Purchasing Department

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1 Purchasing Department Addendum #1 Date: April 4, 2017 Title: RFB/RFP #LH-0407 Compliance Coding and Billing Audit Subject: Questions and Responses 1. Page 9. Do you have any onsite requirements either for education or presentation of results? If yes, please clarify number of times it will be required? Answer: No onsite requirements. I envision the methodology will be based on the issue being addressed. 2. General. Are there any restrictions concerning location of credentialed auditors? Is offshore acceptable? Answer: No, we (Compliance and IT Departments) would work with the selected vendor to determine how the data would be transferred is the auditors were offshore. 3. Page 15/16. Women/Minority owned although we qualify, our certification is being renewed but a section in the RFP says we just need a letter from a competent authority. Would a letter from a banker or CPA suffice as an authority until we get our certificate? Answer: I m not finding where it states in this RFP you need a letter from a competent authority. 4. Page 18. Are we allowed to mark up the professional services agreement and the fee schedule with changes we propose? 5. The RFP indicates that the scope of services are inpatient and outpatient lines of business. Does the scope of service include facility services claims only? Currently, yes, however we provide compliance oversight for our physician group and need to consider how we will accomplish that function. This could happen in the form of a year two amendment to the original contract. 6. Acclaim Physician Group is listed as one of the units to be included in the required services. However, there is not a specific scope of services outline included for professional fee services. Are professional fee claims included in this scope of work? a. If yes, what is the expected scope of work related to professional fee services claims? b. If yes, what is the expected sample size for professional fee claim audit(s)? c. Is this sample size included in the 100 charts per quarter? d. If yes, please provide a breakdown of the number of providers / provider types (e.g. MD, NPP etc.) by medical specialty. Answer: Not at this time. See answer response to question 5 above. 7. For those units listed as included in the scope for Outpatient Line of Business does JPS bill both facility and professional services claims or is a single claim produced (e.g. CMS-1500 or electronic equivalent)? Answer: No.

2 8. Are hospital outpatient services provided at JPS Hospital (e.g. ED) included in the Outpatient Line of Business scope? 9. In Deliverables Item C, please confirm the definition of each audit. Does this refer to each quarterly audit? a. If yes, please confirm the maximum sample size is 100 per quarter for all audits. Answer: Yes, the maximum sample size is 100 unique records for each quarterly audit. 10. Page 10 - Inpatient Line of Business Item D Chart to Bill Audits indicates respondent will review samples of outpatient claims Should this read inpatient instead of outpatient? 11. Is all medical record documentation maintained in an electronic medical record ( EMR ) system? a. If not, is some documentation maintained in a paper format? 12. What EMR system(s) is used by JPS? If the systems vary by location or types of services, please identify all that are used and what types of services are documented in each. Answer: Epic 13. What billing / claims processing system(s) are used by JPS? If different system(s) are used, please identify all by type of service(s) that are applicable to each. Answer: nthrive 14. Project scope indicates samples will include M Care, M Caid and other third party payor claims. Will JPS provide it negotiated contracted fee schedules / rates for non-public payors to support calculations of reimbursement impacts by payor? 15. What is meant by charge accuracy rate under detailed reports section on page 12 of the RFP? Answer: Charge accuracy by percentage. 16. Section 05. Proposed Pricing: Please clarify the first sentence and what is meant by each entity in the JPS Health Network and out of the pocket costs. Answer: We are not sure what the reference is to. Section 05. Proposed Pricing states: Provide a two year annual fee include other pertinent information deemed necessary. Describe the fee rate for each entity in the JPS Health Network describe out of the pocket costs the District is responsible for the services. The proposed costs shall directly relate to the work plan. Finally, provide a description of expected payment terms. Contract pricing shall remain firm for the term of the contract. If a price increase is warranted the vendor must submit a written request justifying the reason for the price to the JPS business owner 30 days prior to effective date. 17. Page 11 (inpatient) and page 12 (outpatient) indicates reports will include follow-up from previous findings, analysis, trends, and comparison with state and national data. Does previous findings refer to the analysis of JPS data conducted from prior audits performed as part of this engagement (e.g. prior quarter audits)?

