CMS-RFP-2010-0016_DME MAC Juris D RFP_04-19-10 Questions.xls
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- CMS-RFP-2010-0016
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Amendment 000002 attachment 3 - Questions and Answers
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Section A
| DME D RFP Questions from Industry - RFP - Section A - SF 33 | ||
| Section | Question | Answer/Action |
| Section A | Please confirm the correct RFP number for the DME MAC Jurisdiction D procurement | The correct RFP number for the DME MAC Jurisdiction D procurement is CMS-RFP-2010-0016. Amendment 000002 of this solicitation hereby corrects all references to the RFP number, including all attachments, to reflect the solicitation number CMS-RFP-2010-0016. |
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Section C
| DME D RFP Questions from Industry - RFP Section C - STATEMENT OF WORK (INCLUDES ALL J.1 SOW-related questions) | ||
| Section | Question | Answer/Action |
| SOW Section E.4.7 | This section states that complex medical review personnel shall include only RNs and PT/OTs. Will CMS require that only RNs and PT/OTs perform the Routine Manual Medical Reviews workload provided in Section L.11.d of the RFP? | CMS will not require that only RNs and PT/OTs perform the Routine Manual Medical Reviews workload. Routine review requires hands-on review of the claim, and/or claims history file and/or internal MR guidelines but does not require the application of clinical judgement by a licensed medical professional. See PIM chapter 3, Section 3.4.5 B. |
| SOW Section B Key Personnel Requirements | Some key personnel have degree requirements. Is it acceptable to CMS if the degree requirements are met by the Operational State Date? | CMS expects that proposed key personnel will meet applicable degree requirements as of the date of proposal submission. |
| SOW Section D.3.2. Unanswered Additional Documentation (ADR) Reopenings | This function is described in the Program Management section of the SOW but appears in the MIP section of the Cost Proposal Templates provided with the RFP. Please clarify whether this function should be in the PM or MIP SLIN of the templates. | In cases where a reopening by Medical Review is appropriate, costs for the activity should be reported under the MIP section E.4.7. Medical Review of Claims. |
| Statement of Work Section under Program Management Requirements, Section D.2.6 Document Imaging (Page 88) | In the Statement of Work Section under Program Management Requirements, Section D.2.6 Document Imaging (Page 88), the last bulleted item states: "Adhere to CMS' standard for three-tier security architecture." Please clarify what additional information or guidance is available explaining the three-tier architectural structure. What is the intended timeline for implementation of the three-tier architecture or is it assumed it will be available upon contract award? | Documents on three-tier architectural requirements may be provided by the PO/GTL/COTR via encrypted email upon request. For new development efforts, it is required that three-tier architectural requirements would be implemented prior to the processing of claims however for existing systems that are already operational and not in compliance, a plan should be developed and submitted to bring the system into compliance. |
| Section J.1 SOW, page 62, SOW Section C.3.3 Internal Controls, SOW page 39 | Please clarify if the first SAS 70 report is due July 2011 or July 2012. | Due to the timing of contract award and the requirement for at least 6 months of processing, the first SAS-70 Report would be due in July 2012. |
| Section J.1 SOW, page 62, Section C.5.5 Debt Referral, SOW page 59 | Please clarify which debt recovery and debt referral functions are the responsibility of the DME MAC and which are the responsibility of the PSC/ZPIC. | It is the responsibility of the contractor who maintains the accounts receivable to pursue collection of the debt, including recoupment, and referral to Treasury. It is the responsibility of the contractor reporting the accounts receivable to accurately and timely report all activities associated with the status and balance updates to the debt, including referral to Treasury. |
| Section J.1 SOW, page 62, SOW Section D.1.2.2., Electronic Data Interchange (EDI) Support Related to General Claims Processing, SOW page 70 | In this section, the SOW indicated: “The Contractor shall continue to support the direct data entry access to perform Claims Status Inquiry (CSI), where it existed pre-HIPAA.” Please clarify whether the current contractor is performing this work as part of the current DME contract and whether it will be transferred during implementation. | Per the SOW, support of the direct data entry access to perform Claims State Inquiry (CSI), where it existed pre-HIPAA is the responsibility of the DME-MAC. |
