E.5 Questions-Answers.xlsx
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- Recovery Audit Contractor Validation Contractor (RVC) Federal contract opportunity
- Solicitation number
- 75FCMC20R0017-Solicitation
About this file
This document includes a solicitation for the Recovery Audit Contractor Validation Contractor (RVC). The Centers for Medicare and Medicaid Services (CMS) is soliciting proposals to review claim determinations made by Recovery Audit Contractors (RACs) to ensure RACs are not improperly denying Medicare claims. The RVC will review up to 1,000 randomly selected claims per month from each RAC region to validate RAC accuracy and medical necessity determinations. The RVC must have experience performing Medicare medical reviews and disputes, and key personnel including the Contractor Medical Director must have experience with hospice medical policies. The RVC will require access to CMS systems and be responsible for acquiring pricing and grouping software to perform reviews. The statement of work specifies tasks including accuracy reviews, special studies, and travel requirements for attendance at program integrity meetings.
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Questions
| RFQ Questions | |||||
| h | c number 1 | 25-36 | Are QIC's considered a COI for this contract? | QICs are not considered to be a COI for this contract. | |
| L.3 | d. Offer expiration date | 67 | There is a reference to "cover sheet" in bullet (d): "Proposals in response to this solicitation will be valid for the number of days specified on the solicitation cover sheet (unless a different period is proposed by the offeror)." | ||
| Please confirm CMS is looking for a Cover Letter where Offerors can include response to this requirement, and that the cover letter will be outside any page count. | Offers shall provide a cover letter where Offerors can include response to this requirement and the cover letter will be outside any page limit count but shall not exceed one page. See solicitation section L.12 for details. | ||||
| L.11 | 72 | RFP states: "The Offeror should be aware that CMS will include pages numbered with roman numerals (title pages, tables of contents, and executive summaries, etc.) as part of the page limit." | |||
| Will CMS please confirm the cover page is outside the page limit. | The cover letter will be outside any page count but limited to 1 page. | ||||
| L.11 | 72 | RFP states: "The Offeror should be aware that CMS will include pages numbered with roman numerals (title pages, tables of contents, and executive summaries, etc.) as part of the page limit." | |||
| Will CMS please allow for the Offerors to include list of tables and graphics as part of the table of contents? If yes, please confirm this will be outside the page limit. | No. The table of content is strickly a list of titles of the parts of the proposal, organized in the order in which the parts appear. No graphs or tables will be permitted. | ||||
| L.11 | 3. Accuracy/Validation and Medical Record Review Experience | 73 | This section is titled "Accuracy/Validation and Medical Record Review Experience", but includes multiple references to "Describe a strategy and technical approach to meet ALL specifications regarding the…" |
Will CMS please revise this language to match the evaluation factors listed on Page 81 for this section?
Sections L purpose is to instruct/summarize. Whereas Section M, purpose is to further detail the specific approach used to evaluate Section L, which includes page 81. Therefore, the offeror should use section M as a checklist to confirm that all responses are complete in Section L.
L.11 4. Technical Understanding and Approach 74 The second last bullet in this section is asking for a description of which personnel will be involved throughout the process. This requirement is also listed in the last bullet of Evaluation Factors for Section 1 - Accuracy/Validation and Medical Record Review Experience on Page 81: "...member of the RVC (i.e. which personnel will be involved in the process of each requirement)."
Will CMS please verify to which section shall we include the response to this specific requirement?
Sections L purpose is to instruct/summarize, which includes page 74, Section L. Whereas Section M, purpose is to further detail the specific approach used to evaluate Section L, which includes page 81. Therefore, the offeror should use section M rather as a checklist to confirm that all responses are complete in Section L.
| L.13 | Business Ethics, Conflict of Interest and Compliance Proposal Submission Instructions | 79 | Tab D is requesting for a completed Attachment J.2 Contractor Personal Conflict of Interest Financial Disclosure. However, Attachment J.2 states that "personal conflict of interest disclosure information shall NOT BE submitted to CMS." | |
| Please confirm that Attachment J.2 is not required to be submitted as part of the proposal? | Attachment J.2 is not required to be submitted as part of the proposal. Reference of TAB D in section L.13 has been removed. | |||
| L.11 Technical Proposal Instructions & M.2 Technical Evaluation | 3. Accuracy/Validation and Medical Record Review Experience & Factor 1. Accuracy/Validation and Medical Record Review Experience | 73 & 81 | The 1st bullet under L.11, #3 (Page 73) speaks to "performing medical review" in general terms and M.2 Factor 1 (3rd sub-bullet under 1st bullet on Page 81) appears to define medical review to include reviewing "coverage, coding, payment, and billing" policies. Is it correct to assume "medical necessity" is part of medical review (e.g., under "coverage") and, if so, do these 5 components (coverage, coding, payment, billing, and medical necessity) cover all policy areas to be reviewed under "medical review"? |
Sections L purpose is to instruct/summarize. Whereas Section M, purpose is to further detailed the specific approach used to evaluate Section L, which includes page 81. Therefore, the offeror should use section M rather as a checklist to confirm that all responses are complete in Section L. Yes, it is correct that medical necessity is a part of medical review. Coverage, coding, payment, billing and medical necessity are the major components of medical review.
