Medical and Dental Coding, Auditing, and Data Entry Services, Area-wide Phoenix Area IHS

Questions & Answers / Clarifications

This document provides responses to vendor questions regarding the RFQ-26-PHX-021, clarifying aspects of coding and auditing services.

• Inpatient Coding Volume: Average length of stay metrics will not be provided. Encounters may be presented to coding prior to full chart completion.
• Outpatient Coding Service Types: Service types vary by Service Unit and may include Emergency Departments, outpatient, and specialty services.
• Audit Scope: Coding quality audits, including clinical documentation, regulatory compliance, and third-party denials, will be specified at the BPA call level. Audits may include both Government and contractor coding activities.
• Encoder Software: The Government does not provide encoder software; contractors must supply their own.
• Coding Policies: Unique coding policies and procedures per site exist.
• Query Process: The Government uses standard clinical documentation query processes. Contractors may be required to identify documentation deficiencies and initiate or track queries per Service Unit procedures. Response timelines vary.
• Volume Expectations: Stated volumes are estimates only; no minimum quantity is guaranteed.
• Payor Edits/Denials: Third-party billing and accounts receivable functions are managed separately.
• Backlog: Backlog conditions may exist and will be addressed through BPA calls; specific volumes will be defined at the call level.
• Immediate Site Needs: Priorities for sites needing immediate assistance will be determined at the BPA call level.

This Q&A clarifies operational details and requirements. Bidders should note that specific audit scopes, workload distribution, complexity, and prioritization will be defined at the BPA call level. Quantities are estimates, and no minimum is guaranteed. Contractors are responsible for providing their own encoder software.

Solicitation / RFP / RFQ

This is a combined synopsis/solicitation for a Multiple-Award Blanket Purchase Agreement (BPA) under FAR Part 12 for off-site medical and dental coding, auditing, and data entry services. The Indian Health Service (IHS), Phoenix Area Office, requires these services to support compliance with CMS, Federal, State, and third-party payer requirements, improve data integrity, and ensure timely and accurate reimbursement. The acquisition is conducted pursuant to the Buy Indian Act and is set-aside exclusively for Indian Small Business Economic Enterprises (ISBEEs).

• Off-site medical and dental coding, auditing, and data entry services.

• Services must support compliance with various payer requirements and improve data integrity.

• The Government does not guarantee any minimum quantity; payment is based solely on completed encounters.

• A Statement of Work (SOW) is provided as an attachment detailing specific requirements.

• Contract Type: Multiple-Award Blanket Purchase Agreement (BPA).

• Anticipated BPA Term: Up to five (5) years from the date of award.

• Number of BPAs Anticipated: Up to two (2).

• BPA Calls (Orders) will be firm-fixed price.

• Quotations must be submitted electronically via email to dekovan.cook@ihs.gov by the specified due date and time (local Phoenix, Arizona time).

• Technical Quotations: Searchable PDF format.

• Priced Quotations: Separate Excel file with active formulas, valid for at least 90 calendar days.

• Evaluation Factors (in descending order of importance): Technical Capability and Approach, Relevant Experience and Past Performance, Quality Control and Compliance, and Price.

• Award will be made on a best-value tradeoff basis, where non-price factors are significantly more important than price.

• This acquisition is restricted to Indian Small Business Economic Enterprises (ISBEEs).

• Eligibility must be demonstrated by submitting a completed and signed Indian Economic Enterprise (IEE) Representative Form. Failure to submit this form will render the quotation ineligible.

• The NAICS Code is 541611 – Other Accounting Services, with a Small Business Size Standard of $24.5m.

• Services are anticipated to be performed remotely.

• Applicable clauses include FAR 52.212-1, 52.212-2, 52.212-3, 52.212-4, and 52.212-5, along with specific HHSAR clauses related to Buy Indian preferences and electronic invoicing.

Statement of Work (SOW) / Performance Work Statement (PWS)

To provide comprehensive medical and dental coding, auditing, and data entry services for various Service Units within the Phoenix Area Indian Health Service (PAIHS) to ensure compliance with federal and state laws, policies, and regulations, and to facilitate proper reimbursement.

