The Centers for Medicare & Medicaid Services (CMS) is seeking a contractor to build, operate, and maintain a “Provider Compliance Reporting System” (PCRS) to track enforcement actions against Medicare providers over questionable claims, reports Modern Healthcare. The PCRS will be an application designed to provide CMS with a single source of information about Medicare review programs from a provider perspective. Users will be able to access the system via a web-based user interface or in a system-to-system manner.
CMS contracts with a number of private companies that audit claims, “However, none of the existing reporting mechanisms allows for a comprehensive view of Medicare’s activity with the CMS and its contractors,” CMS said in a Statement of Work it released along with the Request for Proposals. “The CMS needs a system that will allow Medicare review contractors and CMS staff to view a provider profile” that will show when a provider received one-on-one education and which claims have been flagged for review. The current Recovery Audit Contractor-Data Warehouse (RAC-DW) is designed to prevent the same claim from being reviewed by two review contractors, and the new system will have to ensure that the same topic is not being reviewed by two review contractors for the same provider at the same time. Likewise, as a customer service improvement for the provider community, the PCRS will allow providers to view their review and education activities with Medicare at one web location.
The proposal submission deadline is June 18. CMS said the anticipated contract start date is September 30, 2015; the contract will be for one year, with a one-year option. A launch date for the new system was not provided.
