www.Lifecare-USA.com

Capability Statement

LIFECARE MANAGEMENT PARTNERSHealthcare Claim Reviews and Payment Validations

http://lifecare-usa.com

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Lifecare Management Partners (“Lifecare”), a minority owned, small disadvantaged business (SDB) has been providing outstanding professional services to our customers since 1995. Lifecare was accepted into the U.S. SBA 8(a) business development program in March 1998 and has since successfully graduated from the program.

Lifecare maintains a government compliant and certified accounting system and has had its rates approved by the Centers for Medicare and Medicaid Services (CMS). Under its existing CMS contracts, Lifecare has successfully undergone Security Test and Evaluation (ST&E) reviews and has received the Authority to Operate (ATO). Lifecare continues to maintain its Program Safeguard Contractor (PSC) IDIQ contract which was originally awarded by CMS in 1999. Lifecare performed program integrity work for CMS, the DHHS/OIG, and the FDIC has also conducted background investigations for the IRS. In the performance of its work, Lifecare has processed confidential and HIPAA sensitive data related to Medicare beneficiaries, providers and suppliers. Lifecare’s corporate headquarters are located in Alexandria, VA and conducts its current Medicare business from its Medical Review Center in Annapolis Junction, MD.

Lifecare’s mission is to provide quality services and support to both public and private health insurance programs with a particular focus on healthcare medical record claim reviews, appeals, provider enrollment and oversight, fraud waste and abuse detection and prevention, and other related program integrity support functions.

Company Overview

Mission

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CertificationLifecare is a small disadvantaged business (SDB); a Hispanic American owned company and is proud to be a member of the following distinguished organizations:

The National Minority Supplier Development Council advances business opportunities for certified Asian, Black, Hispanic and Native American business enterprises and connects them to corporate members. One of the country’s leading corporate membership organizations, NMSDC was chartered in 1972 to provide increased procurement and business opportunities for minority businesses of all sizes.

The Virginia Minority Supplier Development council (VMSDC) foster relationships between minority suppliers and their potential clients: Fortune 500 corporations, government agencies and universities.

"Lifecare has made a significant contribution to the achievement of our small business subcontracting goals."

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Lifecare’s leadership includes Joseph C. Molina, LLM, JD, James C. Bordeau, Michael F. Berkey, CPA, JD., and Joy Bahnemann. Lifecare’s leaders all have extensive experience in Federal government contract operations with a focus on contracting with the Centers for Medicare and Medicaid Services (CMS).

Joseph C. MolinaMr. Molina is the founder and owner of Lifecare and has been involved in operating contracts across numerous Federal agencies. He has an in-depth knowledge of Federal law, regulations, and various agency operating policies and procedures. Specific to CMS, Mr. Molina has been involved in transitions of Medicare operations to new contractors, CMS payment error rate initiatives, background investigations, joint operating agreements, Medicare documentation requirements, medical reviews and overpayment recoveries involving statistically valid random samples, law enforcement fraud referrals, and pro-active data analysis of complex and large data sets.

James C. BordeauMr. Bordeau is the President of Lifecare and has spent his entire career in Medicare program administration. He is considered an expert in Medicare Part A and Part B operations including contractor technical requirements and performance standards. He began his career at CMS where he was responsible for Medicare contractor oversight, inspections and performance evaluations and also served on various CMS Technical Advisory Groups and Steering Committees. Mr. Bordeau also managed various aspects of both Part A intermediary and Part B carrier operations at Aetna and United Healthcare. At AdvanceMed Corporation, Mr. Bordeau served as Vice President of CMS Payment Safeguard Contractor (PSC) contract operations.

Joy BahnemannMs. Bahnemann is the Executive Vice President of Lifecare responsible for Business Development, Marketing and Sales. She is considered an expert in Medicare and Managed Care operations and Medicare fraud, waste and abuse. Prior to joining Lifecare, Ms. Bahnemann was President/CEO of Security Care, a CMS program integrity contractor. Other senior leadership positions include President of TriCenturion, a CMS program safeguards contractor; Vice President, Regence BCBS Medicare Part A and Part B operations/CWF and FISS Data Warehouse; Vice President, BCBSMN Government Programs; Vice President, Account Services at United HealthCare; CIO at the Medica Health Plan and VP of Contracting at McKesson.

Michael F. BerkeyMr. Berkey served as Project Manager for Lifecare’s Medical Review Center. He also serves as Program Director for Lifecare’s Worker Compensation Review Center and as Chief Legal Counsel for the Medicare Part D RAC Validation contract. An attorney and Certified Public Accountant (CPA), Mr. Berkey earned his JD from the University of Maryland’s School of Law, and his CPA from Loyola College. His career began as a legal analyst for CMS’ predecessor, the Health Care Financing Administration and he also worked for the Social Security Administration by formulating and defending policy. Prior to joining Lifecare, Mr. Berkey served as the Medicare Appeals Counsel for CareFirst of Maryland and as the Eastern Regional Associate Counsel for the Blue Cross and Blue Shield Association.

