COST REPORT AUDIT RISK ASSESSMENT ACCURACY AND EDUCATION CONTRACTOR (CRARAAE)

Introduction: The Centers for Medicare & Medicaid Services (CMS) is hereby conducting market research to identify sources to support informed decisions to procure for the required services. All types of business concerns, both large and small, are encouraged to submit responses to this Sources Sought Notice (SSN). This SSN is for all interested qualified businesses that meet the requirements for this effort. The information from this market research will help CMS plan their acquisition strategy. This announcement is a SSN for planning purposes only. This is not an invitation for bid, request for quote or other solicitation and in no way obligates the Government to award a contract. CMS will not entertain questions regarding this market research. However, CMS would encourage feedback to the SOW, to include any Tasks or subtask found within this document. Background: Medicare-certified institutional providers are required to submit an annual cost report to a Medicare Administrative Contractor (MAC)-CMS receives over 50,000 Cost Reports annually. The cost report contains provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data along with determining the amount of Medicare Part A reimbursement due to the provider. The desk review and audit process helps to ensure that Cost Report data is accurate and reliable for use by CMS, as well as by other government and non-government agencies. Currently there are 12 MACs that conduct Audit and Reimbursement (A&R) activities. A&R requires highly specialized professionals to conduct desk review audits and other cost report activities that effectively protect the Medicare Trust Fund from improper payments. Medicare A&R requirements are not stagnant; instead these requirements are revised and improved to prevent improper payments, increase the return on investment and reduce the number of cost report appeals. CMS seeks to acquire a Contractor to, at a minimum assist in: 1. Developing, implementing and maintaining a cost report risk assessment process. 2. Reviewing the compliance of MAC A&R activities. 3. Conducting outreach and education for the MACs. 4. Other A&R projects. Together these activities are referred to as the Cost Report Audit Risk Assessment Accuracy and Education (CRARAAE). These activities may be accomplished by one or more contractors and by the creation of one or more new processes. The goal is to have a contractor that will: - Identify the issues and select Medicare cost reports for the MACs to audit; - Assist CMS in the review of MAC Audit and Reimbursement (A&R) activities; - Assist CMS in developing ongoing Medicare Cost Report and Medicare Cost Report Reimbursement training for the MACs. CMS is seeking to establish a Risk Assessment Process (RAP). The RAP includes all of the activities that pertain to the risk-assessment of Medicare Cost Report Audits. CMS intends to establish a RAP operation that provides quality customer service and streamlines the audit risk-assessment and scoping process, while ensuring the integrity of the Medicare Trust Funds. As with any consolidation of efforts for similar functions, savings of time and costs can be realized. CMS is seeking to expand review of compliance of MAC Audit and Reimbursement (A&R) activities. The process will include, but will not be limited to, the accuracy and completeness of MACs A&R activities such as reviewing desk reviews, audits, appeals and cost report reopening's. The task will include revisions and automation of the programs used by the MACs that fall under the Office of Financial Management (OFM) Financial Services Group (FSG) Division of Provider Audit Operations (DPAO) portfolio. The task may also include CMS Manual Reviews and Revisions and ad-hoc Reimbursement-related activities such as specialized Desk Review program development, automating the Desk Review and Audit Process and workflow redesign. CMS is seeking to establish an improved process to assist in the on-going professional training of MAC personnel. This training would be based on results of the MAC compliance reviews, changes in policy, feedback from the MACs, and other sources. The MACs currently are responsible for the training of their A&R auditors and other personnel; the professional training is intended to augment and assist MACs in their training efforts, not to replace the MAC training efforts. Based on guidance provided by CMS, the Contractor will incorporate feedback from the Quality Assurance Surveillance Program (QASP) reviews, Policy-related changes, and feedback from CMS Stakeholders into a comprehensive (A&R) training program for the MACs. The Contractor will develop and present interactive, web-based video training courses on various Medicare Audit and Reimbursement (A&R) topics for the MACs, to include: - The flow of the Medicare Cost Report - Audit and Reimbursement - Federal Register Updates - Special Topics Response Information: In order to respond to this notice, contractors must be able to indicate experience and/or the ability to provide all of the numbered points below. The services required are to be provided by a contractor with experience in Medicare Part A cost reports, and Medicare Part A cost report reimbursement issues. There are no exceptions to the requirements listed below. Offerors who do not clearly demonstrate such capabilities, assets, and experience will not be found to be capable. Give enough detail so your response clearly indicates that you can provide the following: - Knowledge of the Medicare regulations and policy related to PPS and cost-based providers (hospitals, SNFs, HHAs, etc.). - Capability to analyze Medicare reimbursement issues. - Capability to analyze the MACs audit and reimbursement workpapers. - The contractor shall have Medicare cost report audit and reimbursement experience