CMS Seeks Provider To Build Provider Compliance Reporting System
By Megan Williams, contributing writer
Healthcare fraud has been an increasingly difficult thorn in the government’s side —annually it faces costs of $60 to $90 billion in fraudulent Medicare activity. In response to the problem, the Centers for Medicare and Medicaid Services (CMS) has decided to launch a system designed to track enforcement actions against Medicare providers involved with questionable claims, according to Modern Healthcare.
Why IT Solutions Providers Should Pay Attention
To launch the project, CMS is looking for a contractor to build and maintain the PCRS (provider compliance reporting system), which will be available on ProviderMedicare.gov. The statement of work can be accessed here and states,
“PCRS will be an application designed to provide CMS a single source of information about Medicare review programs from a provider perspective. Users can access the system via a Web-based user interface or in a system-to-system manner through Health Information Handlers (HIHs).”
The contract will also require the development of an outreach campaign around ProviderMedicare.gov, which likely means the public will be able to access information house on the site as well.
Proposals are due by June 18 and CMS expects the two-year contracts to be awarded by September 30. No budget or launch date is currently available.
Requirements
The agency currently contracts with private companies in protecting the Medicare trust fund against fraud, unfortunately, their coverage is not enough. According to the statement of work, “…none of the existing reporting mechanisms allows for a comprehensive view of Medicare's activity with the CMS and its contractors. The CMS needs a system that will allow Medicare review contractors and CMS staff to view a provider profile.”
The systems as they stand are designed to keep the same claim from being reviewed by two contractors. CMS now needs the new system check that the same topic is not being reviewed by more than one contractor for the same provider at the same time.
The new site will also be accessible by providers, and according to the solicitation notice, “A provider who was reviewed by three different contractors would have to visit three different websites to get a full picture of their review and education activity with Medicare.” The ideal contractor would be able to handle this issue.