obtain meaningful information without programming skills.

• The Contract includes bringing in the leading consultants in the country with regard to coding compliance, billing, legal and data analysis applications.

• We accomplish a business case in the first 60 days of the contract that validates our return on investment and provides a focused approach to improving revenue in the shortest possible time. For example, at the Wilkes-Barre, VA where we have coded and entered 80,000 records in their billing system, they recently experienced the highest revenue collection month in the history of the facility. Our consolidated billing report has almost entirely done away with the thousands of claims forms that used to clutter their office. For the MHS facility, this allows program managers to justify the budget for our services based on ROI. This is an important attribute considering the austere funding often faced by MHS facilities.

• A Web Library is provided as part of our services. This will allow PlanetGov/HTSI and the MHS facility to post key documents, compliance plans, performance metrics, and individual provider statistics on coding accuracy and frequency of non-billable records. This capability is provided under a teaming agreement we already have with the Department of Health Affairs. This provides easy access for MHS facility staff and is so documents and reports are current and controlled in a secure environment. Please refer to for details regarding knowledge management and the Web Library.

• Our software applications provide many benefits beyond coding and third party collection analysis. For example, we have already proven we can load MHS and identify the chronically ill patient population and provide statistics by diagnosis, visit frequency, claims history, clinic usage, and look up capability for the clinical notes maintained as part of the billing process. The benefits include reduced time in gathering data for clinical studies, determining best practices, and information that may lead to improved quality of care.

Problem Statement:

The following problem statements are ones that are common to MHS facilities. We conduct a study at each facility to see if these problems exist. Based on the results of the study, we work with the facility to maximize the return on investment by attacking the problems that exist for that facility. Most MHS facilities continue to face financial challenges with budget shortfalls and have difficulty in obtaining and maintained the coding services that are key to describing the relationship between the complexity of care and the funds required to provide a best practice environment. Based on previous studies, the following problems need to be solved in order to maximize revenue, justify resources based on the complexity of care and insure compliance with DoD, HCFA, and insurance company payment guidelines.

• The identification processes of determining what patients have third party insurance is a problem in a MHS facilities that do not have the staffing to interview patients and research insurance benefits. The belief is many patients who have third party insurance are never identified and MHS facility never gets reimbursed for the care given to these patients. The identification problem is multifaceted with regard to establishing responsibility, training, collection of insurance information, and patient convenience associated with possible changes in point of service (POS) procedures.

• Documentation problems are prevalent in the identification of the patients with third party insurance and in documenting the care given to the patients. The documentation of the care results in decreases in the reimbursement rate and potential legal and certification issues. The belief is lots of care and diagnostic services are provided but not documented or the documentation cannot be found. Use of automated documentation tools can be problematic based on the lack of knowledge on ease of use, accuracy of the billing code, and ability to capture required documentation. Efforts in the MHS to provide pick lists for diagnosis codes and assistance for leveling E&M codes still require an expert coder to insure any probability that the diagnosis’s and CPT codes are accurate enough to result in meaningful information for best practice decisions and clinical studies.

• The coding of medical records remains a problem as long as many providers and clinic support staff are entrusted with entering codes into the Ambulatory Data Module (ADM), the Composite Health Care System (CHCS) and the Third Party Outpatient Collections System (TPOCS). Although solutions exist to allow providers the on-line entry of a code, it does nothing to help them select the appropriate code based on the care provided and what got documented in the patient record. Historically, coding issues are further complicated with regard to the timely updating of coding software to reflect the changes in codes that occur annually. With regard to billing, a pattern of coding inaccurately can lead to repayment of money to the insurance companies and/or fines and penalties. The following table is an example of the number of changes by MEPRS description in a MHS facility.

