Page 1 of 13 ADDENDUM NO. 2. September 26, Coding Medical Records for Cook County Health and Hospitals System RFP # H

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1 ADDENDUM NO. 2 September 26, 2016 Coding Medical Records for Cook County Health and Hospitals System RFP # H General This addendum revises RFP documents. This addendum is issued to respondents of record prior to execution of contract, and forms a part of contract documents and modifies previously issued documents. Insofar as previously issued contract documents are inconsistent with modifications indicated by this addendum, modifications indicated by this addendum shall govern. Where any part of the contract documents are modified by this addendum, all unaltered provisions shall remain in effect. 2. Addendum Acknowledgement Form Acknowledge receipt of this addendum in the space provided on the Addendum Acknowledgement Form. Proposers must include the signed form with their response. Failure to do so will subject Proposers to disqualification. 3. Changes and Clarifications a. Responses to Vendor Questions are provided below. 4. Attachments a. ne NEXT PAGE Page 1 of 13

2 Responses to Vendor Questions ID Section of the RFP Question CCHHS Response 1 If our coders are preforming at a level of 98% or greater after their first month of coding would you be open to moving the audits to Quarterly? 2 Section 5,. Quality Assurances, Misc., #3 ; Most hospitals that we work with have an Encoder built into their EMR. Are our coders expected to have their own Encoder? 3 Section 5,. Quality Assurances, Assurance #2; How is the Cost of coding the record calculated as a refund to CCHHS? Is it based on coding 5 charts an hour? Therefore the credit would be 1/5 of the hourly cost? How shall the credit be issued? How often has this occurred in the past?, as all coders vendors included are expected to code in the CCHHS Nuance coding system The cost of coding the record is based on each coders hourly productivity rate divided by the hourly rate. The credit is issued based on the productivity rate per service per hourly rate. 4 Section 6 Productivity. We have worked when many hospitals with a similar case mix as CCHHS. Our concern is not being able to meet your productivity expectations of 5 per hour for IP coding (and most other production expectations listed). The national average of coding IP charts in ICD-9 was 3 per hour and 2.5 in ICD-10.. How are you achieving 5 charts per hour? We don t want to fail your expectations and your response would help us feel more comfortable responding to your RFP. 5 Is the work schedule flexible (time of day, week days, weekends, etc) 6 Please describe your on-boarding process Background, drug screen, number of days it will take to issue IT Access for coder, etc Supporting documentation would need to accompany your RFP, Response for the 2.5 records per hour coding in ICD-10-CM. The 5 IP charts per hour is based on a length of stay of less than 10 days. All staff must be credentialed (AHIMA, RHIT, RHIA, CCS), current, not expired and a copy of all credentials must be provided to CCHHS before staff can work in the CCHHS Cerner, Nuance IT system. This includes Coders, Supervisors and Managers Page 2 of 13

3 7 What are your FTE requirements for each coding discipline (IP, OP, ER, etc) All vendors should staff according to coding workloads and or assignments requested from the CCHHS System 8 Our medical billers & coders are CPC certified through the AAPC- is this congruous to the CCS certification that is required in the RFP? Coding Manager for all disciplines All staff must be credentialed (AHIMA, RHIT, RHIA, CCS), current, not expired and a copy of all credentials must be provided to CCHHS before staff can work in the CCHHS Cerner, Nuance IT system. This includes Coders, Supervisors and Managers 9 Will this be Ad Hoc work or a fixed volume? All vendors should staff according to coding workloads and or assignments requested from the CCHHS System Coding Manager for all disciplines 10 What is the estimated volume of work? The System Coding Manager will provide an estimated volume of work once the contract has been established. 11 Will CCHHS accept the industry and AHIMA standard of a 95% accuracy rate? 12 Will CCHHS allow the selected coding vendor to correct its errors rather than reimburse CCHS for missed codes? 13 Is 95% an acceptable level of accuracy for all coders? Although that is the standard, CCHHS is requesting a 98% accuracy rate. Key performance Indicators (KPI s) will be included in the Contract language.. Reference response to Inquiry #11 14 Is there a backlog for ICD-9 coding? If so what is the volume? 15 What is the name of billing system coders will be entering into? 16 In regards to the productivity standards in section 6, are these the minimum productivity standards? 17 Depending on the type of coding, will alternative productivity standards be accepted? 18 Are CCHHS intending or do they prefer to award a single vendor or multiple vendors? t applicable as coders are only required to code and not bill for services Single vendor. However award will be based on best interest of the CCHHS. Page 3 of 13

