Florida Benefit Integrity Support Center
The Florida Benefit Integrity Support Center (FLA-BISC) is a PSC operated by both IntegriGuard, as a subcontractor, and SafeGuard Services, LLC (SGS), the prime contractor for this contract. The contract to operate this specific PSC was awarded to IntegriGuard and SGS in January 2005 at the end of a competitive procurement process.
Which Medicare providers are in the catchment area of the FLA-BISC?
Medicare Part A and Part B providers that submit claims for Medicare reimbursement in the state of Florida are in the catchment area, or claims jurisdiction, of the FLA-BISC.
Why did CMS decide to enter into this arrangement?
This contract arrangement is consistent with CMS' business plan for Medicare fee-for-service claims operations and supports CMS' efforts to improve its oversight of Medicare contractors. Utilization of the specific competencies of IntegriGuard in medical review and audit functions in concert with the data and investigative capabilities of SGS provides value and reduced risk for CMS. This PSC structure is a win-win situation for CMS, the PSC, the Carrier/FI, and Medicare providers and beneficiaries because it allows all parties to focus on their strengths and provide quality services to our Medicare providers and beneficiaries.
What activities do both contractors perform for the FLA-BISC?
IntegriGuard has the responsibility for medical review, education, and cost report audit functions in support of fraud and abuse cases and complaints development.
SGS is contracted to perform the fraud and data analysis scope of this work.
How is CMS ensuring that the contractors and the PSC properly coordinate their activities and respond to provider needs?
The accountability for ensuring that the two contractors coordinate appropriately rests with CMS. Through active involvement in the transition process, CMS ensured that both parties understand their individual and collective roles and responsibilities. In addition, CMS required both contractors to enter into a Joint Operating Agreement (JOA). This document delineates each contractor's roles and responsibilities, including how each operates and coordinates activities and data between them. CMS monitors both contractors and the JOA throughout the life of both parties' contracts.