NCI Inc. has won a $87 million firm-fixed-price contract with the Centers for Medicare and Medicaid Services. The contract continues support of CMS’ Comprehensive Error Rate Testing program by NCI and its wholly owned subsidiary AdvanceMed.
“NCI reviews an average of 50,000 medical claims per year under the CERT program, in order for CMS to statistically determine the improper payment rate for the Medicare FFS program,” NCI’s then-president and CEO Brian J. Clark said. “We are proud to continue our work on this important program serving CMS, one of our largest and longest-standing customers. Our CERT team has delivered superior results over the past 16 years while bringing innovative technology to enhance outcomes for CMS.”
The expanded scope of work includes request and receipt of medical documentation for Medicare claims billed and call center support. The award consists of a 1-year base period and four 1-year option periods.
CMS developed the CERT program to calculate the Medicare Fee-for-Service program’s improper payment rate using a sample of claims from the Medicare claims universe to determine whether the claims have been paid properly based on Medicare coverage, coding and billing rules. NCI will use the innovative medical review tracking, reviewing and reporting system it built for CMS — CERT360 — which integrates and controls all aspects of the CERT program’s medical review activity.
NCI will work with billing and ordering providers to receive and process medical records for purposes of conducting medical reviews. The company also will provide customer service support to the Medicare administrative contractors and providers that have claims sampled for review. It will conduct medical reviews on claims sampled for CERT and other CMS accuracy reviews; communicate results; and maintain various websites for internal and external stakeholders.
NCI also will provide the data from the review of these claims to CMS for the agency’s use in submitting the National Medicare FFS program’s improper payment rate to the U.S. Congress and to publicly report the findings and actions CMS is taking to cut improper payments.