Attn: Department of Veterans Affairs Acquisition Operations & Analysis Service, (93), 810 Vermont Avenue, N.W., Washington, District Of Columbia 20420

R -- RECOVERY AUDITS FOR INPATIENT SERVICES SOL 101-18-00 DUE 042800 POC Contracting Officer -- Tyrone Lassiter, Contracting Officer, (202) 273-8771 WEB: RFP 101-18-00, http://www.bos.oamm.va.gov/solicitation?number=101-18-00. Department of Veterans Affairs (VA), Veterans Health Administration (VHA), healthcare system is currently structured into 22 geographically defined Veterans Integrated Service Networks (VISNs). These 22 VISNs are composed of approximately 172 Medical Centers (VAMCs) and in excess of 600 community-based outpatient clinics. Veterans who are eligible for VA healthcare benefits may, in some circumstances, receive healthcare services from non-VA providers. In these cases, VA reimburses the healthcare providers their fees for services rendered on behalf of the eligible veterans. Care provided by non-VA medical providers is referred to as fee basis care. Fee basis care is approved and monitored by VHA and the extent of the services rendered is governed by VA regulations 38 CFR 17.52 through 38 CFR 17.56, 38 CFR 17.120, and 38 CFR 17.128. Additionally, VHA reimburses non-VA providers for healthcare services provided to certain dependents of veterans under the CHAMPVA Program and Spina Bifida Healthcare Program. These programs are administered by VHA's Health Administration Center, Denver, CO (HAC) under the authority of 38 CFR 17.270 -- 17.278 and 38 CFR 17.900 -- 17.905. The Department is looking for a contractor capable of conducting a recovery audit for inpatient services provided by private-sector providers to veterans and their dependents under healthcare programs administered by the VA. The scope of this contract is to perform a post-payment review to detect inappropriate provider coding for the services rendered and verify appropriate payment methodologies had been utilized for inpatient services. To appropriately assess the right payment amount, medical documentation must be obtained from the provider and reviewed to determine whether (1) the correct codes were billed to the VA, (2) the correct codes were input by the VA for payment, and (3) the correct VA payment methodologies were applied. Payment for the contract will be based on a percentage of the amount collected as a result of an audit carriedout by the contractor. The contract will be for a base year and (2) one-year option periods. However, the contract may be terminated after six months if the cost-effectiveness of this initiative has not been demonstrated. The Department is also interested in receiving the following information from potential sources: 1) prior similar experience; 2) ADP Requirements needed to accomplish; AND 3) method used for audits and collections. VA is looking for a contractor to provide information on potential difficulties related to the review of out-year claims that date back as far as 6-years, and the types of incentives required to pursue such claims. Please provide a response by April 11, 2000. However, any responses submitted after the above deadline will be reviewed. A solicitation for this requirement will be synopsized on the Government Electronic Posting System at www.eps.gov, and in the CBD. It is the potential offeror's responsibility to monitor these cites for release of any future solicitation or synopsis.Vendors having capabilities necessary to meet or exceed the stated requirements are invited to provide information to contribute to this market survey/sources sought synopsis including commercial market information and company information via e-mail to the Contracting Officer at tyrone.lassiter@mail.va.gov or mail it to the following address, Tyrone Lassiter (93A2), Department of Veterans Affairs, Central Office, 810 Vermont Ave. NW, Washington, DC 20420. Responses should include the following information: capability to meet the requirements, company name, address, point of contact and phone number; business size and status. This synopsis is for information and planning purposes and is not to be construed as a commitment by the Government nor will the Government pay for information solicited; no basis for claim against the Government shall arise as a result from a response to this Sources Sought or Government use of any information provided. The Government reserves the right to consider a small business, 8(a) or any other set aside arrangement as deemed appropriate for this procurement. All of the information sought should be conveyed in no more than 10 pages. Each response must reference the sources sought title. Posted 04/14/00 (D-SN445089). (0105)

Loren Data Corp. http://www.ld.com (SYN# 0083 20000418\R-0017.SOL)