3 18. What is the expected completion date for the first audit? Answer: Approximately 90 days after receipt of a fully executed agreement, however, this is negotiable due to it being the one that will be a standard for audits to follow. 19. What computer systems will be accessed for each audit? Answer: System access will be granted as identified. All data is stored in Epic, however, if an audit(s) can be accomplished with a report versus system access we will provide the report through a secure file transfer. 20. What data elements will be reviewed for each chart type (DX, PCS, E&M, facility & profee CPT codes, HCPCs, I&I, Obs hours, Modifiers etc.)? Answer: DX, PCS, E&M, facility CPT codes, HCPCs, I&I, Obs hours, Modifiers 21. How will the deliverables (report and education) be divided among the facilities? Answer: JPS will dictate this based on the specific audit. For example we currently use an audit report template with a distribution list that changes depending on the audit except for a core group that includes the CEO, COO, CFO, CCO and leadership of the impacted area. 22. How many total coders will be audited per review period? Answer: this will be dictated by the audit. Specific services might be coded by a certain number of coders, this is especially true with specialty services. 23. Does this audit include charge validation/ If yes, how will the UB04 be provided? (scanned, PDF, thumb drive etc.)? You may tell us how you would prefer to receive them and we will make every effort to accommodate. 24. Is each facility involved in this review using the same systems? Answer: Yes 25. What is your standard hourly productivity for an IP coder? Answer: 2 charts/hour, except Labor and Delivery 4 charts/hour 26. Could you include a list of technology enablers used to assist with clinical documentation and charge capture? Optum, 360, Encoder 3M, Clinical Documentation Improvement System? Answer: 360, Encoder 3M 27. What is the average LOS? Answer: 4.5 excluding OB 28. What % of payers are MS-DRG vs APR-DRG? Answer: This information is not readily available. Please let us know if it is necessary for your response and we will make every effort to provide it. 29. Please verify the calculation of the CC capture rate you are requesting as it will affect the data we request from you. o Option one: CC capture rate based on audited changes to MCC/CC s i.e. addition, deletion or revision of CC/MCC only. o Option 2: CC capture rate based on the total amount of CC s assigned by coders for the entire audit compared to the amount of CC/MCC added, deleted, revised Answer: Option one

4 30. What E&M criteria do you currently use Answer: E/M (evaluation and management criteria) are primarily used for the physician fee schedules and outpatient encounters. The criteria used for hospital admission and utilization is Medical Necessity for the level of service, (used for Acute, Psych, SNF, and Rehab). Our current criteria set is the MCG Inpatient & Surgical Care Guidelines. We will be reviewing the InterQual Decision Support Criteria sets (McKesson) for a potential revision in July. 31. What is your current OP coder productivity rate? Answer: Emergency Departments 19 charts/hour, Primary Care & School Based Clinics 19 charts/hour, Specialty Clinics 17 charts/hour, Same Day Surgeries/Observation 5 charts/hour 32. Will injections and infusion codes need to be validated if present in the observation and or ED record samples? 33. Will facility E&M codes need to be validates for the ED record samples? Answer: Yes 34. Will profee E&M codes need to be validated for the ED record samples? Answer: No 35. What is the expected completion date for the first audit? Answer: Same as What computer systems will be accessed for each audit? Answer: Same as What data elements will be reviewed for each chart type (DX, PCS, E&M, facility & profee CPT codes, HCPCs, I&I, Obs hours, Modifiers etc.)? Answer: Same as How will the deliverables (report and education) be divided among the facilities? Answer: Same as How many total coders will be audited per review period? Answer: Same as Are PCS codes used on OP accounts? Answer: Yes 41. Is there an incumbent currently performing this audit? Answer: No, we are currently performing audits internally. 42. Is each facility involved in this review using the same systems? Answer: Same as What is your standard hourly productivity for an OP coder? Answer: same as How will the UB04 be provided? Via scanned image? Answer: Same as Is the coding and billing information in a separate billing system or are they all resident in a single system?

5 Answer: All interface with Epic so the data can come from one system although the reside in separate system 46. What is the sample size for the chart to bill audits? Answer: We use 100 as a baseline for most audits, however, if you have a recommended approach please explain in your response. Any valid sample size will be considered. 47. Is the charge capture review a requirement of in patent and outpatient chart audits? Answer: Required for outpatient audits 48. Is there a preference for the platform for national comparisons? We use MedPar data. Answer: MedPar data is preferred 49. What is your % of denied claims to total annual billed claims? Answer: This information is not readily available. Please let us know if it is necessary for your response and we will make every effort to provide it. 50. What is your % of denied claims as a % of gross revenue? Answer: This information is not readily available. Please let us know if it is necessary for your response and we will make every effort to provide it. 51. How will the reports be divided? By provider, by specialty etc.? Answer: Specialty to the medical director 52. How will the education sessions be organized? By provider, by specialty? Answer: Specialty, depending on the audit/session two or more may be combined 53. Will there be any profee charts included in the audits? If so, what are the requirements specific to profee audits? Answer: No 54. Acclaim Physician Group is not listed under either line of business. Does it fall within the Outpatient Line of Business requirements? If not, are there specific requirements for the District has requested references. As a courtesy to our clients, we would like to tell them when and how the District will be checking references. Answer: This will be determined at a later date We believe the bolded text is associated with question 55. Is that correct? 55. How do you intend to check references (e.g., brief phone call, , questionnaire)? If by phone, can we schedule any references calls with our clients? If physician group? Or is Acclaim outside the scope of the RFP? Answer: We will attempt to check references by first and if preferred by phone. If by phone you can schedule. We are not sure where the second bullet should go. Currently Acclaim is not included in the scope of the RFP, however, we would like to know if you have the capability to perform audits on professional billing. 56. Are the audits able to be performed via remote access? Answer: We believe so. Please state systems used: Electronic Health Record: Epic

