RCMI & CDM Support Services

Subject: Revenue Cycle Modernization & Innovation (RCMI) & Charge Description Master (CDM) Support Services to Defense Health Agency (DHA) Resources & Personnel Integration (R&PI), J-8 Financial Operations.          

THIS IS NOT A REQUEST FOR PROPOSALS (RFP) OR A REQUEST FOR QUOTATIONS (RFQ); IT IS STRICTLY A REQUEST FOR INFORMATION (RFI). NEITHER UNSOLICITED PROPOSALS NOR ANY OTHER KINDS OF OFFERS WILL BE CONSIDERED IN RESPONSE TO THIS RFI. NO CONTRACT WILL BE AWARDED PURSUANT TO THIS ANNOUNCEMENT.
 

1.0 DISCLAIMER: This RFI is issued solely for information and planning purposes and does not constitute a solicitation. Responses to this notice are not offers and will not be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI. All information received in response to this RFI that is marked Proprietary will be handled accordingly. Responses to the RFI will not be returned. At this time, questions concerning the composition and requirements for a future RFP will not be entertained.

2.0 SUBJECT: The DHA R&PI, J8 Financial Operations is obtaining information for a potential non-personal services contract to provide administrative and technical execution services, as well as technical expertise, for the Revenue Cycle Management (RCM) activities, to include CDM optimization, enhancement, and operations, to support the DHA Electronic Health Record (EHR), Military Health System (MHS) GENESIS, and its itemized billing solution, RevX.

3.0 BACKGROUND: The DHA J-8 recognizes the need to enhance its RCM processes to ensure the efficient and effective management of healthcare finances within the MHS. Using the MHS GENESIS EHR as a catalyst, J-8 seeks to address several critical challenges within its RCM framework: Revenue Leakage and Inefficiencies, Compliance and Regulatory Risks, Data Accuracy and Integration, Patient Experience, Resource Utilization, Financial Transparency, Clean Audit Capability, and Technology and Innovation. In response to these challenges, DHA J-8 aims to launch the RCM Initiative to transform its RCM processes. The goal is to enhance workload capture, financial performance, compliance, patient satisfaction, and resource utilization while ensuring transparency and embracing innovative technologies within the MHS.

Industry practice is to document, and bill patient encounters based on an itemized list of charges. To ensure documented care in MHS GENESIS results in an all-inclusive itemized bill within RevX, numerous actions must occur throughout the revenue cycle process (assignment of Patient Identification Process (PIP), provider documentation, medical record coding, and patient billing). Administration staff must ensure the PIP providers completely document and select the proper patient orderable description of care provided. Medical record coders must properly code the care provided. Finally, Uniform Business Office (UBO) staff must properly generate a bill on established separate billing forms for professional charges and institutional charges.

The DHA supports and provides medical care for the Department of War, 9.4 million eligible beneficiaries through the $52 billion Defense Health Program (DHP), which includes contracted healthcare networks and Military Treatment Facilities (MTFs). The deployment of MHS GENESIS is complete and currently in a transition phase. While this major technology transformation has provided a significant set of enhanced revenue cycle and business management capabilities for the MHS, they have also brought new requirements to align with industry-leading practices and underscored underlying issues in the legacy environment. For the Government to fully realize the benefits of MHS GENESIS revenue cycle capabilities, these cross-functional challenges require an integrated approach to resolve.

The Government will direct the actual implementation and detailed tasks for the RCM Activity as the MHS lacks knowledgeable in-house staffing to execute these specific operations. Specific assistance is required to support the DHA Financial Operations, J-8 with capabilities for optimization of revenue cycle efforts to prioritize improvement opportunities, begin reducing work queue backlog in MHS GENESIS, increase clinical workload capture, increase total billed for Third Party Collections (TPC), identify and correct areas where revenue leakage may be occurring, improve enterprise knowledge of workload and revenue capture, and enhance MTF staffs' ability to manage their business and be audit-ready.