| L.11 Technical Proposal Instructions | 3. Accuracy/Validation and Medical Record Review Experience | 73 | Under the 1st bullet, can knowledge and experience performing medical review be other than Medicare knowledge and experience? | Knowledge and experience performing medical review may be other than Medicare knowledge and experience, however, Medicare knowledge and experience are required of the CMD, MR Manager, and nurse reviewers (SOW, section IV Personnel Requirement). |
| M.2 Technical Evaluation | Factor 1. Accuracy/Validation and Medical Record Review Experience | 81 | 4th sub-bullet under 1st bullet: Does it matter the types of entities involved for which capabilities, knowledge, and experience are required for medical review disputes/disagrees (e.g., providers, other contractors such as RACs, government agencies, the QICs, etc.)? | The offeror may describe experience with disputes/disagrees when performing medical review involving providers, other contractors such as RACs, government agencies, the QICs, etc., however, for this contract, the RAC may dispute the RVC finding. |
| M.2 Technical Evaluation | Factor 1. Accuracy/Validation and Medical Record Review Experience | 81 | 5th sub-bullet under 1st bullet: Please clarify the phrase "one targeted area of medical review," and/or please provide examples of "targeted areas." Does that mean, for example, coverage area, coding area, etc.? | One targeted area of medical review may include coverage area, coding area, etc. |
| M.2 Technical Evaluation | Factor 1. Accuracy/Validation and Medical Record Review Experience | 81 | 2nd bullet: What types of "proposals" are intended in the 1st sentence with the reference to "analyzing data from proposals"? Proposals of what? | The New Issue proposals are typically submitted by the RAC for CMS review and approval, see SOW, page 13, Task 3, Accuracy Reviews for further details. |
| SOW Questions | ||||
| Section | Subsection | Page number | Contractors Question | CMS Response |
| iii. | Task 3: Accuracy Reviews | 13 | This section states: "CMS will provide up to 1,000 randomly selected claims per month to send to the RVC". Will CMS please provide a breakdown by RAC Regions, the number of claims selected monthly, specifically Regions 1-4 vs. Region 5? | The historical breakout varies based on CMS COR discretion, RAC proposals by Region and Accuracy Review Results. There will be 200 from each RAC monthly. |
| xi | Task 11: Travel | 28 | This section states: "The contractor is required to travel to CMS Central Office in Baltimore, Maryland for the initial meeting with CMS after contract award. In addition, the contractor is required to attend both the Program Integrity Annual Meeting (5 days) and the RAC Operational Meeting (1 day).". This makes a total of seven (7) days of travel - one day for initial Kick Off meeting, five days for PI Annual Meeting and one day for RAC Operational Meeting. |
However, in the next paragraph, CMS confirms that it will reimburse travel for four (4) personnel for six (6) days per performance year.
| Will CMS please correct the number of days for reimbursement of travel for four (4) personnel to seven (7) days? | CMS has revised the SOW to reflect up to seven (7) travel dates per year for four (4) individuals. | ||||
| IV. Personnel Requirements | i. Key Personnel | 7 | First full sentence at top of Page 7, beginning "All backup positions" states that the individual in a backup position and working in the backup capacity may be a "part-time RVC employee." Elsewhere in the SOW it clearly states that backups of key personnel who serve in the capacity of key personnel must be fully dedicated to that position. Please clarify. Does this mean that a backup employee serving in a key personnel position may be a part-time employee BUT must work full-time (i.e., "subject to the same availability requirements") while serving in a key personnel position? | Correct. A backup employee that may serve in a key personnel position may be a part-time employee BUT must work full-time (i.e., "subject to the same availability requirements") while serving in a key personnel position. SOW revised to state: "All backup positions, while working in the backup capacity, may be a part-time RVC employee, but must work full-time while serving in a key personnel position." | |
| IV. Personnel Requirements | b. Contractor Medical Director (CMD) | 8 | Among his/her experience, the CMD must possess experience with Hospice medical policy. However, Hospice is notably absent in other areas of the SOW which spell out provider/claim type reviews (e.g., Accuracy Reviews and Special Studies). Should Hospice be included under Accuracy Reviews and Special Studies? | The claim types listed under Accuray Reviews and Special Studies in the SOW are not all inclusive. RAC Region 5 is fully dedicated to home health and hospice reviews, therefore the CMD must possess experience with Hospice medical policy. |
| V. Specific Tasks to be Performed | iii. Task 3: Accuracy Reviews and v. Task 5: Special Studies | 14 & 20 | Task 3 and Task 5: 1st sub-bullet under the 1st bullet beginning, "Detail of the claim selected": The only reference to "charges" relates to "items/services." It is understood that the listed items may not be all-inclusive, but will you confirm that charges will include billed charges AND the Medicare approved amount? Will billed and approved charges be provided for hospital claims billed with DRGs? Similarly, will billed and approved charges be provided for other institutional provider types which don't get paid under a DRG system (e.g., SNFs)? | The RVC will receive charges billed from documentation provided by the RAC. The RVC shall be responsible for purchasing all pricers and groupers needed to perform review. (Please refer to the SOW Task 3: Accuracy Reviews for more information). The Medicare approved amount will not be provided by CMS or the RAC for any of the provider types. |
| V. Specific Tasks to be Performed | iii. Task 3: Accuracy Reviews | 15 | 2nd full paragraph: The 3rd sentence states that CMS will not reverse the original RAC decision even though the RVC disagrees with the RAC determination. Can you clarify whether this only applies to cases under appeal or all cases? Wouldn't CMS reverse the original RAC decision if CMS agrees with the RVC's position? | This applies whether the claim has been appealed or not. It is CMS' discretion whether the RAC is required to reverse their original decision. |
| V. Specific Tasks to be Performed | iii. Task 3: Accuracy Reviews | 15 | Will the contractor require access to CMS systems, or are all sources of information required to perform a complete review identified in the RFP? | The RVC will require access to CMS systems. As discussed in Task 3, Accuracy Reviews, the RVC is required to access the RAC Data Warehouse (RACDW). The RVC may also need to verify claims data in the Common Working File (CWF). |
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