|Coding Accuracy by MEPRS Description |

|MEPRS Description |EM Codes Evaluated |No Change |Levels Up |

| |13809 |$108.41 |$1,509,023.24 |

|CARDIOLOGY CLINIC |2291 |$71.73 |$165,130.17 |

|PHARMACY |1540 |$58.39 |$92,434.33 |

|INTERNAL MEDICINE |992 |$92.13 |$91,856.89 |

|PRIMARY CARE CLINIC |784 |$80.79 |$63,504.24 |

|UROLOGY CLINIC |575 |$118.92 |$68,854.75 |

|EMERGENCY MEDICINE |569 |$121.13 |$69,285.27 |

|OPTHALMOLOGY DEPARTMENT/DIVISION |516 |$85.75 |$44,591.54 |

|DERMATOLOGY CLINIC |504 |$58.39 |$29,487.70 |

|WELLNESS CLINIC |382 |$111.37 |$42,656.49 |

|NUTRITION CLINIC |363 |$28.11 |$10,259.14 |

|THERAPUTIC RADIATION |340 |$93.12 |$32,033.77 |

|PHYSICAL THERAPY |313 |$34.75 |$11,014.17 |

|MINOR CARE |310 |$116.16 |$36,243.22 |

|RHEUMATOLOGY |305 |$86.87 |$26,668.66 |

|OTORHINOLARYNGOLOGY CLINIC |305 |$118.52 |$36,149.55 |

|ENDOCRINOLOGY |267 |$87.14 |$23,265.12 |

|PULMONARY DISEASE |240 |$109.06 |$26,175.02 |

|GENERAL SURGERY CLINIC |235 |$161.38 |$38,246.93 |

|ORTHOPEDIC CLINIC |232 |$124.87 |$29,095.71 |

|NEUROLOGY CLINIC |229 |$107.73 |$24,778.66 |

|HEMATOLOGY |215 |$129.42 |$27,954.38 |

|GASTROENTEROLOGY |208 |$113.62 |$23,859.77 |

|ONCOLOGY |172 |$136.75 |$23,658.38 |

|GYNECOLOGY CLINIC |168 |$113.13 |$19,119.66 |

|ALLERGY CLINIC |134 |$41.17 |$5,516.87 |

|AUDIOLOGY CLINIC |132 |$25.65 |$3,436.77 |

|NEPHROLOGY |128 |$130.32 |$16,681.41 |

|VASCULAR |124 |$84.84 |$10,604.55 |

|UROLOGY-APV |106 |$956.40 |$103,290.71 |

|DIABETES WELLNESS CLINIC |101 |$87.93 |$8,880.92 |

|OPTOMETRY CLINIC |95 |$47.07 |$4,471.72 |

|PSYCHOLOGY |91 |$80.66 |$7,420.73 |

|PEDIATRICS CLINIC |82 |$68.79 |$5,641.18 |

|WOMENS CYTOLOGY CLINIC W |72 |$114.29 |$8,228.65 |

|GASTRO APV |68 |$1,142.71 |$77,704.42 |

|CARDIOVASCULAR/THORACIC SURGERY |54 |$129.11 |$7,101.30 |

|PSYCHIATRY CLINIC |48 |$104.64 |$5,127.53 |

|GENERAL SURGERY-APV |46 |$1,120.22 |$51,530.34 |

|PODIATRY CLINIC |45 |$59.74 |$2,748.03 |

|OCCUPATIONAL THERAPY |43 |$55.27 |$2,376.73 |

|SLEEP LAB |35 |$116.04 |$4,061.30 |

|PLASTIC SURGERY |32 |$125.24 |$4,007.72 |

|NEUROSURGERY |28 |$217.81 |$6,098.70 |

|OBSTETRICS CLINIC |27 |$100.89 |$2,724.00 |

|SPEECH PATHOLOGY |27 |$46.84 |$1,264.68 |

|OB GYN, MHS facility |24 |$132.61 |$3,182.53 |

|ORTHOPAEDIC APPLIANCE |23 |$72.52 |$1,668.07 |

|OPTHALMALOGY APV |19 |$752.30 |$14,293.70 |

|ADOLESCENT |19 |$76.61 |$1,455.60 |

|ORTHO-APV |19 |$982.16 |$18,660.95 |

|OTHLARINGOLOGY APV |17 |$1,105.69 |$18,796.75 |

|PULMONARY-APV |14 |$678.80 |$10,182.00 |

|BEHAVIORAL HEALTH PSYCH,W |13 |$104.77 |$1,362.00 |

|PEDIATRIC APV |11 |$1,443.41 |$15,877.50 |

|AUDIOLOGY |11 |$22.69 |$249.60 |

|IMMUNIZATIONS |10 |$17.46 |$174.60 |

|CARDIOLOGY-APV |9 |$979.03 |$9,790.31 |

|INFECTIOUS DISEASE |7 |$89.26 |$624.80 |

|CHIROPRACTIC CLINIC |6 |$25.50 |$153.00 |

|PLASTIC SURGERY-APV |6 |$1,129.80 |$7,908.60 |

|ALLERGY |5 |$57.72 |$288.60 |

|BONE MARROW TRANSPLANT |4 |$148.32 |$741.60 |

|PULMONARY RESP RESOURCE SHARING |4 |$133.00 |$532.00 |

|GYNCELOGY APV |3 |$916.33 |$2,749.00 |

|INTERNAL MEDICINCE APV |3 |$1,062.75 |$3,188.25 |

|ET |2 |$107.70 |$215.40 |

