E.2_MRAC_Answers_to_Questions.docx

J.9 – Questions and Answers (QAs) Template Questions and Answers – 75FCMC18R0013 *Please use the below required format. Also, make sure to add ‘CMS Answer’ below each question.

REQUEST FOR PROPOSAL QUESTIONS (RFP):

Question #1 Section/ Page Number: Schedule of Supplies/Services Pages 6-7 Question: Why are Optional Standard Medical Reviews listed as Time & Material? Can they be FFP at the same rate as Standard Medical Reviews?

CMS Answer: The Optional Standard Medical Reviews are not a guaranteed workload and the quantities are only an estimate.

Question #2 Section/ Page Number: L.11 Tab D Key Personnel & Staffing Plan Page 93 Question: Does the Standard MR Manager and the Program Integrity MR Manager have to be two separate individuals? Based on the volume, it appears one person with experience in each area can manage both positions.

CMS Answer: CMS agrees that one person may function as the Standard MR Manager and the Program Integrity Manager if they demonstrate the required credentials and experience.

Question #3 Section/ Page Number: H.1.c Significant Potential Conflict of Interest, page 29 Question: Does CMS believe it is possible to provide an acceptable mitigation plan for an MRAC subcontractor who is also a subcontractor to an existing ZPIC (providing services other than medical review/claim determination support to the ZPIC)?

CMS Answer: No.

Question #4 Section/ Page Number: H.3 HHSAR 352.237-75 KEY PERSONNEL (DEC 2015), page 41 Question: Do key personnel need to be full-time?

CMS Answer: Yes, key personnel need to be full time. The SOW has been updated to reflect this change.

Question #5 Section/ Page Number: H.3 HHSAR 352.237-75 KEY PERSONNEL (DEC 2015), page 41 Question: Can key personnel serve in more than one role?

CMS Answer: CMS will only consider the Standard and Program Integrity MR Manager Key personnel positions to serve as one role. See response to question #2 for the key personnel role of MR Managers.

Question #6 Section/ Page Number: L.3.c.2 — Page 81/105 Question: The RFP requires several items that must be shown on the first page of the proposal (e.g., solicitation number, POC information, statement specifying the extent of agreement with all terms…). Is this Cover Sheet/Cover Letter included in the page restrictions?

CMS Answer: It is not.

Question #7 Section/ Page Number: L.12 — Page 97/105 Question: RFP Section L.12 regarding “Tab C Reps & Certs” states “…In addition, Sections B.1 shall be filled out in its entirety.” However, RFP Section B.1 is the description of services. Please clarify what is meant by this requirement.

CMS Answer: The RFP has been corrected to read B.3.

Question #8 Section/ Page Number: Attachment E1 Business Proposal Template & SOW Task 2 - Transition Period (page 7) Question: The SOW indicates that the Transition Period “shall be a 90-day ramp up period initiated at the time of contract award.”

· We assumed this to be a “Transition-In” with a 3-month duration. However, Attachment E1 prescribed 4 Units (assumed to be months) under CLIN 0001AA Base Period (Transition) for both the Standard Medical Review and the Program Integrity Review. Should this be corrected to 3 units, meaning 3 months?

CMS Answer: Yes, this should be corrected to 3 units, meaning 3 months. See below.

· Additionally, Attachment E1 also prescribed 1 Unit for Task 2 - Transition under CLIN 0001AA Base Period (Fully Operational) and each of the out years on both Standard Medical Review and the Program Integrity Review tabs. Should these units be removed since the Transition-In is only applicable under CLIN 0001AA Base Period (Transition)?

CMS Answer: Yes, the transition period units should be removed from CLIN 0001AA Base Period (Fully Operational), CLIN 0002AA Option Year One, CLIN 0003AA Option Year Two, CLIN 0004AA Option Year Three, and CLIN 0005AA Option Year Four from both Standard Medical Review and the Program Integrity Review tabs. The Transition period is only applicable to the Base Period, CLIN 0001AA (Transition). The Business Proposal Template has been revised and will be included with the responses to these questions.