Leadership

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Core Competencies &Support Services

Medicare & Medicaid Subject Matter Expertise

Medicare Claims & Medical Record Reviews

Medicare RAC Appeals

Provider Enrollment

Data Analysis & Data Management

Fraud, Waste & Abuse Detection, Investigations & Prevention

Program Integrity Assessments & Reviews

Background Checks, Risk Assessments & Surveillance

Legal Counsel

Cost Accounting & Compliance Auditing

Our core competencies and support services include the following:

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Background & Experience

Claim Reviews & Appeals

Medicare Part A & B Coverage & Payment Policies

Prime Subcontractor

• Centers for Medicare and Medicaid Services (CMS)

• Program Safeguard Contractors (PSCs)

Subcontractor

• Medicare Administrative Contractors

• Program Safeguard Contractors (PSCs)

Government Approved Accounting System and G&A Rates

Undergone Security Test & Evaluations (STEs) & Conflicts of Interest (CQI) audits

Compliant in The Processing of Confidential & HIPAA Sensitive Data

"Lifecare was able to ramp up its operations quickly in terms of staffing and supporting infrastructure to address workload and production expectations."

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Professional Service ExperienceMedical Claim Review and Appeal Support

In 2005 Lifecare established a Workers’ Compensation Review Center (WCRC) for CMS. For over seven years Lifecare reviewed all Medicare Set Aside Agreements submitted to CMS. For each agreement, Lifecare reviewed and audited extensive medical documentation and provided CMS with an independent evaluation on future Part A, Part B and Part D drug costs related to the impacted Medicare beneficiaries.

Lifecare opened its Medical Review Center (MRC) and is currently conducting medical record claim reviews and appeals. Our initial MRC office consisted of an 8,100 sq. ft. secure facility staffed with experienced reviewers including nurses, certified coders and other individuals with certifications and medical degrees. Our business expanded quickly and Lifecare now operates multiple shifts in a campus of three office suites totaling 22,000 square feet. The MRC also includes managers, supervisors, quality assurance and IT staff to support ongoing medical review operations. Our systems security officer (SSO) and network engineers establish and maintain secure links to our customer sites. The MRC is equipped to handle the medical review of initial claims as well as appeals. In addition, our Medicare subject matter experts are available to assist customers with the development and implementation of their medical review strategies.

Lifecare’s MRC staff performs medical claim reviews, appeals and other support services to support Medicare Administrative Contractors (MACs). These reviews include Medicare Part A and B claim medical necessity and coverage determinations and RAC appeals, as well as DRG and other coding validations. We have the capacity to quickly expand our operations to support additional Medicare contractors and other organizations needing claim review services. Our proven project management and implementation skills allow us to quickly ramp-up to meet the timeliness and production priorities of our customers.

"Lifecare was able to ramp up its operations quickly in terms of staffing and supporting infrastructure to address workload and production expectations."

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Medical Review Support

In 2005 Lifecare established a Workers’ Compensation Review Center (WCRC) for CMS. For over seven years Lifecare reviewed all Medicare Set Aside Agreements submitted to CMS. For each agreement, Lifecare reviewed and audited extensive medical documentation and provided CMS with an independent evaluation on future Part A, Part B and Part D drug costs related to the impacted Medicare beneficiaries.

Workers’ Compensation Review Center (WCRC)

Medicare Medicaid Review Support is one of Lifecare’s core competencies. We are currently performing claim and appeal reviews for multiple MACs in multiple jurisdictions. To date, more than 70,000 claims and 70,000 appeals have been processed in our Medical Review Center.

Medical review of Medicare Part A & B claims for a MAC contractor. Lifecare’s clinical staff evaluated claims for appropriate coding and payments.

MAC Medicare Part A & B Medical Claims Review

Independent medical review of Medicare Part A provider submitted appeals challenging RAC claim denials. Lifecare clinicians determined the medical necessity and appropriateness of care by evaluating applicable coverage payment policies and procedures resulting in a favorable or unfavorable outcome.

MAC Medicare Part A RAC Appeals

Lifecare was engaged by a MAC to review Medicare Hospice claims to determine the eligibiilty for payment based on the patient medical record and Medicare’s payment policies and guidelines.

