HHS - Medical Coding, Auditing, and Data Entry Support - MRAS

On behalf of the Department of Health and Human Services (HHS), the U.S. General Services Administration (GSA) is conducting market research to identify potential contractors capable of providing comprehensive off-site medical coding, auditing, and data entry support services for the Indian Health Service (IHS). The primary focus is to enhance the accuracy and timeliness of clinical documentation and billing data within the Gallup Indian Medical Center and its associated clinics. This initiative aims to address existing backlogs due to high patient volumes and limited staffing, thereby improving reimbursement cycles, compliance tracking, and reporting accuracy.

The work requested involves coding up to 36,000 medical records over a six-month period under a Firm-Fixed Price (FFP) contract. The contractor will be responsible for applying ICD-10, CPT, HCPCS, and E/M codes with appropriate modifiers in accordance with IHS and federal guidelines. These services are crucial for both inpatient and outpatient encounters across various departments such as Cardiology, Gynecology, Mental Health, Pediatrics, Surgery, among others. The contractor must ensure compliance with HIPAA regulations as well as IHS IT security policies while utilizing the Resource and Patient Management System (RPMS) for accurate data entry.

The objective of this contract is not only to maintain a minimum coding accuracy rate of 98 percent but also to improve overall management operations by reducing backlogs and increasing billing efficiency. By ensuring that all data adheres to applicable regulations and standards set forth by IHS, this effort will contribute significantly towards enhancing patient care quality and operational efficiency. Additionally, consistent coding practices will facilitate better audit readiness and organizational accountability in healthcare information management.