Document Screening Tools that provide Natural Language Processing engines for Documentation Submitted to Support Medicare Fee for Service (FFS) claims.

***********Deadline has been extended to 10/31/11 no longer than 11:00am******* REQUEST FOR INFORMATION (RFI) THIS IS NOT AN INVITATION FOR BID, REQUEST FOR PROPOSAL (RFP), PROPOSAL ABSTRACTION, OR OTHER SOLICITATION, AND IN NO WAY OBLIGATES CMS TO AWARD A CONTRACT. THE INTENT IS TO OBTAIN CAPABILITIES MARKET RESEARCH AND TO MAKE INFORMED DECISIONS REGARDING A POTENTIAL SMALL BUSINESS SET-ASIDE. This is a Request for Information (RFI). This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this notice is to obtain information/feedback from industry regarding this potential requirement as well as to obtain information regarding the availability and capability of sources to perform a potential requirement. The Provider Compliance Group (PCG) within the Centers for Medicare & Medicaid Services (CMS) Office of Financial Management (OFM) is conducting market research to identify potential sources that meet the requirements generally described in this notice as well obtain feedback from industry. The intent of this announcement is to: (a) Notify potential sources about the CMS national requirement, (b) Help CMS identify the interested vendors; (c) Identify any existing contracting vehicles; and (d) Obtain feedback from industry in an effort to assist CMS in the development of its requirements THIS IS STRICTLY MARKET RESEARCH. CMS WILL NOT ENTERTAIN QUESTIONS REGARDING THIS MARKET RESEARCH. I. Background: The Medicare FFS Program makes an estimated 35.4 billion in improper payments each year. CMS estimates that the Medicaid FFS programs issues more than 18.1 billion in improper payments each year. CMS employs several types of Review Contractors to measure, prevent, identify, and correct these improper payments. These Review Contractors to find the improper payments by selecting a small sample of claims, requesting supporting medical documentation from the provider who submitted the claim, and manually reviewing the claim against the medical documentation to verify the provider's compliance with Medicare rules. Other CMS programs also issue payments to physicians, hospitals and other health care organizations. The other programs also review a small sample of their payments to determine which ones were made improperly and do so by requesting, receiving, and reviewing supporting documentation. The Provider Compliance Group (PCG) within the Centers for Medicare & Medicaid Services (CMS) Office of Financial Management (OFM) is responsible for identifying, measuring, and preventing improper payments in the Medicare Fee-For-Service (FFS) program, Medicare Health Information Technology for Economic and Clinical Health (HITECH) program initiatives, and measuring improper payments in the Medicaid program. The PCG Information Technology (IT) Team oversees a number of projects including the Electronic Submission of Medical Documentation (esMD) Project. More information regarding the esMD project is available on the CMS website at www.cms.gov/esmd - The current system where Review Contractors send paper request and providers send paper documentation - Phase one of esMD where Review Contractors send paper requests and providers send electronic documentation, and - Phase two of esMD where Review Contractors send electronic requests and providers send electronic documentation CMS' Office of Financial Management is in the process of reviewing vendor capabilities and tools to assist CMS with the enhancement of the Electronic Submission of Medical Documentation (esMD) project. We are seeking to identify and solicit feedback regarding leading cutting-edge technology capabilities for Document Screening Tools that provide Natural Language Processing engines for Medicare Fee for Service (FFS) claims. At this time, we are interested in seeking a Document Screening Tool that can supplement and enhance the current medical documentation process and have the capability to integrate within the existing esMD processing system. Specially, CMS seeks information about Document Screening Tools that provide Natural Language Processing Engines those are capable of reading the test of a physician's report and automatically assigning accurate CPT (Current Procedural Terminology) Codes. CMS is seeking companies that have mature Document Screening Systems with updated medical diagnosis codes. CMS is not simply looking for a rules engine that will need to be configured with medical diagnosis codes. An integral part of this RFI is to identify and understand what is available on the market. CMS understands that more than one product may be required to obtain the full functionality required. CMS' goal is to select one or more product(s) for integration into the esMD processing system flow to meet the requirements. II. Business Purpose and Objectives CMS or the assigned contractor have a need to review the Medical Records/Documents that providers will send thru esMD as .pdf or .tif file after receiving an ADR (Additional Documentation Request) letter from the Review Contractor (i.e. RAC, MAC etc). Human review for each medical documents