Loren Data's SAM Daily™

FBO DAILY ISSUE OF JUNE 24, 2012 FBO #3865
DOCUMENT

R -- Project Hero Claims Audit - Attachment

Notice Date

6/22/2012
 

Notice Type

Attachment
 

NAICS

541211 — Offices of Certified Public Accountants
 

Contracting Office

Department of Veterans Affairs;VA Denver Acquisition & Logistics Center;(001AL-A2-4D);555 Corporate Circle;Golden CO 80401
 

ZIP Code

80401
 

Solicitation Number

VA79112Q0050
 

Response Due

7/2/2012
 

Archive Date

9/30/2012
 

Point of Contact

Brian J. Turk
 

E-Mail Address

turk@va.gov<br
 

Small Business Set-Aside

N/A
 

Description

REQUEST FOR INFORMATION 1.0SUBJECT The Department of Veterans Affairs (VA) VHA Chief Business Office (CBO) Purchased Care Business Line is issuing this Request for Information (RFI) to gain a better understanding of the scope of services and resources available and costs associated with providing Project HERO Claims Auditing. 2.0DESCRIPTION The Veterans Health Administration Chief Business Office-Purchased Care seeks a contractor to provide an audit of health care claims submitted to VA by health care (1) and dental (1) companies under contract with VA for Project HERO, Healthcare Effectiveness through Resource Optimization. This Project HERO pilot program was established in 2006 with contracts for health care services becoming active in January 2008. As the contracts near their end and the pilot begins to come to completion, VA wishes to conduct an audit of a statistical sample of health care and dental claims submitted in Federal Fiscal Year 2011 (October 1, 2010 - September 30, 2011) and first quarter of Federal Fiscal Year 2012 (October 1, 2011 - December 31, 2011) to determine accuracy of billing by the contractors to VA. This audit does not include audit of payments in return to VA. The Department of Veterans Affairs (VA), Veterans Health Administration (VHA) is one of the world's largest health care delivery organizations. As part of an integrated strategy to provide veterans with timely access to quality health care services, VA clinics are authorized to pay for health care services acquired from non-VA health care providers. These services may be acquired by eligible veterans from non-VA health care providers when access to services is not available from VA. The VA manages authorization, claims processing and reimbursement for services acquired from Non-VA health care providers through a program called the Fee Basis Program (Fee). The basic provisions of and authority for the Fee Program are provided by public laws passed by congress. In the case of Project HERO, this care is purchased through contractual agreements that establish pricing per the type of care being authorized. The Dental services contract is priced based on an agreed upon percentage (ex. 105%, 98%, 87%, etc.) of the local NDAS pricing guidelines in place for that geo zip at the date of service. The medical services are priced at a percentage of Medicare (ex. 105% of Medicare, 98% of Medicare, 87% of Medicare, etc.) per the type of care authorized. For example, cardiology services could be priced at 98% of Medicare and gastroenterology at 88% of Medicare, etc. The objectives for this task order are as follows: 1.Audit a statistically valid number of health care claims submitted to VA by the Project HERO contractors to evaluate accuracy of billing per the contractual agreements. 2.Develop and audit report that includes executive summary and detailed information resulting from the audit. 3.A presentation that summarizes the detailed information suitable for presentation to Senior VA Officials. 3.0SCOPE OF WORK The work that will be performed under this contract includes analyzing a statistically valid number of health care claims data per the pricing and billing instructions contained in the contracts. The work will be conducted in consultation with the Project HERO Program and Project managers and subject matter experts from the Project HERO Program Management Office. Consultations are likely to occur with contracted partners, Humana Veterans Healthcare Services and Delta Dental Government Services, the two contract holders in place for Project HERO. In FY11 there were approximately 68,000 health care and 10,000 dental claims submitted. In FY12Q1 there were approximately 17,000 health care and 1,500 dental claims submitted. 4.0SUBMISSION INFORMATION REQUIRED Please include, at a minimum, the following information in the initial paragraph of the submission: -Vendor information, including point of contact and phone number -A rough order of magnitude (ROM) for this effort -Explanation of direct work experience in regards to this RFI -Website -GSA Schedule and small business size, if available. Please include number, and expiration date 5.0DISCLAIMER This RFI is issued solely for information and planning purposes only and does not constitute a solicitation. All information received in response to the RFI that is marked Proprietary will be handled accordingly. Responses to the RFI will not be returned. In accordance with FAR 15.202 (e), responses to this notice are not an offer and cannot be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI. 6.0CONTACT INFORMATION Please submit responses via email in Microsoft Office format by July 2, 2012 to the Contracting Office at the below listed address. You may also submit supplemental hardcopy materials such as brochures etc. to the Contracting Specialist (Brian Turk) at the following address(es). All supplemental material must be received by deadline date. Email and hardcopy responses should be mailed to the following address: Email: brian.turk@va.gov Regular mail:VA Denver Acquisition & Logistics Center PO BOX 25166 Denver CO, 80225-0166 Hand Delivery: VA Denver Acquisition & Logistics Center 555 Corporate Ave Golden, CO 80401
 

Web Link

FBO.gov Permalink
(https://www.fbo.gov/spg/VA/VADDC791/VADDC791/VA79112Q0050/listing.html)
 

Document(s)

Attachment
 

File Name: VA791-12-Q-0050 VA791-12-Q-0050.docx (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=379840&FileName=VA791-12-Q-0050-000.docx)

Link: https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=379840&FileName=VA791-12-Q-0050-000.docx

 

Note: If links are broken, refer to Point of Contact above or contact the FBO Help Desk at 877-472-3779.
 

Place of Performance

Address: 1615 Woodward St;Austin, TX

Zip Code: 78772
 

Record

SN02783617-W 20120624/120622234848-0de7205047154dbdaaf8cd23b3bc241b (fbodaily.com)
 

Source

FedBizOpps Link to This Notice
(may not be valid after Archive Date)

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