4 19 If we are using the good faith effort plan then what form should be completed and which all section needs to completed? Economic Disclosure Statement (EDS) pages EDS-1 thru EDS-3. Insert additional document if necessary. 20 Do we have to complete all the sections of EDS if we are using the good faith effort plan? Where do we get the list of MBE/WBE certified firm to be used for good faith effort plan so we can send them the for soliciting the quotes? 21 Section 7.11 says Execute and submit the Economic Disclosure Statement. So, do we have to complete the entire EDS form? If no, then what all sections needs to be completed of this form? 22 What do we have to do with the Proposal receipt Acknowledgement Form? Is this needs to be sent before the RFP response submission or this needs to be submitted with the RFP? 23 If we are using the good faith effort plan then what form should be completed and which all section needs to be completed? 24 Do we have to complete all the sections of EDS if we are using the good faith effort plan? Where do we get the list of MBE/WBE certified firm to be used for good faith effort plan? 25 If Proposals are submitted via overnight courier, how should we handle the Proposal Receipt Acknowledgement Form? 26 Please clarify format of Proposal submission. How many paper and/or electronic (USB) copies? 27 Is this facility or professional coding? Facility www. cookcountyil.gov The official of contract compliance certified vendor listing.. Forms must be completed in their entirely. Receipt Proposal Acknowledgement forms will be completed for those proposers that hand deliver the response Reference answer to inquiry #19 Reference answer to Inquiry #20 The form will be completed internally and kept on file. Three (3) paper copies one marked as an original and one (1) electronic copy. 28 What is the monthly expected chart volumes for each specialty listed? 29 Please list the systems that we will have access to by name and function. 30 Will the coders be responsible for system edits/denials? To be determined Cerner, Nuance 31 Please provide average LOS for inpatient. 5 to 7 days Page 4 of 13

5 32 Please provide estimated volumes for: t available In-patient Same day Surgery Emergency Department Observation Minor Procedure Chemo Therapy Cardiac Cath 33 What types of procedures are in the Minor Procedure category? All vendors should know what is in a minor procedure category 34 Is the expectation that the Contractor will provide its own encoder?, all coders will code in the CCHHS Nuance coding system 35 Is the expectation monthly QA of a minimum of 10 coded records for each coder, or is it weekly as is stated in the same section #3, bullet 3? Monthly 36 What is CCHHS' average Case Mix Index (CMI)? 37 On the pricing proposal chart they have Inpatient records, 5 per hour. Is this professional hospitalists? We charge by encounter not by chart. What is the average LOS (length of stay). 38 Same Day Surgery What types of surgeries? All types Burns, Cardiology, Cardiovascular Surgery, Gynecology, Medicine, Neurology, Neurosurgery, Oncology, Orthopedic Surgery, Orthopedics, Psychiatry, Pulmonary, Surgery, Urology, Vascular Surgery, Surgery for Malignancy Encounter and Chart is the same. ALOS as stated in question #31 39 Minor procedures What specialties? What types of procedures? Will these procedures be stand alone or included in an E/M? All specialties, these are facility services 40 What will the volumes be on a monthly average for the coding specialties outlined in the pricing proposal section. We realize the volume will fluctuate but can there be an average that can be shared. 41 Will the coding be a augmentation to the existing team or a full outsourcing of the coding? As stated volumes will fluctuate To be determined Page 5 of 13

6 42 In section 5. Specific points it is suggested the vendor uses an encoder to code. Will that be furnished by Cook County so integration is already achievable with the EHR and or billing? If the vendor can use the current encoder at CCHHS is it 3M or Quantim? If we have to furnish the encoder how will the charges b entered into your Patient Financial System? 43 Based on the pricing is all of the coding for the professional component of care? There was one portion of pricing that stated inpatient but there is no mention of DRGs or ICD10 PCS. So just wanted to clarify. 44 Our medical billers & coders are CPC certified through the AAPC- is this congruous to the CCS certification that is required in the RFP? 45 Will this be Ad Hoc work or a fixed volume? Varied All vendors will code into the CCHHS Nuance system only Facility services only The RFP is for Coders only, not medical billers. All staff must be credentialed (AHIMA, RHIT, RHIA, CCS), current, not expired and a copy of all credentials must be provided to CCHHS before staff can work in the CCHHS Cerner, Nuance IT system. This includes Coders, Supervisors and Managers 46 What is the estimated volume of work? 47 Can contractor coders with CPC and/or COC credential be utilized for outpatient coding types that involve CPT-4/Evaluation and Management coding? 48 There are 7 CCHHS facilities, is it possible ALL contract coding assistance will be needed at any of the 7 facilities or will it primarily be needed at John H. Stroger Jr. Hospital of Cook County Hospital of Cook County, Provident Hospital of Cook County and Ambulatory and Community Network? 49 Can patient volumes be provided for each of the 7 CCHHS facilities? 50 What Coding/Abstracting system is used? Cerner Page 6 of 13

