Strategic provides professional health care related solutions and services for Federal and State Governments. Currently, its prime focus is work required by the United States Department of Health and Human Services (DHHS), specifically, the Centers for Medicare & Medicaid Services (CMS).
Strategic’s services are available through the award of the General Services Administrative (GSA) Mission Oriented Business Integrated Services (MOBIS) contract (GS-10F-0231T). Services offered by Strategic pursuant to this contract include consulting services, as well as program integration and project management services.
Strategic is ISO 9001:2008 certified and is committed to providing quality products and services.
Risk Adjustment Data Validation (RADV) Intake Medical Record Review Contract (IMRRC)
This is a two-year contract that requires Strategic to function as the intake point for medical records, and conduct medical record review for the RADV project. Strategic will conduct an independent medical record review to evaluate the accuracy of diagnosis data submitted for Medicare Part C payment by Medicare Advantage (MA) organizations from hospital inpatient, hospital outpatient, and physician settings. Strategic will also participate in extensive training, collaborate with other contractors, develop educational materials, and support medical record appeals and litigation.
Medicare Part C and Part D Program Integrity Technical Assistance
This contract provides the overall national support for the analysis of Medicare Parts C and D program integrity initiatives. Current program processes will be reviewed to uncover operational risks, program vulnerabilities, and process improvements. While working directly with senior level Centers for Medicare & Medicaid Services (CMS) executives, beneficiary advocacy groups, local law enforcement, MA Organizations, and Medicare Part D Plan Sponsors. Strategic will implement new and innovative approaches to minimize vulnerabilities and address crucial program areas in management, administration, operation, and oversight of the Medicare Part C and Part D programs.
Education Medicaid Integrity Contract (Education MIC) Task Order 1
This program is national in scope and intended to promote the integrity of Medicaid programs by developing education and outreach for Medicaid service providers, managed care entities, Medicaid recipients, State agencies, and other stakeholders regarding Medicaid payment integrity and quality of care issues. Education and outreach activities include conducting training to target audiences at various national conferences, disseminating informational and educational materials, and building partnerships to network and collaborate on educational endeavors. At the onset of the task order, Strategic performed a gap analysis which documented shortcomings and gaps in existing fraud, waste, and abuse (FWA) education, outreach, and training efforts. Based on the priority areas identified in the gap analysis, Strategic developed FWA education and training campaigns, each comprised of several initiatives. The campaigns created to date are Building Partnerships, Write it Right, Code it Right, and Protect Yourself/Protect Medicaid. In addition, Strategic has established and regularly updates social media sites such as http://www.EducationMICatFacebook.com and http://twitter.com/educationmic. These pages serve as useful sources of quick information on Education MIC activities.
Education Medicaid Integrity Contract (Education MIC) Task Order 2
This program is designed for the development and delivery of training materials to educate Medicaid providers about Medicaid payment integrity and quality of care issues as they occur in MIC Regions III and IV. Strategic promotes Medicaid program integrity by educating Medicaid providers in areas related to Medicaid overpayments. The five focus areas initially identified are Prescribing Information, Long-Term Care, Inpatient and Outpatient Care, Home Health, and Behavioral Health. Educational content is currently being created to address issues related to multiple drug therapy classes including atypical antipsychotics, proton pump inhibitors, antidepressants, anticonvulsants, enoxaparin, and stimulants, and related drugs. Strategic will also be identifying vulnerabilities in the school-based services program that could be addressed through program integrity education. To facilitate Medicaid provider education, Strategic is developing an Education MIC website, which will provide access to educational materials, along with access to web-based training materials and webinars. Attendance and registration information for upcoming training opportunities and events will also be available on the site. In the future, the Education MIC will be able to offer continuing education credits for both in person and web-based training events.
Medicare Outreach and Quality Assurance
The objective of this contract is to provide educational outreach to Medicare providers and enhance the work currently performed by the CMS Division of Provider Information, Planning, and Development. The goal is to ensure that health care professionals receive timely, accurate and consistent information related to Medicare Fee-For-Service Programs.