MAC Medicare Hospice Claims Review

MARCH2012

JUNE2012

OCTOBER 2012

2005

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Medical Review Center (MRC)

MRC ResourcesFull & Part Time Staff

Pool of additional experienced staff to quickly address spikes in workload

Registered Nurses

Certified Coding Specialists & Certified

Professional Coders

Registered Health Information Administrators &

Technologists

Personnel with Medical Degrees

PharmD & pharmacy technicians

Management & Supervision

Training

Quality Assurance

Chief Information Officer (CIO)

Systems Security Officer (SSO)

Application Programmers

Network Engineers

Help Desk Personnel

Open in March 2012

Conveniently located between Baltimore and Washington, DC

Located 10 miles South of CMS

22,000 sq. ft. facility

CMS compliant office suites and Data Center

Meets CMS System Security requirements

Conference/Training center

Remote Training, Webinars and Go To Meetings

“Hands On” Training

180 full and part-time employees

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MRC Current Operations

MRC Training Program

Supports current Medicare Administrative Contractors (MACs) across multiple

Medicare Medical Review Claim Determinations Include

Part A Inpatient – Medical Necessity & DRG Validations

Part A Inpatient Cardiac Rehabilitation

Part A Home Health

Part A Hospice

Part B of A

Part B including E&M, Drug Administration, Therapy, Laboratory, Radiology, Oncology, Ophthalmology, etc.

Provider Appeal Reviews of:

Recovery Audit Contractor (RAC) denials

MAC and ZPIC denials

MAC Train-the-Trainer and Internal Training Program

Annual System Security, Conflicts of Interest, Compliance, HIPAA and Data Privacy Training

CMS Medical Review (MR) and Appeals Manual training

Claim processing, workflow and adjudication training specific to individual MAC requirements

MAC, RAC and ZPIC Appeals, workflow and adjudication training specific to individual MAC requirements

Inter-Rate Reliability testing/training

Quality Assurance Plan Program in place with routine internal and external reporting and feedback

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MRC Case Management System

MRC Network Connectivity

Features Include

Workload distribution, tracking control, reporting & invoicing support

Customized report, worksheet & letter templates

Data auto-fill, mapping & edit capability

Customized for each

MAC client

Capable of integrating

access to FISS, MCS & VMS

Comprehensive Case Tracking

System

Accommodates every type of MAC claim &

appeal

Separate installations for each customer

Site-to-Site VPN

CMSnet

User VPN

IVANs

Citrix

MoveIt

Secure electronic importing & exporting of data

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Program Integrity Support

Medicare/Medicaid program integrity support is also a Lifecare core competency. As the only small business awarded a CMS PSC IDIQ contract, Lifecare has served CMS as both a prime contractor and a principal subcontractor in its anti-fraud and abuse initiatives. As a prime contractor, Lifecare was awarded a CMS task order to review nebulizer drug payments in 17 states. As a subcontractor on four PSC task orders, Lifecare provided legal counsel, investigative and data analysis services and support.

Review RAC claim determinations on Medicare claims that were paid under part D of title XVIII of the Social Security Act to ensure that the RACs only identify and attempt to recoup claims resulting in an overpayment to the plan sponsor.

RAC Validation Contract for Part D

CMS awarded a similar contract to Lifecare for the collection of medical records related to the Medicaid Payment Error Rate Measurement (PERM) program. The initial sample involved 17 state Medicaid programs.

Medicaid Payment Error Rate Measurement (PERM)

Under its PSC IDIQ contract, Lifecare currently performs work for the CMS Comprehensive Error Rate Testing Program (CERT). Under this initiative, Lifecare is responsible for the procurement of medical records from providers whose claims are selected for CERT medical review. Lifecare has been responsible for the successful procurement, scanning and control of over 120,000 provider medical records per year.

Comprehensive Error Rate Testing Program (CERT)

2005

2005

2004

Our program integrity staff are available to assist customers with fraud, waste and abuse initiatives including data analysis, investigations, provider risk assessments, background checks, risk scoring and surveillance.

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Lifecare Value Adds

SMAll DiSADVANTAgEDBUSiNESS (SDB)

Medicare Subject Matter Experts

Flexible & multiple work

schedules

Known entity at CMS

Exceptional CMS

Contractor Performance

Reports

Qualified subcontractors:

Advanta Government Services and

Livanta

CMS COI Compliant

Supports multiple MACs

and CMS contractors

CMS Systems Security

Compliant

"Lifecare’s flexibility in working closely with our staff on all process and systems modifications has been commendable."

ContactPlease visit our website for more information: www.Lifecare-USA.com

Lifecare Medical Review Center10810 Guilford Rd, Suite 111Annapolis Junction, MD 20701301-490-8853

Jim BordeauPresident203-630-9922jbordeau@lifecare-usa.com

Joy BahnemannExecutive Vice President803-338-0586jbahnemann@lifecare-usa.com

NAIC Codes5218210

5241114

524298

541110

541219

541611

541612

541614

541990

561110

561320

561422

561440

561499

561611

611430

DUNS Number932201437