7 51 What encoder is used? Will contractor be able to use CCHHS encoder or have to provide own encoder to contractor coders? Nuance 52 What EMR is used (list for each facility if different EMR s are used)? 53 Does CCHHS have CAC Computer Assisted Coding software? If so, which product and what coding types are routed through CAC? 54 Confirm productivity standards for ICD-10 coding by type: a. Inpatient 5 records/hour b. Same Day Surgery 10 records per hour c. Emergency Department 16 records per hour d. Observation 11 records per hour e. Minor Procedure 13 records per hour f. Chemotherapy 8 records per hour g. Cardiac Cath 9 records per hour 55 Does Same Day Surgery coding include any charge validation and/or Interventional Radiology coding? Cerner Confirmed 56 Does Emergency Department coding include any of the following:? a. Procedure charging b. Injection & Infusion c. Facility E/M assignment d. Professional E/M assignment 57 Provide examples of Minor Procedure coding? 58 Does Cook County Health System currently use a 3rd party coding services company? 59 Are privately held companies required to submit 3 years of financial statements with RFP submission or will a letter of opinion a. b. c. d. Reference answer to Inquiry #33 Please follow the requirements of the RFP to avoid possible Disqualification Page 7 of 13

8 suffice until award, or considered as a finalist? 60 This volume may fluctuate from time to time and the Contractor shall be expected to provide the staffing necessary to facilitate timely coding of all records as designated by CCHHS. 61 Services will be performed remotely (off-site) for electronic records, therefore, it is necessary for the Contractor to demonstrate a secure ability to connect to CCHHS systems. Can you provide a break out of estimated volumes by modality? Is this work to replace existing staff and/or existing vendor staffing? 62 I see that you are requesting multiple pricing options, which we will be happy to provide you with. For staffing purposes, can you let us know what level of volume you are anticipating for this project? 63 In regards to CCHHS insurance requirements, can you let us know the specific amount that is required by CCHHS? 64 For the personnel reviews done by us, on our staff, is this billable time to CCHHS? 65 For the encoder - is this supplied by CCHHS or will vendor need to supply encoders for the coding professionals? Also, if we code within the CCHHS encoder - what encoder is utilized? In the RFP in this section under Specific Points #1 it is stated "Above noted tools and resources shall be provided by the Contractor". But then further in the RFP, in the same section under #5 it states "enter the coded data into the CCHHS system". Please clarify - and thank you! Industry Standards CCHHS will provide the encoder, Nuance All vendors must code in the CCHHS Nuance coding system Page 8 of 13

9 66 Under #2 within this section, the E&M facility leveling tool is noted - could this be supplied to potential respondents? 67 Under the Miscellaneous portion of this section internal CCHHS guidelines are noted. Could these guidelines be supplied to potential respondents? 68 Under the Miscellaneous portion of this section internal CCHHS guidelines are noted. If these guidelines cannot be released, can you please clarify the following: Inpatient Coding - do you code all secondary diagnoses noted on the record including all history of and status codes? Or do you only code current treated and chronic conditions? Same Day Surgeries - do you code CPT only or CPT & PCS? Observations - do you code/calculate the hours? Do you code injections/infusions? Do you code all secondary diagnoses noted in the record including all history of and status codes? Or do you only code current treated and chronic conditions? Emergency Records - Do we need to code the Professional E&M codes? Do we need to code injection/infusions? For your "Minor Procedures/Chemo/Card Cath" - will we need to code PCS and CPT or CPT only? DO we need to code injection/infusions CPT's? 69 Under the productivity noted - is this your current actual productivity for each area? IF SO - please clarify if this is the coding ONLY or coding and data entry/abstracting. What encoder is being used to achieve these numbers? Is there a CAC involved? The numbers are exceptionally high compared to national averages. IF THEY ARE NOT: please tell us what your current productivity numbers are for each given area and what it entails (coding only or coding and abstracting, encoder used, CAC, etc.) 70 Under General Requirements - what EMR do you utilize? What hospital system? All ICD-10-CM Official Guidelines for Coding and Reporting FY2016/2017 are listed on the CMS web site. Cerner Page 9 of 13

