Sources Sought-Medical Review OIG260145 v2.pdf

Sources Sought Notice #OIG260145 OIG, Office of Audit Services (OAS)

SOURCES SOUGHT ANNOUNCEMENT (SSA)

Medical Record Review and Consultative Services

Department of Health and Human Services (HHS), Office of Inspector General (OIG), Acquisitions Division (AD), Washington, DC is pursuing the acquisition of medical review (MR) and consultative services to assist the OIG in conducting its’ oversight responsibilities regarding the programs operated by the Department of Health and Human Services. The acquisition will primarily result in services that support the OIG’s auditing function and the production of audit reports. The resulting contract will include professional services to determine whether selected medical services and claims pertaining to beneficiaries of Medicare (and occasionally Medicaid) complied with coverage, coding, payment, and billing requirements and to provide medical consultative services to the OIG with respect to such services and claims. The acquisition is primarily to assess services and claims for Medicare fee-for-service payments for Part A and Part B. Other analyses on an infrequent basis may include assessment of services and claims for Medicaid or the Medicare Prescription Drug Plan (Part D). While individual reviews may comprise 100-200 claims, annual volume is expected to be 2,000-3,000 claims.

CONTRACTING OFFICE ADDRESS:

Department of Health and Human Services Office of Inspector General (OIG), Office of Management and Policy (OMP) Acquisitions Division (AD) 330 Independence Ave. SW 5th Floor, Suite 5550 Washington DC 20201

INTRODUCTION:

This is a SOURCES SOUGHT to conduct market research and determine the availability and technical capability of all sources to provide the required products.

The OIG is seeking information for potential sources to provide Medical Record Review and Consultative Services

DISCLAIMER:

THIS SOURCES SOUGHT IS FOR INFORMATIONAL PURPOSES ONLY. THIS IS

NOT A REQUEST FOR PROPOSAL. IT DOES NOT CONSTITUTE A SOLICITATION

AND SHALL NOT BE CONSTRUED AS A COMMITMENT BY THE GOVERNMENT.

RESPONSES IN ANY FORM ARE NOT OFFERS AND THE GOVERNMENT IS

UNDER NO OBLIGATION TO AWARD A CONTRACT AS A RESULT OF THIS

ANNOUNCEMENT. NO FUNDS ARE AVAILABLE TO PAY FOR PREPARATION

OF RESPONSES TO THIS ANNOUNCEMENT. ANY INFORMATION SUBMITTED

BY RESPONDENTS TO THIS TECHNICAL DESCRIPTION IS STRICTLY

VOLUNTARY.

CONTRACT/PROGRAM BACKGROUND:

Contract Number: HHSP233201500023B Contract Type: FFP Incumbent and their size: MAXIMUS FEDERAL SERVICES, INC., Large Business Method of previous acquisition: Full and Open competition via GSA.

Brief description of the current program/effort:

OIG has current requirement to procure medical review and consultative services associated with the oversight activities of the OIG primarily involving Medicare fee-for-service payments. Occasionally it may include assessment of services and claims for Medicaid or Medicare Part D.

Anticipated Timeframe: October 2020 contract award with 1 base year and four, 1-year options

Place of Performance: Contractor’s site

WORK TO BE PERFORMED:

Medical Review of Claims

Vendors will be required to perform medical review of claims and the supporting medical record documentation as part of the development of audits and other OIG activities (e.g., evaluations or investigations). Prior to the medical review, the OIG will select the claims for review and in most cases collect the medical documentation. The number of claims and timeframes will vary by review. Claim reviews require, at a minimum, the clinical evaluation of medical records and related documents to determine whether Medicare claims were billed and paid in compliance with Medicare's coding, coverage, billing and payment requirements.

A medical record is the systematic documentation of a single beneficiary's medical history and care across time. Medical record review is the evaluation of the beneficiary's information and medical records to ensure that payment is made only for services that meet all Medicare coverage, coding, and medical necessity requirements. When clinical judgment is needed, a medical record review must be performed by appropriate licensed professionals within the scope of their practice. Occasionally the OIG may request assistance in collecting the records.

The Contractor will perform medical record review and/or support a large volume of claims that are generated from all fifty (50) States and in six (6) territories.

Consultative Services

Consultative services will primarily consist of assisting the OIG both orally and in writing in responding to auditee comments and other information received by the OIG pertaining to work previously conducted by the awardee. In addition, consultative services may include providing expertise on a wide variety of medical related issues including assistance in assessing risk in designing future oversight activities or in assessing the Medicare program to identify fraud, waste, and abuse vulnerabilities.

MINIMUM REQUIREMENTS AND QUALIFICATIONS

• The Contractor must have in place adequate facilities, personnel, and equipment to perform medical reviews.

• The Contractor shall provide a secure environment for the transmission of information and adequate protection of all personally identifiable information (PII).

• The Contractor must have professional staff (medical and coding) with thorough knowledge of and extensive expertise in applying requirements for providing and billing services to Medicare beneficiaries.

• The Contractor shall develop medical record review instruments based on the particular review, with detailed knowledge of the Medicare criteria.

• The Contractor shall provide a detailed final review results letter for each sampled claim.

