AB MAC JH MASTER RFP Offeror Questions second set of answers.xlsx

Section C

4 22. Section C.5.5 – Provider Enrollment Question/Comment: This section of the SOW states “…For providers who are participating in the Medicare program but do not have an established record in PECOS, the Contractor shall require these providers to complete and submit a complete Medicare enrollment application ( the Internet-based PECOS enrollment application or applicable paper CMS-855, to establish such a record.”

a. Please indicate if this revalidation workload is part of the revalidation workload noted in the workload assumption section of the final RFP.

b. Please provide the volume of providers who don’t have an established PECOS record by CLIN. CMS Response: Providers that began participating in Medicare before the PECOS system was implemented, that do not yet have an established record in PECOS, must file an initial enrollment application. New providers must also file an initial enrollment application in order to receive Medicare billing privileges. Providers file a revalidation enrollment application when required, to enable the MAC to revalidate their credentials. Estimates for both types of provider enrollment workload (initial applications and revalidations) are included in the workload estimates. In PECOS workload reports, there is no differentiation between initial and revalidation enrollments, and CMS does not assume any productivity difference between initial and revalidation enrollments. CMS has been tracking the number of Medicare providers enrolled in PECOS vs. the overall number of providers enrolled within local contractor systems. The discrepancy is trending down and should be minimal by the end of 2011. These numbers are also incorporated into the overall total initial enrollment estimates provided with the workload assumptions in Section L.10.e.

a. Is it CMS’ intent to index images only for those Appeals that are being requested by the QIC? Requiring this indexing of all appeals may not have a positive return on investment.

b. Please confirm the date required in the index is the scan date and not the Julian date.

CMS Response: For the Indian Health Services workload, the incumbent Jurisdiction 4 A/B MAC services approximately 59 Part A providers (including 43 hospitals and 11 federally-qualified health care centers) and 8700 Part B providers. The IHS facility/provider claims workloads for February 2010 through January 2011 were: Part A claims- 730,920 and Part B claims- 557,190 The IHS facilities do file cost reports and are subject to Medicare cost reporting review and reimbursement requirements. The applicable volume of IHS claims, audit, and other workloads are reported in the current J4 workload and are included within the workload estimates provided in Section L.10.e of the solicitation.

This section of the JH SOW states “The Contractor shall provide hardware and software identified in Attachment J-22, Contractor Furnished Property (CFP)……”, This appears to be an incorrect Attachment reference. Please clarify that the Contractor Furnished Property reference should be Attachment J-05.

The JH SOW states, “The Contractor shall provide project management, testing, and other services to successfully merge the Idaho Part B Customer Information Control System (CICS) region with the combined Alaska, Oregon, and Washington Part B CICS region at the CDS EDC. Please clarify that this section of the JH SOW should state that the Arkansas, Louisiana, and Mississippi Part B CICS regions will be merged into one CICS Region at the CDS EDC.

The JH SOW states that the Contractor shall perform work on Alaska, Oregon, and Washington mappings, duplicate provider identification numbers and testing. Please clarify that this section of the SOW should state the Contractor shall perform work on Arkansas, Louisiana, and Mississippi mappings, duplicate provider identification numbers, and testing.

This JH SOW requirement states the Contractor shall interact with the Individual Authorized Access to the CMS computer services (IACs) to ensure the EDI submitter/receiver is an authorized EDI submitter for each transaction. The use of IACs to validate each EDI transaction could add significant overhead to the EDI framework. If the offeror is an existing A/B MAC, could they use their existing translator, which has a built-in trading partner validation, instead of adding the IAC’s loop?

This JH SOW section states that the Initial Certification of the MAC Front End Certification must be completed prior to exchanging transactions (ASC X12 or other standard transaction) with the MAC’s trading partner community. Should the contractor assume that the JOA and certification must be completed prior to any transaction being exchanged, in both the test and production environments?

CMS Response: CMS confirms that the Initial Certification of the MAC Front End Certification applies to both test and production environments.

13 C.5.4.1.11 Contractor Medical Director (CMD) Question/Comment C.5.4.1.11 states that the offeror must employ a “minimum of one (1) FTE CMD for each line of Medicare business per contract” and “one CMD will be in an executive management role”. We assume that CMS is looking for offerors to propose the “one (1) FTE CMD” as the key personnel. Please confirm.

CMS Response: CMS clarifies that according to SOW C.5.4.1.11 the contractor shall employ a minimum of 2.0 full-time-equivalent (FTE) Contractor Medical Directors (CMDs) for this A/B MAC contract. At least one of the CMDs assigned to the contract will serve in an independent executive leadership role to provide an overall leadership role. The executive CMD shall serve as key personnel under this Statement of Work.