are time consuming and expensive. The automated system will help reduce the time for human review and reduce improper classification of claims for patient visits. III. Project Business/Technical/Performance Requirements Vendors expressing an interest should provide the appropriate level of detail in the response to clearly indicate that the system can support the following questions and requirements: There are no exceptions to the requirements below; offerors must clearly demonstrate capabilities, assets and experience. Document Screening Tool Capability Requirement: 1. Tool should have Pre-Populated Medicare Rules. CMS especially interested in Physician E&M Services (Evaluation and Management Services) for any type of patient visits like, Office Visit, Skill Nursing Facility Visit, and Outpatient Visit etc. 2. Tool should have the capability of assigning the Correct Code (CPT/ICD) for the procedure after screening the documents and physician notes. 3. After the Code is assigned by the tool, the review contractor will decide if the assigned code is correct. 4. If the system decides after screening the documents that the procedure is a Level 3, and the doctor's note also categorized as a Level 3, then no human review should be needed. But, if the tool decides the procedure as a Level 3 but doctor's note categorized as Level 5 then it should be flagged for human review. 5. A workflow management for the document review will also be helpful Below are lists of functional areas and questions that should be answered: a. Medical record codes, how are they updated, what type of rules are pre-populated? b. How up to date is the tool? How are the latest medical diagnoses codes maintained and updated in th system? c. Experience and number of installation? Any experience in other government agencies? d. Can your system be integrated in a 3-Zone mainframe or mid-tier environment? e. What is the data volume capacity? f. Can the tool be hosted in the CMS data center? g. Is your system compliant with the HIPPA requirements? How does the system meet HIPPA standards? h. Is your system compliant with FISMA Security requirements? How does your system meet FISMA Security standards? i. Does your system capture auditable history? At what level and for what duration of time? j. Does your system include any base or ad hoc reporting capabilities? k. Does your system provide any user interface or administrative tool? If so, is the user interface 508 compliant? IV. Information Requested Vendors responding to this RFI may provide a response that includes the following information for CMS internal use and consideration: a. Questionnaire - Please respond to the questions in Section III. b. Provide copies of your commercial price list (if any) and customary terms and conditions for similar services (if any) delivered to other commercial customers and/or to any federal customers. c. Provide information about GSA Schedule Contracts (if any) or other contractual vehicles used by your company for selling similar services to the Federal Government, for instance: - Identify GSA Schedule (i.e., FABS, MOBIS, etc) - Identify other contracting vehicles in place with the Federal Government and provide contact information for the Contracting Officer. d. Vendor's DUNS number, organization name, address, size and type of business (e.g., 8(a), WOSB, VOSB, SDVOB, or HUBZone small business) pursuant to the applicable NAICS code; respondents' technical and administrative points of contact, including names, titles, addresses, telephone and fax numbers, and e-mail addresses. e. Relevant professional certifications V. Instructions for Submittal Written responses shall be provided electronically, by October 31, 2011. The subject line of the e-mail message shall read: "Document Screening Tool" and shall be addressed to the attention of: Info@cms.hhs.gov CMS will not accept telephone, facsimile, courier, mail, or hand delivery methods of response. The page limitation is 20 pages. Corporate capability information used as marketing material and commercial price list information are in addition to the 20 page limit and may be submitted as separate files. The file size limitation for e-mail attachments is 3 megabytes. Further, access by CMS to information in any files attached to a response is the responsibility of the submitting party. CMS is not responsible for any failure to access information. Therefore, please ensure that files are easily accessible by CMS - Word files are preferable, but we will accept .pdf files as long as they meet the 3 megabyte size limitation. CMS will not notify respondents of the results of this market research. Information submitted will not be returned, and will not be accepted after the due date for responses. CMS will not be responsible for any costs for the preparation of responses to this announcement or project. THIS IS NOT A REQUEST FOR PROPOSAL. THIS NOTICE CONSTITUTES THE ENTIRE REQUEST FOR INFORMATION ANNOUNCEMENT AND IS THE ONLY INFORMATION PROVIDED BY CMS. REQUESTS FOR ADDITIONAL INFORMATION WILL NOT BE HONORED. Disclaimer and Important Notes: 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. 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).