Question #9 Section/ Page Number: Attachment E1 Business Proposal Template & SOW Task 2 - Transition Period (page 7) Question: While the transition task requires that "Accuracy reviews shall be initiated in modified quantities as directed by CPI within 30 days of contract award and increased to the full requirements of this SOW for the MACs, CERT, SMRC, BFCC-QIOs and ZPICs/UPICs by the end of the 90-day ramp-up period," the transition line item did not include any unit cost and unit for Task 4 – Accuracy Review. How many units should the offeror include for the Transition-In (CLIN 0001AA Base Period (Transition))?

CMS Answer: The assumptions have been updated to include an assumed workload of 30 standard medical reviews and 30 program integrity medical reviews to be completed during the transition period. This change is reflected on Attachment E.1 and the SOW.

Question #10 Section/ Page Number: Attachment E1 Business Proposal Template & SOW Task 6 – Status Reports (page 14) Question: The SOW indicates that there should be Claim-by-Claim Monthly reports for each MRC. For the 3-month Transition-In period, attachment E1 does not prescribe any quantity/unit for reports to be produced. Should there be 3 monthly reports (3 units) for Task 6 in Attachment E1 under CLIN 0001AA Base Period (Transition)?

CMS Answer: Yes, there should be three monthly reports. Attachment E.1 has been updated to reflect this change.

Question #11 Section/ Page Number: Attachment E1 Business Proposal Template & SOW Task 4 (pages 12 & 13) Question: There are discrepancies in the total records to be reviewed between the SOW Task 4’s prescribed quantity and Attachment E1’s prescribed quantity as summarized in the table below. Would the Government please provide the required corrections/updates?

SOW TASK DESCRIPTION

Att E.1 Business Proposal Template

OPTIONAL TASK

(Base & Option years)

CMS Answer: The SOW TASK DESCRIPTION CHART contains the correct numbers. Corrections to the business proposal template have been made to reflect the correct categories and workload quantities and will attach with these responses.

Question #12 Section/ Page Number: Attachment E1 Business Proposal Template Question: Attachment E1 does not provide a line item for the offeror to price the Medicaid program Integrity Claims, just Part A and Part B. Where this item should be priced out?

CMS Answer: Corrections to the business proposal template have been made to reflect the correct categories and workload quantities.

Question #13 Section/ Page Number: M.3 EVALUATION OF VOLUME I: TECHNICAL PROPOSAL, Pg. 101 & 102 Question: It states Technical Evaluation factors, Key Personnel and Staffing Plan and Past Performance, will be evaluated on a Pass/Fail Basis. Does this mean CMS will assess quantity and quality only for the Technical Approach factor?

CMS Answer: CMS will rate the Technical Understanding and Approach on an adjectival basis. Key Personnel and Staffing Plan, and Past Performance will be rated as a Pass or Fail.

Question #14 Section/ Page Number: B.3 SCHEDULE OF SUPPLIES/SERVICES, Pgs. 8-11 Question: The tables show T&M SLINS for Program Integrity Outreach & Education. There is not a specific Statement of Work Task for this item. Can CMS elaborate on the requirements for this item?

CMS Answer: This was an error on CMS’ part. This is not in the SOW and there was never a plan for the MRAC to provide education or outreach. This has been removed from the solicitation.

Question #15 Section/ Page Number: L.12 VOLUME II: BUSINESS PROPOSAL INSTRUCTIONS, TAB F, Organization Structure, Pg. 99 Question: Under TAB F (Organizational Structure), it states, “Offerors shall submit an organization structure chart that depicts its current internal structure and the relationships between the parent company and any subsidiaries and/or affiliates. This structure should also include Business Units, Divisions, etc. A separate organization structure chart should be provided for each proposed significant subcontractor (as defined in Section L.11).” For each subcontractor, is the organization structure chart only limited to the expected working relationship between the prime and subcontractor under the MRAC solicitation?

CMS Answer: No, this should be included for all subcontractors and their corporate structures to ensure there are no conflicts with the work being performed.

Question #16 Section/ Page Number: L.11, VOLUME I: TECHNICAL PROPOSAL, Tab E- Factor 3: Past Performance. INSTRUCTIONS Pg.95-96

Question: Is there a limit on the number of past performances the Offeror is allowed to submit?