6 Health Information System/medical record system: Epic Abstracting System: 3M Encoder/Grouper: 3M Answer: See above 57. How many different systems are required in order to audit: Inpatient? Facility Outpatient? Professional Services? Answer: We are not requiring a specific number of systems 58. Page 11, B. Medical Necessity: is this item referring to the having the Respondent validate the medical necessity/appropriateness of the inpatient admission based on published admission criteria? If so, please advise what Admission Criteria software is used by JPS Health Network, and confirm that Respondent will have access to it, to ensure consistency in clinical admission criteria utilized. If this is not the intent of this item, please provide greater detail regarding the expectation. Medical Necessity is also shown under Item C of this page. Answer: MCG, we have an Epic interface but will make access to the system available if needed. 59. Page 11, C. Coding Validation: bullets 2 and 3 of this item refer to Facility Evaluation and Management code selection and code assignment for outpatient departments, including Emergency Department. Since this item falls under Inpatient Line of Business, please clarify if these are inpatient claims with outpatient charges, or if this item does refer to Facility Outpatient claims and not Inpatient. It appears that Page 12; Item D under Outpatient Line of Business also refers to Facility Outpatient. Answer: the information on page 11 C. should refer to inpatient charges not outpatient 60. Page 11, D. Chart to Bill Audits: this item falls under Inpatient Line of Business, but refers to Outpatient claims. Please clarify if this was intended to be under a Facility Outpatient line of business, or if these are Inpatient claims with outpatient charges that must also be reviewed/validated. Answer: the information on page 11 C. it should be under the facility outpatient line of business. 61. If possible, please recap the expectation for both Facility Inpatient and Outpatient claims, as well as professional services audit requirement, i.e. do both Inpatient and Outpatient claims require a review of coding abstracts and remittance advice? Answer: No, only the Outpatient claim reviews required a review of coding abstracts and remittance advice 62. For Facility Outpatient, will all charges on the UB04 be reviewed for accuracy Answer: Not for each audit. Some audits will be focused on a specific service. 63. Is ICD-10-PCS assigned to any Facility Outpatient record types? Answer: Same as Page 12, Outpatient Line of Business appears to address professional services (pro fee) rather than Facility Outpatient. Referring back to Question 6 above, is this a correct assumption? Would it be possible to recap the expectation to ensure clarity in responding to the RFP?

7 Answer: the references to professional services should not be a consideration when responding to this RFP except for the purposes of whether or not the respondent may have the ability to provide this service in the future. The main focus for this RFP is hospital billing. 65. According to Page 13, the estimated quarterly audit volume is approximately 30 Inpatient, 30 Observations/Ambulatory Surgery, and 40 ED/Ancillary. Does this refer to Facility coding, Professional Services coding, or both Facility and Pro Fee for the 100 cases? Also, as requested earlier, will each of these cases require review of the coding abstract, UB-04 (or CMS1500), and remittance advice? Answer: Facility only, and coding abstract, UB and remittance advice should be reviewed 66. Will Respondent be given access to JPS encoder/grouper in order to determine exact and specific financial impact to both Facility and Pro Fee charges/claims? Answer: facility only 67. For pro fee coding, does JPS utilize 95 Guidelines, or 97 Guidelines by specialty? Answer: Not applicable 68. In providing the professional fee services error rate by RVU, will JPS provide the facility specific RVUs? Answer: Not applicable 69. Page 14, Section 5 Proposed Pricing requests a two year annual fee. This seems to conflict with the language on page 25, Exhibit 2-A, requesting hourly rates or other basis of determining the Fees. Please clarify. Answer: We would like a pricing proposal for an anticipated two year contractual arrangement. If there is a difference between year one and year two, please note this in the response. 70. Page 17, Tab 7, asks that all administrative documents included with the RFP be completed and submitted with our response, so please confirm that Exhibit C Professional Services Agreement, and Exhibit 3-A Business Associate Insert for Services Agreement will not be needed at this time, but upon award and moving on to the contract stage. Answer: Correct, these documents are provided as exhibits and will not need to be provided at this time. 71. Page 24, Schedule 2, please confirm that total expenses in 1. b) refers to reimbursable expenses mentioned below as part of 3. a). Answer: Correct 72. Page 29, Schedule 3, Standard Terms and Conditions, states commercial general liability with professional liability insurance required, but no amounts are given here to meet the requirement. Please clarify. Answer: This a placeholder in our template agreement. This can be discussed with our legal counsel in during negotiation.

8 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-0407 Compliance Coding and Billing Audit. 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, 2017, by: Respondent: Company Name: If there are questions pertaining to this addendum please contact Lizzie Harris at lharri05@jpshealth.org