Notice ID: 47QFA22Fxxx1
“The scope of this work will be to provide systematic, unbiased, independent examination of medical documentation and coding to validate that all codes entered into the Military Health System (MHS) systems are in conformity with official coding policies, regulations, requirements, and standards. The task involves developing or following a disciplined, systematic process that defines what is to be audited and why, how errors are defined and reported, what documentation and official guidance is required, and how results are reported. The primary area of support is medical coding training with eight (8) specific tasks:
- Task 1: Verifies the accuracy of the diagnosis, procedure, supply codes, modifiers, and sequencing for the professional and institutional (facility) components of Inpatient, External Resource Sharing Agreement (ERSA), Ambulatory Procedure Visit (APV), Observation, Emergency Department (ED), and Outpatient encounters. Codes audited include International Classification of Diseases, Clinical Modification (ICD-CM), International Classification of Diseases, Procedural Classification System (PCS), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and modifiers…
- Task 2: Provides second-level review of coding assignment to ensure compliance with legal and procedural policies to ensure optimal reimbursements while adhering to regulation prohibiting unbundling and other questionable practices. Reviews encounter and/or record documentation to identify inconsistencies or discrepancies that may cause inaccurate coding, medico-legal repercussions, or impacts quality patient care…
- Task 3: Provides each assigned MTF with coding audit accuracy data needed to complete their monthly Data Quality Review List/Statement and collaborate on the explanation and action plan to correct any measures not meeting performance standards IAW DHA MCPO policies, procedures, rules, and standards…
- Task 4: Research, analyze, and respond to inquiries, including focused audits, inappropriate coding, and adherence to Military Health System (MHS) coding guidelines…
- Task 5: Conducts or participates in reviews and evaluations of DHA MCPO operations to determine progress, conformity to program requirements and identifies deficiencies and problems affecting cost and delivery of services. Recommends corrective action and methods to resolve problems and achieve compliance with policy. Provides general consultation and technical guidance in the establishment of new or redefined DHA MCPO operating program guides, policies, and procedures. Plans and conducts projects to gather and analyze data which will improve organizational performance…