|AMBULANCE SERVICE |1 |$26.75 |$26.75 |

|DERMATOLOGY |1 |$10.91 |$10.91 |

|CHEMOTHERAPY |1 |$4.80 |$4.80 |

|FLIGHT MEDICINE |1 |$137.90 |$137.90 |

|OPTHALMOLOGY DEPARTMENT |1 |$155.20 |$155.20 |

|PODIATRY APV |1 |$1,235.50 |$1,235.50 |

|VASCULAR SURGERY CLINIC |1 |$115.54 |$115.54 |

1 Sample Report ER Visits:

In the following table we are determining the amount of outpatient Third Party Collection from Emergency Room visits. We created a bookmark so we can analyze this by just simply selecting the bookmark.

The first table shows we selected all the types of ER outpatient visits and the second shows the results of that selection. The bookmark is added just like the ones you set in a Web browser does all this.

[pic]

[pic]

2 Example Provider Report:

The amount of revenue by provider is important in monitoring the effects of PlanetGov/HTSI education services and may be useful to determine reward programs. The following is a provider revenue table that can be generated by simply selecting the provider revenue graph. Information is updated as of the last reload of information from TPOCS and CHCS – usually on a daily basis.

|Top 20 Providers Sorted by # of Visits |

Provider # |Specialty |# of Visits |Avg Amount |Total Amount | | | | | | | |1 |CARDIOLOGY CLINIC |1833 |$67.50 |$93,690.90 | |2 |PHARMACY |1371 |$58.38 |$80,616.43 | |3 |WELLNESS CLINIC |577 |$115.15 |$32,011.03 | |4 |INTERNAL MEDICINE |384 |$98.34 |$19,569.66 | |5 |CARDIOLOGY CLINIC |316 |$86.02 |$13,418.66 | |6 |THERAPUTIC RADIATION |250 |$93.06 |$23,637.94 | |7 |CARDIOLOGY CLINIC |237 |$75.08 |$8,184.25 | |8 |RHEUMATOLOGY |219 |$88.77 |$15,712.86 | |9 |PHYSICAL THERAPY |198 |$34.65 |$6,721.77 | |10 |PHARMACY |196 |$58.76 |$11,810.89 | |11 |WELLNESS CLINIC |172 |$99.30 |$6,752.56 | |12 |PRIMARY CARE CLINIC |168 |$74.58 |$5,817.53 | |13 |PRIMARY CARE CLINIC |154 |$83.96 |$5,709.14 | |14 |CARDIOLOGY CLINIC |133 |$68.98 |$4,069.98 | |15 |NUTRITION CLINIC |131 |$31.46 |$2,925.60 | |16 |PULMONARY DISEASE |130 |$128.91 |$13,406.60 | |17 |PRIMARY CARE CLINIC |130 |$90.25 |$5,144.10 | |18 |EMERGENCY MEDICINE |125 |$122.92 |$8,358.30 | |19 |EMERGENCY MEDICINE |123 |$122.68 |$6,992.79 | |20 |CARDIOLOGY CLINIC |118 |$96.16 |$5,961.77 | |

3 Sample Queries:

HTSI ClickBill allows you to drill down using millions of combinations of variables. This can be done by simply clicking on the successive variables of interest or by clicking on data fields in objects such as tables, line charts, pie charts, etc. For example, lets assume you are doing a follow-up on a claim on patient Alene Price with Mail Handlers and they are claiming she did not meet her deductible of $100 for calendar year 1999. You simply select the patient by typing in her name in the patient list box, select Mail Handlers from the insurance company list box and then select W15, the transaction code for deductibles. Immediately you see that deductibles have clearly exceeded $100 in calendar year 1999. The actual total is $623.51 and you can see that not only has Ms Price exceeded the deductible, but also Mail Handlers owes MHS facility $523.51 ($623.51- $100).

