Request for Proposal Computer Automated Coding CAC

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Week One: Request for Proposal "Computer Automated Coding (CAC)" Assignment

A large medical group practice is strongly considering the purchase and implementation of a Computerized Automated Coding (CAC) program. Upon the reading of the reference article “How to Conduct a Thorough CAC Readiness Assessment – A White Paper from Nuance Healthcare.” Create a request for proposal (RFP) as a measure to target potential vendors for a response. Your RFP must focus on the accuracy of the software (including documentation of accuracy statistics from providers who have implemented a CAC system), along with recommendations regarding proposed corrective actions.

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A Guide to Writing a Request for Proposal How to let providers propose creative, relevant, and costeffective solutions by focusing on the end, not the means. 1. Structure of an RFP................................................................... 1 1.1. Key sections of an RFP ...........................................................................1 1.2. Statement of Purpose..............................................................................1 1.3. Background Information ..........................................................................1 1.4. Scope of Work .........................................................................................1 1.5. Outcome and Performance Standards ....................................................1 1.6. Deliverables.............................................................................................2 1.7. Term of Contract......................................................................................2 1.8. Payments, Incentives, and Penalties.......................................................2 1.9. Contractual Terms and Conditions ..........................................................2 1.10. Requirements for Proposal Preparation ..................................................2 1.11. Evaluation and Award Process................................................................2 1.12. Process Schedule....................................................................................2 1.13. Points of contact for future correspondence ............................................2 Go to for FREE RFP Documents including: RFP Template RFP Cover Letter Proposal Cover Letter Executive Summary Template Disqualification Letter Rejection Letter Non-Binding Letter of Intent Decision Matrix No-Bid Letter Protest Letter Sole Source Protest Letter Sole Source Justification and Approval (J&A) Letter to Decline a Proposal Contract Award Letter FREE Requests for Proposals (RFP) Template Samples: Software RFP Template Process ERP RFP Template Discrete ERP RFP Template CRM RFP Template Structure of an RFP 1.1. Key sections of an RFP You can easily identify the key sections you should include in your RFP by simply answering each and any of the following questions: 1. Why? Reasons why your organization need to buy a new solution. 2. Who? Description of your organization. 3. What? Nature of your project. 4. How? Contract. Information needed from suppliers. Proposal evaluation criteria. Contract award criteria. 5. When? Selection process timeframe and deadlines. Persons to contact. 1.2. Statement of Purpose Describe the extent of products and services your organization is looking for, as well as, the overall objectives of the contract. 1.3. Background Information Present a brief overview of your organization and its operations, using statistics, customer demographics, and psychographics. State your strengths and weaknesses honestly. Don’t forget to include comprehensive information on the people who will handle future correspondence. 1.4. Scope of Work Enumerate the specific duties to be performed by the provider and the expected outcomes. Include a detailed listing of responsibilities, particularly when subcontractors are involved. 1.5. Outcome and Performance Standards Specify the outcome targets, minimal performance standards expected from the contractor, and methods for monitoring performance and process for implementing corrective actions. A Guide to Writing a Request for Proposal 1/3 1.6. Deliverables Provide a list of all products, reports, and plans that will be delivered to your organization and propose a delivery schedule. 1.7. Term of Contract Specify length, start date and end date of the contract, and the options for renewal. 1.8. Payments, Incentives, and Penalties List all the terms of payment for adequate performance. Highlight the basis for incentives for superior performance and penalties for inadequate performance or lack of compliance. 1.9. Contractual Terms and Conditions Attach standard contracting forms, certifications, and assurances. You may include requirements specific to this particular contract. 1.10. Requirements for Proposal Preparation A consistent structure in terms of content, information, and documents types simplifies things for the people evaluating the proposals. Therefore, you should request a particular structure for the proposal and provide an exhaustive list of documents you want to receive. 1.11. Evaluation and Award Process Lay down the procedures and criteria used for evaluating proposals and for making the final contract award. 1.12. Process Schedule Clearly and concisely present the timeline for the steps leading to the final decision, such as the dates for submitting the letter of intent, sending questions, attending the pre-proposal conference, submitting the proposal, etc. 1.13. Points of contact for future correspondence Include a complete list of people to contact for information on the RFP, or with any other questions. Incorporate their name, title, responsibilities, and the various ways of contacting them into this list. A Guide to Writing a Request for Proposal 2/3 SAMPLE “REQUEST FOR PROPOSALS” TEMPLATE Request for Proposals (RFP) For: [Title of RFP Project] Note: This sample is for a fabrication type of RFP. [RFP ID #] Issued: [Date] Submission deadline: [Time/Date] Bidders Meeting: [Day/Date] Deadline for final submission of questions: [Day/ Date/ Time] Questions: Questions can be submitted prior to the Bidders Meeting on [Date]; however, no answers will be provided and/or circulated prior to that date. ALL QUESTIONS PERTAINING TO THIS RFP MUST BE SUBMITTED BY [Day/Date/Time] No interpretation of the meaning of the Bid Documents (drawings, specifications, et. al.) will be made to any bidder. Questions may be submitted, in written form, to: [Contact details] or emailed to _________ . Questions will be answered by the appropriate individuals and answered within 2 business days via email with a return reply acknowledging receipt of the email requested. Questions and answers will be shared with all bidders. Introduction [Institution], (Owner) invites proposals for [RFP work description]. Based on previous work experience, your firm has been selected to receive this RFP and is invited to submit a proposal to produce the exhibition experiences described herein. BIDDERS SHOULD NOTE THAT ANY AND ALL WORK INTENDED TO BE SUBCONTRACTED AS PART OF THE BID SUBMITTAL MUST BE ACCOMPANIED BY BACKGROUND MATERIALS AND REFERENCES FOR PROPOSED SUBCONTRACTOR(S) - NO EXCEPTIONS. Bidders Meeting There will be an opportunity for prospective Bidders to meet with [Institution} staff for a Question and Answer session at [place] on [date]. Bidders Meeting details: Date: Time: Location: Participation at the Bidders Meeting is not mandatory, however, it is limited to two (2) people per firm. The purpose of this meeting is to give vendors the opportunity to ask [Institution] questions about the exhibition(s). If you are intending to send representatives to this meeting please send an RSVP to [Name], who can be reached at [contact info]. Please provide us names and titles of those attending by [date]. Each bidder will be responsible to provide detailed minutes and notes of the meeting within two (2) business days of the conclusion of the conference including detailed description of any changes made to the scope of work. These should be forwarded to [contact info] as Microsoft Word documents. [Institution] will then create a master meeting record that will be distributed to Bidders within the following two (2) days. The minutes will serve as the (only) official record of the items discussed and resolutions made during the meeting. All modifications noted in these minutes will be shared with all bidders Exhibition(s) included in this RFP: Please refer to the attached [Title of List] for the complete roster of exhibit experiences included in this RFP package. The experiences listed on this roster are part of the following exhibition(s) in development, slated to open [date]: [List Exhibition(s)] The scope of work for each of these exhibitions is detailed in the Proposed Scope of Work section of this RFP. To bid on an exhibit, the Contractor must complete all scopes of work listed therein. [Optional:] Bidders must bid on complete exhibitions. Bidders may bid on all of the exhibitions, or only select ones, but the bid(s) must incorporate all of the identified scopes for ALL of the exhibits described within each selected exhibition project. Background [Provide background on Institution and project(s) relevant to the RFP.] Submission Procedure Proposals conforming to the requirements set out below must be received by [Contact info] by US mail, courier or email [Contact info] no later than the deadline given above. All submittals must be received in PC - CD form along with hard copies. [X #] copies of each format are required. Text portions of the submittals are acceptable in Adobe Acrobat® form by the deadline (including via email) but must be followed in CD and hard copy form within two (2) business days. All electronic Bid Sheets must be submitted as Excel documents, not PDFs. Proposals must state that they are valid for a period of at least ninety (90) days from the closing deadline. Physical proposals must be submitted in sealed opaque containers and marked, [RFP title]. The name and address of the bidder must also appear on the envelope and CD cover. RFP SAMPLE TEMPLATE 2 [Institution] reserves the right to waive irregularities and to reject any or all bids. The Owner also reserves the right to negotiate with the selected bidder in the event that the price exceeds available funds. [Institution] may consider informal any bid not prepared and/or not submitted in accordance with the provisions hereof and may waive any informalities or reject any and all bids. Any bid may be withdrawn prior to the above scheduled time for the opening of bids or authorized postponement thereof. Any bid received after the time and date specified shall not be considered. No bidder may withdraw a bid within sixty (60) days after the actual date of the opening thereof. Modification of Bids Modifications to bids already submitted will be allowed if submitted in writing prior to the time fixed in the Request for Proposals. Modifications shall be submitted as such and shall not reveal the total amount of either the original or revised bids. Standards, Documentation and Training The Contractor (Fabricator) is required to review [insert and Institutional design/fabrication standards documents that might be applicable]. Any deviation from these standards must be approved by [Institution]. [Optional:] These standards and other RFP documents will be made available on the web. Bidders will be notified via email once the RFP website is established. PROJECT DOCUMENTS: The following accompany this RFP in [Disc] Format: [Institution] [RFP Title] [Institution] [RFP Title] Bid Sheets: Each electronic project folder includes a tab for individual exhibits plus a Consolidated Bid Sheet listing all of the exhibits within [the/each] project. [List Bid Sheet titles] Exhibition Documentation: These files include [Exhibit Descriptions/Exhibit Drawings] for the exhibitions included in this RFP: [List exhibition(s) and reference appropriate supporting docs] Exhibition Project Overviews [Institution] Sample Contract Template [date] [Institution] Standards/Guidelines Documents: [List any applicable docs] RFP SAMPLE TEMPLATE 3 [Optional] Accessing the Project Documents via the web. The above documents will be made accessible via the web at: [URL] If you have difficulties accessing these documents please contact [contact info]. Opening, Evaluation and Contracting Proposals may be opened by [Institution] at any time after the submission deadline. All proposals satisfying the requirements of this Request for Proposals will be evaluated to establish which of the offerors best fulfills the needs of [Institution] and this project. [Institution] anticipates entering into a contract with this/these offeror(s) to execute the proposed work. This Request for Proposals, however, does not commit [Institution] to award a contract, to pay any costs incurred in the preparation of a proposal or to contract for the goods and/or services offered. [Institution] reserves the right to accept or reject any or all proposals received as a result of this request, to negotiate with all qualified offerors or to cancel this Request for Proposals, if it is in the best interests of [Institution] to do so. The decision of [Institution] shall be final. After the selection of a Contractor the schedule should include a period of collaboration between [Institution] and the Contractor to better define, elaborate upon and fix the Contractor’s exact and final scope of Work (the “Final Scope”) starting with the date of this Agreement and extending until [date]. In collaboration with [Institution], the Final Scope will be fixed no later than [date]. While the Contractor should assume work begins immediately upon notification that they have been selected, the Final Scope will be defined by editing, redlining or adding superseding documents or drawings to the Proposed Scope of Work as attached hereto. Once contracted, with respect to the Exhibit Documentation, Contractor warrants to Owner that the Scope of Work reflected therein can be completed by Contractor, in a form substantially similar to the preliminary scope, for the amount of the compensation set forth below. Standards and Work Summary Parts of this invitation’s documents are [Institution]'s [list any applicable standards documents and/or official guidelines included in the RFP]. [Institution] expects to enter into a contract using these standards, especially those sections establishing warranties, guarantees and [Institution]'s rights to intellectual property. Form of Contract Enclosed with this Request for Proposal is a sample copy of [Institution]’s typical form of contract. [Institution] expects to enter into contract with the successful bidder on the basis of this form of contract. The submission of a proposal implies an acceptance of determining final scope amounts and general acceptance on the part of the bidder of the terms of this form of contract, and especially of those parts establishing warranties, guarantees and [Institution]’s rights to intellectual property. In addition, all aspects of the proposed work must comply with [Institution’s] [Standards doc(s)] and [Institution]’s Liquidated Damages policy (reference below). Owner’s Liquidated Damages. [Insert Institution’s Liquidated Damages requirements.] RFP SAMPLE TEMPLATE 4 Project Completion The Project is to be completed on or before [date]. Proposal Contents Proposals, together with letters of transmittal, should include the bidder’s description of the work that would be performed and the following information: • For each exhibit describe the level work of work to be performed. • The team of people who would execute the work, with descriptions of the experiences and skills of each and his/her role in the bidder’s firm and in the team. • Names, addresses and descriptions of key subcontractors which your firm would employ and a description of their relevant experience and past performance. Any subcontractors must be identified in the