The final review results letter must contain enough specific detail, in plain language. The letter should clearly explain the basis for each claim decision.

The Contractor shall have in place a mechanism to oversee and monitor the progress of all assigned projects and shall be able to provide status updates to OIG at least bi-weekly.

• The Contractor will be available to participate in discussions (in person or via teleconference) with outside entities (including the auditee and Medicare officials) in the event that the OIG requests such assistance.

• The Contractor shall have a robust quality assurance process to maintain accuracy in decision making (inter-reviewer reliability).

• The Contractor shall have programs in place to identify, report, and mitigate actual and potential conflicts of interest for itself, its employees, subcontractors and consultants.

• The Contractor shall have the capacity to review Spanish medical records.

• The Contractor shall provide a detailed description of up to three (3) recent corporate experience in performing medical reviews for a Government Agency (State or Federal), or for a Domestic/International Company of a similar size, scope, and responsibilities as HHS OIG. (Note: Comparable size, scope, and responsibility is defined as (At least 2,000 health care related claims performed annually with a minimum contract dollar value of $1,000,000).

Recent corporate experience is defined as performing a medical review within five (5) years of the Sources Sought release date.)

• The Contractor shall identify the contracting Agency Name, Contract Number, Contract Point of Contact and phone number, or shall describe the Corporate Experience as for a Domestic/International Company and provide the name of the company for which the work was performed.

• The Contractor shall also state what the period of performance was and shall categorize its role as a “prime contractor” or “sub-contractor”.

SPECIAL REQUIREMENTS

N/A

SOURCES SOUGHT:

This Sources Sought Synopsis is seeking small business sources to determine the availability and capability on providing medical review and consultative services associated with the oversight activities of the OIG primarily involving Medicare fee-for-service payments.

The anticipated North American Industry Classification System Code (NAICS) for this requirement is 541611 Administrative Management and General Management Consulting Services, $16.5M.

This Sources Sought Synopsis is requesting responses to the following criteria ONLY from all sources that can provide the required services under the NAICS Code 541611.

To assist the AD Office in making a determination regarding the level of participation by small business in any subsequent procurement that may result from this Sources Sought, you are also encouraged to provide information regarding your plans to use joint venturing (JV) or partnering to meet the requirement. This includes responses from qualified and capable Small Businesses, Small Disadvantaged Businesses, Service Disabled-Veteran Owned Small Businesses, Women-owned Small Businesses, HUBZone Small Businesses, and 8(a) companies. You should provide information on how you would envision your company's areas of expertise and those of any proposed JV/partner would be combined to meet the specific requirements contained in this announcement.

In order to make a determination for a small business set-aside, two or more qualified and capable small businesses must submit responses that demonstrate their qualifications.

Responses must demonstrate the company’s ability to perform in accordance with the Limitations on Subcontracting clause (FAR 52.219-14).

SUBMISSION DETAILS:

White Paper: Complete a cover page, and White Paper in accordance with the instructions provided. The Contractor shall provide a detailed description of their ability to meet and address the “MINIMUM REQUIREMENTS AND QUALIFICATIONS” as described above. The White Papers shall describe the effort in sufficient detail to allow evaluation of the concept's technical merit and its potential contribution to the OIG mission.

Each Contractor shall submit an electronic copy of their firm’s White Paper. The White Paper shall be submitted to the Contract Specialist, Christopher Winfield Email Address:

Chris.Winfield@oig.hhs.gov and the Contracting Officer, Nicola L. Carmichael, at email address: Nicola.Carmichael@oig.hhs.gov. Failure to submit Papers via email to both the individuals identified above could be considered non-responsive. All White Paper submissions are due no later than 12:00 noon, Eastern Time (ET) July 31, 2020.

Include “SS-OIG260145 WHITE PAPER” in the email subject line. White Papers must be submitted in the following format but do not require any special forms:

•Single PDF formatted file as an email attachment •Page Size: 8 ½ x 11 inches •Page limit: 10 pages• Margins – 1 inch •Spacing – Single Font – Arial, 12-point

The file shall not exceed 2 Megabytes of storage space. Movie and sound file attachments, URL Links, or other additional files, will not be accepted.

Responses must include:

1) Business name and address;

2) Name of company representative and their business title;

3) Type of Business;

4) Cage Code

5) DUNS Number

6) Contract vehicles that would be available to the Government for the procurement of the product and service, to include General Service Administration (GSA), NIH, NASA SEWP, Federal Supply Schedules (FSS), or any other Government Agency contract vehicle. (This information is for market research only and does not preclude your company from responding to this notice.)

Proprietary information and trade secrets, if any, must be clearly marked on all materials.

All information received that is marked Proprietary will be handled accordingly. Please be advised that all submissions become Government property and will not be returned.

All government and contractor personal reviewing the SSA responses will have signed non-disclosure agreements and understand their responsibility for proper use and protection from unauthorized disclosure of proprietary information as described 41 USC

423. The Government shall not be held liable for any damages incurred if proprietary information is not properly identified.

FAILURE TO FOLLOW THE ABOVE INSTRUCTIONS MAY RESULT IN YOUR

SUBMISSION BEING FOUND NON-RESPONSIVE.