[pic]

In another example, you want to examine which diagnosis codes are never paid. This could be for a number of reasons so you want to look at them by transaction code. In the following chart lists the top ten diagnosis codes that were not paid. The full table contains 417 codes. This is the table coders and claims specialists would use to determine if the right code was used or if an insurance company may not pay for that code or they are using a black box edit.

[pic]

Key Personnel:

The following members of PlanetGov/HTSI will be involved in an intensive effort at start up of the contact and will be routinely making on-site visits to provide management oversight, conduct data analysis, and maintain the data analysis and database software. Detailed information on these team members is provided in the resumes attached to this report.

• Sam Fye – Executive Management Oversight and Data Analysis: Sam Fye is one of the owners of Healthcare Technology Solutions International (PlanetGov/HTSI). He was assigned to MHS on two different occasions. The first time was in Medical Systems and the Division of Nursing. The second time was as the CIO of TRICARE Southwest. After retiring, Mr. Fye was asked to conduct the attached MHS study on Third Party Collection. He has spent well over 1000 hours in analyzing coding and MHS Third Party Collection data and processes and has worked many high level projects in addressing case complexity, reimbursement, and data system installations and maintenance.

• Al Alford – Executive Management Oversight and Knowledge Management: Al Alford is also an owner of PlanetGov/HTSI. Mr. Alford was assigned at Wilford Hall where he was first assigned to the Division of Hospital Services and then as the Executive Officer to the MHS Commander. He is one of the DoD’s leading experts in knowledge management and data movement tools. He will provide operations oversight and will oversee the development and maintenance of the PlanetGov/HTSI WebLibrary tool that will provide access to MHS staff and PlanetGov/HTSI staff for billing reports, performance metrics, policy manuals, and provider performance statistics.

• Laura Sosa - RHIA – Consultant for Round Table Sessions, Consultant for Billing Compliance, and Auditor for Claims Compliance and Coding: Based on her experience with San Antonio insurance companies she will also be assisting in answering coding questions associated with third party insurance claims.. Ms Sosa is one of the country’s leading experts in coding compliance and claims processing. Because of her expertise she was hired by the University of Texas Health Science Center at San Antonio (UTHSCSA) to fix the billing and compliance problems associated with their 17 million dollar fine under the False Claims Act. She was responsible for the follow-on integrity audits and led a staff of 50 coders and claims specialists to achieve an error rate of less than four percent. She is accredited for CME credits and is an instructor at St. Phillip’s College. Ms Sosa is the author of the attached presentation on billing compliance and will be providing the provider education that is accredited for continuing medical education (CME).

• Phillip Bishop – Data Analysis Application Development and Maintenance, Application Training, Database Administration, Develop and Maintenance of Consolidated Billing Report: Mr. Bishop is the world’s leading expert in development of QlikView applications that is the foundation for building the HTSI ClickBill and Provider applications. Mr. Bishop developed all the scripts and applications to extract data from the Wilkes-Barre application and provided the programming support to develop the MHS HTSI ClickBill application. He also developed the program for the consolidated billing report used at the Wilkes-Barre VA. Mr. Bishop will do the initial installation and provide follow-on maintenance for the HTSI ClickBill and PlanetGov/HTSI Provider application. Mr. Bishop will be programmed on site for 16 hours per month to train and support MHS staff with the use of the data analysis and reporting applications. He will be developing all the standard and ad hoc reports required under the SOW.

• Patricia Wagner – RN – Coding Compliance and Care Management: Ms Wagner is a registered nurse and an expert on setting up care management programs (utilization review). Ms Wagner, along with her team of three other registered nurses will be setting up the care management program at MHS for PlanetGov/HTSI. Ms Wagner and her staff are also a certified coders and recognized experts for setting master charge tables for filing insurance claims. She will be our consultant in setting up the required processes to implement the reasonable charges program at MHS as part of the planned migration by the MHS.

• Andrea Maslar – Project Manager and Claims Manager. Ms Maslar is currently the Project Manager for PlanetGov/HTSI’s five million dollar contract with the Wilkes-Barre VA. She set up the operations for Wilkes-Barre to meet the coding, producing the consolidated billing report, records management, invoicing, and data entry into the VA’s billing system (PCE). Ms Maslar was also the Billing Manager for Proworks Occupational Health Management, Manager of Admitting and Patient Registration at Wilkes-Barre General Hospital and Nesbitt Memorial Hospital, and Director of Admissions at Wilkes-Barre General Hospital. She will be brought on site to set up the operations at MHS.