• Perform off-site medical and dental coding, auditing, and data entry for Outpatient and Inpatient visits.

• Assign appropriate ICD diagnosis and procedure codes, ADT, CPT, HCPCS, E/M codes, modifiers, and trans-codes.

• Enter data from EHR/EDR notes or PCC paper forms into the RPMS PCC Package.

• Adhere to coding timelines: Outpatient visits coded within 4 business days of service, and inpatient visits within 10 business days of discharge.

• Monitor and complete "Incomplete" visits.

• Merge ancillary service "items" into a single "visit" for charging purposes.

• Scan incomplete inpatient documentation to a secure folder for contractor, COR, and Service Unit personnel.

• Conduct quarterly coding quality audits if requested, identifying areas for improvement.

• Period of Performance: May 1, 2026 - September 30, 2031 (5-year BPA).

• Services will be performed off-site at the Contractor's location.

• Contractor must have experience with the IHS computer system (RPMS), PCC Package, ADT Package, and EHR/Dental Record.

• Staff must be qualified, experienced, and credentialed (AAPC or AHIMA certified).

• Non-credentialed staff must be supervised by a certified coder.

• Contractor must provide expected daily quota for staff.

• Access to IHS systems requires VPN connections and adherence to HIPAA and Privacy Act regulations.

• Compliance with Homeland Security Presidential Directive-12 (HSPD-12) for identification and access.

• Mandatory security and privacy training for all staff.

• Strict adherence to confidentiality, integrity, and availability of government information.

• Reporting requirements include monthly volume and status reports.

• Compliance with NIST SP 800-64, NIST SP 800-53, and NIST SP 800-171 for information security.

• Encryption of all sensitive data (in transit and at rest) using FIPS 140-2 validated solutions.

• Contractor Non-Disclosure Agreement (NDA) required for all employees.

• Privacy Threshold Analysis (PTA) and potential Privacy Impact Assessment (PIA) assistance.

• Mandatory training for all contractor staff, including role-based training and record maintenance.

• Adherence to HHS Information Technology General Rules of Behavior.

• Response to security incidents within 24 hours.

• Background investigations for employees commensurate with position sensitivity designation.

• Compliance with contract initiation, expiration, system documentation, sanitization of files, and records management policies.

Form / Attachment / Pricing Sheet

This document provides the template for the Pricing Schedule required for the Medical and Dental Coding, Auditing, and Data Entry BPA (PAIHS). Offerors must use this template to submit their firm-fixed unit prices for the services listed.

• Instructions to Offerors: Specifies that pricing must be inclusive of all costs (labor, overhead, profit), quoted per encounter (unless otherwise specified), and rounded to two decimal places. Quantities are estimates for evaluation only.
• BPA Pricing Table: Includes CLINs for Outpatient Coding, Inpatient Coding, Outpatient Coding Audit, and Inpatient Coding Audit. Offerors must provide Unit Prices and Extended Prices for each.
• Total Evaluated Price: A field to sum all Extended Prices.
• BPA Call Order Pricing: Notes that individual call orders will be priced based on awarded BPA unit prices.
• Pricing Assumptions: Offerors must identify any assumptions impacting their pricing (e.g., minimum volume, system access, staffing).
• Notes: Payment is based on completed encounters; incomplete or rejected work will not be invoiced. The Government reserves the right to validate quantities.

This pricing schedule is critical for bidders to understand the structure of pricing expected for the BPA. It outlines the specific services to be priced, the unit of measure (primarily 'Per Completed Encounter'), and the estimated annual quantities for evaluation purposes. Bidders must carefully complete this schedule, including any necessary pricing assumptions, to form the basis of their proposal and potential BPA awards.

Form / Attachment / Pricing Sheet

This document is a pricing schedule template for the Medical and Dental Coding, Auditing, and Data Entry BPA (PAIHS). Offerors are strongly encouraged to use this template to ensure consistency in evaluation. Alternate formats are permissible if they include all required pricing elements for direct comparison.

