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Looking to see if any experts can get me in the right direction.  I have a service acquisition where billing doesn't appear it can "normal and as usual".  The contractor would do it's work in a Gov't facility, using Gov't space & equipment.  However, the workers (medical) are not involved in tracking aspects of work performed.  Instead, the work performed is maintained (coded) by Gov't in Gov't systems that cannot be accessed by contractor.  Thus, it appears that contractor would only be able to invoice according to data fed to them by the Gov't.  I'm struggling with - 1) can this be done?, 2) where can it experience failure?, 3) would the Gov't be at risk of losing any rights?, 4) would doing so constitute "receipt of services" erroneously?, 5) should this be done?, 6) what if the data fed to contractor is errored?, 7) what problems could be encountered?

I'm unsure where to look for statutory limitations (or guidance).  The service is a commercial item.

Any guidance would be appreciated.

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Does the Government intend to provide timely information from the Government system to the contractor, so it can prepare its invoices?

If YES, I'm not seeing a problem. 

If the contract says (1) we only pay for billable hours and (2) billable hours are recorded on a Government system, then it seems there is a meeting if the minds to form a contract.

Is this approach consistent with customary commercial practice?  See FAR 12.302(c). 

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Ji20874 - The question of timely is another struggle I didn't mention.  -->I'm thinking that tying a NLT date into the billing language is appropriate, but concerns of recourse if/when NLT date gets busted.  -->The rates would be per a unit of measure other than hours, more of a "production" type of structuring based on cost per code values (numerous codes, with significant variation in values).  -->Yes, regarding customary - after posting the question here, I received information that the practice is the same in the commercial marketplace.

Retreadfed - (kudos to the screenname, reminds me of a few USAF COs from way back when) - Long response here -->The pricing would be per unit of measure.  So, it's hard to explain here, or anywhere, but the service would "by procedure, each procedure being made up of 1 or more codes (no stated limit of how many codes, some could be 2, others 8 or even 12).  Of those codes, a value is placed, could be 0.12, could be 7.7, could be 16.5.  Each procedures is unique.  -->The services are non-personal in nature.  -->Clause not yet determined, but all indication is 52.232-32 will apply.

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p5T, thanks.  This is how doctors get reimbursed by Medicare and insurance companies.  The provider sends a copy of the code sheet to the insurance company and keeps a copy for itself.  Why can't you do this?  In this case, I don't see how 52.232-32 would be applicable.  That clause provides for contract financing payments based on the achievement of measurable outcomes.  See FAR 32.10 particularly 32.1003

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6 minutes ago, ji20874 said:

Can you skip contractor invoicing completely and let payments happen based on the codes recorded in the system?

ji, this makes sense but how would it work for prompt payment purposes?

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It sounds like the Government will pay a fixed-price per recorded code based on a catalog or schedule.  That's okay, as long as the contractor is okay with the Government controlling the assignment of the codes to the work done by the contractor's employees.

For example, if a kids comes in with a scuffed knee, the Government assigns the code for lavage and bandage for $50 rather than the practitioner assigning a code for minor surgery for $3,000.  Is the contractor okay with that?

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2 minutes ago, Retreadfed said:

 how would it work for prompt payment purposes?

Maybe include text saying that the Government will make payment to the contractor based on the codes in the system on a monthly basis, with payment for each month due to the contractor within twenty (or forty-five, or whatever) days after the last day of that month?

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Your questions have definitely added to my list of concerns.  Payments based on system information is definitely not something I want to bring into play (would be absent a proper demand for payment and likely Prompt Payment Act issue).  The scuffed knee scenario is on-target with my concern - reliability of data provided to contractor for invoicing - whether accurate, shorted or fluffed. In the spirit of risk - I'm concerned that providing data is a risk to be avoided and should be lessened by only reconciling a claimed set of values.

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Well, if the Government record-keeping of codes will be inaccurate, then you shouldn't pay using those codes.  Maybe you should simply pay billable hours?  Aren't contract doctors and nurses usually paid by the hour?

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Random thoughts as hard for me to envision the need without more details......

You have not mentioned whether SCLS (Service Contract Labor Standards) is applicable to any part of the contract effort.  You say "services" and while I understand some do not require compliance with SCLS some do.  If SCLS does apply I am having just a little trouble aligning a code payment with a service need.  Could be done but all the same having a little trouble with with limited info.

The Job Corps as supported by the Forest Service and others do contract for medical services.   So does the Indian Health Service and beyond.   Have you reviewed different medical service contract needs posted in SAM to see examples of how agencies might be acquiring the same services you are in need of.  Rarely in the government is someone inventing the wheel,  it has already been done.

Like ji I wonder about payment based on coded effort.  If the coded effort is to track accomplishment for some internal need so be it.  But you say on Government facility, using Government space and equipment and workers not involved in tracking the accomplishment.  So are you not really saying you just want a body, at a location for X hours a day to do what comes at them as needed?   Pay by code does not make sense if so by example.   What if nothing comes at that person at that location for that X hours of a day, you aren't going to pay because no code was accomplished?  If so then won't code costs be exaggerated because a contractor will have to figure the down time and inflate a code cost to cover the fact that they have to have someone there for X hours each day?

That is my quick spin on things.....

 

 

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Can you provide a copy of the proposed language for billing and payment or an example/description of some proposed line items ? I'm somewhat familiar with the BC/BS statements where providers code the services provided and BC/BS reviews and indicates the allowable amount for payment.

As Retreadfed asked yesterday, is the proposed scheme similar to that?  Who determines the allowable amount? 

Unless there is some type of schedule of allowances for specific procedures, what is the purpose of coding the procedures rather than just paying for hours worked? 

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This doesn’t make sense at all.  VA did extensive research a few years ago for a new way of providing medical care on a regional basis.  The only way they concluded was paying providers based on applicable codes.  The provider determined the proper code and VA reserved the right to review.

If I were in your position, I would make a case for changing the contract type with senior agency officials.  The only thing we don’t know here is the agencies rational for them assigning codes.

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