ResponsestoRequestforClarifications.doc

SEQ CHAPTER \h \r 1RESPONSES TO REQUEST FOR CLARIFICATION Request for Clarification No. 1 Current Comprehensive Contract providers to the BOP are required to provide a system of centralized billing which should meet or exceed the requirements listed within the Medical Adjudication Services Statement of Work. Accordingly, since all current Comprehensive Contract Vendors are already required to meet these specifications, please set forth the rationale behind having claims adjudicated twice rather than simply enforcing the requirements contractually agreed upon by current providers.

RESPONSE: Consolidation and re-pricing are not adjudication functions. The institution is still ultimately responsible for reviewing the billings to compare the services received to the services billed, and to reconcile any discrepancies. Even though some level of review by a particular comprehensive medical contractor may exist, not every institution is served by a comprehensive medical contractor, nor does every comprehensive contractor perform these functions. The BOP is attempting to standardize the process, regardless of location or how services are provided.

RFQ 100-0006-07 is soliciting a contractor to adjudicate medical invoices/claims received by the BOP to ensure correctness prior to BOP’s payment of such invoices/claims. Generally speaking, BOP contracts/agreements for inmate health care do not require bill adjudication on the part of the contractor; however, contractors are required to submit proper invoices for services rendered according to the specific terms of the governing contract or agreement. If the contractor chooses to perform bill adjudication prior to submitting an invoice/claim to the Government, it does so of its own initiative likely in the interest of submitting contractually appropriate invoices/claims that are free of mistakes and/or fraud.

Currently, BOP staff review invoices/claims received from contractors/vendors/providers to ensure correctness. It is the BOP's experience that contractors/vendor/providers make mistakes in applying the correct contract rate structures (e.g., utilizing the correct Medicare rate methodology, applying the correct Medicare benchmark wage index, etc.), submitting undetected duplicate billings, making incorrect DRG assignments, etc. When a billing error is submitted by the contractor/vendor/provider and it is not detected by the Government, improper payment can be made from which the contractor/vendor/provider directly benefits. BOP staff catch a variety of billing errors made by current contractors/vendors/providers. However, as an agency, the BOP does not have the expertise or resources to implement a sophisticated process of medical claims adjudication. Thus, the Government has a requirement to implement an unbiased, objective process for determining that medical claims/invoices are correct prior to payment. The successful contractor for RFQ 100-0006-07 will fulfill those requirements.

Request for Clarification No.2 Paragraph 1 on Page 2 of the Revised Statement of Work ("SOW") states that "[c]urrently, medical claims are manually adjudicated by the institution." This statement is inaccurate. In fact, approximately 85% of BOP facilities receive community-based medical services through the contracts administered by the Field Acquisition Office ("FAO"). These comprehensive contracts require the contractor to provide a system of centralized billing which should meet or exceed the requirements listed within the MAS Statement of Work. Please clarify the BOP's basis for the statement referenced above.

RESPONSE: Refer to response to Request for Clarification No. 1.

Request for Clarification No. 3 The last paragraph on Page 2 of the SOW states in relevant part, "[t]he system used by the contractor to adjudicate claims shall ... have the capability [to] automatically "pend" claims for medical records review (for certain DRGs)...."

(a) Please state whether the BOP will provide clarification as to which specific DRGs it is interested in "pending" or whether it will be left up to the contractor to identify which DRGs should be "pended."

(b) If the BOP does have specific DRGs that should be "pended" on a regular basis, please clarify whether the BOP has taken into consideration the revision of the Medicare DRGs to the Medical Severity DRGs (MSDRGs) that went into effect 10/01/07, which increased the list from 536 DRGs to 989 MS-DRGs.

Response: The request was only for the contractor to have the capability to pend claims for medical record review with certain DRGS. The specific DRGs to be included for review will be decided after contract award in consultation with the contractor. As stated in part (b) of your request for clarification, the DRG system is not static. Therefore, the list of DRGs that may be included for medical record review would not be static.

Request for Clarification No. 4 Paragraph #3 on Page 3 of the SOW describes the same preauthorization process required of current Comprehensive Contract Providers. As such, please clarify the following:

(a) Whether the institution will be required to submit preauthorizations to both the Comprehensive Contract Vendor and the vendor awarded this contract simultaneously;

(b) Whether both the Comprehensive Contract Vendor and the vendor awarded this contract are expected to adjudicate the claims simultaneously under the same time requirements; and

(c) The rationale for requiring the vendor awarded this contract to provide an estimate for a procedure if it is simply ensuring that billings are correct.