| Section J.1 SOW, page 62, Section D.1.2.2., Electronic Data Interchange (EDI) Support Related to General Claims Processing, SOW page 70 | In the SOW it appears that all Provider Outreach & Education (POE) falls under Program Management (SOW D). Can CMS please confirm this as with other contracts a portion of POE is funded under the Medicare Integrity Program (MIP)? | Please refer to section E. of the SOW for the Medicare Integrity Program (MIP) requirements on page 105. The last bullet on the MIP functions on page 105 addresses MIP POE and provides a reference to section D.5.1. of the SOW. All requirements in section D.5.1. of the SOW are MIP funded with the exception of D.5.1.6 Bulletin/Newsletter Publication. The Bulletin/Newsletter Publication is a PM activity. |
| Section J.1 SOW, page 62, Section E.2. PSC and ZPIC Support Services, SOW page 106 | Please clarify what the expectations are in more detail related to the PSC, and include items such as who will work ZPIC/PSC suspended claims, who will build the edits, who will recover identified overpayments, who will handle the appeals of these denials etc. | The expectations are that the PSCs and ZPICs will install their own edits in VMS. The PSCs and ZPICs will identify overpayments and notify the DME MAC where recovery should be pursued, but the DME MAC must send the demand letter and recover the overpayment. Appeals are processed by the DME MAC. |
| Section J.1 SOW, page 62, Section E.2. PSC and ZPIC Support Services, SOW page 106 | Please clarify if there is a requirement to provide full data extracts to the PSC/ZPIC such as claims history, provider files, beneficiary files on a daily or monthly basis. | Per SOW section F.1.1.1, the DME MAC and the PSC/ZPIC will address the types of files the PSCs/ZPICs will require to identify overpayments, including the freqency for each file type, in accordance with IOM Pub 100-8. |
| Section J.1 SOW, page 62, SOW Section F.1.1. Execute a JOA, SOW page 115 | Given the work outlined in SOW Section D.1.3.2, Transferring Claims Information to the Coordination of Benefits Contractor (COBC) (page 75), and in Section E of the SOW, please clarify whether CMS will require a JOA with the COBC. | The DME MAC is not required to enter into a JOA with the COBC. The DME MAC is only required to enter into JOAs with the entities listed in section F.1. of the SOW. |
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Section J
| DME D RFP Questions from Industry - RFP - Section J - LIST OF ATTACHMENTS (PLEASE REFER TO SECTION C - SOW for ALL J.1 SOW questions) | ||
| Section | Question | Answer/Action |
| Section J.6, Award Fee Plan, page 62, Award Fee Plan page 8 | In Award Fee Criterion 1: Contract Administration, the award fee document indicates that to receive an "Excellent" rating, the contractor must meet the following criteria: “Collaboration with other entities, including other MACs is evidenced by positive program improvements and problem solving that has broad program benefit.” While we fully support collaborating with other entities to improve program performance, our concern is when the collaboration harms a contractor competitively, or violates any Trade Secret Act protection or antitrust laws. Collaborating with other MACs could be a violation of the Trade Secrets Act, causing harm during the competitive process. Will CMS reconsider including this specific award fee requirement as the basis for an “excellent” score? | It is CMS’ determination that it will not be making any changes to the award fee criterion. Section F 2.3. of the Statement of Work states that the contractor “shall work collaboratively with other MACs outside of their jurisdiction to result in improvements to/cost savings for the Medicare Program.” This section also provides a non-exhaustive list of examples of ways to work collaboratively with other MACs. Concerns with any potential violation of the Trade Secrets Act are alleviated as the language provides the contractor the ability to make a business decision regarding how to collaborate with other MACs. It is within the contractor’s discretion as to the information the contractor chooses to share with other MACs during collaboration efforts. Furthermore, there exist additional ways to obtain an “excellent” rating in the contract administration section of the award fee plan that do not rely on collaboration with other MACs. |
| Section J.7, Attachment J-07 Basis of Estimate, page 62 | Please clarify if the note at the end of the instruction tab should refer to Attachment J-03 or Attachment J-07 in reference to only provided on a CD-ROM. | This reference was in error, it should refer to Attachment J-07. |
