This is a CMS mission critical requirement and supports one of the primary goals of the Agency – better care and lower costs. Beneficiaries should receive high quality, coordinated, effective, efficient care and, as a result, health care costs may be reduced. In particular, the requirements in Section C, Numbers 1- 4 are critical capabilities that must be started and be fully operational with all necessary testing completed no later than one month before the end of the transition period, to ensure that no lapse in contracting activities occurs.
Important knowledge requirements include, but are not limited to: strategic planning and project management expertise, sophisticated knowledge of Medicare Fee-For-Service (FFS) regulations, payment policy and claims data, ability to internally manage large volumes of data including every Medicare fee-for-service claim and Medicare Advantage encounter, personally identifiable information, and work within CMS systems for data storage and sharing, develop tools and implement solutions for automated systems, knowledge of Health Insurance Portability and Accountability Act (HIPAA) of 1996, and knowledge of Protected Health Information (PHI) rules and regulations.