10 71 What is the timeframe Cook County is Within the next two to three months. interested in starting the engagement? 72 What is the final date that an award decision will be made? 73 Will Cook County select more than one Contractor for the award? 74 What is the total budgeted amount of the award? 75 Is Cook County currently receiving the same level of services from another vendor? 76 Will the scope of hospitals and clinics requiring coding services be the same throughout the duration of the contract, or are there any changes expected? 77 Are there any immediate issues that need prioritization or goals that need targeting (eg. high DNFB, backlogged coding in particular areas, etc.)? 78 When coding ER charts will the coders need to do any charge entry or validation, and will it include infusions and/or injections? TBD Reference answer to Inquiry #18 Will vary All ICD-10-CM Official Guidelines for Coding and Reporting FY2016/2017 are listed on the CMS web site. 79 In the heading it shows 5 per hour for IP, 10/hr. for SDS, etc.). Are those the productivity standards required by the vendor? What are the current productivity standards for your current coders by the following chart types (Inpatient, Same Day Surgery, Observations, Ancillary, ER, Minor Procedures, Chemo Therapy? 80 We see the ranges of volumes in the pricing laid out as 1-4. Can you provide any insight on the historical volumes you had vendors help with by chart type? 81 Will the vendor have the opportunity to review the changes and provide confirmation to the mistake or rebuttal before reimbursement is final? Refer to the RFP requirements for answer Reference answer to Inquiry #12 Page 10 of 13

11 82 On page 7, 3 at the top of the page suggests we have to submit hourly rates but in the pricing proposal submission section it states "per chart OR per record". Are you open to one or the other, or do we have to submit both? Refer to the RFP requirements for answer 83 Can you please explain what you mean by the heading in pricing labeled "Monthly Rate per staff person w/qa 10 coded records"? 84 What's the difference between the "Project Scope" and "Proposer's role/scope (sufficient description)"? 85 Will vendor have VPN access to work in the hospitals Electronic Heath Records, Encoder, and Abstracting system? If so, what systems is the hospital using? 86 Is there a current backlog? And if so, what is the size of the backlog and is that something the Vendor would be responsible for? 87 How often will Vendor Supervisor support need to have meetings with Managers of Coding, outside of specified meetings within RFP? 88 Are any of the meetings between Vendor and CCHHS to be done in person and on-site? If so will these be weekly, monthly or quarterly? Refer to the RFP requirements for answer Do not understand the question Reference answer to Inquiry #9 To be discussed upon contract award. Reference answer to Inquiry #9 89 What type of Software does CCHHS Use? Refer to the RFP requirements for answer 90 Will the hospital provide access to the software or will vendor have to provide the sw? Hospital provide access 91 Will the auditing and QA requirements be a fee absorbed by Vendor or a separate line item for services rendered? 92 Is there a breakdown of how the "Take-back" rule applies? And are there any other supporting documents or information surrounding this rule? Vendor Refer to the RFP requirements for answer Page 11 of 13

12 93 There are 4 levels listed; Does this mean there will be at least 4 levels of numbers of charts coded? 94 There are 2 sections for pricing Per hour and per chart; What is the current payout structure? 95 By CCHHS Terms, is there a between Per Chart and Per Record? 96 Please provide what CCHHS defines as a "Minor Procedure". 97 "Volume of work This is listed on per month basis and range is from 2,500 to 10,000+. What is the average monthly total charts? What is the number of claim submission per Week?" 98 Has there been or should we anticipate records to exceed 15,000 in any given month? 99 How is your coding being supported today? Is it outsourced or done in house? 100 If current coding is being contracted, is this contract and amendments accessible for review? 101 Are the coders currently being paid per chart or per hour? 102 Are ICD-9CM records still expected to be coded? 103 Can you please clarify the 4 columns of pricing options? Why are there 2 "Per chart or record" columns? 104 What does "hourly rate OR w/productivity standard" mean? 105 The Productivity Expectations you noted per record type are high compared to that noted in recent literature studies. Please provide clarification on how these expectations were set. If the productivity rate is less than stated, the hourly rate will be less Chart, Record, Encounter all the same meaning CCHHS does not define a minor procedure, industry standards do. Both, via a formal Freedom of Information Act (FOIA) request. The CCHHS currently pay the contractor whom in turns pay s coders. To provide a broad range of CCHHS expectations How many hours worked per service as determined by the productivity rate CCHHS set standard 106 How are work queues set-up? By encounter number, length of stay, patient name, patient date of birth Page 12 of 13

13 ADDENDUM ACKNOWLEDGEMENT FORM As required by the RFP, Proposers must submit this acknowledgement form with their response. One acknowledgement form per response, listing all addenda, is appropriate. Addendum.: Addendum.: Addendum.: Addendum.: Addendum.: Addendum.: Company Name: Representative s Name: Signature: Date: END OF ADDENDUM Page 13 of 13

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