Notice ID: 36U10122Q0001
The Payer Relations and Services (PR&S) department, within the Office of Community Care (OCC), Revenue Operations, provides detailed analytical support to review reimbursement rates paid or proposed by Third-Party Payers (TPPs) and Pharmacy Benefit Managers (PBMs) to determine whether payments meet federal payment requirements. PR&S is also responsible for the implementation of VA’s rates and charges billed to third party payers and other entities. PR&S further provides analysis of the effect of alternative payment methodologies and the financial impact of emerging payment methodologies in the insurance industry on VA revenues. Annual Charge Master updates are analyzed to illustrate the impact of variances in charge amounts, unit dosage changes, and VA utilization from previous years.
The contractor shall provide subject matter expertise sufficient to support PR&S in areas to include Electronic Health Record Modernization (EHRM) implementation, development of rates and charges, changing payer reimbursement models, rate verifications, expanding OCC analytical needs, and program/project support.
Specifically, the contractor shall support PR&S with the following:
Overall PR&S program support to include project management, Standard Operating Procedure (SOP) and Guidebook development, special project support, business and strategic analysis of PR&S operations, development of executive presentations, and facilitation of executive briefings
Planning, development, calculation and implementation of VA Rates and Charges for inpatient admissions, skilled nursing admissions, outpatient services, professional services, supplies, and drugs; encompassing all medical services for over 1500 VA hospitals/clinics in over 700 geographic areas
Provision of national rates and charges to the specific geographic adjusted charge for stationed in production with the VA’s new EHR
Administration of TPP Rate Verification activities
Key Performance Indicator (KPI) monitoring and risk mitigation under Electronic Health Record Modernization (ERHM) Charge Services (CS) and Charge Description Master (CDM) governance
