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Agreement for Vendor Negotiation and Project Management Services document sample
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DEPARTMENT: Regulatory Compliance POLICY DESCRIPTION: Certified External
Support Vendors for Coding Reviews and Related
Education
PAGE: 1 of 3 REPLACES POLICY DATED: 4/16/99, 8/1/00,
6/1/02, 3/1/04, 11/30/04 (HIM.COD.011), 3/6/06,
RETIRED 11/3/09 (replaced by REGS.COD.017)
EFFECTIVE DATE: January 1, 2009 REFERENCE NUMBER: REGS.COD.011
SCOPE: All Company-affiliated facilities including, but not limited to, hospitals and all Corporate
Departments, Groups and Divisions, including, but not limited to, the following departments:
Facility Health Information Management Department Nursing
Corporate Regulatory Compliance Support Ancillary Departments
Case Management/Quality Resource Management Legal
National Agreements/Materials Management Finance
Ethics & Compliance Officers Service Centers
Administration
PURPOSE: To ensure that all ICD-9-CM and CPT coding reviews of medical records for
outpatient and inpatient services and education related to such reviews performed by external
vendors are compliant with official coding guidelines, Company coding policies, and other
regulatory requirements.
POLICY: ICD-9-CM and CPT Coding reviews performed by external vendors will only be
completed by vendors who have been certified to meet the quality and business practice standards
outlined in this policy. Certification of vendors is the responsibility of the Corporate Regulatory
Compliance Support Department. Contract negotiation is the responsibility of National
Agreements. This policy does not apply to chargemaster reviews or coding/billing reviews for
physician professional services.
PROCEDURE:
SECTION I: Requesting an External Coding Review
Any facility, Group, Division, Service Center or Corporate Department requesting a retrospective
external coding review must choose a vendor from the certified vendor list and follow the process
outlined below.
1. The facility should notify a Regulatory Compliance Support Coding Manager of the planned
review so the need and scope of the review can be clarified/evaluated.
2. The facility must select a vendor from the certified vendor list for coding reviews. (See the list
of Certified External Vendors for Coding Reviews on the Company’s Intranet site at:
http://atlas2.medcity.net/portal/contentuid/f0f3fc5ae5212c37904f5ad29c01a1a0/Certified
ExtVenCodingRvsREGSCOD011.doc).
1/2009
DEPARTMENT: Regulatory Compliance POLICY DESCRIPTION: Certified External
Support Vendors for Coding Reviews and Related
Education
PAGE: 2 of 3 REPLACES POLICY DATED: 4/16/99, 8/1/00,
6/1/02, 3/1/04, 11/30/04 (HIM.COD.011), 3/6/06,
RETIRED 11/3/09 (replaced by REGS.COD.017)
EFFECTIVE DATE: January 1, 2009 REFERENCE NUMBER: REGS.COD.011
3. Make arrangements for the review through the vendor contact person listed.
a. All arrangements must be confirmed in writing by completing the Work Order/ Provider
Agreement for Coding Review Services (See Attachment A ) or other Corporate
Regulatory Compliance Support-approved work order.
b. If the selected vendor cannot accommodate the request, select another vendor from the
list.
c. If all certified vendors cannot accommodate the request, contact the Coding Vendor
Project Coordinator.
4. The facility should notify a Regulatory Compliance Support Coding Manager of review dates
including the exit conference.
5. Final reports must be submitted to the facility or other requester and copied to the Vendor
Project Coordinator by the vendor as agreed upon with the Work Order/Provider Agreement
within 30 days after the completion of an engagement.
6. The facility must keep the Work Order and all supporting documentation (e.g., record pull lists,
review logs) to verify appropriate billing by the vendor.
7. Payment to a vendor for services rendered shall be handled by the accounts payable department
of the facility, Market Division, Group, or Corporate Department requesting the services.
8. Unresolved concerns regarding the vendor should be communicated to the Materials
Management Customer Service Call Center at 800-265-8422.
a. Unresolved concerns regarding coding recommendations will be forwarded to the
Vendor Project Coordinator for resolution.
b. Unresolved concerns regarding contract issues will be handled by the National
Agreements contact for resolution.
SECTION II: Request to Certify a Vendor
1. The Regulatory Compliance Support Department is responsible for approving all vendors and
maintaining the certified vendor list. Any facility, Group, Division, Market, or Corporate
Department wishing to use a vendor not on the certified vendor list to perform external coding
reviews must perform the following procedure before making review engagement
arrangements. In addition, vendors requesting to be added to the certified list must contact the
Coding Vendor Project Coordinator. The facility, Group, Division, Market, or Corporate
Department must submit a written request to the Vendor Project Coordinator stating the vendor
name, address, contact person and the reason they are requesting to use the vendor.
