RFQ ID: RFQ1492996
“The contractor shall perform cost report audit activities to include desk reviews, audits, reopenings, and provider-based determinations and review. The cost report audit activities workload will come from Medicare Administrative Contractor (MAC) surplus open inventory in these areas.”
“Medicare Audit Desk Review and IRIS Duplicates (MADRID) is a multi-faceted contract which includes:Task 1: Cost Report Audit, Desk Review and Reopening Activities
- Perform cost report audit and desk review activities on a select subset of cost reports to reduce the surplus open inventory of open cost reports and facilitate CMS’ and the MACs’ ability to accommodate changing audit requirements.
- Complete the workload pertaining to cost report reopenings; the selected reopenings contain various issues.
- Provide other audit support activities for CMS as needed.
Task 2: Intern and Resident Information System (IRIS) Review for Duplicate FTEs
- Generate IRIS overlap reports utilizing the national IRIS database that is stored in the CMS System for Tracking Audit and Reimbursement (STAR).
- Review 100% of overlaps.
- Address duplicates and overlapping FTEs for all rotations noted.
- Issue audit result notifications to Medicare Administrative Contractors (MACs) regardless of whether there are any adjustments to the counts of intern and resident FTEs used in the final cost report.
- Track the changes made to the individual FTE counts.
Task 3: Graduate Medical Education (GME) and Indirect Medical Education (IME) Affordable Care Act (ACA) Section 5503 Audits
- Perform cost report audit activities to verify the accuracy of all unweighted primary care and/or general surgery Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) Full Time Equivalent (FTE) counts, as well as the reported § 5503 used slots, utilized in determining whether a hospital, during the 5-year period beginning on July 1, 2011, met the 3-year primary care average requirement and the 75 percent threshold test.
- Determine whether the hospital qualifies to keep either all, or only a portion of, its § 5503 awarded slots.
- The Section 5503 Audits shall be conducted using the Audit program provided by CMS for Graduate Medical Education (GME) and Indirect Medical Education (IME) Affordable Care Act (ACA) audits.
Optional Task 4: Appeals
- Complete Appeals workload which will include appeals selected to expedite the processing of these appeals and alleviate the surplus open inventory of appeals at the Board. The selected appeals will involve group appeals, individual appeals containing many issues, OPO appeals, and appeals identified as part of PRRB appeals streamlining initiatives…”