Strategic assists CMS in the design, development, and production of plain language educational materials, marketing products, and media (e.g., brochures, articles, press releases, reference guides, marketing materials, PowerPoint presentations, and web-based training courses). Topics include Medicare provider enrollment; benefits and coverage; coding, billing, and documentation requirements; and reimbursement, as well as resource information for Medicare beneficiaries. Additionally, Strategic provides a Quality Assurance Program, which includes reviewing all CMS Change Requests to update and maintain the most current content/language in Medicare Learning Network products.
Part D Formulary Review Contractor
Strategic is contracted to assist CMS in reviewing plan formularies and benefits related to the Medicare Prescription Drug Benefit (Part D). This initiative will help CMS in achieving its objective of reviewing plan formularies and benefits to ensure compliance with CMS’ benefit guidelines and the guidelines outlined in Chapter 6 of the Medicare Part D Manual.
Quality of Care Monitor
Strategic was chosen by the Office of Inspector General (OIG) to serve as the Quality of Care Monitor for a dental management company that manages clinics throughout the United States. Strategic is responsible for evaluating the effectiveness of the company’s internal quality control systems, its response to quality of care issues, and its compliance with the quality of care provisions of the OIG’s Corporate Integrity Agreement (CIA).
Specialty Medical Review (MR) of Medicare Part A and B Claims
Strategic provides CMS with a centralized MR resource that performs MR nationally, which allows for a timely and consistent execution of MR review, activities, and decisions. In accordance with the CMS Medicare Program Integrity Manual, these claim reviews require, at a minimum, the evaluation of medical records and related documents to determine whether Medicare claims were billed in compliance with coverage, coding, payment, and billing policies. In addition, Strategic developed and maintains a tracking system to reflect and identify MR activities of all claims reviewed, including a narrative report showing denials, appeals, payments, and reasons for MR determinations. Strategic provides all necessary services, personnel, material, equipment facilities, management, control, and other resources needed to perform the task order. All task order deliverables are subject to Section 508 standards.
Quality Improvement Strategy and Guidance for Medicare Advantage (MA) and Special Needs Plans (SNPs)
Strategic provides a quality improvement strategy for the management and oversight of the CMS Quality Improvement (QI) Program for the MA Organizations, including the SNPs. The scope of the QI program is to identify, in all MA products, best practices through the use of audit and enforcement information, member satisfaction and health status reported data, and clinical outcomes. This will increase CMS’s ability to understand quality improvement and care coordination strategies currently being undertaken by MA plans, and to provide guidance to other plans on best practices.
Medicare Prescription Drug Benefit Part D Payment Process Support Services
Strategic is the Reconciliation Support Contractor for CMS. In this role, Strategic provides a full range of statistical, analytical, audit, financial, and professional business services to CMS. Specifically, Strategic assists CMS with the intake and review of cost estimates, attestations, and other supporting documentation provided by Part D Sponsors, along with all communication to Sponsors regarding the final Medicare Part D payment reconciliation process. Strategic also assists in designing and implementing a set of standard procedures to support the annual Medicare Part D reconciliation process.
Medicare Part C and D Monitoring Methods
As a subcontractor, Strategic assists the CMS by analyzing approaches to monitor Medicare Part C and Part D sponsors and to develop enhancements to current monitoring methods. The project involved an analysis of multiple areas across Medicare Part C and Part D including marketing, enrollment, and benefit administration. Based on the recommendations from this analysis, new measures were developed and implementation was coordinated with CMS and plan sponsors.
Provider Enrollment
In order to bill and receive payments from Medicare, healthcare providers must complete an enrollment application. These enrollment applications must be completed according to the instructions in Chapter 10 of the Medicare Program Integrity Manual (PIM). As a subcontractor for a Medicare Administrative Contractor (MAC), Strategic validates and processes the submitted information in accordance with the requirements outlined in the PIM and within the specified turn-around time.