Advanced Search

Home Health & Hospice Week

Contractors:

Get Ready For The Medicare Contracting Revolution

Published on Wed Feb 02, 2005

CMS already has reassigned some states to new DME carriers. What's next?

Big changes are coming to the Medicare contractor system - but the Centers for Medicare & Medicaid Services hopes to minimize any adverse impacts on providers and beneficiaries.

At least that's what the agency said during the Feb. 25 special Open Door Forum on Medicare contractor reform, which is already underway for durable medical equipment.

Under the Medicare Modernization Act, CMS must put all fee-for-service claims processing up for bid by 2011, though the agency hopes to complete the process two years earlier. The new claims payment contractors will be called Medicare administrative contractors, or MACs. The agency will award four "specialty" DME MACs, 15 primary MACs and four other specialty MACs serving home health and hospice providers.

The agency is taking comments on its DME MAC request for information through March 10. It plans to have the final request for proposals out by March 31 and to award contracts by Dec. 30."It's a very ambitious schedule," an agency spokesperson acknowledged in the forum.

Check Out the New DMERC Jurisdictions

CMS has published regulatory changes that will allow it to "expeditiously" change the DME regional carrier service area boundaries without formal notice and comment rulemaking.

The agency also is reassigning some states and territories within the jurisdictions of the four DMERCs, it announced. CMS is making the change to fit the DMERCs within the boundaries of the 15 new jurisdictions that will be served by the primary contractors that will process Part A and B Medicare claims.

For example, CMS has moved the District of Columbia and Maryland from Region B to Region A, and Virginia and West Virginia from Region B to Region C. The new jurisdictions are:
 

  • Region A - Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont;
     
  • Region B - Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin;
     
  • Region C - Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia and West Virginia; and
     
  • Region D - Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington and Wyoming.

    "We believe that a very small percentage of suppliers and beneficiaries [will be] affected by this change," Karen Jackson, Medicare Contractor Man-agement director for CMS, said in the forum.

    CMS Wants Your Feedback

    CMS is eager to receive feedback from suppliers and other stakeholders on several specific issues, the agency said in the forum. For example, "We cannot say strongly enough how important it is to hear back from you on performance measures," Jackson said.

    In addition, the RFI assigns responsibility for pre- and post-payment medical review of DME claims with the program safeguard contractor rather than with the MAC. But at the same time, CMS has chosen to locate the contractor medical director with the MAC. That's because agency staff believe if local coverage decisions are developed at the MAC, the medical director needs to reside there.

    CMS wants to know whether stakeholders think splitting up those functions makes sense.

    The agency also wants stakeholders' thoughts on its plans to institute a single front end for the DME workload - that is, having all electronic claims come to one place before they are routed to the DME MACs.

    The move would simplify dealings with providers and clearinghouses, noted CMS data specialist Gary Kavanagh. And the switch would "give us the ability to more quickly update and change these front ends and perhaps bring the Internet ... to that environment much more quickly," he said.

    Editor's Note: Medicare contracting reform details, including instructions for submitting comments on the RFI, are at     www.cms.hhs.gov/medicarereform/contractingreform. The rule on DMERC service areas is at www.access.gpo.gov/su_docs/fedreg/a050225c.html.

    • Other Articles in this issue of

    Home Health & Hospice Week

    View All