Health Care Financing Administration, Acquisition and Grants Group, C2-21-15, 7500 Security Boulevard, Baltimore, MD., 21244-1850

Q -- DEVELOP MANDATORY MEDICAL CASE REVIEW PROCEDURES AND DETERMINE RESOURCES ASSOCIATED WITH THE REVIEW. SOL HCFA-00-BG POC Beverly Gillette The Health Care Financing Administration (HCFA) is seeking sources to develop mandatory medical case review procedures and to determine resources associated with the review. HCFA contracts with fifty-three (53) Peer Review Organizations (PROs) who are responsible for performing mandatory case review under the 6th Statement of Work (SOW). The Office of Clinical Standards and Quality (OCSQ), within HCFA, is responsible for monitoring the health care provided to Medicare beneficiaries and ensuring the integrity of the Medicare Trust Fund. Section 1154 of the Social Security Act requires that PROs determine whether: services and items are reasonable and medically necessary, the quality of services meet professionally recognized standards of health care and that the care provided is in the appropriate setting. The goals of this contract are: 1)to determine the most effective and efficient procedures for performing each type of mandatory medical case review and recommend "best practices" for the case review process; 2)to recommend an average length of time and staff mix for each type of mandatory case review; and 3) to complete the effort in five (5) months. Specific qualifications for the organization and or employees who will perform this work are: 1)any organization currently conducting medical case review as described under Task 5 of the PRO SOW (6th round) is NOT eligible for this contract award; 2)experience performing medical case review; 3)familiarity with HCFA's PRO contracts, particularly those aspects of the 6th SOW which affects the mandatory case review requirements (Task 5), basic case review activities, and case review procedures; and 4)familiarity in determining level of effort and staffing needs. This synopsis is for information purposes only, does not constitute a Request for Proposal (RFP) and is not to be construed as a commitment by the Government. The information you provide will be evaluated to identify capable potential sources. Respondents will be included on any mailing list for any RFPthat may result from this Sources Sought. Interested parties should submit appropriate documentation of your capability with specific experience to: HCFA, Acquisition and Grants Group, Division of Quality Contracts, ATTN: Beverly Gillette, 7500 Security Boulevard, Mail Stop C2-21-15, Baltimore, Maryland 21244-1850. No telephone, facsimile or telegraphic requests will be accepted. DOCUMENTATION MUST BE RECEIVED WITHIN 30 DAYS OF THE PUBLICATION DATE OF THIS NOTICE and must include the name of a point of contact and a telephone number. Posted 08/26/00 (W-SN490605). (0239)

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