CMS Answer: There is no limit.

Question #17 Section/ Page Number: L.11, VOLUME I: TECHNICAL PROPOSAL, Tab E- Factor 3: Past Performance. Pg.95-96

Question: Is a write-up required for past performance relevancy or is the summary table in Excel all that must be submitted?

CMS Answer: The summary table in Excel is all that is required.

Question #18 Section/ Page Number: L.11, VOLUME I: TECHNICAL PROPOSAL, Tab E- Factor 3: Past Performance. Pg.96 Question: In the past performance section of the table below that will be provided to CMS, will the government accept a table provided in Microsoft Word?

CMS Answer: CMS will accept this information in a table format in Microsoft Word.

Question #19 Section/ Page Number: L.11, VOLUME I: TECHNICAL PROPOSAL, Tab E- Factor 3: Past Performance. Pg.96 Question: Is the table sample on page 96 for past performance a summary of the Offeror’s past performances? Or does each past performance have its own table?

CMS Answer: This would be a summary of all past performances submitted.

MISCELLANEOUS:

Question #20 Section/ Page Number: General Information Question: Is there an incumbent and if so, who?

CMS Answer: The incumbent information will not be released at this time.

Question #21 Section/ Page Number: Miscellaneous Question: Is the Incumbent Contractor using a CMS authorized MRAC Operations Manual? If yes, will CMS share this Manual with prospective bidders?

CMS Answer: There is no MRAC Manual. The SOW and the IOM 100-8 Program Integrity Manual provide information for an offeror to use in their development of a plan to operationalize the requirements for this contract.

Question #22 Section/ Page Number: Miscellaneous Question: Does the security controls assessment and authority to operate process apply to the MRAC? If yes, is the completion of this process required before the MRAC can commence work on the contract?

CMS Answer: An Authority to Operate (ATO) is not required for the MRAC to meet the requirements of this contract. CMS Medicare contractors shall comply with all security, policies, regulations, and laws contained in the BPSSM.

Question #23 Section/ Page Number: E.1_Business_Proposal_Template, Standard Medical Review Spreadsheet and Program Integrity Medical Review Spreadsheet Question: Except for Task 4, quantities are listed for Tasks which have no corresponding, specific workload requirements in the SOW? What do the quantity figures represent under each Quantity column in the spreadsheets?

CMS Answer: Under both of the tabs these numbers represent estimated workload. Under the Disagreement Process, it is estimated that these are the number of claims that the MRAC will disagree with; under the Status Reports, these are the estimated number of status reports to be delivered. In the Base Year, it is estimated that there will be 9 months of operational time, thus 9 monthly status reports and one end of year summary report; for the option years, this number represents the estimated 12 monthly status reports and one annual summary report.

Question #24 Section/ Page Number: E.1_Business_Proposal_Template, Standard Medical Review Spreadsheet Question: Quantities are listed for Task-2 Transition in the option years. Is the transition of work expected in the option years?

CMS Answer: Please see the response to Question #8 above Question #25 Section/ Page Number: E.1_Business_Proposal_Template, Program Integrity Medical Review Spreadsheet Question: The quantities listed for the stated claim counts in the SOW do not match the quantities listed for Task 4 - Program Integrity Medical Review Part A and Task 4 - Program Integrity Medical Review Part B. Which quantities should bidders use to determine the proposed costs?

CMS Answer: Please see the response to Question #11 above

Question #26 Section/ Page Number: E.1_Business_Proposal_Template, Program Integrity Medical Review Spreadsheet Question: Quantities are listed for Task-2 Transition in the option years. Is the transition of work expected in the option years?

CMS Answer: Please see the response to Question #8 above

STATEMENT OF WORK QUESTIONS (SOW):

Question #27 Section/ Page Number: Task 4: Accuracy Review Process Question: For clarity, will the MRAC receive case and documents on an encrypted CD from the MRC?

Can the MRAC receive cases and documents in any other way such as HIPAA, encrypted secure file transfer protocol (FTP) site?