• Instructions to Offerors: Requires firm-fixed unit prices per service, inclusive of all costs (labor, overhead, profit). Prices are quoted per encounter unless specified otherwise. Quantities are estimates for evaluation and do not guarantee a minimum amount. Unit prices should be rounded to two decimal places. All cells must be workable and unlocked.
• Per Completed Encounter: Defined as a single patient visit documented in the Government system (RPMS/EHR) that is fully coded and marked complete.
• BPA Call Order Pricing: Individual BPA Calls will specify service unit, type of service, quantity, and period of performance. Pricing will be based on awarded BPA unit prices.
• Pricing Assumptions: Offerors must identify any assumptions impacting pricing, such as minimum volume, system access, or staffing models.
• Priced Quote Sheet: Includes CLINs for Outpatient Coding, Inpatient Coding, Outpatient Coding Audit, and Inpatient Coding Audit, with estimated annual quantities and unit prices (initially set to 0.0).

This document is critical for bidders to understand how to structure their pricing. It outlines the required format, specific services to be priced (coding and auditing), the unit of measure (per completed encounter), and the need to detail any pricing assumptions. Bidders must provide firm-fixed unit prices for each CLIN listed, ensuring their pricing is comprehensive and comparable to other offers.

Form / Attachment / Pricing Sheet

This document is Attachment B, a Business Associate Agreement (BAA). It outlines the terms and conditions under which a "Business Associate" (the vendor) will handle Protected Health Information (PHI) on behalf of the "Covered Entity" (Indian Health Service - IHS).

• Definitions: Clarifies terms such as Business Associate, Covered Entity, HIPAA Rules, and Master Patient Index (MPI).
• Obligations of Business Associate: Details requirements for safeguarding PHI, reporting unauthorized uses/disclosures/breaches, managing individual access to PHI, accounting for disclosures, and amending PHI.
• Permitted Uses and Disclosures: Specifies how the Business Associate may use and disclose PHI, generally limited to performing services for the IHS, with specific conditions.
• Obligations of Covered Entity: Outlines the IHS's responsibilities, including providing privacy notices and notifying the Business Associate of limitations or changes.
• Termination: Defines the term of the agreement and conditions for termination, including obligations upon termination (e.g., returning or destroying PHI).
• Indemnification: Addresses liability for failure to comply with HIPAA Rules.

Vendors who will have access to or handle Protected Health Information (PHI) as part of this contract must understand and agree to the terms of this Business Associate Agreement. Compliance with HIPAA Rules is mandatory. This document is critical for ensuring data privacy and security and will likely be a required part of the contract if awarded.

Form / Attachment / Pricing Sheet

This document is the "Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form." It serves as a self-certification for offerors to declare their status as an "Indian Economic Enterprise" in accordance with the Buy Indian Act. This form is required in response to a Sources Sought Notice, Request for Information (RFI), or Solicitation.

• Solicitation/Sources Sought/RFI #: Field to enter the relevant identifier.
• Project Title: Field to enter the project title.
• Date: Field to enter the date.
• Representation: Offerors must indicate whether they represent that they do or do not meet the definition of an "Indian Economic Enterprise" with "Indian Ownership."
• Name of Federally Recognized Tribal Entity: Field for the name of the tribal entity.
• Name of the 51% owner of IEE Firm: Field for the name of the 51% owner.
• Business Name: Field for the business name.
• Certifying Signature: Field for the signature.
• Unique Entity Identifier (UEI) Number: Field for the UEI number.
• Print Name: Field for the printed name.

Bidders must complete and submit this form to self-certify their eligibility as an "Indian Economic Enterprise" if they intend to claim this status for the opportunity. Failure to meet the definition of an "Indian Economic Enterprise" throughout the solicitation, award, and performance periods can lead to disqualification or penalties. Offerors must also be registered with the System of Award Management (SAM).