Notice ID: VA-RFI-2024-001
The Department of Veterans Affairs (VA), Veterans Health Administration (VHA), Office of Finance (OF) requires a highly skilled contractor to conduct Recovery Audit (RA) activities for a variety of programs, as described below. Each program has specific payment methodologies as defined by VA regulations. In general, the audit will review various types of paid claim data with specific dates and criteria included in the description of each auditing scenario.
OF intends to award a RA, no cost (contractor is paid out of recovered funds only) task order, to provide auditing services. The Government’s obligation to make payments to the contractor under this task order is contingent upon both the contractor’s correct identification of valid overpayments and the Government’s subsequent recovery of overpayments, or portion of overpayments. The contractor shall bear the burden of costs of performing the task associated with the RA and will be compensated only on a percentage of the actual funds recovered.
Throughout this document, the term “improper payment” is used to refer to overpayments only. Situations where the provider submits a claim containing an error (e.g., an incorrect diagnosis code, incorrect/missing modifier), but the payment amount is not altered by the error, are not considered improper payments.
Key objectives of the RA contract are to receive access to paid claim data, audit that data for potential overpayments to providers, verify overpayments and report results to VA. The contractor shall also identify root causes or trends for potential reduction of improper payments. Another key objective of the contract is to establish a Customer Service Center (CSC) for addressing questions from providers.
The Period of Performance (POP) for the base period shall be from the date of award for a period of one (1) year with four (4), one (1) year option periods to be awarded at the discretion of the Government.
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