CMS Answer: Yes, at this time, the encrypted CD is the preferred mode of transmission of PHI until such a time that the COR provides additional instructions/technical direction.

Question #28 Section/ Page Number: Task 4.1 and 4.2 Question: Does CMS have any historical data regarding the average time to complete a standard accuracy review and a program integrity review?

CMS Answer: Not at this time.

Question #29 Section/ Page Number: Task 4.1 and 4.2 Question: Does CMS have any historical data regarding number of received standard accuracy and program integrity reviews for Part A and Part B claims for the last three years?

CMS Answer: CMS will not be releasing this information. Please see provided assumptions.

Question #30 Section/ Page Number: Task 6.1: Claims Report Question: Does CMS have any historical data for the past three years regarding the number of disagreements, agreements, the leading rationale/reasons for disagreements, and the agreement/accuracy rate?

CMS Answer: This data is still in the process of analysis and there is not a projected timeline and/or plan to release this information at this time. Please see the provided assumptions.

Question #31 Section/ Page Number: Task 1.2 Project Manager, Contract Medical Director, Medical Review Managers, Standard MR Manager, Program Integrity MR Manager Question: Does CMS have any historical data for the past three years regarding the number of work hours furnished/invoiced for each position.

CMS Answer: Please see estimated workload load numbers for Task 4 standard A and B medical review on Exhibit E.1 Business Proposal Template.

Question #32 Section/ Page Number: II. Requirements, A. General Requirements, Assumptions and Constraints, Pg. 3 Question: How many claims were reviewed by the incumbent by year during the period of performance under contract number HHSM500201500308C?

CMS Answer: Please see estimated workload load numbers for Task 4 standard A and B medical review on Exhibit E.1 Business Proposal Template.

Question #33 Section/ Page Number: II. Requirements, A. General Requirements, Assumptions and Constraints, Pg. 3 Question: Of the claims reviewed by the incumbent under contract number HHSM500201500308C, what was the number of total number of agreements; number of total number of disagreements; and agreement/accuracy rate?

CMS Answer: OAGM - Please see estimated workload load numbers for Task 4 standard A and B medical review on Exhibit E.1 Business Proposal Template.

Question #34 Section/ Page Number: II. Requirements, A. General Requirements, Assumptions and Constraints, Pg. 3 Question: For the base year, using the incumbent contractor’s history, what percentage of the claims workload does CMS estimate will involve the review of Part A and Part B prescription drugs (e.g., C-codes, J-codes, Q-codes, etc.) as part of a medical review?

CMS Answer: The type of work that will be included in the Standard and Program Integrity MR samples to be selected is unknown at this time. It is expected that the offeror will be prepared to perform all of the requirements of this contract at the time of award/fully operational.

Question #35 Section/ Page Number: II. Requirements, A. General Requirements, Assumptions and Constraints, Pg. 3 Question: Will the successor contractor receive any work-in-progress from the incumbent contractor?

CMS Answer: There is currently no plan to transition work in progress from the incumbent contractor.

Question #36 Section/ Page Number: II. Requirements, A. General Requirements, Assumptions and Constraints, Pg. 3 Question: Using the incumbent contractor’s historical information, what percentage of each workload category does CMS anticipate will involve a complex review?

CMS Answer: The type/percentage of work that will be included in the Standard and Program Integrity MR samples to be selected is unknown at this time. It is expected that all of the Accuracy Reviews performed will require a complex medical review. It is expected that the offeror will be prepared to perform all of the requirements of this contract at the time of award/fully operational.

Question #37 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 1 – Administrative Requirements, Task 1.2 – Key Personnel, Pgs. 4-6 Question: What is the required level (percentage) of Full-Time Equivalent for each key personnel position?

CMS Answer: Please see Question #4 above.

Question #38 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 2.1 – Joint Operating Agreement (JOA), Pg. 8 Question: Will CMS review and approve of each JOA prior to the execution by the parties?

CMS Answer: Yes. JOAs will be approved by the COR.

Question #39 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 3.6 – Communication, Pg. 10 Question: Is this coverage for all time zones during regular business hours?