bid. [Institution] must know if work is being done outside of the firm. Please see the contract on details of subcontractors. Please remember that after contract signing [Institution] reserves the right to approve all subcontractors that were not approved during the RFP process. Denial of a subcontractor by [Institution] will NOT absolve the bidder from getting the work done for the contracted price. • The name of the person in your firm who would be the official contact person for any contractual relationship. • At least two comparable previous projects in which the bidder has engaged, with names and telephone numbers of contacts with whom the bidder’s previous performance can be discussed. • Examples from past projects that reflect the deliverables and scope that are listed in the scope of work. • A management plan for the work. • A schedule for the work, including the range of start dates to which your firm is prepared to commit and anticipated completion dates. This schedule should work within the timeframes outlined by [Institution]. Any conflict in the two should be described. The schedule should include a list of all anticipated meetings with [Institution] and their locations. • Proof of insurance and bonding. • Completed Bid Sheets. • Written description and explanation of the completed Bid Sheets. • A completed [Institution] Consolidated Bid Sheet, an estimated detailed budget, an estimate for the full scope of work described for the exhibition(s) in its(their) entirety, and the anticipated cash flow. P LEASE NOTE: BUDGET ENTRIES SHOULD BE MADE IN THE SAME ORDER AS THE EXHIBITS LISTED ON THE BID SHEETS. With their proposal, the Contractor must complete the [RFP title] Bid Sheets. RFP SAMPLE TEMPLATE 5 Each exhibition project includes individual Bid Sheets for each of the exhibit experiences included in this Request for Proposals, as well as a Consolidated Bid Sheet which lists all of the experiences in that project. Each bidder shall use the Bid Forms included in the Bid Documents to prepare their bid. No other bid forms or formats will be allowed except as part of the supplemental information described above (e.g. estimated detailed budgets). For Bid A on the bid sheets we are asking each bidder to describe the experience that comes as close as possible to the Exhibit Description provided. Bid A is mandatory. All blank spaces must be filled in. Bidders should also review the preliminary equipment lists and identify any issues (e.g., either overkill on equipment or lack of necessary equipment to make the experience work) [Optional:] Additionally we are inviting bidders to propose up to three (3) Alternate Bids that provide for cost savings and value engineering. Bidders should include the cost estimate(s) for Alternate Bids on the Bid Sheets, in the spaces allocated, and provide a short description of the experience and any fabrication approach. Submission of Alternate Bids is optional. Total calculated prices shall be given in both words and figures. These sheets have been included in an electronic form as Excel documents. Contractors can decide to bid only on one or more exhibitions within this RFP, however, as noted previously, bid submittals should be for the [RFP type] project(s) as a complete package. In other words, Contractors cannot bid on select scopes of work and/or experiences within a single exhibition project. If a Contractor selects not to bid on the entire RFP, please provide the reasoning for your selection(s). PROPOSED SCOPE OF WORK: Exhibit Elements Covered by this Request for Proposals This Request for Proposals covers defined elements for each exhibition. These elements are described in the Scopes of Work section of the Drawings / Descriptions provided for each of the exhibit experiences within each exhibition project. These include the Scopes of Work listed under the header, “General Fabricator” in the Exhibit Descriptions and Drawings. As mentioned in the “Opening, Evaluation and Contracting” section above, the final scope and thus final fee will be determined in meetings immediately following the award of the work. The actual elements and a list of implementation responsibilities are found for each exhibit in the Scope of Work section of the Exhibit Descriptions and the Exhibit Drawings under the title “of “General Fabricator.” For each of these elements, the Contractor must perform “The Work” as listed in this document. [Institution] will be operating as Project Manager and Coordinator for the work. Request for Proposals Overview Details on the exhibitions and exhibits accompany this Request for Proposals in three forms: RFP SAMPLE TEMPLATE 6 (1) The first is the Exhibition Overview documents for [Exhibition(s)], which provide a short summary of the exhibition(s). (2) The second are Exhibit Descriptions for exhibit experiences for: [List exhibit experiences] These describe each of the exhibits that are part of each of the RFP exhibition projects, including the educational goals, how the exhibit should operate, the content we are drawing on for each exhibit and a description of the scopes of work. The Contractor should review these carefully, as these indicate the desired operation of the exhibit. Contractors should point out in their RFP any conflict between the designs and their indicated operation. [Optional under #2:] Additionally, as part of the Exhibit Descriptions, a tentative equipment list is included as well. As mentioned before, bidders should indicate if they feel the equipment will not allow for a successful exhibit and offer alternates. (3) The third component set is the Exhibit Drawings and an exhibition floorplan(s). Contract [Institution] intends to enter into a contract, which will include the fabrication scope of work outlined in the Project Documents. RFP Scope Clarifications and Exceptions [List anything applicable] THE WORK: All proposals must account for the following scope of work for the elements of the exhibition described in the Scopes of Work section of the Exhibit Descriptions and Drawings listed under the headers, “Scope of Work: General Fabricator.“ If the offeror recommends additional scope, substitutions and/or value engineering alternatives, it should be clearly described in full with the reasons for the alternative and a separate pricing for its inclusion. The [Institution] Standards provide the details on many points of the work listed below. All work must comply with the following [Institution] standards including: - [List any applicable Institutional Standards doc and/or Guidelines] - All applicable [State] Codes [Optional:] In addition, the successful bidder may need to meet with [Institution]’s contracted vendors in the future to detail specialty work as required, and with our multimedia/video software vendors to finalize the scope of work to be performed by the AV Installer. RFP SAMPLE TEMPLATE 7 1. Work Parameters The Exhibit Descriptions describe in as much detail as possible at this time the design intent, pertinent content and any resources available for each of these exhibits. For each exhibit, bidders must describe in specific terms, the experience in the exhibit they will provide as compared to the description provided in the Exhibit Description. These should be supplied on the bid forms. There is a place on each Bid Form for estimated costs for Alternates to the exhibits, as regards design, format, materials, etc. Bidders are encouraged to describe alternates that will accomplish a program’s objectives while reducing the cost of a program. Design The Contractor will be required to produce shop drawings of the exhibit experiences found in this RFP. The Contractor is to collaborate with the [Institution] team to complete the detailed design of the experiences. Creativity must be a strong suit here. [Institution] is looking to improve upon and be innovative with these experiences. As part of the design, engineering or shop drawings, the Contractor may need to work with [Institution]'s lighting Contractor: [list lighting contact as applicable] The successful bidder will be able to call on [Lighting Designer] for