Medical Review Accuracy Contractor (MRAC)   3

The Centers for Medicare and Medicaid Services (CMS) is seeking eligible 8(a) small business offerors having the ability for providing Medical Review Accuracy Contractor (MRAC) services to assist CMS in monitoring the accuracy of CMS' Medicare and Medicaid Medical Review Contractors (MRCs) medical review (MR) decision making, their ability to implement Medicare and Medicaid coverage, coding, payment, and billing policies, and the identification of potential fraud, waste, or abuse (FWA) patterns and/or trends. MRAC will help CMS measure the accuracy rate for each MRC by reviewing a representative sample of claims based on the universe reviewed monthly by each MRC. At a minimum, the MRAC's claim reviews require the use of clinical review judgment in the evaluation of medical records and related documents to determine whether the MRCs made accurate claim decisions in compliance with Medicare and Medicaid coverage, coding, payment, and billing policies (i.e., Code of Federal Regulations, National Coverage Determinations, Local Coverage Determinations, and in accordance with the MRC-specific requirements in the CMS Internet Only Manuals and the Medicaid State statutes, regulations and manuals). In addition, for some work, the reviews require that the MRAC evaluate not only each claim but the entire pool of related claims as a whole for FWA patterns and/or trends.

CMS anticipates award of a firm fixed-price type contract for a one-year Base Period, four one-year Option Periods, and a 60-day Option Transition Period that can be exercised at the unilateral discretion of the Government.

This acquisition is being offered for competition limited to eligible 8(a) participants under North American Industry Classification System (NAICS) code 541611. The solicitation will be available on or about May 1, 2023, and it will be distributed solely through the System for Awards Management (SAM) website at http://www.sam.gov. Hard copies of the solicitation document will not be available. The site provides downloading instructions. All future information about this acquisition, including solicitation amendments, will also be distributed solely through this site. Interested parties are responsible for monitoring this site to ensure that they have the most up-to-date information about this acquisition. The estimated closing date of 75FCMC23R0015 will be on or about June 1, 2023. All responsible 8(a) sources may submit a proposal which will be considered by this agency. No telephone requests or written requests for the solicitation will be accepted.