S05 - Q_A_3rd Party Outpatient Medical Billing.pdf

3rd Party Outpatient Medical Billing

Questions and answers

1. Q - There appears to be a substantial infrastructure setup cost in this project while the number of placements has no minimum and the contractor is primarily being used as “overflow” processing for the VA. To offset this, is there a minimum number of encounters per month to be placed?

A – No, there is no monthly minimum

2. Q - Concerning 6.1 Non-Billable. The work effort to process an encounter is virtually the same regardless of the ultimate status of the encounter. Does this mean the contractor must process, but not be paid, for encounters that are/have:

a. Returns Not Billable

b. Verification issues

c. ROI

d. Provider issues

e. NPI number issues

f. Coding issues

A – See revised PWS Section 6.1

3. Q - What percentage of the encounters will need to be returned and a Quic completed in OnTrac that will not result in reimbursement to the contractor, due to the encounter being non-billable at the time?

A – Reference PWS Section 6.1

4. Q - The RFP states in 6.1 Non-Billable “the VA estimates 10% of daily workload will be determined not billable.” Would the contractor be reimbursed for non-billable placements that exceed this stated percentage?

A - No

5. Q - Will each CPAC continue to require Quality Audits to be completed by the Contractor and sent bi-weekly to CORS? This Audit requires up to 10 bills to be reviewed and Quality Audit form to be completed on each biller.

A – Reference PWS Section 6.5 Item #2 in the table, see “Method of Surveillance”. Quality Audits are required on a monthly basis

6. Are you able to provide an idea of an average amount of claims this Presolicitation would entail per month?

A – Reference Section E.1 Sub-Factor II Corporate Experience, paragraph (i) in the solicitation: Estimate is an average of 60,000 encounters per month

7. Q - Would claims processing and adjudication be construed as “relevant” to third party billing?

A – Reference Section E.1, Factor II Past Performance in the solicitation for definition of Relevant; “Relevant past performance is defined as contracts completed similar in scope as the PWS and at a minimum valued at $1 Million per year.”

8. Q - Can the Government please provide the daily workload volumes, there were none indicated in the PWS?

A – Reference Section E.1 Sub-Factor II Corporate Experience, paragraph (i): Estimate is an average of 60,000 encounters per month

9. Q - Excel Price Schedule Column E. Quantity has an asterisk but no corresponding definition. What are the volumes to be used for pricing the Third- Party Billing Services?

A – See revised Price Schedule.

10. Q - PWS page 9 Section 6.4.2.2 states “Substitution of Key Personnel notes

‘security requirements as defined in Section J’.” There does not appear to be a Section J, will the government provide section J or elaborate on the specific security requirements or do the requirements outline in Section 6.7.3 apply to the reference to Section J?

A – See revised PWS

11. Q – PWS Section 6.4.2.5 states “Incumbent serves as Billing Supervisor”. Can the government clarify what is meant by stating the incumbent serves as supervisor? This sentence seems to give an advantage to the incumbent contractor.

A – Upon contract award, Incumbent (Awardee) serves as Billing Supervisor

12. Q - E.1 Volume II Technical Capability section b. Sub-factor II Corporate Experience paragraph iii. States: ‘Relevant is defined as work similar in complexity and at a minimum valued at $1 Million per year as described in the

PWS.’ However, E.1 Volume III Factor II Past Performance states: ‘Relevant past performance is defined as contracts completed similar in scope as the PWS and at a minimum valued at $3 Million per year.’ Would the government please clarify? Furthermore, as a small business set-a-side this clearly limits competition and hampers a small business team from pursuing this opportunity.

We are asking that the government reconsider these very restrictive parameters.

A – See revised Solicitation: E.1 Volume II Technical Capability section

b. Sub-factor II Corporate Experience paragraph iii.

13. Q- E.1 paragraph Volume III Factor II Past Performance paragraph a. States:

‘If in a teaming agreement or joint venture with no combined past performance, contracts from either/both team members can be submitted not to exceed three

(3) total contracts with at least one (1) contract from each team member.

However, E.2 EVALUATION FOR AWARD, Factor II Past Performance paragraph a. iii.3 states in part, ‘Projects/contracts performed by contractors other than the offeror, such as teaming partners or subcontractors, will not be evaluated as prime contractor experience or past performance, unless those other contractors are part of a joint venture offeror as demonstrated by a signed joint venture agreement’.

We are asking that the Government accept past performance from the prime and its subcontracting teaming partners. Again, only evaluating the past performance of prime severely hampers competition and seems to favor the incumbent contractor.

A – See revised solicitation Reference Section E.2 Evaluation for Award, Factor II Past Performance.