any lighting questions. The successful bidder will be responsible to work with the AV installer to ensure that lighting does not interfere with the visual elements that the AV installer is providing. Drawings The Contractor shall include in their proposal all elements required for a complete exhibition, even if not shown on the attached drawings or design development drawings when complete. For the contract, the Contractor must submit a schedule for fabrication and installation that is approved by [Institution]. All exhibits must have shop drawings that are approved by [Institution] prior to fabrication. Final approval will be from the official [Institution] representative, [Name/Title]. If required, the Contractor shall provide drawings and calculations, stamped by a [State] registered structural engineer, which may be submitted to the required [State] agencies for permits, where necessary. All engineering drawings must be reviewed by [Institution] prior to the start of complete engineering shop drawings. Shop drawings and "As Built" drawings will be a final deliverable in both printed and electronic formats. Engineering/Permitting The Contractor is responsible for all necessary engineering and shop drawings of the exhibition, including determining if stamped drawings are necessary. The Contractor is solely responsible to apply, pay for and obtain all permits required for this project including not limited to: Building and Trade permits from [applicable State agency] for hauling equipment and any and all other City, State and Federal permits required for the execution of this contract. Responsibility includes obtaining engineering drawings by a professional engineer licensed in [State], which may be required by applicable authorities. RFP SAMPLE TEMPLATE 8 In addition to shop drawings the Contractor is responsible for supplying fabrication documentation necessary for the permitting authorities. This may include, but is not limited to materials spec sheets with flame spread information and final equipment lists with power distribution documentation. Prototyping As specified in the Scopes of Work, certain exhibits will require prototyping. All prototypes must be reviewed by [Institution], and [Institution] must approve any changes to the exhibit resulting from the prototype prior to final fabrication. The Contractor can suggest elements that do not require prototyping; however, these must be reviewed and approved by [Institution]. Equipment Identification and Acquisition Early in the design development and engineering process an equipment list with vendor sources shall be provided to [Institution] for review and approval for purchasing, as necessary. A final equipment list with contracted vendors will be required for approval by [Institution]. [Institution] has strong relationships with many industries and may elect to seek donations of some equipment. The Contractor should, at the earliest point, identify fabricators of preferred equipment in order to facilitate [Institution]'s desire to ask for support. The Contractor will be responsible for notifying [Institution] of any conflicts with the approved schedule, should [Institution] seek these donations. Construction The Contractor is responsible for the construction of exhibition elements as noted in the Scopes of Work sections of the drawings and Exhibit Operational Descriptions. These include the Scopes of Work listed under the header, “General Fabricator.” [Institution] reserves the right to visit the Contractor during construction of the components. Of special note: If the Contractor is intending to subcontract any work outside of its shop, these Subcontractors must be listed in the response to the Request for Proposals and examples of previous work supplied. Acceptance of the Request for Proposals is NOT an acceptance of these Subcontractors. Once in contract negotiations, [Institution] will reserve the right to review Subcontractors, visit their facilities, talk with references and approve of their inclusion on the job. During fabrication, if a Subcontractor becomes necessary, [Institution] must approve the Subcontractor and reserves the right to review Subcontractors, visit their facilities, talk with references and approve of their inclusion on the job. Fabrication Coordination As noted in the Scopes of Work section of the attached Exhibit Descriptions, there [are/may be] other contracted vendors responsible for production and installation work. The successful bidder will be required to work closely with other vendors/contractors to coordinate construction, shipping and installation details and schedules, as required. Power and Data Access to power and data for all exhibits will be done through [describe details specific to institution]. [As applicable:] As noted in the Exhibit Descriptions and Drawings and the detailed Scopes of Work contained therein, the Contractor is responsible for hard-wiring exhibits to the overhead grid as well as supplying convenience power outlets and power strips. Pretest RFP SAMPLE TEMPLATE 9 The Contractor will provide sample full-scale construction of the proposed designs, as required, for testing before final fabrication. Shipping and Installation All components of the exhibition(s) must be shipped and installed complete by the Contractor. The proposal should indicate the intended means of shipping and any shipping concerns due to exhibit configuration. If needed, Contractor is solely responsible for rigging all equipment into place as designated on plans. Rigging includes lifting, hauling, erection, etc. Should Contractor entertain utilizing cranes for such rigging, Contractor is responsible to perform field engineering test for positioning of crane. Field engineering tests are to include soil borings and a written report by a [State Geophysical Engineer reqt] with recommendations for crane set-up. Guarantee and Service Contract The successful bidder will be required to guarantee that all work shall remain free of defects for one (1) full year after the exhibit opening. A one-year service contract should be included in the proposal. Service contracts should cover periodic maintenance and emergency calls as required. Hardware shall be designed and specified so that if there is a failure of a particular component, [Institution] staff can swap out a back-up piece of equipment while the down part is repaired. Bidders shall describe in detail what is included in their proposed service contract. [ Refer to [Institution] Standards documents for more information regarding guarantees and service contracts.] Schedule [sample] The Contractor's schedule of work must fit within the following estimated project schedule. [List with dates:] RFP Issued Bidders Meeting (optional) RFP Due RFP Awarded/Work Commences/Letter of Intent Sent 50% Design/Engineering Prototyping (as required) 100% Design/Engineering Shop Drawing Deadline Fabrication Commences Fabrication Ends Burn-In: Ready for Exhibit Opening: Warranty The Contractor must warranty all products, work and services provided for a period of one year after the punch list is completed. The Contractor must turn over all equipment warranties to [Institution]. Standards, Documentation and Training The Contractor must comply with all standards described in the [Institution] Standards/Guidelines]. Any deviation from these standards must be approved by [Institution]. The Contractor will be responsible for complete training of [Institution] staff on the operation, maintenance and service of the exhibits and equipment. A manual will be required that includes operation and upkeep RFP SAMPLE TEMPLATE 10 instructions, drawings, diagrams and equipment lists and vendors. This should be supplied in CD PC form. A second manual, with simplified operations and “fix-its” for floor staff, is also required. Notes [List any other specific information that Bidders should be aware of, e.g. as regards on-site installation work.] Other Work If a bidder has identified a scope of work not listed in either the section called “The Work,” nor in “Proposed Scope of Work” that the