Medical Review Phase 2 Questions and Answers Final.pdf

RFP #OIG260145/Phase 2 Questions and Responses Date: January 21, 2021

1 4 C.1, 1.1 Medical Review of

Claims (RFP v.6) Question: Regarding "clinical judgment," what is the extent to which medical guidelines/medical literature need to be provided to support the decision, particularly when Medicare is silent on medical necessity (e.g., national coverage determination)?

Answer: This is a question the Government expects the Offeror to answer.

2 4 C.1, 1.1 Medical Review of Claims (RFP v.6)

Question: In some cases, a local coverage determination (LCD) may apply, whereas if the case arose from a different region, the lack of an LCD— based on literature—might result in a different decision. How is this to be handled?

Answer: This is a question the Government expects the Offeror to answer.

3 4 C.1, 1.1 Medical Review of Claims (RFP v.6)

Question: Is the reviewer's identity revealed during any phase of the review or consultative services?

Answer: We are not obligated to disclose a person’s name, but we will ask for a reviewer’s qualifications to make medical determinations on a particular claim (or series of claims).

In addition, we anticipate that auditees may challenge the initial medical determinations and we would expect the vendor under this contract to make available someone to either meet directly with the auditee or to rebut any challenges from auditees (a qualified medical review professional would seem to be the most logical choice in this case).

4 4 C.1, 1.1 Medical Review of Claims (RFP v.6)

Question: Is a reviewer bio to be provided? If, so how detailed should it be?

Date: January 21, 2021

Answer: There is no requirement to provide a reviewer bio for purpose of this scenario, the decision to do so is up to each individual offeror.

However, qualifications of the individuals making medical determinations under the contract may be requested on a case by case basis.

5 N/A N/A Amendment-2, Summary of Changes on SAM website

Question: The procurement website indicates the Phase 2: Oral Presentations will occur 1/26/21 through 1/29/21. When will we schedule the exact date and time for our presentations?

Answer: Offerors will be notified on January 21, 2021.

6 24 L.2, Section 3

Element 2 - Scenario (RFP v. 6)

Question: The RFP states that the "offeror shall develop a written medical review instrument and prepare a detailed report with the results for each claim reviewed." Please confirm that the instrument and detailed report are due the day of our presentation (during the window 1/26/21 through 1/29/21).

Answer: The reports are due on the day the offeror does their presentation and OIG anticipates the Offeror will be furnishing the reports to OIG after the presentation.

7 26 Power Point Presentation

Question:

1. Per page 26 of the solicitation, there are two required components required for inclusion in the 20 page power point presentation:

a) Two (2) summary statement reports, SF 295. Each report will require aprox. Three (3) PP slides to include/present.

b) Subcontracting Plan Review Form, for a total of eight (8) pages.

2. Is the intent to capture/present/include the above #1 in the 20 page power point presentation page count, or to present via chart provided on page 26 of the solicitation?

3. Would the above #1 requirements then become attachments therefor not counted against the 20 page limitation?

Answer #1: The Power Point presentation shall not exceed 20 slides (excluding the cover page and agenda slide). The two (2) Summary Subcontracting Reports (SF 295) and the “Subcontracting Plan Review Form (Revision April 2017)” do not count towards the 20 slide limitation and may be included as attachments.

The PDF version of the Power Point Presentation will be utilized to determine the 20 page count.

8 24 RFP Question: Page 24 of the RFP states under Subfactor B that offerors shall present a small business subcontracting plan in accordance with FAR 52.219-9, and also states that offerors shall complete and submit Attachment 1 titled “Subcontracting Plan Review Form (Revision April 2017)”. Are we correct in assuming that the requirement will be satisfied if we submit a completed plan using Attachment 1, and that it will not be necessary to submit 2 separate documents (i.e. a completed copy of Attachment 1 as well as another version of a subcontracting plan not on Attachment 1)?

Answer: The requirement is for the offeror to inform the Government on their Subcontracting plan goals. It is up to the offeror to best decide how to do so.

9 Question: Because of the phased nature of this procurement, we had not planned to complete detailed pricing until after we received the advisory notification following Phase 2. For the version of the subcontracting plan that will be submitted in Phase 2, would it be acceptable to include only the percentages to be subcontracted rather than the precise dollar amounts?

Answer: For Phase 2, it is acceptable to include only the percentages to be subcontracted rather than the precise dollar amounts.

10 23 Section 3 Oral Presentation Question: “The briefing (Element 1) shall be one hour in length (1.5 hours inclusive of Q&A period) and documented by an accompanying power point presentation, limited to 20 slides (excluding the cover page and agenda slide).”

Would the government please clarify whether “transition slides” will be excluded from the 20-slide limitation count?

Answer: The Power Point presentation shall not exceed 20 slides (excluding the cover page and agenda slide). The two (2) Summary Subcontracting Reports (SF 295) and the “Subcontracting Plan Review Form (Revision April 2017)” do not count towards the 20 slide limitation and may be included as attachments.

The PDF version of the Power Point Presentation will be utilized to determine the 20 page count.

11 23 Section 3 Oral Presentation Question: Will the members of the Government Technical Evaluation Panel (TEP) be the same for both Element 1-Briefing and Element 2 - Scenario?

Answer: Yes

12 General Question: The proposal instructions call for the offeror to submit a subcontracting plan. Would the government please clarify whether the subcontracting plan document is required to be completed and submitted as part of the Orals presentation or submitted as part of the Phase III pricing should an offeror be down selected for that phase?

Answer: See also question #9

13 General Question: Will only the offeror’s “approach” to subcontracting be included in an Orals presentation or do the actual numbers, which are usually part of a pricing proposal, need to be included in the Orals presentation?

