Home Health & Hospice Week

HHAs served by new MACs are in for tough times, expert predicts.

The Medicare program's push for contracting reform will result in big changes for many home health agencies and hospices in the coming year -- and probably big headaches.

The Centers for Medicare & Medicaid Services has named new Medicare contractors for 34 states. The new Medicare Administrative Con-tractors (MACs) will take over from the current regional home health intermediaries.

HHAs and hospices currently served by Palmetto GBA and National Government Ser-vices shouldn't notice many changes. That's because Palmetto is retaining its 16 states of home health work and the new contractor taking over NGS's six-state workload, National Heritage Insurance Corp., will retain NGS as its home health contractor.

"It would make sense ... that NHIC would contract with NGS," says consultant M. Aaron Lit-tle with BKD in Springfield, Mo. "I'm not certain that NHIC had an existing infrastructure for processing home health and hospice claims."

NHIC providers "will likely experience less turmoil than those in other states," the National Association for Home Care & Hospice says.

"Those with PBGA should count their blessings," says Tom Boyd with Rohnert Park, Calif.-based Boyd & Nicholas. "None of the others have HHA and hospice experience. Better the devil you know than the one you don't."

HHAs and hospices served by new MACs Highmark Medicare Services and Noridian Administrative Services will see "major changes," NAHC predicts.

Timeline: The deadline of March 2010 should give the new MACs time to ramp up, Boyd expects. But you can nearly always expect rough patches in any transition.

"I hope the new guys hire more staff prior to the change or the increased work load will cause problems," Boyd tells Eli. "Nordian is my main concern here as I question if their available labor pool has the necessary skill set."

"I'm hoping for is a smooth transition similar to what providers experienced when Cahaba took over the contract previously held by WellMark," Little says. "Our experience in transitioning our [skilled nursing facility] billing clients to the new MACs has -- for the most part -- gone smoothly."

Cahaba GBA "will work closely with the incoming contractors throughout the transition process to ensure a smooth transfer of business functions for our current home health and hospice providers," the intermediary pledges in an email to providers. "Until the transition to MAC is complete, Cahaba will continue to serve as your Intermediary, maintaining the same level of service to our provider community."

Here are the new jurisdictions with their incoming home health MACs, according to Cahaba:

• Jurisdiction 6 (includes HH+H Jurisdiction D) HH+H States: AK, AZ, CA, HI, ID, MI, MN, NV, NJ, NY, OR, WI, WA. Incoming MAC: Noridian Administrative Services.

• Jurisdiction 11 (includes HH+H Jurisdic-tion C) HH+H States: AL, AR, FL, GA, IL, IN, KY, LA, MS, NM, MC, OH, OK, SC, TN, TX. Incoming MAC: Palmetto Government Benefit Administrators (the same).

• Jurisdiction 14 (includes HH+H Jurisdic-tion A) HH+H States: CT, ME, MA, NH, RI, VT. Incoming MAC: National Heritage Insurance Corp-oration.

• Jurisdiction 15 (includes HH+H Jurisdic-tion B) HH+H States: CO, DE, DC, IA, KS, MD, MO, MT, NE, ND, PA, SD, UT, VA, WV, WY. Incoming MAC: Highmark Medicare Services.

CMS originally planned to have four specialty MAC jurisdictions for home health, notes the National Association for Home Care & Hospice. But the agency changed its mind and integrated the work into four of the Part A/Part B MAC workloads.

That's too bad for home care providers, Boyd says. When contractors have to service both hospitals and HHAs, "MACs will first focus on the hospitals as being the larger receiver of Medicare monies," he believes.

"As sure as daylight, the time will come when a MAC employee will [think] that an HHA with $50,000 is a minor problem and the payment snag should only be a mild inconvenience because ... it is for the hospitals," Boyd worries. This type of thing has "happened so many times in the past I lost count."

Chain woes: Chains have another problem with the new MAC structure, Boyd points out. They no longer will be able to send all their claims to one contractor. Instead, each location will have to send its claims to the MAC from its geographic jurisdiction, forcing one company to deal with up to four MACs.

Home care providers have also lost the option to switch to a backup intermediary, he adds.