CMS Answer: This applies to all time zones. Phone calls and email requests shall take into consideration the time zone the Contractor and CMS are in. It will be essential for both parties to discuss the need for such communication and an agreed upon time/mode for that communication to take place.

Question #40 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 4 – Accuracy Reviews, Pg. 10 Question: For some claim types (e.g., Home Health or SNF), it’s helpful to review a beneficiary’s history leading to a claim, such as the review of other claims to identify patterns, trends, or anomalies. Does CMS expect the scope of the medical review to go beyond a specific line item in those instances?

CMS Answer: No, CMS does not expect the scope of the medical review to go beyond a specific line item in those instances.

Question #41 Section/ Page Number: III. Performance Standards, IV., Deliverable Schedule, Pg. 18 Question: Does CMS have a preferred template for bidders to use for preparing the Project Plan?

CMS Answer: No.

Question #42 Section/ Page Number: III. Performance Standards, IV., Deliverable Schedule, Pg. 18 Question: Does CMS have a preferred template for bidders to use for preparing the IT Systems Project Plan?

CMS Answer: No.

Question #43 Section/ Page Number: II. Requirements, A. General Requirements, Assumptions and Constraints, Pg. 3 Question: The SOW states, “The base year of this contract will be limited to the review of the MACs, SMRC, CERT, BFCC-QIOs, QIC and ZPICs/UPICs. The additional contractor types will be integrated into the workload after the evaluation of the base year of work and at the direction of CPI/CMS.” How and when will the additional contractor types be integrated into the workload?

CMS Answer: As stated in the SOW, the additional contractor types will be integrated into the workload after the evaluation of the base year of work and at the direction of CPI/CMS. There is not a defined plan/timeline for the implementation of additional contractor types at this time.

Question #44 Section/ Page Number: Task 4 – Accuracy Reviews, Accuracy Review Process, Pg. 11 Question: Under Accuracy Review Process, in the first sentence of this paragraph, it states: “The MRAC will receive a claims universe from the Standard and Program Integrity MRCs specified by CPI/CMS and generate a random representative sample of claims to be reviewed.” How will these claims be received?

CMS Answer: Please see Question #7 above.

Question #45 Section/ Page Number: Task 4 – Accuracy Reviews, Accuracy Review Process, Pg. 11 & 12 Question: For claims that do not fall under the Disagreement Process, where and how will the MRAC transmit these results?

CMS Answer: As stated in the SOW, Task 6.1 – Claim by Claim Monthly Report.

Question #46 Section/ Page Number: III. Performance Standards, Standard – Performance Metrics, Pg. 14 & 15 Question: Under Standard – Performance Metrics, it states, “Identification of patterns and/or trends which may support an allegation of potential fraud, waste, or abuse and were not referred to the ZPIC/UPIC.” A metric to measure performance is not listed. The MRAC should have the responsibility of attempting to identify patterns and/or trends in 100% of the reviews. Correct?

CMS Answer: Yes, the MRAC shall have the responsibility of attempting to identify patterns and/or trends in 100% of the reviews.

Question #47 Section/ Page Number: Task 2.3 – IT Systems Project Plan, Pg. 7 & 8 Question: It states the project plan should include the “Capability to securely receive and utilize data from CMS.” What mechanisms and data sources does CMS anticipate will be used to receive and utilize data from CMS?

CMS Answer: At this time, the encrypted CD is the preferred mode of transmission of PHI until such a time that the COR provides additional instructions/technical direction. Non-protected information may be received/sent via email.

Question #48 Section/ Page Number: Task 4 – Accuracy Reviews, Accuracy Review Process, Pg. 11 Question: Is CMS requiring a statistician or equivalent position to extract the random sample?

CMS Answer: No.

Question #49 Section/ Page Number: Task 4 – Accuracy Reviews, Accuracy Review Process, Pg. 11 Question: Are there specific requirements CMS expects the MRAC to use in generating a random representative sample of claims?

CMS Answer: No. Contractor’s discretion; must be verifiable and consistently applied.

Question #50 Section/ Page Number: Task 4 – Accuracy Reviews, Accuracy Review Process, Pg. 11 Question: What specific fields does CMS expect the MRCs to provide the MRAC as part of the claims universe?

