Centers for Medicare & Medicaid Services #270048

CMS Solicitation for Supplemental Medical Review Contractor (SMRC) Services

This opportunity is a nationwide service contract from the Centers for Medicare & Medicaid Services (CMS) for Supplemental Medical Review Contractor (SMRC) services. - Government Buyer: - Department of Health and Human Services (HHS) - Centers for Medicare & Medicaid Services (CMS) - OAGM Division (ASG - DPIFMC) and Center for Program Integrity (CPI - PCG) - Scope of Work: - Nationwide, post-payment medical review services for Medicare Fee-for-Service claims - Includes Medicare Part A, Part B, and DMEPOS programs - Conduct specialty reviews based on issues identified by federal agencies (e.g., OIG, GAO) and CMS data analysis - Provide comprehensive program integrity reviews to reduce improper payments and combat fraud, waste, and abuse - Notable Requirements: - Contractor must have expertise in medical review and program integrity - Must support nationwide coverage and respond to evolving program integrity needs - OEMs and Vendors: - No specific OEMs or vendors are named, as this is a service-focused procurement - Estimated Contract Value: - Exceeds $100 million - Duration is over five years, including base and option periods

Description

The CMS plans to procure a Supplemental Medical Review Contractor (SMRC) to perform and support nationwide, post-payment medical review and related tasks aimed at lowering improper payment rates and combating fraud, waste, and abuse. The contract includes two core tasks within the Center for Program Integrity (CPI): Specialty Reviews supporting issues identified by federal agencies and Program Integrity Reviews providing comprehensive medical review for CMS requests. Medical reviews will be performed on Medicare Fee-for-Service claims for Medicare Part A, Part B, and DMEPOS programs. The contract is anticipated to last over 5 years with an estimated total value of at least $100 million.

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