4.0 RESPONSE INSTRUCTIONS:   Respondents should address the following in their response:

4.1 Organization Information:

a. Organization’s full legal name and Address

b. Unique Entity Identifier (UEI), Cage Code, Tax Identification Number, and company structure (Corporation, LLC, partnership, joint venture, etc). Companies must be registered in the System for Award Management (SAM, at www.sam.gov) to be considered as potential sources.

c. Small Business Designation certified by the Small Business Administration, if any.

d. Point of contact name, phone number, and email for individual with the authority and knowledge to clarify responses with Government representatives.

e.Information pertaining to the following:

1. Does your company participate in any Government-wide Acquisition Contracts (GWACS)?
2. Does your company have a Federal Support Schedule Contract?
3. Are you currently on General Services Administration (GSA) One Acquisition Solution for Integrated Services (OASIS) (Prime or Sub); and if so, which pool(s) does your company participate?
4. Does your company have a Cost Accounting Standards approved accounting system and are you immediately postured to perform cost reimbursement type contracts?

4.2 Company Capabilities Statement: The capability statements provided must include the following:

a. Your company’s program management plan and control policies that adhere to standard industry practices. Must demonstrate the ability to accurately track projects and ensure timely completion of projects. Must include a recruitment and retention strategy to confirm their capability to provide varying levels of support for the tasks listed below.

b. General information and technical background describing your firm’s experience within the last three to five years; specifically with contracts similar in scope, complexity, and size to meet the program objectives in accordance with the draft Performance Work Statement (PWS) tasks outlined below, to include subject matter expertise with Cerner/Oracle experience, data software developers, data analysis business process and workflow support, business support personnel, training, and risk mitigation.

c. Demonstrated working knowledge and experience in: RCM and Solution Owner, and CDM support in the context of MHS GENESIS optimization, enhancement, and ongoing operations; and support for Innovative Technology Design, Implementation, and Sustainment Support to enhance revenue cycle operations within the MHS GENESIS environment.

d. Sufficient information/details to determine how you fully meet the requirements as specified in the tasks listed from the Draft PWS provided below:

1. Possess and maintain tools for proper and compliant charge master input, including but not limited to government approved, fully vetted, and validated electronic CDM application.
2. An ability to utilize and pull from existing MHS data systems to populate the CDM.
3. Possess an expertise in CDM auditing to ensure defensible charges/prices.
4. Provide education regarding charge input and charge master related items to MHS Business Community personnel.
5. Advise the MHS on CDM policy and practices to ensure regulatory compliance.
6. Possess an understanding of medical record coding and how the CDM assists the medical record coders in accurately coding patient encounters.
7. Continuous update of CDM based on American Medical Association (AMA) quarterly releases and Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) revisions.
8. Incorporate AMA/Centers for Medicare and Medicaid Services (CMS) code adds, modifications, and obsolete codes into the CDM.
9. Continue to support the on-going maintenance of annual updates from AMA code sets, and quarterly updates based on payer interpretations and changes to activate/inactivate CDM line items by site.
10. Conduct reviews of CPT/HCPCS cost-based prices as codes are added, deleted, or modified based on CMS annual and quarterly reports.
11. Include validation steps for existing, or unique, MHS code descriptions, revenue codes, surgical levels, clinical areas, and other Maintenance data components.
12. Support MHS-specific CDM modifications, additions, and deletions as requested by the DHA or MHS GENESIS client.
13. Continue to organize maintenance efforts by clinical specialty rather than facility to maintain efficiency regardless of the location of service while communicating CDM updates or modifications to clinical department leaders for validation.
14. Continue to develop/refine a supply item file to serve as the source file for all chargeable supply items.
15. Document and maintain maintenance and pricing guidelines in CDM standard operating procedure files and review/update inputs on a recurring basis.
16. Continue to evaluate, develop, and maintain the CHAMPUS Maximum Allowable Charge (CMAC) rate tables within the CDM based on annual Tricare data release and existing MHS rate structures; along with additional rate tables/prices scheduled required.
17. Continue calculation of regional cost-based pricing based on Military Treatment Facilities (MTF) historical data for all chargeable health care products and services.
18. Utilize MEPRS, CAPERS, DMLSS, and CMAC data sources to define cost-based and CMAC-based procedure pricing methodologies.
19. Analyze MTF localities at the Parent and Child facility level to construct proposed grouping methodologies based on geographic, workload, resource, or other consistencies to develop a defensible charge table structure.
20. Calculate standard rates (room, tiered surgical services, etc.) based on DoD costs incurred for delivering such services.
21. Communicate CDM pricing updates and decisions to billing department leaders for validation.
22. Maintain existing business process and methodology for 100 Character Descriptions for all active and obsolete codes, while updating list in line with all regulatory updates.
23. Create and maintain American Dental Association Current Dental Terminology code table and descriptions within the CDM as required.