• Mildred Mosella – RHIT – Consultant for Medical Claims and Records Management. Ms Mosella has extensive experience as a consultant with regard to working with insurance companies, attorneys, clients, patients, and insurance contracts. She will be used to address JCAH accreditation issues and addressing medical record issues. She is also a certified coder and will be assisting Laura Sosa with compliance audits.

• Dena Perry – Consultant for Entire Revenue Process. Ms Perry is a certified coder and has lead many projects targeted at revenue enhancement to include audit process for claims specialists and creation and interpretation of payment analysis reports and protocol. She will also be used to assist in setting up protocols for claims follow-up and for insurance company requests for audit.

• Karen Gilbert – RN – Certified Coder, Quality and Care Reviews. Ms Gilbert is a registered nurse who will be assisting in setting up our processes for quality and care reviews. She is also a certified coder and familiar with NCQA guidelines.

• Kathleen Raver – Processing of Billing Data and Claims Specialist. Ms Raver provides expertise from her experience in the Federal Government and Commercial billing systems. She is responsible for processing the coding data for over 45,000 claims at the Wilkes-Barre VA. In her previous job with the Center for Diagnostic Imaging she was responsible for verifying insurance coverage and the accuracy of coding information. Ms Raver will be brought on-site at MHS to assist in the initial set up of the coding and records management database.

• Mariah White-Belt- Claims Processing and Collections. Ms White-Belt provides expertise from her experience in the Federal Government and Commercial billing systems. She provides specific expertise in collection of money owed by insurance companies and patients and accounting and verifying collection of money. Ms White-Belt will be brought on-site at MHS to assist in the initial set up of collection processes and to assist in the set-up of the data entry processes.

1 Continuity and Quality of New Hires: Revise to make MHS specific

The full time on-site staff will have to be hired from the local area. Since these people will be doing the day-to-day work and provide the daily interface with MHS facility staff and patients, it is absolutely essential that these new staff members be of the highest quality and has the incentives to remain on site throughout the life cycle of the contact. Because PlanetGov/HTSI maintains a low overhead we offer our employees 20% - 25% higher wages than comparable employees in the MTF’s local area. This incentive works very well in getting the highest quality people and keeping them from being hired away from competitors. In addition to the higher wages, we provide a bonus based on the quantity of work performed, the quality of work, and customer satisfaction. Prerequisite to earning a bonus is a quality percent in excess of 95 % and a minimum score of 4.0 on a scale of 1-5 on customer satisfaction surveys. For example, by using this approach, we solved a long-standing problem at the Wilkes-Barre VA where there had constant turn over in staffing provided by other vendors. After 11 months on site there has not been one employee who has voluntarily left our staff. They are a well-motivated staff providing the continuity and experience required to meet our goal of exceeding the customer’s expectations.

references:

PlanetGov/HTSI is very proud of our previous and current performance under contracts with our Government and commercial customers. We encourage you to contact the following references to determine customer satisfaction with our performance.

1 Wilkes-Barre DVAMC:

The reference that best matches the scope, magnitude, and complexity of the task order requirements under this BPA is the work performed for the Wilkes-Barre Department of Veteran’s Affair’s Medical Center (DVAMC). The Technical Representative to the Contracting Officer is Jeanine Marino. She is the Business Director at the Wilkes-Barre DVAMC. The following is Ms Marino’s contact information and alternative contacts that are also cable of assessing our performance at the Wilkes-Barre DVAMC:

Jeanine Marino

Business Office Director

Phone: (570) 821-7229

E-Mail: Jeanine.marino@med.

Gina Warnagiris

Billing Department Director

Phone: (570) 824-3521 Ext 7310

E-Mail: Eugenia.Warnagiris@med.

Terry Milbrodt

Coding Analyst

(570) 824-3521 Ext 7700

E-Mail: Terry.Milbrodt@med.