bidder feels is required to complete the project, then the bidder should assume that scope falls within the bidder’s responsibilities. Any work identified as such must be listed and described separately in the Request for Proposals response and detailed estimates of costs provided. [As applicable:] Therefore, the Union Wage and Affirmative Action Regulations apply to any trades work performed on site. For trade work performed off-site to fabricate the exhibits, Union Wages and Affirmative Action Regulations do not apply. If the onsite work is not trade work, then the regulations do not apply. [Describe any specific requirements for on-site trade labor work and Affirmative Action Regulations.] Ownership [Note: This section should be a summary overview - - with specifics outlined in the contract sample; particularly as regards multimedia projects and 3rd party property.] Any and all drawings, specifications, studies, electronic data, estimates, inventions, discoveries, improvements, concepts, enhancements, and ideas or any portion thereof that the Contractor may conceive, make, invent or suggest, either solely or jointly with [Institution] or any other person or persons, at any time during the provision of the Services, whether at the request or upon the suggestion of [Institution] or otherwise, and whether or not patentable or copyrightable (any such drawings, specifications, studies, electronic data, estimates, invention, discovery, improvement, concept, enhancement, idea, program or portion thereof and any and all derivative works created or prepared from the foregoing being hereinafter referred to as “Work Product”) shall fully, freely and immediately be communicated by Contractor to [Institution] and shall belong to and be [Institution]’s sole and exclusive property. Contractor shall not at any time, whether during or after the termination or expiration of this Agreement, apply for any letters of patent, design, copyright, trademark, mask work right or other form of protection whatsoever in the United States of America or elsewhere for the Work Product. Without limiting any other provision of this Agreement, any Work Product qualifying for protection under the copyright laws of the United States shall be considered “works made for hire” under such copyright laws, and shall be the sole and exclusive property of [Institution]. Contractor hereby irrevocably assigns to [Institution] any right, title, or interest Contractor now has or may hereafter acquire in, to, and under all Work Product, and to any patent, copyright, trademark, mask work right, or other proprietary or intellectual property rights or interests in, to, and under such Work Product. [Institution] and its assigns shall be the sole and exclusive owner of all patents, copyrights, trade secrets, mask work rights, and other proprietary or intellectual property right or interest in connection with such Work Product. Contractor agrees to assist [Institution], at RFP SAMPLE TEMPLATE 11 [Institution]’s cost, in every proper way to obtain and from time to time enforce patents, copyrights, trademarks, trade secrets, mask work rights, and all other proprietary and intellectual property rights and interests in the Work Product, and to that end Contractor will execute and deliver or procure the execution and delivery of all documents and other papers and materials for use in applying for, obtaining and enforcing such patents, copyrights, trademarks, mask work rights, and other proprietary and intellectual property rights and interests, as [Institution] may request in writing, together with any assignments thereof to [Institution] or persons designated by it. Insurance Insurance requirements are specified in the Sample Contract Template provided as part of the RFP materials. Bonding [as applicable] The successful bidder may need to furnish bonds covering faithful performance of the Contract and payment of obligations arising there under as stipulated in this Request for Proposals or specially required in the final Contract Documents on the execution of the Contract. Bidders should assume the bonding amount to be equal to their bid. The Form for Bid asks for the cost of establishing that Bond. Bonding costs should be itemized on the Bid Sheets. Invoicing [List any requirements specific to the Institution.] Subcontractor Bid Please list any subcontractor that you intend to use on this project, their scope of work, and the amount that was included in the bid to cover their work. Subcontractor’s Scope of Work (Example: John Doe Acoustics – acoustic set up Bid $XXXX RFP SAMPLE TEMPLATE 12 Ten More Questions for CAC Vendors | Journal of AHIMA Ten More Questions for CAC Vendors | Journal of AHIMA Ten More Questions for CAC Vendors | Journal of AHIMA Ten More Questions for CAC Vendors | Journal of AHIMA W H I T E PA P E R How to Conduct a Thorough CAC Readiness Assessment A White Paper from Nuance Healthcare H E A LT H C A R E COMPUTER-ASSISTED CODING Contents Introduction................................................................................................................................. 3 The Benefits of CAC.................................................................................................................... 4 The New Role of the Coder.......................................................................................................... 4 Change Management................................................................................................................... 5 Understand The Types of Clinical Document Capture............................................................. 5 Understand Your Technology................................................................................................. 6 Review Your Productivity Standards....................................................................................... 6 Analyze Your Documentation Readiness ................................................................................ 6 Inpatient Coding.......................................................................................................................... 7 Outpatient Coding........................................................................................................................ 7 Analyze Vendors, Assess Resources............................................................................................ 9 Nuance Clintegrity 360 | Computer Assisted Coding (CAC)........................................................... 9 CAC Glossary............................................................................................................................ 10 2 INTRODUCTION Computer-assisted coding (CAC) is a term most hospital executives and health information management (HIM) professionals are exploring, but CAC continues to be an unknown technology. It has been defined by the American Health Information Management Association (AHIMA) as “…the use of computer software that automatically generates a set of medical codes for review, validation and use based upon clinical documentation provided by healthcare practitioners.”1 The learning objective of this white paper is to identify the critical success factors for positioning CAC in your organization. These include: • Prepare your workplan to create a future state environment for CAC. • Assess your own readiness for CAC – resulting in next steps in workflow redesign and technology adoption. • Analyze documentation and workflow requirements. • Analyze vendors – assess resources. CAC is often misunderstood and mistakenly associated with the concept of auto-coding. Auto-coding completely supplants the need for human coding professionals. Indeed, in a few areas of clinical practice with very limited code selection — such as laboratory, radiology or physical therapy services, for instance — a CAC solution could significantly reduce the need for a human coder to validate code assignment. More often than not, however, CAC will transform the role and enhance the work of human coding professionals. 