3M Sole Source Intent.pdf

Description

This is a Notice of Proposed Contract Action Synopsis: The Centers for Medicare & Medicaid Services (CMS) intends to issue a new non-competitive contract to 3M Health Information Systems (HIS) pursuant to the authority of FAR 6.302-1, Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements. This action is subject to the availability of funds.

CMS intends to extend the unique services of 3M HIS to continue the maintenance of the groupers, conversion of the COBOL-based products to Java versions, ICD- 10, maintaining CMS national coverage determinations and enhance the editing and grouping programs listed below:

1) Medicare Severity Diagnosis Related Grouper (MS-DRG).

2) Medicare Code Editor (MCE).

3) Medicare Integrated Outpatient Code Editor (I/OCE) with Ambulatory Payment

Classifications (APCs).

4) Long Term Care Hospitals (LTCHs) Prospective Payment System (PPS) and

Inpatient Prospective Payment System (IPPS) Relative Weight Computation (including development of an interface with PRICER).

5) Home Health Prospective Payment System (HH PPS) and Home Health Grouper (HHG) Analytic and Programming Support.

6) Analysis and editing of National Coverage Determinations (NCDs).

7) Maintain and update the ICD-10 Procedural Coding System (PCS) developed by 3M under the direction of CMS.

8) End Stage Renal Disease Prospective Payment System (ESRD PPS).

9) Skilled Nursing Facility Prospective Payment System (SNF PPS).

10) Federally Qualified Health Centers (FQHCs).

11) Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS).

12) Inpatient Rehabilitation Facilities Prospective Payment System (IRF PPS).

13) Rural Health Clinic Prospective Payment System (RHC PPS) development.

Section 9343(g) of the Omnibus Budget Reconciliation Act of 1986 required hospitals to use the Healthcare Common Procedure Coding System (HCPCS) to bill for hospital outpatient surgical services. The contractor, 3M HIS, has been performing the validation of HCPCS codes since the inception of the Medicare PPS. CMS requires this support for software systems maintenance and annual/quarterly updates to the MS-DRGs and HHG software, the I/OCE, the MCE, the LTCH PPS and IPPS relative weights. CMS requires the support for the developing of the Rural Health Centers (RHCs) PPS. The contractor is expected to furnish all of the necessary services, software, qualified personnel, supplies, and any other materials or equipment necessary to provide support for the above critical functions.

3M HIS contractor support is required to enable MACs to process and edit Medicare claims to ensure proper payment. As a result, continued 3M HIS contractor services are critical to the success of CMS’ billing, editing, and coding for the following reasons:

• Continuation of the planning and pre-development sources for all of the major payment programs listed above is required to ensure accurate payment and uninterrupted claims processing;

• Updates of the ICD-10-CM, ICD-10-PCS coding systems;

• Ensure changes to edits and logic for all of the above products required in response to multiple annual legislative mandates. This includes non-anticipated legislative mandates thus requiring analysis and implementation within a very short timeframe;

• Ensure the maintenance of the complicated MS-DRGs in ICD-10-CM as well as the ICD-10 PCS;

• Continue to optimize all Groupers with real time ICD-10 data; and

• Continue value added improvements and expansion of remotely accessible web based interfaces for the I/OCE, the Groupers, and MCE.

In addition, CMS is modernizing its grouping and code editor software. Medicare processes all Original Medicare institutional claims through one of three sub-systems within the Fiscal Intermediary Shared System (FISS). These sub-systems are built with an antiquated programming language (Assembler) that is difficult to extend, maintain, support and test.

Modernizing these programs will protect CMS from future quality and integration risks.

Currently, CMS posts these programs on its website as both COBOL source code and in a COBOL-based PC format. Over the next 2 years, CMS will convert these COBOL-based products to Java versions. 3M HIS is currently in Phase 3 of the six phases of conversion for these systems to Java versions.

As CMS programs have evolved, so has the complexity and scope of these software systems.

Due to the unique nature of CMS requirements, 3M HIS is exclusively qualified to meet CMS’ need to continue to ensure the accurate editing and payment of Medicare claims.

It is critical that CMS have a contractor with the technical skills and knowledge to maintain and update the ICD-10-PCS on a national basis. 3M HIS has the unique knowledge and experience coupled with the necessary advanced technical skills needed to maintain the ICD-10-PCS and to map/crosswalk the system into the MS-DRG structure as well as the on-going maintenance of the groupers. In short, 3M HIS’ extensive knowledge of the computer logic of the groupers and expertise is unmatched in the industry and their continued support with the recent JAVA conversion is in the best interest of CMS and the healthcare industry.

Please note that any firm interested in this synopsis must be proficient in the assembler and JAVA computer languages, have a thorough understanding of the CMS groupers and PPS, show demonstrated proficiency in ICD-10 CM coding as it applies to Medicare claims processing and be able to analyze and interpret final rule outcomes and recommend appropriate coding updates to CMS.

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