SOLICITATION NOTICE
70 -- Medicare Pricing Solution for Enterprise with 150+facilities Sources Sought Notice per the attached RFI
- Notice Date
- 4/23/2009
- Notice Type
- Modification/Amendment
- NAICS
- 511210
— Software Publishers
- Contracting Office
- Department of Veterans Affairs, VA Center for Acquisition Innovation (Austin), VA CAI Austin, Department of Veterans Affairs;Center for Acquisition Innovation-Austin;1615 Woodward Street;Austin TX 78744
- ZIP Code
- 78744
- Solicitation Number
- V798A-09-RI-0100
- Response Due
- 5/15/2009
- Archive Date
- 6/8/2009
- Point of Contact
- Angela Deren512-326-6662<br />
- Small Business Set-Aside
- N/A
- Description
- V798A-09-RI-0100 GENERAL INFORMATION The Department of Veterans Affairs is searching for a Medicare Pricing solution that accurately prices services using Medicare payment schedules, adheres to HIPAA rules, and has capacity to support government Enterprise that includes 150+ facilities. Solution must be deployable at one location and accessible by all Enterprise facilities via web front end. RESPONSE DUE BY Due to VA by 4pm CST, 05/15/2009. PURPOSE This Request for Information (RFI) is to seek products/systems that are available to apply the following Medicare Payment Schedules and Pricing systems that are necessary to accurately edit, group and price claims, or re-price claims. In response confirm whether proposed solution can accommodate each of these schedules. Systems and Schedules 1)Acute Care IPPS: http://www.cms.hhs.gov/acuteinpatientpps/ 2)Physician Fee Schedule: http://www.cms.hhs.gov/PhysicianFeeSched/ 3)Clinical Laboratory Diagnostic Schedule: http://www.cms.hhs.gov/ClinicalLabFeeSched/ 4)Ambulance Fee Schedule: http://www.cms.hhs.gov/ambulancefeeschedule/ 5)Ambulatory Surgical Center (ASC) Payments (a)http://www.cms.hhs.gov/HealthCareConInit/03_ASC.asp (b) http://www.cms.hhs.gov/ASCPayment/ 6)Hospital Outpatient PPS: http://www.cms.hhs.gov/hospitaloutpatientPPS/ 7)Inpatient Psychiatric Facility PPS: http://www.cms.hhs.gov/inpatientPsychFacilPPS/ 8)Inpatient Rehabilitation Facility PPS: http://www.cms.hhs.gov/InpatientRehabFacPPS/ 9)Long Term Care Hospital PPS (http://www.cms.hhs.gov/longtermcarehospitalpps/ ) 10)Durable Medical Equipment, Prosthetics/Orthotics, and Supplies Fee Schedule http://www.cms.hhs.gov/dmeposfeesched/ 11)Home Health PPS (http://www.cms.hhs.gov/HomeHealthPPS/ ) 12)End Stage Renal Disease (ESRD) (http://www.cms.hhs.gov/PCPricer/02e_ESRD_Pricer.asp ) 13)Dental (a)(http://www.cms.hhs.gov/MedicaidDentalCoverage/ and (b)http://www.cms.hhs.gov/SCHIPDentalCoverage/ ) 14)Hospice (http://www.cms.hhs.gov/Hospice/ ) 15)Skilled Nursing Facility PPS (http://www.cms.hhs.gov/SNFPPS/ ) A single solution is being sought to fill these Medicare payment methods. Proposal should reference vendor's products that are currently available instead of possible future products. The solution should provide/include: 16)Web-based interface. 17)Enterprise system that is centralized; can be hosted at one location and deployed on a common platform to provide a single point of maintenance for the common suite of integrated applications. 18)Centralized reporting for nationwide or specified sites, while still supporting the option for local reports accessible by 170 facilities nationwide. 19)Compliance with VA security standards and HIPAA regulations. 20)Timely update of the schedules and software according to the latest regulations, rules, and guidelines. 21)Easy integration with other applications (ex, the pricing results may be used by other applications.) 22)Ability to process request and return pricing results on-line 23)Ability to process request and return results via batch process. 24)Ability to customize interface, output and other system features. 25)Ability to archive the pricing results and the original input data (for both batch and one-line use) which may be used by other applications. 26)Ability to price claims up to 10 years old using appropriate schedule for the year of the claim/care. (If this 10-year requirement is not possible, then state the length of time that can be priced.) 27)Ability to maintain CMS reference files for processing claims up to 10 years old. 28)Ability to print and save reports of pricing transactions. 29)Web-enabled reporting with different levels of security; i.e., one facility, group of facilities, or all. 30)Tools to search and locate report information for specific veteran or vendor. 