CMS Answer: At this time there is no specific spreadsheet or template required to communicate between the MRC and the MRAC.

Question #51 Section/ Page Number: II. Requirements, A. General Requirements, Assumptions and Constraints, Pg. 3 Question: Of the number of total number of disagreements reported by the Incumbent Contractor, what was the CMS concurrence rate with the Incumbent Contractor? How many did CMS overturn?

CMS Answer: This data is still in the process of analysis and there is not a projected timeline and/or plan to release this information at this time. Please see the provided assumptions.

Question #52 Section/ Page Number: II. Requirements, A. General Requirements, Assumptions and Constraints, Pg. 3

Question: The SOW language states the following: The base year of this contract will be limited to the review of the MACs, SMRC, CERT, BFCC-QIOs, QIC and ZPICs/UPICs. The additional contractor types will be integrated into the workload after the evaluation of the base year of work and at the direction of CPI/CMS. Please confirm that the “additional contractor types” will be the MEDIC and MIC Contractor.

CMS Answer: As stated in the SOW, MRCs are defined as the Medicare Administrative Contractor (MAC), Supplemental Medical Review Contractor (SMRC), Comprehensive Error Rate Testing contractor (CERT), Zone Program Integrity Contractor (ZPIC)/Unified Program Integrity Contractor (UPIC), Medicare Drug Integrity Contractor (MEDIC), Medicaid Integrity Contractor (MIC), Qualified Independent Contractor (QIC) and Beneficiary and Family Centered Care - Qualified Independent Contractor (QIC) and Quality Improvement Organization Contractor (QIO).

Question #53 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 2 – Transition Period, Pg. 7

Question: The Transition Period language states: Accuracy reviews shall be initiated in modified quantities as directed by CPI within 30 days of contract award and increased to the full requirements of this SOW for the MACs, CERT, SMRC, and BFCC-QIOs and ZPICs/UPICs by the end of the 90-day ramp-up period. During this 90-day time period, is there a measurable % of ramp up or volume by claim type on the ‘modified quantities’ that can be anticipated by the Contractor?

CMS Answer: Please see Question #9 above

Question #54 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 2.1 – Joint Operating Agreement, Pg. 8

Question: What are the responsibilities of the Medical Review Contractor (MRC) in supporting the MRAC tasks? Is there a JOA template that CMS can provide?

CMS Answer: The responsibilities of the MRC in supporting the MRAC are addressed in the SOW. Currently there is no template.

Question #55 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 4 – Accuracy Reviews, Pg. 10-11

Question: What percentage of the claim volume/workload is anticipated to be medical/clinical review (clinicians) versus coding determinations (certified coders)?

CMS Answer: The type/percentage of work that will be included in the Standard and Program Integrity MR samples to be selected is unknown at this time. It is expected that the offeror will be prepared to perform all of the requirements of this contract at the time of award/fully operational.

Question #56 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 4 – Accuracy Reviews, Accuracy Review Process, Pg. 11

Question: Are there any statistical measuring requirements that CMS has or is the sampling technique left to the contractor’s discretion?

CMS Answer: Please see the response to Question #49 above.

Question #57 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 4 – Accuracy Reviews, Accuracy Review Process, Pg. 11

Question: What sampling technique was utilized to arrive at the projected volumes CMS published in the SOW?

CMS Answer: These are projected workloads based on the contracted workload of the MRCs.

Question #58 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 4.1– Standard – Accuracy Reviews for MACs, SMRC, CERT, QICs and BFCC-QIOs, Pg. 12

Question: The SOW states the following: The MRAC shall only review the specific line(s)/purpose that the claim was reviewed by the MRCs. Many times, claim lines are interdependent and an error on one claim line may affect the outcome on another claim line both from a coding standpoint (e.g. NCCI edits) or a payment standpoint (e.g. APC payment methodology). May other claim findings be reported as an Observation on the claim or is CMS requesting reporting of the limited view of a single claim line finding?

CMS Answer: Observations may be reported, but for the purpose of accuracy of a specific MRC, the MRAC shall only review and report the results of the specific line for the same purpose that the specific MRC reviewed.

