Description
The Centers for Medicare & Medicaid Services (CMS) is seeking information from industry to determine the feasibility of fixed-price pricing structures for the Supplemental Medical Review Contractor (SMRC) Statement of Work (SOW). The SMRC SOW encompasses a broad range of medical review, program integrity, data analysis, reporting, and administrative support activities. The contractor will be required to perform tasks such as medical record review, claim adjudication, discussion and education sessions with providers/suppliers, statistical extrapolation of overpayments, and monthly and annual reporting. The contractor will also be responsible for maintaining a public website and providing IT support.
Some key points to consider:
• The contractor will be required to furnish the IT environment and equipment necessary to complete the medical review project/tasks and reports.
• The contractor will be responsible for managing a public mailbox and responding to approximately 75 emails per day.
• The contractor will be required to send secured data to 20 Medicare Administrative Contractors (MACs) and CMS monthly.
• The contractor will need to provide a list of staff who will be using OnePI with details on previous OnePI training and current use of OnePI.
• The contractor will be required to maintain a public website that contains the SMRC medical review project activities and other work stream data.