The contract at the Wilkes-Barre DVAMC matches your scope, magnitude, and complexity as follows:

Scope: The Wilkes-Barre DVAMC is similar to any large MHS medical center with regard to the inpatient and outpatient care provided and the associated need to code records involving multiple specialties and compliance issues associated with residency programs. In addition, the Wilkes-Barre DVAMC provides nursing home care that is part of the contract coding requirement. Specifically, the Department of Veteran’s Affair’s Medical Center Wilkes-Barre, Pennsylvania is a General Medical and Surgical facility consisting of 116 operating hospital beds, 173 nursing home beds, and 10 Substance Abuse Residential Rehabilitation Treatment Program (SARRTP) beds. This facility serves veterans throughout northeastern and central Pennsylvania and southern New York State and is affiliated with Hahnemann University Hospital, the MCP Hahnemann School of Medicine and the Pennsylvania College of Optometry. There are presently 59 residents in established residency programs at this Medical Center, 54 in Internal Medicine, 2 in Ophthalmology, 2 in Dental, and 1 in Optometry. Additionally, there is 1 Pulmonary Fellow also in training. The facility also supports over 55 affiliations with other colleges, universities, and schools of allied health. Ambulatory care services are provided through a variety of outpatient clinics conducted in Wilkes-Barre, Pennsylvania and at satellite outpatient clinics located in Allentown, Sayre, Williamsport, Tobyhanna, and Schuylkill county, Pennsylvania. Several special programs offered at the Wilkes-Barre, Pennsylvania facility include: A Hemodialysis Unit, Cardiopulmonary Rehabilitation Program, Outpatient Post-Traumatic Stress Disorder Program, Home Based Primary Care, Mental Hygiene Clinic, Polysomnography Laboratory, Short Procedures Unit, Same Day Surgery Program, Women’s Health Program, Step-Down Unit, 23 Hour Observation Beds, Substance Abuse Residential Rehabilitation Treatment Program (SARRTP), Halfway House, and Visual Impairment Services. The extended care program encompasses a Nursing Home Care Unit, a Geriatric Evaluation and Management Program, a Subacute Unit, a Hospice Unit, and Respite and Residential Care Programs. The facility also provides HIV, Persian Gulf, Ex-POW, sexual abuse and spiritual counseling as well as psychological testing, and behavior management modification.

Magnitude: We code all the inpatient discharges to include the nursing home. For outpatient care, we code all records that are identified as claims for third party insurance. We code for all the specialties offered at the Wilkes-Barre DVAMC and for all the satellite facilities. Full time on-site coders are located at Wilkes-Barr, Allentown, and Sayre. Our coders also make on-site visits to the other facilities listed below. When on-site at remote facilities they are capable of remote access to the Wilkes-Barre information systems using notebook computers. The following charts are extracts out of the HTSI ClickBill application showing the volume of records coded by record type and by facility:

[pic] [pic]

Complexity: We provide the following services under our coding services contract with the Wilkes-Barre DMAMC. We believe they demonstrate that we have experience in all phases of the services required in your task order.

• Certified Coders: We have nine certified coders that code records at the Wilkes-Barre DVAMC on either a full time or part time basis. Seven code outpatient records and two code inpatient records. Of the Seven outpatient coders, we have one full time coder at Allentown and one at Sayre. We handle all the complexities associated with coding records for multiple specialties and multiple facilities. We have a mix of very experienced coders – two are RNS, two are RHIAs, one RHIT, and four CPCs. The average years of experience for these coders exceeds 10 years.

• Program Management: We have a full time Program Manager on site with 18 years management experience in multiple healthcare settings ranging from clinics to major medical centers. This individual is our direct contact with the customer and provides support for reports, invoices, training, security, staffing, and computer applications. This individual is a non-coder and is fully dedicated to program management responsibilities.

• Records Administration: We have three full time administrative assistants with each having numerous years experience in physician offices. They do the abstracting for inpatient coding, pull records for the Allentown facility, maintain a filing system and associated data base for the 60,000 coded records, do data entry into the DVAMC’s hospital information system (VISTA), and provide data validation.

• Senior Systems Analyst: A senior systems analyst spends two days on site every month to design, program, and maintain reporting and decision support software designed to convert clinical and coding data into useful information. The HTSI ClickBill application is used to improve third party revenue and to increase the efficiency of the Coding and Billing Department. This software will be discussed in detail later.

• Senior Consultant: A senior consultant spends two days a month on site working directly with the coding staff and the DVAMC staff to review and report performance with regard to revenue objectives and compliance with contract specifications. This senior consultant also addresses any problems or issues that have not been solved by the on-site Program Manager.

• Senior Auditor: An independent auditor comes on site once a quarter to provide an external audit of the contract coders. This is in addition to the internal audits conducted on-site on a weekly basis. Based on audit findings the senior auditor provides training to the contract coders and any DVAMC staff who wish to attend.

