Develop Benchmarks for Medical Procedure Codes

FOR INFORMATION (RFI) PART I This SSN/RFI is issued solely for market research and does not constitute a solicitation. Responses will be used for planning purposes only and will not be returned. The Government will not reimburse vendors for any costs associated with responding. The Department of Labor (DOL), (OASAM)/ (OSPE) on behalf of the ’ Compensation Programs (OWCP) is Requesting Information (RFI) to better understand current industry capabilities along with common practices and to identify any impediments in obtaining scope of services described below. SCOPE U.S. DOL OWCP administers four individual programs based on separate legislation —the Federal Employees’ Compensation Act (FECA), the Energy Employees Occupational Illness Compensation Program Act (EEOICPA), the Black Lung Benefits Act, and the Longshore and Harbor Workers’ Compensation Act (LHWCA)—to mitigate the impact of work-related injuries through the provision and management of medical and other benefits. OWCP seeks to modernize its approach by acquiring benchmark-driven fees to ensure fair, market-based reimbursement and improve claimant access. OWCP seeks to obtain services for the delivery of benchmark data for CPT, HCPCS, and dental codes (see Attachment “Service Code List - Attachment A. xlsx”); data distribution for all states and nationwide, identification of derived versus actual rates, and support of modifiers, multipliers, and conversion factors; and periodic updates and customer support for data interpretation. The anticipated

requirements for Benchmark Data services are: Obtain benchmark

pricing data (charge and allowed amounts) for Current Procedural Terminology (CPT), Healthcare Comon Procedure Coding System (HCPCS), Current Dental Terminology (CDT), and any other applicable codes provided in the attachment. Ensure benchmarks are statistically valid, transparent, and regularly updated within the supporting period. Provide ongoing support for interpreting and updating underlying fee schedule data, benchmarks, and analyses. Provide benchmarks for each service code based on national rates, state-based rates, ZIP codes, and rural or non-rural s. Benchmark rates should include industry, federal government, state government, and other credible sources. Ensure that the rates provided represent one unit of service unless they are clearly identified as a different unit of measurement (such as per diem or daily rate, 1 ML, 1 MG, 1 Dose, or fees that include additional bundled services) not reflected in the service code description. TASKS The anticipated tasks are: 1) Provide Charge and Allowed Benchmarks (all states and nationwide) for each code a) Using standard benchmark percentiles i) 50th, 60th, 70th, 75th, 80th, 85th, 90th and 95th, or increments of 5 from the 5th to the 95th ii) Mean, median, mode, maximum, and minimum values b) For codes with less than 25 frequencies (9 for dental) provide derived benchmarks c) Indicate for each service code i) the number of underlying data points, if available ii) whether the benchmarks are based on actuals or derived

2) Provide Ongoing customer support for data

questions, including but not limited to a) the reason behind changes b) how a value is calculated c) why benchmarks may vary from one geographical area to another d) graphical illustrations (histograms) that show the relationship between a benchmark value and the underlying data that support it

3) Update data twice yearly on a rolling monthly basis, to include new codes DEFINITIONS Actuals: based on data reported for the specific code in the geographic area Allowed: amount the program will pay for a specific code Charge: amount the provider may bill for a specific code Derived: based on data from related codes in the geographic area PART II RFI QUESTIONNAIRE Provide a company description, discussion of company capabilities, and general summary of approach to accomplishing the