Offerors should review amended SOW C.5.4.1.11 in its entirety (Amendment 0003).

14 7. C.5.4.8.1 Review and Comment on Draft Change Requests Question/Comment C.5.4.8.1 states “No response is required if the Contractor concurs with the Change Request (CR).” Please confirm this requirement as it is a change in CMS’ current A/B MAC requirement covered in JSM/TDL-08436, 08-06-1850.

C.5.10.1.2 states, “All redetermination requests be scanned, including documentation and incoming correspondence supplied in support of the request. Document imaging shall include scanning a claim in its entirety when it reaches the MAC, performing Quality Assurance (QA) on scanned images, indexing the scanned images, and using these scanned images to make a decision on the claim. At a minimum, all images shall be indexed by date scanned, MAC contract number, claim number and beneficiary HICN. The Contractor shall electronically image and index all redetermination correspondence upon receipt in the corporate mailroom.” Please clarify that using a single, reliable index to accomplish retrieval meets the requirements of C.5.10.1.2, versus using multiple indexing references (e.g., HIC, claim number).

CMS Response: Using a single index to accomplish retrieval does not meet the requirements of C.5.10.1.2. The requirements listed in C.5.10.1.2 allow retrieval of documents by many different criteria and are not limited to retrieval of a single case file.

16 9. C.5.10.1.3.1 Acknowledgement of Redetermination Requests Question/Comment This requirement states the Contractor is required to acknowledge the request for redetermination within 14 calendar days of receipt of the request in the Contractor’s mailroom. At a minimum, the acknowledgement shall identify the date the request was received, the items/services/claims at issue and verbiage indicating the appeal shall be completed within 60 days of receipt. Requiring the inclusion of the item/services/claims at issue is currently not required in the acknowledgement of redetermination requests. Requiring this information for JH will be labor intensive because this information will be difficult to identify without doing significant manual research, thereby taking resources away from processing the redetermination. Providers often submit multiple claims in large volumes as a single redetermination request. Would this requirement mean that all claims included in the redetermination request need to be acknowledged? Would CMS consider requiring only the Health Insurance Claim Number (HIC) for this requirement?

CMS Response: Similar to instructions contained in IOM 100-6, Chapter 6, Section 460.1, related to counting cases, CMS expects an acknowledgement letter to be sent for each redetermination request. CMS, however, is agreeable to the approach suggested in the Offeror's question regarding use of the Health Insurance Claim (HIC) Number as a means of consolidating redetermination acknowledgements, as long as the acknowledgement letters reference every claim involved in each request for redetermination.

17 10. C.5.11.3.2.5.2 Audit Plan Question/Comment This JH SOW requirement states that “The audit plan shall include any cost report in which the Contractor will start audit during the year”. Should this statement more appropriately be worded “the audit plan shall include any cost report in which the Contractor will start and complete audit during the year”?

CMS Response: CMS confirms that the audit plan should include those cost reports started during the year. There may be cases when a limited number of cost report audits have been started but not completed by the end of the year. Historically, the number of open cost report audits in the Jurisdiction H workload at the end of each federal fiscal year is very low (fewer than 10 open audits for the past several years).

18 11. C.5.11.4.3 Description Question/Comment This SOW section states that the RAC will send out the first demand letter and all other letters pertaining to the RAC overpayment will be sent by the Medicare Contractor. Please confirm for RAC overpayments that the only follow-up demand is the Intent to Refer Letter (IRL), and that there is no requirement for the MAC to send out a second demand letter prior to the IRL.

Are “billing records” synonymous with “claims?” Please clarify how this activity differs from Medical Review data analysis. If the same, should the Contractor notify CMS regarding each probe review that is conducted, (e.g., the provider has “aberrant billing”)? If different, please clarify what is meant by aberrant billing in this scenario. Clarify if this same definition applies in SOW requirement C.5.15.2 (Review of Comprehensive Outpatient Rehabilitation Facility Billing Records).

Section C.6.1 of the SOW requires the MAC to execute a JOA with various business partners, including the EDC and MSPRC. Historically, we have found that the EDCs and MSPRC have not had similar requirements in their contracts with CMS to have JOAs with the MACs. Does CMS intend to require these business partners to have JOAs with the MACs?

This SOW section states: “The Contractor shall supply to the QIC all appeals case file information, within five (5) calendar days of request.” The IOM states in Pub.4, Chapter 29, Section 320.4 that “Contractors shall send/transmit the case file within seven (7) calendar days of the date of the QIC's request”. Please clarify the timeframe requirement for supplying case files to the QIC.