• Senior Trainer: The senior auditor is usually the senior trainer. Using the HTSI ClickBill application, the auditor is provided with specific specialty, provider, and facility information coding accuracy and reasons not billable to conduct a problem focused training approach targeted at specific providers, specialties, and facilities. In addition to this problem-focused training, general sessions are provided to improve documentation in the provider note and provide instruction on teaching physician guidelines. This is CME accredited training. We assist the education department by providing lesson plans, completing attendee lists, and providing copies of our Power Point presentations.

2 Assistant Secretary of Defense, Health Affairs:

We use a number of software tools that give us a competitive advantage in the program management aspects of coding service contracts. In addition to our HTSI ClickBill application we use our Web Library and data movement tools to enhance the distribution of coding knowledge, distribute and track key documents, and to provide a state of the art communications infrastructure. Our past performance reference for the Web Library and the data movement tools is:

Marco Johnson

Program Management of Health Information Resources Service

5109 Leesburg Pike, Falls Church VA 22041

Phone: (703) 681-8780

E-Mail: marco.johnson@tma.osd.mil

3 Integrated Outcomes:

Integrated Outcomes is a reference for our ability to analyze and report clinical, coding and billing information in the commercial sector. Under our contract with Integrated Outcomes we associate laboratory, patient, claims, pharmacy, and provider data with ICD 9CM and procedural codes for WellMed, a large HMO in San Antonio Texas. The application produced for WellMed allows a user to select an individual diagnosis code or a major diagnosis category and profile this information by medications, insurer, specialty, laboratory results, adverse events, claims, provider, or any other variable available in in the WellMed clinical databases. The contact at Integrated Outcomes is:

Jim May

CEO

Integrated Outcomes

Phone: (972) 675-2445

E-Mail: jmay@

4 Wilford Hall Medical Center:

The attached study demonstrates our understanding of the Third Party Collection issues at a large MHS facility and our ability to understand and make recommendations in a very complex environment .

Lieutenant Colonel Steve Wolf

Phone: (703) 575-2387 or

E-Mail: Stephen.Wolfe@tma.osd.mil.

5 Wilford Hall Medical Center:

This was an unsolicited proposal for records management. The proposal demonstrated our understanding of the complex issues associated with records management and the potential effect these issues have on Third Party Collections and ability to meet JCAH requirements.

Ms Hattie Wright

Phone: (210) 292-5779

E-Mail: hattie.wright@lackland.af.mil

6 Electronic Paper Solutions

This project we provided services to EPS to assist them in reviewing medical records processes and the review of IDX Billing System at Fallon Clinic – a large HMO located in Worcester, Massachusetts. In this project we extracted appointment scheduling information and claims data for the purpose of analyzing missed billing opportunities and to profile bad debt patients. The resulting application allowed EPS to help Fallon profile the use of diagnosis codes and CPT codes by provider, specialty, HMO membership, payments, processing times, etc. The contact for our work for EPS is as follows:

Arthur Fitzgerald

Electronic Paper Solutions (EPS)

Pine Brook Dr, Peabody, MA 01960

(978) 535-5556

E-Mail: epsinc203@

Sequence of Events:

PlanetGov/HTSI will take a systematic approach to performing the tasks proposed in the technical proposal. We realize the first priority is to take immediate action to meet MHS facility’s expectation for revenue growth. To that extent, the first order of business will be to catch up the backlog of medical records that need to be coded, ensure compliance, and the immediate use of the HTSI ClickBill application to monitor coding processes and to identify billable visits and admissions in CHCS. This will drive the revenue gains that provide a positive return on investment with the coding services contract. Shortly thereafter we will begin provider training and reporting activities.

point of Contact for Technical Proposal:

We would be glad to answer any questions concerning this proposal, present on our capabilities, or provide a demonstration of our software products. Our point of contact is Sam Fye. He can be reached by phone at (830) 606-4918 or by E-Mail at SFYE@satx.,

-----------------------

[1] Operations Management, Continuous Improvement, Schonberger & Knod

-----------------------

(-)

Submitted February 28, 2002

PlanetGov/HTSI Components and Services are designed on a positive return on investment

(=)

ROI

(+)

Costs

Contract Cost

Overhead

Cost Savings

Improved Quality

Compliance

Efficiency

Personnel

Revenue Increases

Insurance

Budget

Business Case

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download