Description
This is a Sources Sought Notice to determine the availability of potential small businesses (e.g., 8(a), service-disabled veteran owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) to perform Pricing, Data Analysis, and Coding (PDAC) services for all four Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) under contract to the Centers for Medicare & Medicaid Services (CMS). The PDAC contractor will be the single organizational entity responsible for providing specified support functions to CMS contractors that adjudicate Medicare claims for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) and/or perform program integrity functions with respect to such Medicare DMEPOS claims (i.e., the DME MACs and the DME Program Safeguard Contractors [PSC]). These support activities facilitate processing DMEPOS claims and include pricing, coding, and policy development; additionally, they provide statistical analysis in support of the program integrity function. The PDAC MAC was developed because of the unique and specialized requirements that distinguish DMEPOS suppliers, claims processing, and statistical analyses from other similar functions (i.e. fee-for-service) under Medicare. The primary functions of the PDAC MAC are, at a minimum, to (1) coordinate the development of Healthcare Common Procedure Coding System (HCPCS) codes for DME, prosthetics, orthotics, and supplies in support of numerous Medicare DMEPOS claims processing-related functions (e.g., policy development, claims processing, program integrity, and medical review); (2) provide Medicare coding guidance and advice to the DMEPOS supplier community and other stakeholders, including Medicaid State Agencies, MACs, carriers, and fiscal intermediaries; (3) provide statistical analyses of regional and national DMEPOS claims data to CMS, the DME MACs, the DME PSCs, the National Supplier Clearinghouse MAC, and law enforcement in support of program integrity and medical review activities, including policy development; (4) develop and maintain a cross-walk to be used in processing claims between HCPCS codes and the National Drug Code for certain drugs; (5) establish and distribute pricing files for oral anti-cancer drugs to DME MACs in support of their claims processing operations. In order to be considered for this requirement, an offeror: a. must have current and direct access to and experience with Medicare DMEPOS claims data through one or more Medicare systems such as the Common Working File system and substantial experience in administering CMS-contracted Medicare activities involving DMEPOS. There are no exceptions to this requirement; offerors which do not clearly demonstrate such access and experience will not be given further consideration. b. must have the capability to conduct sophisticated and complex statistical analyses and be capable of achieving full production mode in a very short time frame (i.e., 30-60 days); c. must provide or recruit staff (i.e., medical director/pharmacist, nurses, statisticians, etc.) to perform the functions described in this notice within a very short time frame; d. will be required to determine the best approach for absorbing this workload from the current Statistical Analysis DME Regional Carrier; e. must develop and maintain a web-based data and analytical support infrastructure that can be accessed by CMS and contractors; f. must develop and maintain a web-based system for making DMEPOS coding information available to suppliers and the general public; and g. must appropriately review and test products and assign appropriate HCPCS codes. Business Information: Please provide the following in your response: a. DUNS # b. Company Name c. Company Address d. Current GSA Schedules, if applicable, appropriate to this Sources Sought e. Do you have a Government approved accounting system? If so, please identify the agency that approved the system. f. Type of Company (i.e., small business, 8(a), woman owned, veteran owned, etc.) as validated via the Central Contractor Registration (CCR). All offerors must register on the CCR located at http://www.ccr.gov/index.asp. g. Company point of contact, phone, and e-mail address h. Point of contact, phone, and e-mail address of individuals who can verify the demonstrated capabilities identified in the responses. Responses must be submitted no later than August 22, 2007. They should clearly reflect the respondent's ability to meet the requirements included in this notice. Capability statements will not be returned and will not be accepted after the due date. Respondents will not be notified of the results of the review of their submissions. Information received will be considered solely to make informed decisions regarding a potential small business set-aside. The maximum number of pages for submission is 10. This is not an invitation for bid, request for proposal (RFP), or other solicitation and in no way obligates CMS to award a contract. The sole intent is to obtain capabilities for set-aside and procurement planning purposes. CMS intends to issue a competitive solicitation for the PDAC MAC. It is anticipated that a contract will be awarded with a 1-year base period and 4 option years. CMS anticipates the release of the RFP on or about August 30, 2007, which will be available on the Federal Business Opportunities (FedBizOpps) website. The anticipated award date for this effort is on or before December 1, 2007.