R -- Pricing, Data Analysis, and Coding (PDAC)

The purpose of this contract is to obtain a Pricing, Data Analysis and Coding (PDAC) Contractor, hereinafter, referred to as the - Contractor to provide specified services in support of the sound administration of the DMEPOS benefit within the - traditional Medicare FFS program. The Contractor shall perform its responsibilities under the direction of CMS. The Contractor shall facilitate, coordinate, and support activities among various Medicare contractors with DMEPOS-related responsibilities (e.g., DME MACs, DME PSCs, NSCs, etc.) as well as other agencies (at the federal and state levels of government) and other stakeholders. 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 conducts a variety of different supplier services, such as answering written inquiries and providing Medicare guidance and advice on coding of DMEPOS claims. The Contractor answers a wide-range of questions from DMEPOS suppliers and other stakeholders from across the country. The Contractor will operate and maintain a web-based tool used by suppliers and other stakeholders to facilitate coding claims for DMEPOS. The Contractor performs complex statistical analyses of Medicare FFS DMEPOS claims data and reports on trends, significant changes and other relevant factors. The Contractor stores and maintains this information in a data warehouse. The Contractor maintains statistical reports, data analyses and other statistical information in a web-based environment that is easily accessible to the DME PSCs, DME MACs, NSC, CMS and certain law enforcement staff. The Contractor controls access to this environment through user passwords and other physical, administrative, and technical safeguards. The Contractor develops and maintains a crosswalk for certain drugs from the NDC code to an appropriate HCPCS code. The Contractor codes and prices certain oral anti-cancer drugs. All of these functional activities have major component tasks as specified under Section E of this SOW.