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1 2/7/2018 Request for Information PURPOSE The Business Integrity & Compliance (BIC) directorate of the Veterans Health Administration Office of Community Care (VHA OCC), is responsibile for auditing ... 1 2/7/2018 Request for Information PURPOSE The Business Integrity & Compliance (BIC) directorate of the Veterans Health Administration Office of Community Care (VHA OCC), is responsibile for auditing health care claims for various programs. Many of the VHA OCC payment methodologies are based on Medicare rates. This is a Request for Information (RFI) to identify the abilities associated with Medicare Pricing services to be used by VA auditors in support of audits. VA would like to identify companies that have the ability to receive VA de-identified claim data, through a) manual input into a web-based portal and/or, b) from a document sent to the contractor with multiple episodes of care (bulk data), and provide VA with an accurate Medicare rate for the episode(s) of care. However, VA is not seeking proposals at this time and will not accept unsolicited proposals. All responses shall be solely in the form of information and materials. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. The Government is under no obligation to issue a solicitation or to award any contract on the basis of this RFI. All costs associated with responding to this RFI will be the sole responsibility of the respondent. All submissions will be treated as business confidential materials, become Government property, and will not be returned. Program Information VA Points of Contact: Contracting Officer: Terri Duenas VA Strategic Acquisition Center Virginia (SAC-V) Email: Terri.Duenas@va.gov Contract Specialist: Justin Sink VA Strategic Acquisition Center Virginia (SAC-V) Email: Justin.Sink@va.gov Statement of Needs The intent of this RFI is to determine contractor availability to calculate a Medicare price for an episode or for multiple episodes of care from data manually loaded into a web-based portal or from bulk data provided to the contractor. Program Requirements The scope of this RFI is to obtain information on the availability of electronic Medicare pricing services for episodes of Veteran care based on de-identified data provided by VA. VA is requesting information about the following components of electronic Medicare pricing services: Overall system(s) Limitations of the system Verifying accuracy of the Medicare price Options available for input and format of de-identified claim data Claim data required for accurate pricing Maintaining currency on Medicare updates Singular manual data input Platform Options available for output of Medicare price Ease of use of web-based portal Bulk data input Platform Options for receipt or upload of de-identified data to system Options available for output of Medicare price Capacity In Response to this RFI VA is seeking qualified respondents that offer solutions and systems that meet the RFI Statement of Needs in Section 2, Statement of Needs and the requirements noted in Section 3, Program Requirements. Respondents are requested to provide the minimum capability listed below this paragraph and answers to questions in Attachment A, RFI Respondent Questionnaire. Please simply indicate N/A for any question that is not applicable. VA requests interested parties furnish the following minimum information: Company name and address. Company point of contact name, telephone number and email address. Company business size and status (e.g., Large Business, Small Business, Service-Disabled Veteran Owned Small Business, Women-Owned Small Business), the number of years in business, affiliate information: parent company, joint venture partners, potential teaming partners. Indicate if the company holds a Government Wide Acquisition Contract (GWAC) and list the Contract Number. List the North American Industry Classification System (NAICS) codes and/or the relevant Special Item Numbers (SIN) used for providing Medicare pricing services. Indicate if your company is active in the System for Award Management (SAM) and provide the Commercial and Government Entity (CAGE) code. Capabilities/Qualifications: A written response providing clear and unambiguous evidence to substantiate the capacity to fulfill this potential requirement. Description of the capabilities/qualifications/skills the company possesses to perform services described in any potential scope of work or performance work statement. Responses It is requested that the above information be provided no later than May 20, 2021, by 4:00 PM EST. Responses must be emailed to Terri.Duenas@va.gov and Justin.Sink@va.gov. All email correspondence for this project must reference the RFI Number, Project Identifier and Project Title in the subject line of the email. Example: RFI VA-16-N-0006, Medicare Pricer Sources Sought. Disclaimer This RFI is for the purpose of market research only and is issued for information and planning purposes only. This does not constitute a solicitation, nor does it bind the government to produce a solicitation or restrict as to the ultimate acquisition approach should a solicitation result from this RFI. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Any contract that might be awarded based on information received or derived from this market research will be the outcome of a competitive procurement. Attachment A RFI Respondent Questionnaire COMPANY INFORMATION 1. What is your company name and address? Ans: 2. What is the contact information for your company Point of Contact (POC)? Ans: 3. What is your company s business size and status (e.g., Large Business, Small Business, Service-Disabled Veteran Owned Small Business, Women-Owned Small Business), the number of years in business, affiliate information: parent company, joint venture partners, potential teaming partners? Ans: 4. If your company holds a Government Wide Acquisition Contract (GWAC), please list the Contract Number: Ans: 5. List the North American Industry Classification System (NAICS) codes and/or the relevant Special Item Numbers (SIN) used for providing Medicare pricing services Ans: 6. Indicate if your company is active in the System for Award Management (SAM) and provide the Commercial and Government Entity (CAGE) code. Ans: OVERALL QUESTIONS 1. How long does it take your company to assess Medicare regulation and policy changes and incorporate those updates into your pricing system? Ans: 2. How do you ensure your system is providing accurate Medicare prices to include, rates, rules, and edits by line and claim level? Ans: 3. Can your system s individual pricing rules and edits be suspended on an as needed basis? Ans: 4. On pricing outputs, is your system able to identify when specific items like Rural, HPSA bonus, wage index, etc. are applied? Ans: 5. Quality of results is vital to the VA. How do your system and internal business processes allow end users to audit results for accuracy? Ans: INDIVIDUAL MANUAL DATA INPUT 1. Do you have a web-based portal for manually entering individual claim data for Medicare pricing? Ans: 2. How is access to this system controlled? Ans: 3. Does the web-based portal provide output as a pdf? What other formats are available for output of the Medicare prices? Ans: BULK DATA INPUT 1. Can you accept bulk data submissions for pricing? Ans: 2. If yes to D.1, what mode(s) are used to transmit bulk data to you and receive the bulk data results from you? Ans: 3. If yes to D.1, in what format must the bulk data be submitted? Ans: 4. If yes to D.1, how long will it take to get bulk data results based on: 500 claims submitted in bulk format, and 5,000 claims submitted in bulk format? Ans: 5. If yes to D.1, in what format is the output provided? Ans: Attachment B Contractor Capabilities Document Table 1: Contractor Capabilities Process Area Requirement Outcome Web-based Portal Ability to create a user friendly web-based portal that can calculate an equivalent Medicare price following manual input of VA de-identified data. De-identified data is data where sensitive information has been removed. Ability to remain current on all updates to Medicare regulations. Ability to ensure the web-based portal consistently produces accurate Medicare prices for a specific episode of care. Ability of the system to suspend individual pricing rules and edits as needed. Ability of a system that can identify items such as Rural, HPSA bonus, Wage index, etc. Ability of the system to provide the output as a pdf file. Contractor s web-based portal system will accept manually input VA de-identified data and calculate an equivalent Medicare price for that specific episode of care. Contractor will have or develop processes that will ensure all updates to regulations affecting Medicare pricing are quickly incorporated into the system to consistently provide accurate and up to date outputs. Contractor portal will return real time Medicare prices to the VA in pdf form. Bulk-Data Processing Ability to accept bulk de-identified data from VA. Ability to quickly run de-identified data through the system, calculate the equivalent Medicare rate for each of the claims with the output being an individual pdf for each claim line item. Ability to remain current on all updates to Medicare regulations. Ability to ensure the system for bulk data consistently produces accurate Medicare prices for a specific episodes of care. Ability to return the multiple pdf outputs electronically to VA auditors. Contractor s bulk data processing system will accept bulk VA de-identified data and calculate equivalent Medicare prices for each of the specific episodes of care. Contractor will have or develop processes that will ensure all updates to regulations affecting Medicare pricing are quickly incorporated into the system to consistently provide accurate and up to date outputs. Contractor will return Medicare prices for all bulk data to the VA in multiple pdf files. Quality Assurance The Contractor must establish and maintain a Quality Assurance Plan (QAP). The QAP must be submitted in accordance with the Schedule of Deliverables. The Contractor s QAP must demonstrate how the Contractor s performance will adhere to the Quality Assurance Surveillance Plan (QASP). The Contractor will address all QASP metrics and whether performance thresholds were missed, met, and/or exceeded for each standard within a Monthly Progress Report (MPR). The Contractor shall meet performance targets established by the QASP.