Home Health & Hospice Week

New players add mystery to DME payment environment.

Region A and Region D suppliers will submit their claims to new carriers effective July 1.

The Centers for Medicare & Medicaid Services has awarded new contracts for the administration of durable medical equipment Medicare claims.

This change is another step forward in CMS' plan to reengineer Medicare's claims administration process, with former DMERC responsibilities split up among other contractors. The new Medicare Affiliated Contractors (MACs) will take care of billing, customer service, and other day-to-day operations while the Program Safeguard Contractors (PSCs) will focus on fraud and abuse and medical review.

Meet The New Players

The existing DMERCs in regions B and C (AdminaStar Federal and Palmetto, respectively) were awarded the new MAC contracts for their regions.

Region A suppliers will make the move from HealthNow New York Inc. to National Heritage Insurance Company. Region D suppliers will transition from CIGNA Government Services to Noridian Administrative Services.

"Hopefully, there will be a seamless transition from one contractor to the other," says Washington, DC-based attorney Asela Cuervo. But suppliers should be watchful that the process goes smoothly, she says.

A handful of states will also change regions when the new MAC environment becomes effective. Maryland and the District of Columbia will join Region A; Kentucky will join Region B; and Virginia and West Virginia will join Region C. Region D remains the same.

Some suppliers express concern over how these changes may impact their businesses. With the DMERCs, "at least you know how they've done things in the past," says Alan Grogan of Grogan's Healthcare Supply in Lexington, KY. Add in a bunch of new players and "it's an utter mystery" what will happen, says Grogan, also a trustee with the Kentucky Medical Equipment Suppliers Association.

Suppliers will lose "the continuity and the experience that the [existing] contractors brought to the table," says Cuervo.

Establish Relationships For Success

Experts advise suppliers to take a proactive approach to this change. Review the carrier Web sites and participate in their listservs, Web conferences and teleconferences, advises attorney Jeff Baird with Brown & Fortunato in Amarillo, TX. "Glean as much as possible to see if there will be any change in direction," he says.

Suppliers in regions that will be working with new carriers should be on the lookout for different interpretations of policies, says Cuervo. Suppliers should also be watchful of the file transfer process to make sure that no issues arise there, she says.

The key to making the new environment work will be communication, says Cuervo. This includes establishing relationships with the new contractors that are similar to those that already exist between the supplier community, the medical directors and the DMERC staff, she says.