Heather Kirk October 18, 2022 0 Comments

A research request was recently provided to OS AI from an 8(a) small business IT consulting and automation firm that specializes in identifying and eliminating fraud, waste and abuse, looking for details related to a potential FY 2023 recompete of this Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) requirement.  

We at OrangeSlices AI do believe in the need for more and better-informed competition, so provided below are 1) opportunity details provided by the requestor; 2) some key points of contact; 3) related pursuit/capture data; and 4) when possible, projected odds of this contract going back to the incumbent. 

Competitive Details (if known) related to the predecessor contract: 

  • Funding Agency: HHS / Centers for Medicare & Medicaid Services 
  • Incumbents: There were two awardees – RELI Group for MRRC A and Visual Axis (a Joint Venture between Axis Consultant Group and Visual Connections) for MRRC B. 
  • Contract Vehicle: This was 8(a) competed using SAM (FBO).     
  • Expected Competition Date: Fiscal Year 2023 – date tbd  
  • Contract Details and Spend to Date for Award IDs: RELI Group – 75FCMC19C0015 and  Visual Axis- 75FCMC19C0013 

OS AI Note: Both contracts are set to expire in early 2024. If competed, we would expect the competition to take place in late Q3 or Q4 of calendar year 2023. 

Scope: “For the prior competition CMS awarded two (2) separate and independent Medical Record Review Contracts (MRRC A and MRRC B) to conduct medical record review for various projects including the RADV projects and Ad Hoc Studies.” 

“CMS required offerors that have the ability for providing Medical Record Review Contractor (MRRC) services to conduct medical record reviews supporting various projects including the Risk Adjustment Data Validation (RADV) projects. The purpose of RADV is to measure the extent to which inaccurate diagnosis codes impact Hierarchal Condition Categories (HCC) assignments and the associated payment for Medicare Advantage (MA) beneficiaries. The validation process involves the evaluation and analysis of the risk adjustment data via medical record review. 

CMS conducts two (2) major RADV projects: the National sample and the Contract-Level sample (the term sample is synonymous in this context with audit). The National sample is used to compute an error estimate for the Medicare Part C Program. The Contract-Level sample is used to estimate extrapolated payment adjustments at the MA Contract-Level based on medical record review findings. The Part C payment error estimate and the MA Contract-level extrapolated payment adjustments represent CMS’s response to provisions set forth in the Improper Payments Information Act (IPIA) of 2002, as amended by the Improper Payments Elimination and Recovery Act (IPERA) of 2010 and the Improper Payments Elimination and Recovery Improvement Act (IPERIA) of 2012.” 

** Please note that OS AI will not speculate here as to the accuracy of any scope details provided and/or any current plans related to the timing, details, and likelihood of any recompete.  

Related Data:  

Sample of Key Potential Points of Contact (current or past): 

What are the odds of the incumbent company winning this contract as a Prime again?  

The OS AI Bot calculates the odds of either of the incumbents winning this contract back at greater than 50%.

  

SBA tools indicate that Visual Axis is no longer an 8(a), but partner Visual Connections carries a long history of supporting CMS on Risk Adjustment Data Validation Medical Record Review activities. Potential Partners/Competitors will be looking at recent partnerships/JVs these groups might put in place to pursue this.  

As of this date, RELI Group maintains their 8(a) status and they should have Prime access to several 8(a) contract options, to include 8(a) STARS III, even if they size out prior to any competition.  

Looking for an 8(a), WOSB, HUBZone or SDVOSB to partner with at CMS? Click Here 

You can filter the list by several key indicators, to include socio-economic status, NAICS, Contract vehicle, etc.

If you are a small business with capabilities and socio-economic status that might support this effort, comment below and we will add you to the list.

Firms drawing the most attention: 

Included below is a list of the large and small companies we have noted as drawing the most views by Government and industry leaders on the OrangeSlices AI consultant directory over the past week and that bring direct past performance and/or related relationships in support of CMS. 

We cannot and will not speculate here as to the reasons for the increased interest, but whether it is a company evaluating them as a potential partner; a federal acquisition leader doing their due diligence; or a consultant weighing their next job move, this group of companies has been receiving increased interest. 

Please note that the research requestor for this item received a Premium OS AI Opp Segment report including 1) known details about how/if/when/where this contract will be competed; 2) a list of the top companies that are in position to win today (as well as those who have been making key investments and moves of late to position for a win); and 3) a detailed list of the top potential opportunity influencers any potential bidder will want to get to know.  

About OrangeSlices AI  

Developed by a team of government and industry contracting subject matter experts, the OrangeSlices AI data driven platform is a publicly available searchable listing of the top information technology and consulting services contractors doing business with the Federal government today. Driven by a robust and comprehensive set of authoritative and trusted data sources, the OS.ai tool is intended to help government and industry leaders find the right partner to help deliver on the important missions of the Federal government. Learn more about how you can engage with OS AI here.   

 

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