1 AHIMA e-HIM® Work Group on Computer-assisted Coding, “Delving into Computer-assisted Coding” Journal of AHIMA 75, no. 10 (Nov–Dec. 2004): 48A-H. 3 IDENTIFY THE GOALS AND OBJECTIVES FOR EMBRACING CAC TECHNOLOGY: THE BENEFITS OF CAC Improved coder productivity, coding accuracy, data integrity, coding compliance, physician relations, and coder retention are among the many long-term benefits promised by a well-planned and well-executed CAC solution. Throughout the healthcare industry, there is evidence that CAC increases coder productivity. In fact, hospitals report that CAC improves coder productivity by as much as 20 percent.2 It is difficult to argue that a well implemented automated code validation process could be less efficient than a traditional coding process in which every single code must be manually researched and entered. By automating formerly manual coding and documentation processes, healthcare organizations can also begin to take advantage of software interfaces. CAC systems are capable of linking code selections back to their original supporting documentation, which can help facilitate review and correction. In addition, documents that are well organized, with important terms and likely codes clearly highlighted, have been shown to help coders improve accuracy.3 With greater accuracy, of course, comes enhanced data integrity and quality. In the increasingly data-driven healthcare environment, higher quality data can have far-reaching implications for meeting Meaningful Use and quality care goals. Furthermore, improved accuracy better supports coding compliance efforts aimed at reducing potential payer audit liability. CAC will strengthen the accuracy and speed of data for decision making, as it streamlines the revenue cycle workflow for clinical documentation improvement, coding and billing processes. In addition, a CAC work environment will be very beneficial to recruit and retain top HIM talent. Consider, for example, the role a CAC could play in making the transition to ICD-10 a more interesting, empowering — and less daunting — experience. CREATE A FUTURE STATE FOR CAC AND PREPARE YOUR WORKPLAN: THE NEW ROLE OF THE CODER Throughout the healthcare industry, enabling technologies that streamline workflow are rapidly changing traditional paper-based workflows. CAC, clinical documentation improvement methodologies and technology, and other tools are redesigning the role of the coding professional. Whereas coders now are tasked with reviewing documentation and then assigning appropriate codes, the coders of the near future are destined to become code ‘validators’. On any given record, CAC will be used to narrow the field of applicable codes, with coders making the critical final affirmation based on their professional knowledge, skills, and ability to ensure accuracy and compliance.4 2 Adele Towers, M.D., M.P.H., medical director, UPMC Health Information Management, quoted in July 10, 2012, Healthcare IT News. KLAS includes additional provider perspectives on real and anticipated benefits of CAC in the report, “Computer-Assisted Coding: A Glimpse at the Future of HIM Technology,” April 2012: 6. 3 ibid: 6. 4 AHIMA, “CAC 2010–11 Industry Outlook and Resources Report,” 2011: 3-4. organizations will not realize all of the solution’s potential benefits. In fact, those who rush to implement CAC without first conducting a thorough analysis of their existing technologies and processes may well find that the implementation falls far short of expectations. 4 CHANGE MANAGEMENT, WORKFLOW AND TECHNOLOGY BEST PRACTICE: CONDUCT A CAC READINESS ASSESSMENT Proper preparation will ensure the successful introduction of new technology such as CAC into your organization’s work flow processes. There are three main components to an effective CAC readiness assessment: • Understand the different types of clinical documentation capture. • Know the technology that will be affected by CAC within your organization. • Review your productivity standards. STEP 1: Understand the Types of Clinical Documentation Capture Take an inventory of the different ways in which documentation is captured in your organization today, paying particular attention to the format of each of the report types. TYPE OF DATA DESCRIPTION Structured Structured data capture is often associated with information entry into EHR fields. It is a method in which data is carefully constructed and coded.5 As a result, individual pieces of information within a record can be easily located and used. Unstructured Unstructured data capture typically refers to paper/scanned documents. While information may be retrieved and viewed in electronic form, the data itself is not chopped into discrete bits to allow it to be effectively searched and used electronically. Narrative Narrative data generally enters the HIM workflow in the form of transcription. Many organizations use automated speech recognition to help turn providers’ spoken documentation into text, which medical transcriptionists then turn into a final document. Built on the Nuance Clinical Language Understanding (CLU) platform, CLU represents Nuance’s implementation of Natural Language Processing (NLP) in the clinical domain. Through CLU, implied facts can then be extracted from the text as structured data.6 Hybrid Some form of hybrid data capture exists in most healthcare organizations today, usually a combination of electronic structured/ narrative information and scanned document images. One key concept for organizations to recognize is that CLU — a vital element for CAC — will only be as good as: • The quality of the documentation in the underlying system (EHR). • The ability to analyze structured data in the most important components of the EHR — which means moving away from hybrid records. 5 AHIMA, “CAC 2010–11 Industry Outlook and Resources Report,” 2011: 16. 6 Ibid: 16. 5 STEP 2: Understand Your Technology Healthcare organizations must be careful not to make the common mistake of confusing a true Electronic Health Record (EHR) with a document imaging system. Very often, the legal medical record that is coded resides in an electronic document management (EDM) system, not the EHR. The difference? An EDM typically does not offer a structured data environment. Instead, much of the information is imaged. The distinction is crucial, because unstructured imaged information often cannot be ‘read’ by CAC technology. For this reason, organizations must carefully evaluate all technology used — including dictation/transcription technology — and recognize whether it captures medical record information as structured or imaged data. In addition to examining individual technology systems, an investigation is necessary of how data passes through interfaces. CAC functionality relies on its ability to exchange information with clinical, financial, EHR, dictation, transcription and other systems in order to generate potential code lists for validation.7 STEP 3: Review Your Productivity Standards As with any implementation, the ultimate success of CAC depends on the ability to set goals and measure improvement. To that end, there are several productivity and workflow considerations to take into account before moving forward with CAC. For instance, an organization may want to look at how much of its coding process is performed internally vs. outsourced. The adoption of CAC could very well affect future outsourcing decisions. Baseline productivity and accuracy rates should also be measured in order to effectively set – and reach – long-term, post-CAC productivity and accuracy goals. BEST PRACTICE: Analyze Your Documentation Readiness Once a high-level evaluation of existing workflow, technology and data capture has been performed, it’s time to drill deeper into the information most directly connected to CAC. Organizations contemplating CAC must know which documents and data are critical to their coding processes. A high-level breakdown of coding workflow may reveal, for instance, that 50 percent of documentation is captured electronically and the other 50 percent is paper, scanned into the system. The question then becomes: “What is your core designated record set for coding?” If those records all fall within the ‘scanned’ category, your organization is not yet ready for CAC. Seldom defined in coding compliance policies are the actual core medical record documents that should be used as the designated record set for coding. A good coding compliance policy should identify medical record documents that require a mandatory review by coding staff. A critical success factor in CAC readiness is to identify your core designated record set for coding, because it is essential for building your roadmap. In a CAC environment, an encounter or inpatient discharge case has initial codes available to review, even if all the documents required for quality code assignment are not yet available. However, CAC systems can allow coding professionals to set a flag that ‘holds’ a record pending specific documentation (e.g., when a pathology report is missing). When the required document is available in the system, an alert is sent to the coding professional for final review. So, regardless of the CAC vendor, an organization’s HIM team must create and designate the data sources required for your coding compliance program. 