RESPONSE: a. Preauthorization to the comprehensive medical contract vendor (if one exists) is a request to obtain services on behalf of the institution for the inmate. This allows the comprehensive medical contract vendor to identify the appropriate provider, setting, date, and time for services to be rendered. Preauthorization with the bill adjudication vendor serves to notify that vendor that a service has been requested and that a bill will be forthcoming. The bill adjudication vendor will use that information in adjudicating the claim.

b. If a comprehensive medical contractor exists, they would submit their consolidated invoices to the bill adjudication contractor (as they do now directly to the BOP), and the adjudication contractor would begin their review at that time.

c. The Health Services Administrator (HSA) is required to provide a good faith estimate of charges for medical services at the time the funds are obligated. The bill adjudication vendor will be responsible for generating estimates based on the terms of medical contracts specific to that facility, and analysis of payments made. Over time, these estimates will be more refined, and therefore, more accurate.

Request for Clarification No. 5 Paragraph #6 on Page 4 of the SOW states that "[t]he contractor shall not make payments for medical services rendered to BOP inmates on behalf of the BOP. Final decisions about payments will be made by the institutions." As noted above, over 85% of the current BOP institutions are under a Comprehensive Contract, the vendors performing on those contracts are making payments to providers for medical services. In this regard, please clarify the following:

(a) Whether the award of this contract will change the payment requirements in all of the current Comprehensive Contracts;

(b) If the vendor awarded this contract arrives at results that differ from the results obtained by the Comprehensive Contract Vendor on any claim, who will determine which result is the correct result;

(c) Who at the institution, or the BOP, has the expertise to evaluate differing results to determine which payments should be made;

(d) How this process of reviewing differing results will be implemented to ensure that the prompt payment requirements for claims processing can be met by either vendor;

(e) If the results of the contractor awarded this contract are determined to override the results of the Comprehensive Contract Vendor, how the Comprehensive Contract Provider can be expected to pay a result that is not in their system;

(f) Whether the institution will pay the vendor awarded this contract, as well as paying the invoices of the Comprehensive Contract Vendors; and

(g) How the current Solicitation, which will cause BOP to pay twice for the same claims adjudication services, offers BOP the "best value" in light of the nature of the competitive pricing environment for current Comprehensive Contracts.

RESPONSE: a. This contract does not change the payment requirements in current comprehensive contracts.

b. All BOP institutions currently make the determination whether a bill is correct for payment to a comprehensive contractor. This will remain the same.

c. The HSA will make the determination based upon information received from the bill adjudicator and the comprehensive contractor.

d. Under #7 in the SOW, it is explained that if the bill adjudicator receives an improper claim from a healthcare provider, the contractor shall notify the healthcare provider (comprehensive contractor) within (7) days after the receipt of the improper claim. The beginning of the prompt payment time period will not begin until a proper claim has been submitted.

e. Differences between adjudicated amounts and billed amounts will be resolved by the HSA with the bill adjudicator and comprehensive contract vendor.

f. The comprehensive contract vendor will be paid for their services provided (i.e. medical claims) and the bill adjudicator for the services they render.

g. The BOP currently does not have a requirement for comprehensive medical contract vendors to adjudicate bills, and not all comprehensive medical contract vendors perform this service. In addition, there are a number of institutions who are not served by comprehensive medical contract vendors. This solicitation does not result in the BOP paying twice for a service that has been specifically contracted through another vehicle. It is the best value for the BOP to have an unbiased review of medical claims across all locations to prevent fraud, waste, and abuse of government funds.

Request for Clarification No 6 Paragraph #8 on Page 5 of the SOW at Letter D states that the vendors' system shall "function and provide adequate response times across wide area network connections that are part of the Department of Justice's JUTNET network." Please clarify whether outside contractors are permitted to connect to the DOJ JUTNET network.

RESPONSE: No. Outside connections are not generally permitted to the Department of Justice's (DOJ) telecommunications network. Any outside connection requires the approval of the DOJ Chief Information Officer.

Request for Clarification No. 7 Paragraph #8 at Letter I states that the vendors' system "must be able to interoperate with other BOP information systems such as our email system GroupWise and network file server system from Novell, and our Electronic Medical and Pharmacy systems. "Interoperate" is a vague term that can mean anything from sending a flat ASCII file to creating an active, real time interface built into both systems.

(a) Please clarify the BOP's definition of "Interoperate" as set forth in the Solicitation.

(b) Further, in order to respond and price these capabilities accurately, any vendor interested in this RFQ will need specifications for exactly what the BOP wants this interface to be. Accordingly, please state whether the BOP will provide detailed specifications for each interface before the due date for responses to the RFQ, or whether the BOP will amend the RFQ to agree to deal with these features as a separate effort and separate price after award.

