Pricing, Data Analysis, and Coding (PDAC) Pre-solicitation Notice

Added: Jan 16, 2018 8:55 am Pricing, Data Analysis, and Coding (PDAC) Pre-solicitation Notice:

The purpose of this contract is to re-procure a PDAC Contractor, hereinafter referred to as the "Contractor", to provide specified services in support of the sound administration of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) benefit under the Medicare Fee-For-Service (FFS) program. The Contractor shall perform its responsibilities under the direction of the Centers for Medicare and Medicaid Services (CMS). The Contractor shall facilitate, coordinate, and support activities among various Medicare contractors with DMEPOS-related responsibilities, including the Durable Medical Equipment Medicare Administrative Contractors (DME MACs), Zone Program Integrity Contractors (ZPICs), Unified Program Integrity Contractors (UPICs), and the National Supplier Clearinghouse (NSC). The Contractor shall also perform these facilitation and support activities for other Medicare contractors at the direction of CMS. In addition, the Contractor shall perform facilitation and support activities for Federal and State agencies, and other stakeholders, as defined and directed by CMS.

The Contractor shall perform the requirements of this contract in accordance with applicable laws, regulations, Medicare manuals (as specified in this SOW) and CMS requirements to ensure the financial integrity of the Medicare FFS program. The Medicare program's legal, policy and operating environment is complex, and the Contractor shall utilize or interact with certain CMS-required systems, equipment and/or operational capabilities in the performance of its functions

The Contractor shall receive and control Medicare national DMEPOS claims data from CMS. The Contractor shall also conduct a variety of different customer service activities, such as answering written inquiries and providing Medicare guidance and advice on coding of DMEPOS items that are billed to the DME MACs. The Contractor shall answer a wide range of questions from DMEPOS manufacturers, distributors, suppliers and other stakeholders from across the country. The Contractor shall operate and maintain an Internet-based tool used by DMEPOS manufacturers, distributors, suppliers and other stakeholders to facilitate product identification and coding of DMEPOS items that are billed to the DME MACs. The Contractor shall perform complex statistical analyses of Medicare FFS DMEPOS claims data and create reports on trends, significant changes and other relevant factors. The Contractor shall store and maintain this information in a data warehouse. The Contractor shall maintain statistical reports, data analyses and other statistical information in a web-based environment that is easily accessible to the ZPICs, UPICs, DME MACs, NSC, CMS and specific Health & Human Services Office of Inspector General (OIG) personnel limited to the Office of Audit Services (OAS) and Office of Evaluation and Inspections (OEI). The Contractor shall control access to this environment through user passwords and other physical, administrative, and technical safeguards. The Contractor shall develop and maintain a crosswalk for certain drugs from the NDC code to an appropriate Healthcare Common Procedure Coding System (HCPCS) Level II code. The Contractor shall code and price certain oral anti-cancer drugs. All of these functional activities are specified in detail under Section E of this SOW.

CMS anticipates releasing a solicitation for the PDAC on or about February 1, 2018. The contract will include a base year and four one-year options. The anticipated proposal due date is March 1, 2018 with an anticipated award date of September 1, 2018.

This solicitation is expected to be issued as pending availability of funds.