RAC Statement of Work (SOW, updated 11/07/2007)

On April 28, 2009, in Archives, by AQ-IQ LLC

Statement of Work (SOW) for Recovery Audit Contractor (RAC)

Taken from:  FedBizOpps.Gov  (www.fbo.gov)   visit original page HERE
Solicitation Number: RFP-CMS-2007-0022
Agency / Office: Department of Health and Human Services / Centers for Medicare & Medicaid Services
Download most recent version HERE ( V11072007.doc MS Word doc, 425 KB)

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Added: August 16, 2007

The Centers for Medicare and Medicaid Services (CMS) intends to solicit proposals for Recovery Audit Contractors (RACs). Section 302 of the Tax Relief and Health Care Act of 2006 requires the Secretary of the Department of Health and Human Services (the Secretary) to utilize RAC s under the Medicare Integrity Program to identify underpayments and overpayments and recoup overpayments under the Medicare program associated with services for which payment is made under Part A or B of title XVIII the Social Security Act.

This contract includes the following tasks which shall be defined in further detail in the forthcoming solicitation:

  1. Identifying Medicare claims that contain non-MSP underpayments for which payment was made under part A or B of title XVIII of the Social Security Act.
  2. Identifying and Recouping Medicare claims that contain non-MSP overpayments for which payment was made under part A or B of title XVIII of the Social Security Act. This includes corresponding with the provider.
  3. For any RAC-identified overpayment that is appealed by the provider, the RAC shall provide support to CMS throughout the administrative appeals process and, where applicable, a subsequent appeal to the appropriate Federal court.
  4. For any RAC-identified vulnerability, support CMS in developing an Improper Payment Prevention Plan to help prevent similar overpayments from occurring in the future.
  5. Performing the necessary provider outreach to notify provider communities of the RAC?s purpose and direction.
NOTE: The proactive education of providers about Medicare coverage and coding rules is NOT a task under this RAC statement of work CMS has tasked QIOs, FIs, Carriers, and MACs with the task of proactively educating providers about how to avoid submitting a claim containing a request for an improper payment.

It is anticipated that contingency fee contracts will be awarded in accordance with the 4 RAC Jurisdictions outlined in the RAC expansion strategy (http://www.cms.hhs.gov/RAC/). The period of performance for these contracts shall be one twelve-month base period and four one-year option periods beginning in April 2008. CMS intends to solicit this requirement through full and open competition. This announcement is not a request for proposal (RFP). CMS anticipates release of the RFP on or around August 30, 2007 and it will be available on the Federal Business Opportunities (FedBizOpps) website.

The CMS has scheduled a pre-solicitation conference call for August 29, 2007 from 1:00 PM to 2:30 PM local time Baltimore, MD. The purpose of this conference call will be to discuss conflict of interest scenarios related to the forthcoming RAC solicitation. The call-in number for this conference call is (410) 786-3100 PIN: 749620. Vendors are requested to submit questions regarding RAC conflict of interest to craig.gillespie@cms.hhs.gov no later than 12:00 PM local time Baltimore, MD August 27, 2007. For review, a DRAFT Statement of Work (SOW) is attached to this notice.

Added: Oct 07, 2008 3:57 pm

The purpose of the Recovery Audit Contracts (RAC) is to reduce Medicare improper payments through the efficient detection and collection of overpayments, the identification of underpayments and the implementation of actions that will prevent future improper payments. This includes the identification and recovery of Non-MSP overpayments.

 

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