RESPONSE: a. Interoperability with GroupWise would require the capability to interact with SMTP and MIME protocols and would allow IMAP4-compliant e-mail clients to read and manipulate GroupWise messages. Interoperability with the Medical and Pharmacy systems would require compatibility or the ability to exchange information with a J2EE-compliant application with a backend DB2 database.

b. The response in (a) should provide enough clarification so that a vendor can address the RFQ.

Request for Clarification No. 8 Paragraph #10 on Page 6 of the SOW states that "[t]he contractor further agrees to work with the BOP to develop an inmate demographic extract from the BOP's inmate management system." In order to respond and price these capabilities accurately, any vendor interested in this RFQ will need specifications for exactly what the BOP wants this interface to be. Please clarify whether the BOP will be providing detailed specifications for each interface before the due date for responses to the RFQ, or whether the BOP will amend the RFQ to agree to deal with these features as a separate effort and separate price after award.

RESPONSE: The vendor will be given inmate demographic information as well as the location the inmate is currently housed at. Generally, the BOP uses a flat file that contains all inmates in our current population as the interface format. The vendor will work with BOP Information Technology staff on what specific data fields will be included in the extract as well as each field's data type and format.

Request for Clarification No. 9 In the Q&A posted on 8/15/07, Question #3, the response states that "the BOP does not have a system or means to provide the composition of the claims processed." All current Comprehensive Contract Vendors are required to collect the data requested by the vendor who submitted Question #3, which means the BOP should be able to collect the requested data for over 85% of their facilities. Can the BOP please collect the data to the extent available and provide it to interested vendors?

RESPONSE: This is currently not a requirement of comprehensive contracts. Some vendors have proposed this type of service and it is available through those contracts, but not all comprehensive contracts. The solicitation contains a good faith estimate based on the information that was available to the BOP from existing systems.

Request for Clarification No. 10 In the Q&A posted on 8/15/07, Question #5, letter (E) regarding the quantification of adjustments, the response states that "the BOP cannot quantify this as it does not have the means to do so." All current Comprehensive Contract Vendors are required to collect the data requested by the vendor who submitted question #5, letter (E), which means the BOP should be able to collect the requested data for over 85% of their facilities. Can the BOP please collect the data to the extent available and provide it to interested vendors?

RESPONSE: See response to Request for Clarification No. 9.

Request for Clarification No. 11 In the Q&A posted on 8/15/07, Question #26, regarding prompt payment, the response states that "the contractor is required to return incorrect claims with notification to the providers and include instructions for correct submissions within seven (7) days of receipt of improper claims." Please clarify the following:

(a) Whether providers serving current Comprehensive Contracts are going to be required to submit claims to the current Comprehensive Contract Vendor AND to the vendor awarded this contract;

(b) Considering that Providers serving current Comprehensive Contracts are contracted by the Comprehensive Contract Vendor, not the institution or the BOP, state whether BOP will enter into agreements with these providers as well;

(c) If both the current Comprehensive Contract Vendor and the vendor awarded this contract determine different errors on different claims, or the same errors on the same claims, state which vendor's results the provider should respond to;

(d) Whether differences in claims will be settled by the institution, or the BOP;

(e) Whether the current Comprehensive Contract Vendor will retain sole communication with the providers under contract, or whether the vendor awarded this contract will take over responsibility for provider communication;

(f) How the institution or the BOP will determine which vendor's results are the correct results.

RESPONSE: a. For the purposes of this scenario, the comprehensive contract vendor would be responsible for all submission of bills to the adjudication vendor. Sub-contracted providers would not submit bills directly for adjudication.

b. The BOP's agreements are with the comprehensive contract vendors.

c. The comprehensive contractor will be notified of the improper claim. A proper claim must be submitted by the provider through the comprehensive contractor.

d. The institution (BOP) will make the final decision.

e. The bill adjudication vendor will communicate with the comprehensive contract vendor who will be responsible for communicating with their sub-contractors.

f. Both vendors will submit their documentation to the HSA, who will review it and make the final determination for payment.

Request for Clarification No. 12 In the Q&A posted on 8/15/07, Question #64, regarding two years of historical data, the response states "the BOP has no way to track and, therefore, provide this information." All current Comprehensive Contract Vendors are required to collect the data requested by the vendor who submitted question #64, which means the BOP should be able to collect the requested data for over 85% of their facilities. Can the BOP please collect the data to the extent available and provide it to interested vendors?

RESPONSE: See response to Request for Clarification No. 9.

Request for Clarification No. 13 Paragraph #4 on Page 4 of the SOW refers to Payment Schedules for patients being transferred between institutions. Please clarify which BOP facility will be responsible for the bills if a patient is transferred between two or more institutions during an inpatient hospitalization.

RESPONSE: This section of the SOW refers to inmates who receive medical services while at one location, but who are transferred prior to receipt of the bills for their care. The bills will be adjudicated based on the location of the inmate during the date(s) of service.