Question #59 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 4.2 – Program Integrity – Accuracy Reviews for ZPIC/UPIC and MEDIC and MIC Contractors, Pg. 13

Question: The SOW language states the following: The MRAC shall perform Program Integrity medical reviews that total 1,450 For Part A claims and 4,100 for Part B and 50 Medicaid claims in the Base Year; and 1,900 for Part A claims and 6,000 for Part B claims, and 100 Medicaid claims in each Option Year period of performance of this contract. This statement outlines total volumes that include Base Year MRC Contractor Types (ZPIC/UPIC) and does not separately identify MEDIC and MIC volumes. What are the claim types and volumes associated with the MEDIC and MIC Contractors?

CMS Answer: Please see Question #43 above

Question #60 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 5 – Disagreement Process

Question: The SOW states: When the MRAC disagrees with the MRC’s payment decision on a claim, or identifies unaddressed patterns and/or trends which may support an allegation of potential fraud, waste or abuse, the MRAC shall fill out the Accuracy Review Disagreement Worksheet. With only a linear review of a single claim (line) and likely low claim type volume per MRC, what is CMS’s expectation for the MRAC to identify patterns and/or trends across providers or beneficiaries that the MRC may not have addressed?

CMS Answer: With regard to the claims reviewed for PI, the MRC will be communicating the allegation related to the purpose of their MR. It is expected that this offeror should be able to review individual/small samples of claims for a specific allegation and provide a summation.

Question #61 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 4 – Accuracy Reviews, page 11

Question: The SOW states, “the MRAC will receive a claims universe from the Standard and Program Integrity MRCs specified by CPI/CMS and generate a random representative sample of claims to be reviewed.” What is the expected frequency for submission of the claims data for sampling (i.e. monthly, quarterly)?

CMS Answer: It is anticipated that the sampling will occur monthly.

Question #62 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 4.2 Program Integrity – Accuracy Reviews for ZPIC/UPIC and MEDIC and MIC Contractor

Per the SOW language, volume is stated to be 50 Medicaid claims in the Base Year and 100 Medicaid Claims in each option year. What claim types and volumes for each will comprise this sample (e.g. professional, institutional)?

CMS Answer: The type/percentage of work that will be included in the Standard and PI MR samples to be selected is unknown at this time. It is expected that the offeror will be prepared to perform all of the requirements of this contract at the time of award/fully operational.

Question #63 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 4 – Accuracy Reviews, Accuracy Review Process, Pg. 11

Question: Under the Accuracy Review Process section, it states: “The MRAC will receive a claims universe from the Standard and Program Integrity MRCs specified by CPI/CMS and generate a random representative sample of claims to be reviewed.” How much time does the MRAC have to generate a random representative of claims to be reviewed and submit it to the MRC?

CMS Answer: We would expect the MRAC to generate a random representative sample of claims to be reviewed as soon as possible after receipt of the universe from the MRCs.

Question #64 Section/ Page Number: II. Requirements, B. Specific Requirements, Task 4 – Accuracy Reviews, Accuracy Review Process, Pg. 11

Question: Under the Accuracy Review Process section, it states: “The MRAC will receive a claims universe from the Standard and Program Integrity MRCs specified by CPI/CMS and generate a random representative sample of claims to be reviewed.” What delivery method does CMS expect the MRAC to use to deliver a ‘random representative sample of claims to be reviewed’ to the MRC?

CMS Answer: Please see Question 27 above.

Question #65 Section/ Page Number: IV. Deliverable Schedule, Pg. 17 Question: Does CMS anticipate ordering any ad hoc deliverables during the course of the contract? If yes, how many by Base Year and Each Option Year?

CMS Answer: CMS is unable to determine the need for ad hoc deliverables at this time.

Question #66 Section/ Page Number: IV. Deliverable Schedule, Pg. 17 Question: The SOW states, “The contractor shall submit all deliverables via secured email to the COR until CPI/CMS- provided IT systems become available, in accordance with the following schedule. Does CMS anticipate the need for users to travel to attend training for these IT systems?”

CMS Answer: Not at this time.