RO PAYER DATA ANALYTICS SUPPORT
QUESTIONS AND ANSWERS
Question: Is the subject effort a new requirement or a follow-on to an existing contract? If the latter, can I please find out the incumbent contractor's name and contract number?
Answer: Yes, the subject effort is a follow-on, meaning the services are currently being provided by the incumbent. The contractor s name is Altarum Institute and the contract number is VA741- 13-F-0118.
Question: Is there a page limit for responses to the RFI?
Answer: No, there is not a page limit. The response/statement of capability should demonstrate the offeror s capability and past performance in providing and meeting the type of service requirement; to specifically include the tasks, data and information stated within the PWS.
Question: Is the plan to have the VA provide secure access to contractor resources to conduct the work within the VA data center/ IT infrastructure?
Answer: No, the VA will not be providing secure access to contractor resources to conduct work with the VA data center/IT infrastructure.
Question: If not, does the contractor need to set-up our own secure infrastructure to conduct the analysis?
Answer: Yes, the contractor will need to set up their own secure infrastructure to conduct the analysis and send and receive data extracts.
Question: If yes, would the VA allow the use of FISMA facilities with provisional authority to operate as the infrastructure for conducting the data analysis?
Answer: No, the VA will not be providing the use of FISMA facilities with provisional authority to operate as the infrastructure for conducting the data analysis.
Question:
What current software or payment system is being utilized?
Are there any projected interface timelines?
How many users /(administrators) will need access to the system
Will there be a test environment set up, a compare and contrast forum?
What type of test(s), if any of the old system needs to be performed?
Will type of methodology is currently being used?
Can an Agile methodology be utilized for the project?
Data migration required? And is there a preferred method?
Will other departments require a technology interface: Pharmacy, clinic, outside facilities?
All work performed onsite, or will remote capabilities be allowed?
Training terms after implementation?
Is there a POS interface required?
Answer: These questions appear to be related to setting up a network system for use by the VA and are not pertinent to the tasks outlined in the PWS.
Question: Can the statement of capabilities and past performances include information about our teaming partners who we will engage for this task?
Answer: Yes, the statement of capabilities and past performances include information about teaming partners who will engage for this task.
Question: The sources sought notice indicates that the contractor will conduct large data extracts. How will the government provide data access? How long is the authority to operate process?
Answer: The data extracts will be generated by Third Party Payers (TPP). They will be extremely large (sometimes in excess of 100 million lines). The vendor is responsible for providing a secure File Transfer Platform and network in accordance with Section 13. of the PWS in order to send receive the data from the TPP s and convert it if necessary to a file format from which they will perform the data analysis. The vendor will also extract data from VA sensitive health data files for comparison purposes. This will require vendor personnel to go through security procedures to obtain access as outlines in Section 13 of the PWS.
Question: Will the VA also provide access to Medicare/Medicaid data for veterans?
Answer: No, the VA will not provide access to Medicare/Medicaid data for veterans for comparison purposes/uses.
Question: Are there any secure data exchanges for reporting and capturing payments from either Internal Revenue Service (IRS) or Social Security Administration (SSA)? If so what interfaces are available to the proposed contractor?
Answer: No, there are not any secure data exchanges for reporting and capturing payments from either Internal Revenue Service (IRS) or Social Security Administration (SSA). This type of data is not utilized in the required analyses.
Question: Regarding 2.1 PWS GOVERNANCE: All work and products executed and provided to the VHA/OCC/CPAC/RO PRO shall be formatted and/or structured to be compatible (e.g., data structures/input/output must execute without error and reports/documents shall be formatted to comply with established guidance) with the following established protocols: VHA Intelligence tools, which specific VHA Intelligence Tools are referenced and in use to support the Revenue Operations Payer Relations Office Performance Work Statement?
Answer: The following intelligence tools may be used to support this work statement: Power+ (Oracle Business Intelligence); Payer Compliance Tool; Tableau or Spotfire.
Question: Regarding 4.3 Task Three: The Contractor shall conduct large database extracts (up to 100,000,000 rows or lines of data), provide secure data transfer capabilities to receive or transmit large database extracts (up to 100,000,000 rows or lines data) of sensitive information in accordance with FISMA from both the VA and external sources, perform rate verifications, and provide analytical support for OCC to determine if reimbursement rates paid or proposed by third party payers (TPP) or Pharmacy Benefit Managers (PBM) meet federal payment requirements by processing the extracted data into a standardized data set that can be used in conducting multiple analyses. Which VA external sources are referenced in this task? Are there additional security protocols or data exchange requirements for this task?
Answer: The external sources references here are Third Party Payers (TPP), not from within the VA. However, there are internal VA data sources that will need to be accessed for data comparison purposes. Vendor should reference Section 13. of PWS for security protocols and VPN access.
Question: Regarding 4.3.2: The Contractor shall perform various large, medium, and small data analysis utilizing both VA claims data and TPP claims data VA billing and coding regulations and practices, TPP Coding and Reimbursement policies such as MS-DRG, APR-DRG, Per Diem, Case Rates, APC, and EAPG, and VA payment posting regulations and policies, and reconcile the data to determine the appropriate reimbursement rate for the same or similar health care service provided by VA within a geographical area. Data analysis at a minimum should include the following:
Comparison of claims data analysis with Peer Facility contract analysis
Is there a referenced number of Peer Facilities to consider? Will travel be required to visit those Peer Facilities?
Answer: There are established definitions of what constitutes a Peer Facility. The number of Peer Facilities varies by VA Station. Peer Facilities are generally defined as those private hospitals in the same 3-digit geo zip code area as a VA hospital. Travel will not be required to visit those Peer Facilities; however, travel will be required to visit the Home Office of the TPP to extract data from the existing contracts and Fee Schedules of the Peer Facilities.
Identify compliance and system/process gaps
Please specify which type of compliance is referenced for this tasking (e.g., HIPAA, FISMA, etc.)
Answer: Title 38 USC Section 1729 and Title 38 CFR Part 17.101 and Part 17.106 provide the legal authority for the billing by the VA and reimbursement by the Third Party Payers (TPP) for non-service connected care. The compliance referred to here is compliance with these regulations which is determined through the analysis of the Peer Facility paid claims data and signed contracts provided by the TPP and VA claims data.
Question: Regarding Government Furnished Equipment (GFE)/Government Furnished Information (GFI): N/A Please confirm that there are no access requirements using GFE/GFI for completing the required tasking in this RFI. Large data extracts and exchange are generally performed using encrypted laptops or VPN requirements from the VA.
Answer: No, there will not be encrypted laptops or other Government Furnished Equipment (GFE) provided; however, the vendor will need to access VA sensitive health data and will have to obtain VPN access in accordance with Section 13. of the PWS.
MARK FERGUSON, CONTRACT SPECIALIST
MARK.FERGUSON@VA.GOV
Mark.Ferguson@va.gov