31)Ability to handle over 100,000 transactions per day via web platform, or at one time for batch processing. The number of transactions per day may increase dramatically in the near future. RESPONSES NEED TO INCLUDE 32)Company Information and experience 33)Government customers utilizing the proposed product (all or part) 34)Confirm that product exists and is currently in production at customer location 35)Size and statistical information about system performance and number of transactions processed by largest enterprise customer 36)Background and description of the proposed technology 37)Benefits, Risks, and Constraints 38)Solutions for items under 'PURPOSE' section 39)Scalability 40)Platforms the package can reside on 41)Ability and availability to provide demo 42)Ability to provide technical support for installation, acceptance testing, and problems that may rise in production environment ORGANIZATION & BACKGROUND The Department of Veterans Affairs (VA), Chief Benefits Office, Fee Program (Purchased Care for Veterans) is a program that provides for non-VA care for eligible veterans including those not able to access VA health care facilities based on geographic constraints or due to medical emergencies, or it is economically advantageous to provide treatment in the community. Effective July 19, 2001, the VA is authorized to utilize various Medicare claims pricing schedules in the processing of payment or reimbursement for fee basis non-service connected emergency care (US Code: Title 38, 1725 - Reimbursement for emergency treatment) approved under the Veterans Millennium Health Care and Benefits Act of 1999 (Section 111 of Public Law 106-117) (Mill Bill). This special legislation authorized the Secretary to determine the appropriate reimbursement for these services. To learn more about the Fee Program access http://www.nonvacare.va.gov/ CURRENT ENVIRONMENT All claims pricing done by the VA systems described below may be sent to re-pricing agent to see if they can provide a better price for the service. Inpatient Prospective Payment System (IPPS) The pricing transactions for IPPS are created by VistA (The Veterans Health Information Systems and Technology Architecture) system using either data previously entered into VistA Fee (from Fee Basis Invoice file) or data entered electronically by a user and are processed using Medicare Code Editor (3M product), MS-DRG Grouper (CMS product - Centers for Medicare and Medicaid Services), PPS Pricer (CMS product), and COBOL interface programs (developed in-house) on z/OS Enterprise Server. The Pricer reports and Reject reports are transmitted to each station (over 170 VA Medical Centers located nation-wide) three times a day. The current system can process transactions using proper schedules/versions as old as fiscal year 1998. All pricing results are saved in Fee History file and available for audit purposes. Outpatient and Inpatient Ancillary The VistA Fee Basis software has two built-in schedules for pricing outpatient and inpatient ancillary claims. It contains the Medicare Physician Fee schedule (RBRVS) and the VA Fee schedule (75th percentile). If the service is provided under an existing vendor contract, then the VA pays the contracted amount. If it is not provided under a current contract and is subject to the Medicare Physician Fee schedule (RBRVS), then the amount from that schedule is paid. If it is not subject to RBRVS, the VA Fee schedule is used assuming there was an amount calculated for the fiscal year for that service on that schedule. There are exceptions; i.e., Dental services are paid using a different schedule and Mill Bill (emergency care) is paid at 70% of the applicable Medicare schedule. Others Desktop applications - either CMS PC Pricers or Excel worksheets based on Medicare Fee schedules that are downloadable from CMS are used at some sites. POINT OF CONTACT All questions and/or documentation should be submitted electronically in a Word document format to Angela Deren at Angela.Deren@va.gov using subject line of "Response to RFI for Pricer" Questions subject line should be "Questions on RFI for Pricer" GENERAL INFORMATION & DISCLAIMER This RFI, as defined in FAR 15.201 (e), is conducted to determine available software/applications in the current market that meet services described below. This information is being obtained for information purposes only and the Government will not reimburse for any cost incurred as a result of this request. Vendors are requested to provide information with sufficient documentation to allow for the evaluation of the potential solution to meet the Government's requirements. There is no solicitation document available at this time and no guarantee that one will be forthcoming. FAR 52.215-3 Request for Information or Solicitation for Planning Purposes (Oct 1997) (a)The Government does not intend to award a contract on the basis of this solicitation or to otherwise pay for the information solicited except as an allowable cost under other contracts as provided in subsection 31.205-18, Bid and proposal costs, of the Federal Acquisition Regulation. (b)Although "proposal" and "offer" are used in this Request for Information, your response will be treated as information only. It shall not be used as a proposal. (c)This solicitation is issued for the purpose of obtaining information on a possible permanent pricing system described above.
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