Please provide an estimated workload for this activity.

Will the incentive and bonus payments for Medicare demonstration projects be made via EFT or check, or both?

Offerors should review amended SOW C.5.4.1.11 in its entirety (Amendment 0003).

All CLINs (CLINs 0001-0008) are required to be submitted at the CLIN level only. Any information submitted beyond that required herein or in attachment J-9 will not be evaluated as part of this procurement.

For proposal purposes, Offerors shall also adhere to the instructions provided in Attachment J-07 of this solicitation which state:

The offeror shall provide a crosswalk to the CLIN templates for the FTEs identified for each workload category using Column I. This crosswalk shall identify each labor category by SLIN and by the lowest WBS level. Each WBS element shall be displayed using a separate row.

Offerors should document any assumptions concerning labor or other expense categories in their submission of the Basis of Estimate forms (Attachment J-07) for the BY and OYs 1-4 in accordance with section L.15 of the solicitation and the instructions provided under Attachment J-07.

&D A/B MAC Jurisdiction H

RFP-CMS-2011-0005 &9&A &9&P

http://www.cms.hhs.gov/DemoProjects Section J

The Attachment J-07 instruction for Column J requires the Offeror to crosswalk the productivity and/or level of effort proposed for each labor category to an Offeror’s proposed innovation in its Technical Proposal. For the particular question referenced above, if the Offeror has referenced historic productivity that is the direct result of an innovation and/or process improvement currently in place within its operations and referenced in its Technical Proposal, the Offeror shall provide a crosswalk in Column J to the detailed section in its Technical Proposal as identified in the instruction. Offerors are reminded that an innovation may be part of the Offeror’s current operations, a new innovation not yet implemented that is proposed to be put in place on this contract, or a new innovation not yet implemented that is proposed to be put in place between the date of the Offeror’s proposal submission date and the contract award date.

52 17. Section C.6.1 Initial Joint Operating Agreement Deliverable Question/Comment The list of parties with whom the JH MAC is required to initiate a JOA is not consistent with the list of required JOAs in Section C.6.1 of Attachment J-01, Successful Collaboration with Entities Requiring Joint Operating Agreements. Attachment J-02, Deliverables Schedule, lists the following parties: Program Safeguard Contractors (PSCs) with Benefit Integrity (BI) task orders; other specialty PSCs, if applicable; Qualified Independent Contractors (QICs); Administrative Qualified Independent Contractors (AdQICs); Quality Improvement Organizations (QIOs); Recovery Audit Contractors (RACs); Beneficiary Contact Center (BCC); and Enterprise Data Center (EDC). Attachment J-01, Section C.6.1., lists the following parties: AdQIC, Appeals Support Contractor, BCC, EDC, PSC/ZPIC, QIC, QIO, RAC, and MSPRC. Please clarify which Attachment represents the appropriate reference for the required initial JOAs for the JH MAC.

The list of parties with whom the JH MAC is required to update JOAs is not consistent with the list of required JOAs in Section C.6.1 of Attachment J-01, Successful Collaboration with Entities Requiring Joint Operating Agreements. Attachment J-02, Deliverables Schedule, lists the following parties: PSCs with BI task orders; other specialty PSCs, if applicable; QICs; AdQICs; QIOs; RACs; and BCC. Attachment J-01, Section C.6.1, lists the following parties: AdQIC, Appeals Support Contractor, BCC, EDC, PSC/ZPIC, QIC, QIO, RAC, and MSPRC. Please clarify which attachment represents the appropriate reference for the required updated JOAs for the JH MAC.

CMS Response: CMS confirms Section C.6.1 of Attachment J-01 contains a comprehensive list of parties subject to a JOA with the MAC. Attachment J-02 has been updated.

&D A/B MAC Jurisdiction H

RFP-CMS-2011-0005 &9&A &9&P

Section L

The IHS facilities do file cost reports and are subject to Medicare cost reporting review and reimbursement requirements. The applicable volume of IHS claims, audit, and other workloads are reported in the current Jurisdiction 4 workload and are embedded within the workload estimates provided in Section L.10.e of the solicitation.

66 12. Section L.10.e Proposal Assumptions - Workloads, page 90-91 Does CMS contemplate an expected level of Provider Education and Outreach support for IHS providers other than that provided to the rest of the provider customer base?

CMS Response: The IHS telephone and written workload for the 12 month period of February 2010 thru January 2011 were:

Part A inquiries = 1,654 Part B inquiries = 2,681

CMS expects education to be performed through the ADR findings letter and probe findings letter. For purposes of this solicitation, Offerors should indicate the number of activities outside POE or the letters that they define as part of medical review.