5.0 SMALL BUSINESS SET ASIDE: The Government has determined this acquisition to be accomplished under the 8(a) program.

6.0 INSTRUCTIONS FOR RESPONDING:

Submission: Please submit RFI response via email in a “.pdf” file type, to Ms. Jennifer Sikes at email address: contact@example.gov and Ms. Courtney Chase at email address: contact@example.gov. Please use the title in your email “RCM&CDM Support Services for R&PI, DHA J-8”.

Due Date: RFI response submission is due no later than 10AM on 16 November 2026.

Page Limit: Limit your total written response to 25 single-sided pages. The cover page and table of contents does not count towards the page limit. Beyond the 25-page limit, the Government may only review examples of media and graphic design, as requested above.

7.0 Tasks Listed in the Draft PWS

7.1 Revenue Cycle Management and Solution Owner Support:

7.1.1 The contractor shall provide Revenue Cycle Management and Solution Owner support in the context of MHS GENESIS optimization, enhancement, and ongoing operations. This support encompasses critical backend system maintenance and optimization for the full MHS GENESIS system platform. Required expertise with Oracle health EHR backend system configurations, existing and pending system capabilities. Key responsibilities include managing and resolving ticket queues through efficient triage and resolution processes, ensuring timely response to system issues and user concerns. The contractor will be responsible for the development and validation of workplans, training material and training courses of varying length of time and platforms which are essential for effective revenue cycle management within the MHS GENESIS environment, report generation in support of audit readiness, downgraded audit opinions pertaining to financial statements, and Medicare-Eligible Retiree Health Care Fund (MERHCF). Additionally, the contractor will provide a designated subset of the workforce to perform Author Query roles, to include writing, testing, modifying, and executing database queries, custom scripts, and data extractions utilizing Cerner Command Language and/or Structured Query Language within MHS GENESIS, RevX, and CDM systems.

7.1.1.1 A crucial aspect of this support will involve preparing the organization for potential transition to Oracle Health’s Patient Accounting (OHPA) or other identified patient accounting solution. This preparation includes assessing current processes, identifying gaps, and developing strategies to align DHA's revenue cycle operations with the new module's capabilities. Additional preparation includes full integration of business and clinical processes in support of successful end-to-end overall system health. The contractor shall provide expertise in troubleshooting, system configuration, process improvement, and change management to ensure smooth functionality of the full MHS GENESIS system platform from clinical, administrative, and business processes/practices, while simultaneously laying the groundwork for a seamless transition to OHPA or other identified patient accounting solution. This comprehensive support is vital for maintaining system integrity, enhancing user experience, optimizing current revenue cycle operations, and positioning DHA for future success with advanced patient accounting tools

7.2 Innovative Technology Design, Implementation and Sustainment Support:

7.2.1 The contractor shall leverage new and emerging technologies to streamline processes and significantly reduce human input errors that are currently impacting efficiency and accuracy. The contractor will be responsible for collaborating with DHA Functional Subject Matter Experts responsible for specific areas of the revenue cycle to identify, in some cases design of solution, and implement cutting-edge technological solutions that can automate repetitive tasks, improve data accuracy, and enhance overall system performance. This may include AI and machine learning algorithms for predictive analytics, RPA for routine tasks, or advanced data validation tools. To accomplish the design, development, and implementation of AI and RPA solutions, the contractor is required to procure and maintain the necessary specialized platforms and licenses. The contractor will also provide ongoing sustainment support to ensure the long-term viability and effectiveness of these innovative solutions.

7.3.   CDM Support:

7.3.1 The contractor shall provide CDM support for MHS GENESIS optimization, enhancement, and ongoing operations. The support requires updating associated charge tables based on geographic location, hospital vs. clinic, and patient category. The contractor shall also coordinate with Cerner/Oracle Health (the contractor that deployed the full MHS GENESIS EHR platform) to ensure proper integration with the Cerner Charge Services Pricing Tool (Charge Services Servers). Additionally, the contractor shall provide overall Program Management Support for ongoing CDM operations.