Notice ID: APP221105
“The purpose of this effort is to determine the impact analysis of the CBR and PEPPER programs and how effective they are helping to meet the goals of reducing provider burden, reducing appeals, and reducing improper payments…”
Task 1: Develop the Framework
- CBR Program — Using the CMS system Integrated Data Repository (IDR) and other CMS’ systems deemed necessary during the contract, the PCG CBR/PEPPER DA Contractor shall develop a framework that they will use to identify and analyze the successes and areas of improvement within the CBR program by:
- Reviewing provider types targeted in the CBR program and determining if the current provider types benefit from the program
- Reviewing metrics relevant to the CBR providers and/or prescribers and determining if the current metrics and methodology are accurate…
- PEPPER Program — Using the CMS IDR and other CMS’ systems deemed necessary during the contract, the PCG CBR/PEPPER DA Contractor shall develop a framework that they will use to identify and analyze the successes and areas of improvement within the PEPPER program by:
- Reviewing provider and facility types targeted in the PEPPER program and determining if the current facility types benefit from the program
- Reviewing metrics relevant to the PEPPER facilities and determining if the current metrics and methodology are accurate…
Task 2: Monitor and Gather Data
- CBR Program — The PCG CBR/PEPPER DA Contractor shall monitor the CBR program processes to gather information regarding whether:
- The program led to any cost avoidance savings
- The program led to more subtle or indirect changes in provider utilization of services and/or beneficiary demographics…
- PEPPER Program — The PCG CBR/PEPPER DA Contractor shall monitor the PEPPER program processes to gather information regarding whether:
- The programs led to any cost avoidance savings
- The program led to more subtle or indirect changes in facility utilization of services and/or beneficiary demographics…
Task 3: Evaluation
- CBR Program — The PCG CBR/PEPPER DA Contractor shall evaluate aspects of the current CBR program processes to determine:
- Whether the appropriate providers were selected for the program
- The optimal targeting strategy that leads to the greatest impact for the CBR program aimed at reducing improper payment rates…
- PEPPER Program — The PCG CBR/PEPPER DA Contractor shall evaluate aspects of the current PEPPER program processes to determine:
- Whether the appropriate facilities were selected for the program
- The optimal targeting strategy that leads to the greatest impact for the PEPPER program aimed at reducing improper payment rates…
