Health Care Financing Administration, Office of Acquisitions and Grants, Mailstop C2-21-15, 7500 Security Blvd., Baltimore, MD 21244-1850

D -- MAINTENANCE OF THE GROUPER, MEDICARE CODE EDITOR AND OUTPATIENT CODE EDITOR PROGRAMS SOL HCFA-99-002/JP DUE 021299 POC Juanita Pang, Contract Specialist, 410/786-5538; Melissa Starinsky, Contracting Officer, 410/786-7665 Contract Summary for Commerce Business Daily 17. The Health Care Financing Administration (HCFA) intends to solicit competitive proposals for maintenance and updates to the GROUPER, MEDICARE CODE EDITOR (MCE) and OUTPATIENT CODE EDITOR (OCE) software systems. These systems are collectively used to administer the Medicare prospective payment system (PPS). Under Medicare, PPS payment to participating hospitals for each inpatient discharge is based on case assignments into one of 511 diagnoses related groups (DRGs). Hospitals must also use the HCFA Common Procedure Coding System (HCPCS) to bill for their outpatient surgical services. To assure that Medicare claims are processed systematically and uniformly, HCFA uses the following computer software programs: GROUPER -- an automated classification algorithm that determines DRG assignment based on data elements reported by hospitals. GROUPER is used for all inpatient discharge or transfer bills received from both PPS and non-PPS facilities, including those from waiver states, long term care hospitals, and excluded units. HCFA will require recommendations for modifications to the DRG system which include annual changes to the ICD-9-CM coding system. These recommendations will take into account the clinical aspects of DRG modifications. Statistical animplicationstential DRG modifications and their impact on GROUPER software. HCFA will require the development of a written paper mapping all ICD-9-CM or applicable coding system changes, showing what the code originally was at the beginning of the Medicare PPS, and demonstrate subsequent changes. Changes made to the DRGs as a result of ICD-9-CM coding changes must be tabulated. HCFA will require discussion of the mplications of any proposed replacement coding systems (such as ICD-10-CM and ICD-10-PCS) on the DRG GROUPER, MCE, OCE, Medicare fiscal intermediaries, and Medicare quality of care review. Medicare Code Editor (MCE) -- an automated edit that determines correctly inputted hospital data for principal diagnosis, secondary diagnoses, procedures, sex, age, and discharge disposition of the patient. Maintenance of this software is mandatory for determination of the quality of information passed on to GROUPER. As GROUPER does not make any attempt to edit the data for accuracy, the MCE must perform this function. Medicare Outpatient Code Editor (OCE) -- an automated edit that detects medical coding errors for hospital outpatient surgery bills, much as the MCE does for inpatient bills. The edit compares HCPCS procedure codes and ICD-9-CM diagnosis codes for accuracy, validity, and coverage. The Request for Proposal (RFP) will be issued approximately January 15, 1999. The agency is contemplating award of a contract for a one (1) year base period, plus four (4) successive one (1) year option periods. Request for the RFP must be in writing and marked ATTN: RFP-HCFA-99-002/JP. All responsible sources may submit a bid, proposal or quotation which shall be considered by the Agency. Telephone requests for the RFP will not be accepted. ... Posted 12/16/98 (I-SN280984). (0350)

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