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Section L
| DME D RFP Questions from Industry - RFP - Section L - INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS | ||
| Section | Question | Answer/Action |
| L.11.d Proposal Assumptions; pg83 | The total of electronic claims and paper claims does not equal total DME claims. Please confirm the Total DME Claims workload. | The total column in the claims volume was incorrect. A corrected set of workload assumptions for the PM Bills/Claims section of the worksheet only has been posted with this amendment. |
| L.11.d Proposal Assumptions | Are the number of claims provided for Option Periods One through Four correct? The Total DME Claims provided equal the electronic and paper claims for only the Base Period and not for any of the remaining contract periods. | The total column in the claims volume was incorrect. A corrected set of workload assumptions for the PM Bills/Claims section of the worksheet only has been posted with this amendment. |
| L.11.d Proposal Assumptions | DME MAC Jurisdiction D RFP lists provider written correspondence workloads significantly higher than is current experienced. Is CMS anticipating a significant increase in this workload? | CMS does not anticipate the number of written inquiries to increase. The number of written inquiries in the RFP is a combined total for general provider inquiries, PRRS inquiries and Congressionals. The correct number of written inquiries for this category should be 5,200. |
| L.11.d Proposal Assumptions | The total number of claims provided for JD is similar to the total number of claims provided in the JA RFP. However, the provided workload of complex reviews for Jurisdiction D is proportionately higher than this workload in JA. Can CMS confirm that this is the correct workload for Jurisdiction D? | The MR workloads identified are correct and should be used in the development of the proposal. |
| L.11.d Proposal Assumptions | The Implementation Cutover Date is assumed to be 3/1/2011. Under the current contract for Jurisdiction D, the period of performance for Option Year 4 ends on 3/31/2011. Should the Implementation Cutover Date be 4/1/2011? | The implementation cutover date is 3/1/2011. This is to ensure there is adequate time for the outgoing MAC to perform any necessarry post-cutover activities before the end of the current contract. |
| L.14.b Proposal Assumptions | The instructions in this section state that “one PPQ, Attachment J-8, may be submitted for multiple DME MAC proposals as long as the PPQ is clearly identified for ‘DME MAC Jurisdiction X’” However, this section also states “This PPQ will be kept on file and used for all current and future proposals as long as it falls within the respective past three years. This list will only include all contracts within the separate Business Units where the DME MAC contracts will be performed. Contracts listed may include those entered into with the Federal Government, agencies of state and local governments and commercial customers.” If an offeror has previously requested customer s’ contracting officers to submit PPQs in connection with another pending DME MAC solicitation, but did not specifically state on the PPQ that it was also requested for Jurisdiction D, will CMS review these PPQs for the Jurisdiction D proposal or should offerors request that new PPQs be completed and returned to CMS? | CMS will review PPQ previously submitted under DME MAC procurements (Jurisdictions A and B). |
| Section L10.o(6), Proposal Assumptions, page 81 | CMS states that each page "shall not be compressed." Can CMS explain what is meant by that statement? Specifically, what is page compression? If it refers to reducing the print size of a document so that it is readable on one page and not scattered across many pages, potential offerors may be at risk of submitting unreadable business proposal documents due to the schedules provided such as J-10 through J-16, when adjusted for each bidder's accounting system. | This is only applicable to the Technical proposal, the offerors may not Compress a page by reducing the print size, margins, and/ or space between lines. All Business proposal templates, including J-10 through J-16, may be submitted in 11 x 17 paper. |
| Section L11.d, Proposal Assumptions, page 83 | Please clarify the correct total DME claims number. In Option Period 1 through Option Period 4, the paper and electronic claims do not total to the number given for the total DME Claims. | The total column in the claims volume was incorrect. A corrected set of workload assumptions for the PM Bills/Claims section of the worksheet only has been posted with this amendment. |