1/2009
DEPARTMENT: Regulatory Compliance POLICY DESCRIPTION: Certified External
Support Vendors for Coding Reviews and Related
Education
PAGE: 3 of 3 REPLACES POLICY DATED: 4/16/99, 8/1/00,
6/1/02, 3/1/04, 11/30/04 (HIM.COD.011), 3/6/06,
RETIRED 11/3/09 (replaced by REGS.COD.017)
EFFECTIVE DATE: January 1, 2009 REFERENCE NUMBER: REGS.COD.011
2. Direct requests from vendors to become a certified vendor must be submitted in writing to the
Vendor Project Coordinator. Direct requests will be considered during open bid periods only.
3. Upon successful completion of contract negotiations, the facility or other requester of a vendor
review will be notified and a contract may be initiated.
4. Regulatory Compliance Support will update the Certified Vendor for Coding Reviews Policy
and Procedure and all attachments as changes occur and communicate these changes throughout
the Company following the policy and procedure revision process.
1/2009
ATTACHMENT A
PROVIDER AGREEMENT FOR CODING REVIEW SERVICES
HCA Management Services, LP
Services Agreement
Vendor ______________________
Date______________________
Vendor:
Provider:
1. The above named “Vendor” hereby agrees to provide to the above named “Provider,” an
affiliate of HCA Management Services, LP (“HMS”), coding review services (“Services”) in
accordance with the terms of the Business Office Services Agreement between Vendor and
HMS dated ________, ___ (“Service Agreement”).
2. Vendor agrees to provide Services in accordance with the following schedule:
Services Commencement Date:
Services Conclusion Date
(i.e., date of exit conference):
Location: On Site at Provider ___________
Off Site on Vendor’s premises ___________
Type of Review Services: Inpatient ________
Outpatient ________
Bill Status: Pre-bill _________
Post-bill _________
Sample Type: Random _________
Focused _________
Combination _________
Review Frequency: Preliminary _________
Concurrent _________
Bi-monthly _________
Quarterly _________
Other _________
Attachment to REGS.COD.011
Other Parameters (if applicable):
Are HCA Regulatory Compliance Support reporting tools &
template required? Yes ________
No ________
Estimated Sample Size: _______________________
Final Report Delivery Date: ________________________
Are review logs, worksheets, and
other papers to be included with
final report? Yes ________
No ________
3. Provider shall pay Vendor based on the total number of charts reviewed according to the
fees set forth in Attachment A in the Services Agreement. Provider shall also pay the
Vendor pre-approved expenses incurred in provide Services. All fees and expenses must
be paid no later than sixty (60) days from the conclusion of the Services performed and
delivery of the Final Report. Fees and approved expenses may be paid:
_____in a single lump sum, or
_____in installments according to the following schedule:
Date Amount
______ _______
______ _______
4. Report shall be sent to: __________________________________
__________________________________
__________________________________
Copy to: Coding Vendor Project Coordinator
Regulatory Compliance Support
One Park Plaza
PO Box 550
Nashville, TN 37203
Attachment to REGS.COD.011
5. Invoices shall be sent to:
__________________________________
__________________________________
__________________________________
6. Key Person(s) include the following individuals:
__________________________________
__________________________________
__________________________________
7. Notices to Provider shall be sent to the following:
__________________________________
__________________________________
__________________________________
ATTN: ___________________________
8. A copy of this completed Provider agreement in its entirety shall be sent to:
Coding Vendor Project Coordinator
Regulatory Compliance Support
One Park Plaza
PO Box 550
Nashville, TN 37203
9. Anticipated Vendor Expenses:
Items Amount
________________________ _________
________________________ _________
________________________ _________
________________________ _________
10. All terms, conditions and fees in the Agreement, shall be applicable to this Provider
Agreement and are incorporated by reference, and together constitute the entire
understanding between the parties with respect to the subject matter hereof. This
Agreement may not be modified except pursuant to an amendment expressly stating a
purpose to amend the terms of this Agreement, and signed by authorized representatives
of both parties hereto.
11. If this Provider Agreement is in effect when Provider is either sold to an unrelated third
party or its shares of stock (or the shares of stock of its parent corporation) are spun off to
shareholders of HCA Inc., this Provider Agreement and all rights and obligations of
Attachment to REGS.COD.011
Provider and Vendor under this Provider Agreement shall continue to remain in effect in
accordance with the terms and conditions herein.
12. This Agreement shall not be effective until signed by authorized representatives of both
parties and fully executed copies of such are delivered to each party.
VENDOR PROVIDER
By: By:
Name: Name:
Title: Title:
Date: Date:
Attachment to REGS.COD.011
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