Answer: See also question #9

14 Question: What font and type size should the Power Point Presentation be for OIG?

Answer: This is a question the Government expects the Offeror to answer.

15 Question: Offeror wishes to confirm

a. the 20 page slide presentation

(PPT) should cover all aspects of C.2 of the solicitation, which were the subject of the Phase 1 white paper?

b. The slide show should not include information and/or documentation related to the actual medical review and final review letter involving the scenario claims?

Answer a: Yes

Answer b: The Government expects the Offeror to determine the best way to present their information.

16 Question: Regarding the methodology and auditing tool(s) which must be described in the PPT, are the methodologies to be a general outline for claims, or instead specific to the scenario cases. Each scenario has unique aspects to it that modify (or amend) the overall auditing process slightly to account for “claim specific” methodologies that must be addressed.

Answer: The Government expects the Offeror to answer.

17 Question: Are the Final review reports and any associated information related to the Scenario due on January 21, 2021? The Solicitation seems to indicate that only the PPT is due that day. If the report are not due on January 21, 2021, does OIG anticipate the Offeror furnishing the reports with OIG after the presentation?

Answer: Yes, the solicitation has been amended on pg 23 and 24.

18 Question: Offeror notes that in order to perform the medical review and auditing of the scenarios, an offeror may not have access to some government Medicare IT systems or not have particular subscription services to various tools that would be useful to complete the cases. Does the OIG anticipate that Offerors will have all the tools available (or buy/subscribe to them) in order to complete the audit, or is the OIG looking to determine that the Offeror can readily identify the tools and information accesses that would be needed to successfully perform the audit?

Answer: We do not expect offerors to buy or subscribe to any tools or publications to respond to the scenario.

19 Question: If the Offeror is a small business, should the Offeror submit the small business subcontracting plan?

Answer: See also question #10

20 Question: Additionally, does the plan count toward the PPT page count, or is the small business plan separate?

Answer: See also question #10

21 Question: Should the small business plan be included within the PPT?

Answer: The SF295 and the Subcontracting plan review form do not count towards the power point page count.

22 Question: Will OIG open the previously received presentation PowerPoint and supplemental scenario files on their end and turn over to us to navigate within Microsoft Teams when our presentation time begins?

Answer: OIG expects to use the share screen function of MS Teams to view presentations.

23 Question: Is OIG hosting and providing a dial-in or web link for the Teams presentations?

Answer: Yes.

24 Question: Is OIG prepared to receive a PDF combined file of various Word and Excel resources documents used to compile our Medical Review? I know CGS had an issue receiving large files.

Answer: Large files may need to be received via Kiteworks.

25 Question: The RFP indicates that the title slide and agenda do not count toward the 20 page limit. Are title slides embedded in the presentation to denote natural changes in topics excluded from page count?

Answer: No

26 Question: In past oral presentations we were permitted to present both the words in print on a PPT slide as well as through spoken words. We are assuming that we will be able to provide the evaluation team with additional spoken information not denoted on the slide.

Answer: Yes

28 Question: With regard to the Small Business Plan, I am concerned as to whether the requested information consistent with FAR 52.219-9 (planned $s to be subcontracted and the types of supplies and services to be subcontracted) can be included in the number of slides available after Subfactor A slides are accounted for.

Answer: For Phase 2, it is acceptable to include only the percentages to be subcontracted rather than the precise dollar amounts.

29 24 L2, Section 3

Element 2 Scenario (RFPv.6)

Question: The RFP states that offerors are to complete and submit Attachment 1: Subcontracting Plan Review Form.

The form includes several questions requiring bidders to provide subcontracting dollar amounts based on the value of the contract; however, pricing and performance work statements will not be proposed until Phase 3 of the procurement. Please provide guidance on how we are to complete this form at this stage in the procurement process.

Answer: For Phase 2, it is acceptable to include only the percentages to be subcontracted rather than the precise dollar amounts.

30 24 L2, Section 3

Element 2 Scenario (RFPv.6)

Question: Attachment 1:

Subcontracting Plan Review Form is seven pages long, and the presentation is limited to 20 slides. Please confirm that Attachment 1: Subcontracting Plan Review Form is not to be included within the presentation, but submitted as a separate file.

Answer: See also question #21

31 Q&A p.4

Questions and Answers v2 #23

Question: The Q&As state that the small business subcontracting plan is to be included within the slide presentation. Please provide guidance on the expected format and details of the plan.

Answer: The answer to questions #23 & #25 from Q&A dated September 16, 2020 has been revised. The two (2) Summary Subcontracting Reports (SF

295) and the “Subcontracting Plan Review Form (Revision April 2017)” do not count towards the 20 slide limitation and may be included as attachments.

32 Q&A p.5

Questions and Answers v2 #25

Question: The Q&As state that the two Summary Subcontracting Reports are to be included within the presentation and count against the 20-slide limit. Please provide guidance on how to incorporate these within landscape-oriented slides in a manner that is legible during the presentation.

Answer: The answer to questions #23 & #25 from Q&A dated September 16, 2020 has been revised. The two (2) Summary Subcontracting Reports (SF

295) and the “Subcontracting Plan Review Form (Revision April 2017)” do not count towards the 20 slide limitation and may be included as attachments.

33 Question: In reviewing the three (3) Medical Review Claims to be addressed during the Orals, our Medical review team has a question specifically relating to the Medicare Part B - Ophthalmology – intravitreal injection and other service provided on the same day of the injection. The redacted documentation shows the Service Billed however, the documentation does not show what services, if any were paid. In addition, we do not see in the documentation provided if an Advance Beneficiary Notice (ABN) was signed by the patient. Can you please provide the paid information and ABN, if applicable?

Answer: The Offeror is expected to complete the Medical Review using the information provided.