7 AHIMA, “CAC 2010–11 Industry Outlook and Resources Report,” 2011: 11. 6 To identify all diagnoses and procedures requiring coding and to increase the accuracy and specificity of coding, it is recommended that coders review the following medical record documents: INPATIENT CODING • Face sheet – code diagnoses and complications appearing on the face sheet. • Progress notes – detect complications and/or secondary diagnoses for which the patient was treated and/or procedures performed. • History and physical (H&P) – identify any additional conditions, such as history of cancer or a pacemaker in situ, for example. These conditions should be coded. • Discharge summary – read if available and compare listed diagnoses with face sheet. Code diagnoses and procedures listed on discharge summary but not specified on face sheet. • Consultation report – detect additional diagnoses or complications for which the patient was treated. • Operative report – scan to identify additional procedures requiring coding. • Pathology report – review to confirm or obtain more detail. • Laboratory report – use reports as guides to identify diagnoses (e.g., types of infections) or more detail. • Radiology report – use reports as guides to identify diagnoses or more detail (e.g., type of fractures). • Nutritional assessment • Physician’s orders – detect treatment for unlisted diagnoses. For example: the administration of insulin, antibiotics, or sulfonamides may indicate treatment of diabetes, respiratory or urinary infections which should be confirmed by the coder. OUTPATIENT CODING For accurate reporting of ICD-9-CM diagnosis codes, the documentation should describe the patient’s condition, using terminology that includes: specific diagnoses as well as symptoms, problems, or reasons for the encounter; an authenticated physician order for services; reason the service was ordered; and test results. There are ICD-9-CM codes to describe all of these. Coders may assign diagnosis codes based on the reason for a referral. A specific diagnosis based on test results is usually not available; in fact, it may not be available until after subsequent evaluations or physician visits. Examples of the documents that you should consider including in your outpatient coding compliance policy are the following: • Authenticated physician order for services • Clinician visit notes • Diagnosis or the reason the service was ordered • Test results • Therapies • Problem list • Medication list 7 Outpatient diagnostic services – For patients receiving only diagnostic services during an encounter/visit, coders must review the documentation for the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the outpatient services provided. These should be found in the encounter and diagnostic documents and physician interpretation reports. Outpatient therapeutic services – For patients receiving only therapeutic services during an encounter/visit, coders must review the medical record for the diagnosis, condition, problem, or other reason for the encounter/visit documented in the medical record to be chiefly responsible for the outpatient services provided. Outpatient or ambulatory surgery – For ambulatory surgery, coders must review the medical record for the diagnosis for which the surgery was performed. If the postoperative diagnosis is known to be different from the preoperative diagnosis, coders must review the history and physical examination, pre-operative report, operative/procedure report, anesthesia record, progress notes, face sheet and encounter summary. Observation record – Coders must review, but should not be limited to, the following information in the medical record: • History and physical • Written progress notes • Physician orders for admission to observation and for treatment • Clinical observations •F  inal progress note or summary that includes the diagnosis and any procedures performed or treatment rendered Emergency department coding – Coders must review: • Emergency department report • Initial encounter physician documentation, including incident event description, chief complaint, clinical history and physical examination • Diagnostic interventions • Treatment interventions • Nursing notes • Physician’s orders • Progress notes with principal diagnosis After identifying the core records required for coding, check the format in which each exists (e.g., text documents, .pdfs) and the method used for accessing them. Ideally, the time to consider CAC is when laying foundational infrastructure, which is when the opportunity exists to place core electronic systems, including encoders, compliance tools and clinical documentation improvement tools all on one platform, before adding CAC technology. A single platform approach reduces integration struggles, thus easing information access across systems. 8 ANALYZE VENDORS, ASSESS RESOURCES Naturally, the transition to CAC should include a requirements definition and will require a review of all potential vendors offering this solution. These might include your EDM, EHR, abstracting and encoder vendors. Discuss how the CAC will seamlessly integrate with all of them. For example, will it be integrated or interfaced with an existing encoder? Regardless of the method used, existing vendors should be willing to become business partners with the selected CAC vendor. In addition, all vendor contracts should clearly delineate the expectations of your organization, of the CAC vendor, and of all applicable business partners. Likewise, CAC implementation requires scrutiny of the resources available within your organization. For example, do your in-house IT and HIM staff members have the expertise and bandwidth necessary for the endeavor? Before organizations can reap the benefits of CAC, HIM and IT staff must work together to champion its implementation. NUANCE CLINTEGRITY 360 | COMPUTER ASSISTED CODING (CAC) With its inherent ability to improve data capture and integrity, CAC represents an exciting future for clinical coding. The challenge now is to ensure that your organization is asking the right questions and putting the right technologies in place to support and maximize its long-term benefits. Healthcare organizations can ensure accurate code assignment, improve productivity, maintain financial health and manage the transition to ICD-10, thanks to the Clintegrity 360 single-platform, web-enabled, CAC solution. Clintegrity 360 | CAC automates and streamlines coding processes to ensure data accuracy and increase efficiency, productivity, and compliance throughout all health information management processes. CAC is a component of the single-platform Clintegrity 360 suite, which works seamlessly with the Clintegrity 360 | Encoder; it is not a ‘bolt-on’ application. Clintegrity 360 offers ‘dual coding’, which gives coders the ability to code in ICD-9 or ICD-10 code sets with confidence. Clintegrity 360 | CAC, which also translates codes into SNOMED, is the coding solution for today and for tomorrow. 