(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...

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How long has respondent company been performing improper payment review and recovery audit services, and fraud-related audit services? How many reviewers does respondent firm currently employ? What is the average experience of reviewers performing similar recovery audit(s) and fraud-related audit services, in years? If a Contract is awarded for provision of the recovery audit(s) and fraud-related audit services, how many individuals will respondent dedicate to the project? What types of payments did respondent investigate during past payment review and recovery audit(s), and fraud-related audit services engagements? What experience does respondent’s staff have at identifying control weaknesses? Please describe in detail. What experience does respondent’s staff have in writing audit reports? Please describe in detail. What experience does respondent’s staff have at reviewing medical services to determine medical necessity, adherence to the CMS Correct Coding Initiative, and compliance with industry coding standards and best practices? Please describe in detail. Describe how respondent will verify the improper payments and what resources and documentation will be required to verify that the improper payments exist. Describe how respondent will identify fraud, waste or abuse and what resources and documentation may be needed to verify the fraud, waste or abuse exists. All respondents must also provide the following in their proposals: Describe respondent’s experience working with mainframe and client server extracted data. Describe respondent’s ability to accept different types of data formats and list preferred data formats. Describe respondent’s ability to accept a high volume of data. Describe the system/software you will use to perform improper payment, or fraud-related detection reviews and provide details of its functionality. All respondents must disclose any potential or actual conflict of interest under this contract as outlined in Section 1.8.2, and include proposed mitigation and management strategies for any conflicts of interests identified. Description and at least three (3) references from projects performed within the last five (5) years that demonstrate the respondent’s ability to perform the Scope of Work described in the RFP. Include contract dates and contact information (customer points of contact, address, telephone number and email address). The respondent must explain whether it performed the 32
work as a prime contractor or subcontractor. If respondent performed the work as a subcontractor, the respondent must describe the scope of subcontracted activities. If the proposal includes the use of subcontractors, include a similar description of each subcontractor’s corporate background and experience. 2. Résumés Identify and describe the respondent’s and its subcontractor’s proposed labor skill set and provide résumés of all proposed key personnel (as defined by the respondent). Résumés must demonstrate experience germane to the position proposed. Résumés should include work on projects cited under the respondent’s corporate experience, and the specific functions performed on such projects. Each résumé should include at least three (3) references from recent projects. References may not be the respondent’s or subcontractor’s employees. 3. Financial Capacity A respondent must supply evidence of financial capacity sufficient to demonstrate reasonable stability and solvency appropriate to the requirements of this procurement. Respondents must submit a current financial statement plus two (2) years of audited financial reports including all supplements, management discussion and analysis, and actuarial opinions. At a minimum, such financial statements and reports will include: balance sheet; statement of income and expense; statement of changes in financial position; cash flows; and capital expenditures. If the respondent is a corporation that is required to report to the Securities and Exchange Commission, it must submit its two most recent SEC Forms 10K, Annual Reports. If any change in ownership is anticipated during the twelve (12) months following the proposal due date, the respondent must describe the circumstances of such change and indicate when the change is likely to occur. A respondent must include responses to this Financial Capacity requirement with the respondent’s Cost Proposal as described in Section 3.15.10. 4. Corporate Guarantee If the respondent is substantially owned or controlled, in whole or in part, by one or more other legal entities, the respondent must submit the information required under the “Financial Capacity” section above for each such entity, including the most recent financial statement for each such entity. The respondent must also include a statement that the entity or entities will unconditionally guarantee performance by the respondent of each and every obligation, warranty, covenant, term and condition of the contract. If HHSC determines that an entity does not have sufficient financial resources to guarantee the respondent’s performance, HHSC may require the respondent to obtain another acceptable financial instrument or resource from such entity, or to obtain an acceptable guarantee from another entity with sufficient financial resources to guarantee performance. A respondent must include responses to this Corporate Guarantee requirement with the respondent’s Cost Proposal as described in Section 3.15.10. 5. Bonding HHSC reserves the right to require the respondent to procure one or more performance, fidelity, payment or other bond, if during the term of the contract; HHSC in its sole discretion determines that there is a business need for such requirement. 33
Page 1 and 2: Tom Suehs, Executive Commissioner R
Page 3 and 4: 4.3 Statewide Annual HUB Utilizatio
Page 5 and 6: define the requirements of Section
Page 7 and 8: Coordination with HHSC in obtaining
Page 9 and 10: due diligence in its efforts to ide
Page 11 and 12: are resolved, whichever happens las
Page 13 and 14: 1.8.2 Conflicts of Interest A confl
Page 15 and 16: 1.13 Protest Procedures Texas Admin
Page 17 and 18: e. Establish a Governance process w
Page 19 and 20: . Notify providers in writing of po
Page 21 and 22: timeline will include reasonable an
Page 23 and 24: . Provide monthly status reports to
Page 25 and 26: 2.6 Location of Services The RAC wi
Page 27 and 28: Respondents must notify HHSC of any
Page 29 and 30: identify trade secret or confidenti
Page 31: 3.15.1 Part I - Business Proposal T
Page 35 and 36: 3.15.4.6 Section 6 - Proposed Appro
Page 37 and 38: Respondents must base their Cost Pr
Page 39 and 40: 3.15.30 Proposed Compensation Table
Page 41 and 42: 4. Historically Underutilized Busin
Page 43 and 44: 4.6.1 Identify Subcontracting Areas
Page 45 and 46: 4.6.7 Written Justification of the
Page 47 and 48: 5. Proposal Evaluation HHSC will us
Page 49 and 50: after HHSC receives payment from th
Page 51 and 52: the overpayments recovered or the u
Page 53: (7) Statistician (8) Other Professi

(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...

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