and strong working relationships when working with other MACs. - Capability to analyze proposed and final Medicare reimbursement regulations. - Capability to analyze proposed and final Medicare policy instructions. - Capability to develop criteria to select and prioritize Medicare Cost Reports for audit review. - Capability to develop a Risk Assessment Process/Medicare Cost Report Audit Selection Strategy. - Capability to develop a Medicare Cost Report Audit Selection System. - Capability to design subsystem interactions, events and software components. - Capability to design interfaces, data stores and reports. - Capability to exchange information with other systems and services in support of the Risk Assessment Process, including, but not limited to, HCRIS, PECOS, PS&R and STAR. - Capability to design and enhance the application code to support business requirements and rules for analysis of risk assessment ranking. - Capability to design, support and enhance (as required) management and operational reports. Senior Project Manager qualifications include: - Possesses and applies a comprehensive knowledge across key tasks and high impact assignments. - Leads team on large projects or significant segment of large complex projects. - Provides applications systems analysis and programming activities for a Government site, facility or multiple locations. - Prepares long and short-range plans for application selection, systems development, systems maintenance, and production activities and for necessary support resources. - It is required that the Project Manager hold and maintain an active Project Management Professional (PMP) certification through the Project Management Institute throughout the duration of this task order, and have a minimum of 5 years of project management experience managing a multi-disciplinary project team. Experience managing a Government project with similar size and complexity is also preferred. Medicare Cost Report Subject Matter Expert qualifications include: - Senior Auditor experience with a Medicare Administrative Contractor (or equivalent industry role) - Ability to review audit work papers for all provider types - Possesses in depth knowledge of: Graduate Medical Education (GME), Indirect Medical Education (IME), Organ Acquisition, Disproportionate Share (DSH), Bad Debts, Interim Rate Reviews, Medicare Cost Report Appeals process, Medicare Cost Report Reopening process, Cost Based Reimbursement. - Minimum of five years of experience (10-years of experience preferred) Risk Assessment Process (RAP) Task Lead qualifications include: - Senior Auditor experience with a Medicare Administrative Contractor (or equivalent industry role) - Team Lead or Supervisory experience/Management-level resource - Ability to review audit work papers for all provider types - Possesses in depth knowledge of: Graduate Medical Education (GME), Indirect Medical Education (IME), Organ Acquisition, Disproportionate Share (DSH), Bad Debts, Interim Rate Reviews, Medicare Cost Report Appeals process, Medicare Cost Report Reopening process, Cost Based Reimbursement. - Minimum of five years of experience (10-years of experience preferred) Please include the following in your response: Business Information - a) DUNS b) Company Name c) Company Address d) Current NAICS Code 541990, titled Administrative Management and General Management Consulting Services e) Type of Company (i.e., small business, 8(a), woman owned, veteran owned, etc.) as validated via the System for Award Management (SAM). All offerors must register in SAMs located at https://www.sam.gov/portal/public/SAM/ f) Company Point of Contact, Phone, and Email address g) Please provide any current Government contracts that you hold that could support this SOW (such as GSA Schedule, OASIS) CMS believes that due to potential OCIs, the CRARAAE contractor cannot be an organization that is a MAC or that contracts with a MAC to perform Audit Reimbursement activities, including appeals or that has a contract to perform work for a provider, subcontract with an organization to perform work for a provider or has any relationship with a provider. In addition, the contractor cannot be an organization that represents Medicare providers on Medicare Part A Cost Report Appeals. While this potential OCI could exist for the above entities, CMS would still be interested in hearing from these organizations on the SOW. Teaming Arrangements: All teaming arrangements should also include the above-cited information and certifications for each entity on the proposed team. Teamingarrangements are encouraged. Responses must be submitted not later than September 6, 2017 at 1PM. Capability statements will not be returned and will not be accepted after the due date. The maximum number of pages for submission is 15 pages. This Sources Sought Notice is for information and planning purposes only and is not to be construed as a commitment by the Government. This is not a solicitation announcement for proposals and no contract will be awarded from this Notice. No reimbursement will be made for any costs associated with providing information in response to this Notice. Respondents will not be notified of the results of this evaluation. Disclaimer and Important Notes: This sources sought is being issued due to the expansion of the audit review program and not due to any performance issues related any contractor. This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization's qualifications to perform the work. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. However, responses to this notice will not be considered adequate responses to a solicitation. Confidentiality: No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s). Documents should be sent to the following: Lyra Correa Contract Specialist lyra.correa@cms.hhs.gov Craig Dash Contracting Officer Craig.Dash@cms.hhs.gov