9 CAC GLOSSARY •C  omputer-Assisted Coding (CAC) – The use of computer software that automatically generates a set of medical codes for review and validation by professional coders based upon clinical documentation provided by healthcare practitioners. The software uses natural language processing (NLP) to highlight key terms and phrases and automatically generate suggested codes for ICD-9 CM, CM and CPT coding. • Encoder – Software that generates medical codes based on a key word that HIM coders enter from the clinical documentation. Encoders provide code options for the coder to review and decide if they apply using official guidelines. CAC systems typically work in conjunction with an encoder to read and interpret electronic clinical documentation provided by physicians. CAC automatically generates suggested codes for review and validation, which accelerates code submissions while enhancing accuracy. • Natural Language Processing (NLP) – A branch of artificial intelligence that deals with analyzing, understanding and generating the languages that humans use naturally, in order to interface with computers in both written and spoken contexts, using natural human languages instead of computer languages. CAC is not possible without some form of NLP — it is the brain of the system that actually assigns the codes to be presented in the user interface. There are multiple technologies used for NLP in the CAC industry, from basic terminology to advanced artificial intelligence, and the NLP engine is a critical success factor for a CAC solution’s success or failure. • SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) – A comprehensive and precise clinical reference terminology designed to make healthcare information useable and accessible. Global in scope, SNOMED CT provides a common language of great depth that enables a consistent way of capturing, sharing and aggregating health data across clinical specialties and sites of care. The 300,000+ concepts available when coding using SNOMED CT not only offer the facility to provide greater detail about a patient than was present in previous coding schemes, but also allow for additional context information to be coded and associated with the patient. 10 ABOUT NUANCE HEALTHCARE Nuance Healthcare, a division of Nuance Communications, is the market leader in creating clinical understanding solutions that drive smart, efficient decisions across healthcare. As the largest clinical documentation provider in the U.S., Nuance provides solutions and services that improve the entire clinical documentation process—from capture of the complete patient record to clinical documentation improvement, coding, compliance and appropriate reimbursement. More than 450,000 physicians and 10,000 healthcare facilities worldwide leverage Nuance’s award-winning voice-enabled clinical documentation and analytics solutions to support the physician in any clinical workflow on any device. To learn more about how Nuance Healthcare can help you improve financial performance, raise the quality of care, and increase clinician satisfaction, please contact us at 888-350-4836 or visit Copyright © 2012 Nuance Communications, Inc. All rights reserved. Nuance, the Nuance logo, and Clintegrity 360 are trademarks and/or registered trademarks, of Nuance Communications, Inc. or its affiliates in the United States and/or other countries. All other brand and product names are trademarks or registered trademarks of their respective companies. 11 L-3555-001 2/13 CB H E A LT H C A R E
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1.2. Statement of Purpose
The implementation of Computer Assisted Coding is vital in tackling most of the
major challenges experienced by Mayfield Medical Group in the conversion of ICD-9 to
ICD-10 and the associated large number of medical coding. The complexity of medical
coding requires the implementation of CAC system that will significantly boost coding
process in the facility. The Computer Assisted Coding will be used with other solutions
in the health center in combination with the encoder chosen by the health institution
management for coding both inpatient and outpatient charts. The solutions are associated
with suggested code sets and the documents corresponding for reviewing the source of
information and indexes of the chart to make sure that the set of codes generated and
provided to the coder are not only complete but also accurate. Streamlining of the health
CAX is driven by the workflow in the medical center and among the most proven
solutions provided by the computer-based coding. It is necessary for improving the
clinical documentation improvement (CDI) and coding of the flows of the work in the
medial group. It is also necessary due to enhancing the productivity of the staff members
and production of accurate coding through the elimination of the handoffs.
All this is possible through the use of the natural language processor (NLP) which
is patterned. It is an engine which enhances reading and interpreting of the text-based
clinical documentation such as the charts indicating the information of the patients.
Natural language processor identifies the essential ICD-1-CM health finding, ICD-1PCS, and CPT processes and gives the CDI specialists the admission (POA) indicators
required in coding and reviewing of after text documents which have been sent from
different hospital systems. Through computer assisted coding, the medical group is
expected to experience robust reporting which will produce predefined reports, for
example, the productivity of the coder, analysis of CMI and the performance of the NLP.
Through the CAC streamlining, the medical group will be able to track their progress
towards achieving their goals.
1.3. Background of the Medical Group
The large medical group operates a total of five hospitals in the city. There have
been series of medical errors due to manual activities, slowness in the events when filing
the health records and it results in slow running of the operations. The failures have been
slowing the actions of the medical group; extra cost due to the mistakes experienced and
required correcting them and extra time when correcting the errors. It has created the
need to come up with a solution, and the Computer Automated Coding would help solve
these issues and increase the chances of achieving the medial group goals. The medical
group implemented the electronic health records in the hospitals though they have not

been entirely embraced by the employees and most would rather use the manual method they
were used to.
There are no computers experts in the medical group, and once the Computer Automated
Coding is installed, the group will be required to hire coding specialists. When hiring the
specialists, various factors will be put into consideration such as the analytic abilities of the
individual, orientation with the coding details, strong morals, and social skills since the
specialists will be required to interact with the medical providers and supervisors when recording
the medical records of the patients. They should be tech savvy where they are comfortable with
using the computers and technology due to use of the electronic health records, due to the
software which will be storing the files such as insurance claims and billing for the parents. In
the healthcare system, the need for accurate data is now critical, and the medical group is
required to keep up with this need which would be through the implementation of Computer
Automated Coding.
1.4. Scope of Work
The vendor of the Computer-Assisted Coding in the medical group will be in charge of
implementing, evaluating and monitoring whether the solution is operating as expected. The
medical-coding professionals will still be required in the coding process, and they will act as the
sub-contractors and through the combination of the efforts, it will help improve productivity and
accuracy. The vendor will ensure that t...

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