| Section L.11.d, Proposal Assumptions Workloads, page 85 | Please clarify whether the “COBC Claims Transferred” workload are crossover claims. If not, please clarify what this workload represents. | "COBC Claims Transferred" does refer to crossover claims. |
| Section L.11.d, Proposal Assumptions, page 85 | Please clarify the source for the “Overpayments recouped (number of cases) at the request of the PSC/ZPIC” workloads. The SOW states the workload of 116,699 PSC/ZPIC overpayment cases in option year 1. This workload category is significantly higher than expected, and significantly higher than both the DME MAC Jurisdiction A and Jurisdiction B workloads, despite similar claim volumes. Is this workload the actual ZPIC cases or is it the volume of overpaid claims referred by the PSC/ZPIC? If it is cases, what is the average number of claims per PSC/ZPIC case? If this workload is actually the claims count, how many PSC/ZPIC cases does this claim volume relate to? | The Overpayment Recouped at the Request of the PSC/ZPIC workload identified are correct and should be used in the development of the proposal. |
| Section L.11.e, Proposal Assumptions, page 87 | Please clarify if the offerer is to use the 15% pend rate or use its own rate? | Offerors are to use their historic suspense rates as it relates to the DME MAC process. The average was provided for offerors without experience on the VMS system. If an offeror proposes less than the average pending rate of 15% there must be an accompanying demonstration that this prooposed suspense rate is reasonable and expected based on some historical information. |
| Section L.11.e, Proposal Assumptions, page 88 | Please clarify if the offeror is required to propose costs for the transfer of Medicare records from the Fargo, ND facility. If so, who will be responsible for the transfer/box removal fees of removing records from the Fargo, ND facility? | Each offeror is responsible for file transfer costs (including transfer/box removal fees) associated with moving the DME MAC D Medicare records from their present location(s) in the Fargo, ND area to the location(s)/facility(ies) designated in its proposal. (Reference: MAC Workload Implementation Handbook, Chapter 9). |
| Section L.11.e, Proposal Assumptions, page 89 | Is the offeror allowed to use bulk mail for the two provider direct mailings in this section? | Offerors may propose to use bulk mail provided that there is sufficient time to do so. |
| Section L.16.a, Volume IIA - Business Proposal Cost Template Instructions, page 99, and L.9, Proposal Submission and Delivery, page 76 Section L.16.a.1, Volume IIA - Business Proposal Cost Template Instructions, page 99 | This section indicates 6 CD-ROM copies of the business proposal spreadsheets are to be provided, section L.9 (page 76) indicates 2 CD-ROM copies are to be provided. Please clarify the number of CD-ROM’s CMS wants for the business proposal spreadsheets. | Please submit two CD-ROM copies of Volume IIA. |
| Section L.16.a.1, Volume IIA - Business Proposal Cost Template Instructions, page 99 | Please confirm the phrase “projected for the base year and all option years” indicates that CMS wants the offerors labor rates escalated for each base year and all option years. | No, it is up to each offeror to determine their own rates. CMS is looking for labor rates for base year and all option years. If the rates are escalated, then the offeror shall provide the rational for the proposal escalation. |
| Section L.16.b, Tab F.1: Business Proposal Assumptions, page 101 | Will CMS adjust the offerors price where labor rates are not escalated? | Any cost information not supported or provided with a rational and approach is subject to discussions and cost realism analysis. |
| Section L.16.b, Tab J: Adequate Accounting and Estimating Systems, page 104 | This section asks the contractor to state whether they have a government approved accounting system as identified in Section K. Please give the specific part of Section K that discusses an approved accounting system. | Offerors must state in their Business proposal whether they have a Government approved accounting system and provide supporting documentation. If an offeror does not have a Government approved accounting system they must provide the information requested under L.16.b. Tab J. |
| Section L.19.3, Participation and Attendance, page 111 | Please clarify who can attend the oral presentation, as the first line in this section appears to be incomplete. | Only offerors Key Personnel may present/ participate in the Oral Presentation. Non-Key Personnel may only participate/ present in the Introduction part of the Oral Presentation. Non-Key personnel may participate in the questions and answer session (discussions). |
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