Request for Clarification No. 14 Paragraph #4 on Page 4 of the SOW refers to Payment Schedules for patients being transferred between institutions. Inpatient hospital bills are based on MS-DRGs, which may only be calculated once a discharge order is written or a transfer order to another medical facility is written. Please address the following:

(a) Whether, in the event that a transfer between BOP facilities should occur, the physician bills will be split based on the date of service between the two BOP facilities or whether the facility that admitted the patient to the hospital will be responsible for the entire hospitalization considering that BOP facility issued the YREGDOC for the hospitalization; and

(b) How the BOP will handle hospital and physician claims when an inmate is released from BOP custody or transferred to some other law enforcement agency during a hospitalization, considering MSDRG and other Medicare methodologies as noted above.

RESPONSE: a. See response to Request for Clarification No. 13.

b. The adjudication will only cover the period for which the BOP is responsible for the inmate. Any charges after that date will not be evaluated under the terms of this contract.

Request for Clarification No. 15 The SOW sets forth 19 detailed requirements that must be addressed in an offeror's Technical Proposal, and the Evaluation Criteria allow for 30 possible points for an offeror's Technical Approach. However, the Evaluation Criteria only state that offerors are to provide a "detailed" technical plan and time line, with no indication how the 30 possible points will be allocated among the 19 requirements. Please clarify how the 30 possible points are to be allocated among the various requirements set forth in the SOW.

RESPONSE: Quoters should address the requirements in their quotation, and the quotations will be evaluated based on the overall value that best meets the requirements stipulated in the SOW. The requirements are not specifically weighted individually.

Request for Clarification No. 16 With regard to scoring, the RFQ sets forth 15 points possible with regard to a contractor's experience. More specifically, the RFQ requires contractors to "describe and quantify their level of experience with providing medical claims adjudication services." Please provide further guidance with regard to this requirement and how the BOP will score this portion of a contractor's technical proposal.

RESPONSE: See response to Request for Clarification No. 15.

Request for Clarification No. 17 Section A. 16 of the RFQ (titled "Subcontracting Certification") fails to indicate whether the contract provides for subcontracting opportunities. Please clarify.

RESPONSE: The contract does not preclude subcontracting opportunities. See Amendment 09 incorporating clause 52.219-9 Small Business Subcontracting Plan (Sept 2007).

ADDITIONAL CLARIFICATIONS

Vendors are strongly encouraged to carefully read the solicitation documents, particularly the Statement of Work. Unless otherwise indicated (i.e., "vendor shall propose . . ."), the requirements in the Statement of Work are specific and are not subject to modification or adaptation to the vendor's solution.

1.

Does each prison have medical clinic facility?

RESPONSE: Yes, each prison has at least an outpatient clinic and some facilities, particularly the medical centers, have both outpatient and inpatient areas which are "self-contained."

2.

If they have clinic facilities - do they each include both outpatient and inpatient areas? In those areas, are there self-contained Lab/Pharmacy/X-ray, etc.

RESPONSE: Yes, each prison has at least an outpatient clinic and some facilities, particularly the medical centers, have both outpatient and inpatient areas which are "self-contained."

3.

When the BOP pays the clinic medical visit - who are they actually paying. Is the recipient of the payment a BOP employee, BOP division or department, or possibly a contracted medical group?

RESPONSE: Claims will be generated by healthcare providers, not from the BOP facilities. As stated in the Statement of Work, the "network of healthcare providers" are those healthcare providers with current BOP contracts, not BOP employees.

4.

How often would a prisoner be sent to an outside facility and what type of outside facility would the prison system utilize?

RESPONSE: Utilization of community-based healthcare providers is dependent on the medical condition of the inmate and the resources available within the institution, but the extent to which that occurs cannot be quantified with existing BOP systems. Contractors provide services within the confines of BOP institutions, at physician offices, surgical centers, and hospitals.

5.

Does the BOP secure contracts with specific outpatient/hospital facilities in all regions? In those contracts, if they exist, there should be the ability to transfer data between the two facilities through communication protocol built into the information technology corridor.

RESPONSE: Each institution within the BOP has separate and unique contract(s) with healthcare providers in their area. Most healthcare providers should be capable of electronic billing via ANSI 837 format, however, some claims may be submitted on paper until such time they convert to electronic billing.

6.

Do any of your patients have medical coverage through medicaid or medicare? I don’t know if Medicare benefits would be lost when someone is incarcerated. But might be something to consider in the specifications for the adjudication system as if pertains to the payor of a claim.

RESPONSE: No, the BOP is responsible for providing the provision of healthcare to inmates remanded to the custody of the BOP. Accordingly, for the purpose of contract award, all federal inmates are considered to have a single benefit plan and are members of this plan.