SOURCES SOUGHT
R -- Compreshensive Error Rate Testing Documentation Contractor - SSN
- Notice Date
- 6/4/2015
- Notice Type
- Sources Sought
- NAICS
- 541513
— Computer Facilities Management Services
- Contracting Office
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Acquisition and Grants Management, 7500 Security Blvd., C2-21-15, Baltimore, Maryland, 21244-1850
- ZIP Code
- 21244-1850
- Solicitation Number
- CMS-SSN-2015-CERTDC
- Point of Contact
- Amy D Duckworth, Phone: 410-786-3111, Nicole Hoey, Phone: 410-786-0489
- E-Mail Address
-
amy.duckworth@cms.hhs.gov, nicole.hoey@cms.hhs.gov
(amy.duckworth@cms.hhs.gov, nicole.hoey@cms.hhs.gov)
- Small Business Set-Aside
- N/A
- Description
- CERT DC SOW SOURCES SOUGHT/REQUEST FOR INFORMATION COMPREHENSIVE ERROR RATE TESTING (CERT) DOCUMENTATION CONTRACTOR Introduction: The Centers for Medicare & Medicaid Services (CMS) is hereby conducting market research to identify sources on the GSA schedule to support informed decisions to procure for the required services, (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) While our intention is to specifically identify small businesses, all types of business concerns, both large and small, are encouraged to submit responses to this Request for Information (RFI). This notice is an RFI for all interested qualified businesses that meet the requirements for this effort. The information from this market research will help CMS plan their acquisition strategy. This announcement is an RFI for planning purposes only. This is not an invitation for bid, request for quote or other solicitation and in no way obligates the Government to award a contract. CMS will not entertain questions regarding this market research. Background: The Improper Payments Information Act (IPIA) of 2002, amended by the Improper Payments Elimination and Recovery Act (IPERA) of 2010 and the Improper Payments Elimination and Recovery Improvement Act (IPERIA) of 2012, requires the heads of federal agencies, including the Department of Health and Human Services (HHS), to annually: • Identify programs that may be susceptible to significant improper payments, • Estimate the amount of improper payments in those programs, • Submit the estimates to Congress, and • Report publicly the estimate and actions the Agency is taking to reduce improper payments. An improper payment is defined as any payment that should not have been made or that was made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements. In addition, improper payments include those to an ineligible recipient, payments for ineligible goods or services, duplicate payments, payments for goods or services not received (except for such payments where authorized by law), and any payments that do not account for credit for applicable discounts. The CMS developed the Comprehensive Error Rate Testing (CERT) program to calculate the Medicare Fee-for-Service (FFS) program improper payment rate. The CERT program considers any claim that was paid when it should have been denied or paid at another amount (including both overpayments and underpayments) to be an improper payment. To meet this objective, a stratified random sample of Medicare FFS claims is selected for review; supporting documentation is retrieved from the provider or supplier who submitted the claim for payment; and the documentation is reviewed by independent medical reviewers to determine if the claim was paid properly under Medicare coverage, coding, and billing rules. If the documentation does not support that the rules were met, the claim is counted as either a total or partial improper payment. The error is then categorized into one of five major categories: (1) No Documentation, (2) Insufficient Documentation, (3) Medical Necessity, (4) Incorrect Coding, or (5) Other. The CERT program calculates bi-annual improper payment rates based on the results of the reviews conducted. These rates include an overall national Medicare FFS improper payment rate and improper payment rates for each claim type [Part A inpatient hospital prospective payment system (PPS); Part A excluding inpatient hospital PPS; Part B; and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)]. The CERT program ensures a statistically valid random sample; therefore, the improper payment rate calculated from this sample is considered to be reflective of all of claims processed by Medicare FFS program during the report period. The CMS also uses the CERT program to perform special studies and supplemental measurements to determine the improper payment rates of particular claim types. Calculations of these rates facilitate CMS ability to take appropriate corrective actions to reduce improper payments. It is important to note the improper payment rate is not a fraud rate, but is a measurement of payments made that did not meet Medicare requirements. The CMS seeks to acquire a CERT Documentation Contractor to, at a minimum: 1. Request medical records from the billing and ordering providers to support the claims billed 2. Receive and process medical records for the performance of medical review by the CERT Review Contractor (CERT RC) 3. Provide customer service support to the Medicare Administrative Contractors (MACs) and providers who have claims selected for review 4. Maintain various websites for internal and external stakeholders 5. Establish mechanisms to manage unexpected fluctuations in the Contractor's processing requirements 6. Perform additional tasks to support the mandate of the CERT program, as directed by CMS and this Statement of Work (SOW) Response Information: In order to respond to this notice, contractors must be able to indicate experience and/or the ability to provide all of the numbered points below. Give enough detail so your response clearly indicates knowledge and experience with SOW requirements, including: 1. Knowledge of and experience with the Medicare FFS program 2. Experience with requesting approximately 80,000 medical records (includes initial additional documentation requests and follow-up requests) in a sample year from healthcare providers, via letter and phone 3. Experience with receiving and processing approximately 80,000 medical records (includes initial additional documentation requests and follow-up requests) in a sample year, in various formats (including Electronic Submission of Medical Documentation, or esMD), including quality assurance 4. Experience with providing customer service to health care providers and MACs 5. Experience with running a call center for purposes of making and receiving calls pertaining to the CERT program and additional documentation requests 6. Knowledge of and experience with medical documentation requirements for Medicare FFS reimbursement 7. Experience with compiling data for collaboration with another contractor 8. Experience with developing and maintaining CMS-approved websites for public and internal stakeholders 9. Experience with developing and maintaining internal IT infrastructure, including the completion of a CMS Security Controls Assessment 10. Experience with managing unexpected fluctuations in processing requirements 11. Demonstrate evidence of related past performance/experience (no more than 3 examples are needed). Provide points of contact and contract numbers for applicable contracts. 12. Experience with hiring and retaining the Key Personnel for this project as identified in the attached SOW 13. Experience with Fixed Fee type contracts Please include the following in your response: Business Information -- a. DUNS b. Company Name c. Company Address d. NAICS code of 541513 "Computer Facilities Management Services e. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. f. Type of Company (i.e., small business, 8(a), woman owned, veteran owned, etc.) as validated via the Central Contractor Registration (CCR). All offerors must register on the CCR located at http://www.ccr.gov/index.asp g. Company Point of Contact, Phone and Email address Teaming Arrangements: All teaming arrangements should also include the above-cited information and certifications for each entity on the proposed team. Teaming arrangements are encouraged. Responses must be submitted not later than June 19, 2015. Capability statements will not be returned and will not be accepted after the due date. The maximum number of pages for submission is 20 pages. This Sources Sought Notice is for information and planning purposes only and is not to be construed as a commitment by the Government. This is not a solicitation announcement for proposals and no contract will be awarded from this Notice. No reimbursement will be made for any costs associated with providing information in response to this Notice. Respondents will not be notified of the results of this evaluation. Capability statements will not be returned and will not be accepted after the due date. Contact information: Contracts Specialist, Amy Duckworth e-mail Amy.Duckworth@cms.hhs.gov phone 410-786-3111. Contracting Officer, Nicole Hoey e-mail Nicole.Hoey@cms.hhs.gov phone 410-786-0489
- Web Link
-
FBO.gov Permalink
(https://www.fbo.gov/spg/HHS/HCFA/AGG/CMS-SSN-2015-CERTDC/listing.html)
- Record
- SN03752732-W 20150606/150604235048-ae45291e7df1c66170552c32c286b135 (fbodaily.com)
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