3M_Sole_Source_intent.docx

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 recent ICD-10 implementation, maintain 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.

Section 601(e) of the Social Security Amendments of 1983 (P.L. 98-21) authorizes the Secretary of the Department of Health and Human Services (DHHS) to provide for a Medicare Prospective Payment System (PPS). Under the Medicare PPS, payments to participating hospitals for each inpatient discharge are based on the case assignment into one of the MS-DRGs. MS-DRGs were originally based on codes in the ICD-9-CM diagnosis and procedural coding system. Beginning with discharges occurring on or after October 1, 2015, the MS-DRGs are based on ICD-10-CM and ICD-10-PCS codes. The ICD-10 version of the MS-DRGs was included in the FY 2016 Inpatient Prospective Payment System (IPPS) final rule.

Over the past seven years 3M HIS, working in concert with CMS, the Centers for Disease Control (CDC) and the National Committee on Vital and Health Statistics (NCVHS), developed the ICD-10 coding system of crosswalks/maps (forwards and backwards), both allowing for the conversion of ICD-9 to ICD-10. As a result, 3M HIS’ continued support to these agencies is vital to the successful maintenance of this complex conversion.

3M HIS also developed the Code Translation Tool (CTT), a proprietary translation tool used by the DHHS, CMS, the CDC and the Medicare Administrative Contractors (MACs) to translate ICD-9 codes to the corresponding ICD-10 codes (forward mapping) as well as from ICD-10 codes back to ICD-9-CM codes (backward mapping). These agencies and the MACs rely heavily on this tool for fast, accurate code translation. The CTT will be used by CMS policy staff in undertaking trend analysis of past claims in use in updating payment systems as well as quality activities for the next few years.

In addition, 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. 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 and to maintain continuity of the ICD-9 to ICD-10 transition. 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 and mappings and back to ICD-9-CM codes as well as use of the mappings in evaluating trend data;

· 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;

· Continue value added improvements and expansion of remotely accessible web based interfaces for I/OCE, Groupers, and MCE; and

· Ensure the on-going benefit of 3M HIS’ proprietary web based tools critical to accurate ICD-10-CM code conversions.

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 maintain the recent ICD-10 conversion, to ensure the accurate editing and payment of Medicare claims. Development of the ICD-10-PCS was initiated by 3M HIS in accordance with final rule making and the requirements set forth by CMS. This new procedure coding system has almost 72,000 codes compared to ICD-9 which has approximately 4,000 codes. CMS has worked closely with the CDC and the NCVHS, an advisory committee to the Secretary, on the implementation of ICD-10-PCS. This task involved public hearings with participants representing diverse medical specialties of the healthcare industry. 3M HIS developed this coding system, and their familiarity of the new system is widely acknowledged throughout the medical community.

As the developer and maintainer of ICD-10-PCS mappings and crosswalks, 3M HIS has the necessary technical knowledge for maintaining the national implementation of ICD-10-PCS. 3M HIS is also responsible for maintaining the MS-DRG software. As such, they are in an excellent position to map new ICD-10-PCS codes into the MS-DRGs. It is expected that there will be a large number of new ICD-10-CM and ICD-10-PCS implemented on October 1, 2016 once the partial code freeze ends. There has been a partial code freeze from FY 2012 through FY 2016 with codes being created for only new technologies and new diseases. Hundreds of other code updates have been deferred until October 1, 2016 when the code freeze ends. Evaluating the MS-DRG classifications for these new codes will require an experienced contractor who is experienced with ICD-10 codes as well as the ICD-10 MS-DRGs.

In addition, as the program evolves, 3M HIS independently makes ongoing recommendations for annual updates to ICD-10-PCS to capture new technologies. This complex task may involve identifying multiple ways in which ICD-10-PCS can be updated to more precisely capture new technologies. These update options are then brought to the ICD-10 Coordination and Maintenance Committee to get public input on the possible update options. These annual updates are designed to stay in step with industry changes to ensure the most robust and efficient processes are in place. They also created and updated the conversion table between ICD-10-PCS and ICD-9-CM.

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 ICD-10 transition 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.