Notice ID: 36C10G22R0015
“The Department of Veterans Affairs (VA) Office of Community Care (OCC), Business Integrity & Compliance (BIC) requires resources to price healthcare claim data using Medicare payment methodologies so OCC may validate the payment accuracy of claims paid through VA Community Care. Claims that require Medicare pricing are identified by VA for the purpose of internal audits performed by VA auditors.”
“Medicare Pricing Requirements:
The contractor shall provide VA with software/technology that allows VA to input individual or bulk medical claim data. In turn, the contractor shall provide VA with the accurate Medicare pricing, to include pricing details for a variety of medical claim types. VA is seeking a reliable source for Medicare pricing information in support of VA internal audits.”
“As such, the contractor is considered a subject matter expert (SME) in Medicare methodologies, payment, and proper billing guidelines including, but not limited to Inpatient institutional, Outpatient institutional, Professional, and other specialty health care services.”
“The contractor shall price claims according to Medicare billing requirements using the following, as appropriate:
- Medicare fee schedules,
- Prospective payment systems,
- Medicare payment methodology,
- Medicare National Correct Coding Policy Edits (NCCI), and
- All other Medicare Edits necessary to ensure proper pricing.”
“The amount of claim data will not exceed a total of 20,000 claims annually and will be disbursed throughout the year.”
“The pricing shall include all referred inpatient and outpatient, institutional, professional and specialty health care claim data utilizing Medicare guidelines and payment methodologies as well as the application and description of applied Medicare edits. The Contractor must be able to provide claim reimbursement and details for all Medicare fee schedules…”
“Accuracy in determining a Medicare price for an episode of care is vitally important for this contract; therefore, the contractor shall have a robust QA program to ensure accuracy levels remain extremely high…”
