(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...
(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...
(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...
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displayed on the Proposed Compensation Tables <strong>and</strong> Proposed Fixed Fee Rates Schedule<br />
submitted as Attachment A.<br />
The selected <strong>RAC</strong> will be compensated as described in Section 6 of the <strong>RFP</strong> <strong>and</strong> at the final<br />
accepted percentage rate(s) included in the contract which shall not exceed the lower of 12.5%<br />
(or the highest rate paid to Medicare <strong>RAC</strong>s, as published in the Federal Register). Respondents<br />
who submit cost proposals which exceed the maximum contingency fee percentage of 12.5%<br />
(or the highest rate paid to Medicare <strong>RAC</strong>s, as published in the Federal Register) shall be<br />
disqualified from further consideration of any resulting contract. In its separate sealed Cost<br />
Proposal, the bidder should propose a percentage rate(s) (which must not exceed the lower<br />
of 12.5%, or the highest rate paid to Medicare <strong>RAC</strong>s, as published in the Federal<br />
Register) using the pricing matrix provided with this <strong>RFP</strong> <strong>for</strong> the contingency fee of<br />
overpayments collected, <strong>and</strong> underpayments identified based on the three payment<br />
methodologies listed.<br />
The first payment methodology listed in the pricing matrix (Attachment A) takes into<br />
consideration the audit result (overpayment or underpayment) <strong>and</strong> the level of difficulty<br />
of the review (automated or complex). A review will be considered automated if the<br />
<strong>RAC</strong> did not need to examine medical documentation to determine the existence of an<br />
improper payment, <strong>and</strong> it will be considered complex if the <strong>RAC</strong> did examine medical<br />
documentation to determine the existence of an improper payment.<br />
Based on the audit result <strong>and</strong> level of difficulty, the appropriate contingency percentage<br />
will be located on the fee table provided by the <strong>RAC</strong>. This percentage will be applied to<br />
the overpayments recovered or the underpayments discovered <strong>and</strong> paid to determine<br />
the contingency fee payable by HHSC to the <strong>RAC</strong> <strong>for</strong> that specific improper payment<br />
audit.<br />
The second payment methodology listed, “Blended Rate”, is defined as a single<br />
contingency percentage that will be applied to all reviews regardless of the audit result<br />
(overpayment or underpayment) or the level of difficulty of the review (automated or<br />
complex). This percentage will be applied to the total overpayments recovered <strong>and</strong> the<br />
underpayments discovered <strong>and</strong> paid to determine the contingency fee payable by HHSC<br />
to the <strong>RAC</strong> <strong>for</strong> all applicable improper payment audits.<br />
The third payment methodology, “Tiered”, provides numerous possible contingency<br />
percentages that each take into consideration a specific audit result (overpayment or<br />
underpayment), level of difficulty of the review (automated or complex), <strong>and</strong> the dollar<br />
value of the recovery audit under review. Based on these three variables, the<br />
appropriate contingency percentage will be located on the fee table provided by the<br />
<strong>RAC</strong>. This percentage will be applied to the overpayments recovered or the<br />
underpayments discovered <strong>and</strong> paid to determine the contingency fee payable by HHSC<br />
to the <strong>RAC</strong> <strong>for</strong> that specific improper payment audit.<br />
Respondents are to use their business expertise in pricing the work described in this <strong>RFP</strong>,<br />
taking into consideration any intervening steps or activities that must be per<strong>for</strong>med in order to<br />
complete the work, <strong>and</strong> offer their rates accordingly, even if HHSC does not explicitly identify<br />
those intervening costs in this <strong>RFP</strong>. No separate travel expenses or any other type of expenses<br />
will be paid under the contract to result from this <strong>RFP</strong>.<br />
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