Medicare Compliance & Reimbursement

Plus:  Medicare will cover pancreas transplants--but only in a few cases.

Part B carriers will soon be a thing of the past. The Centers for Medicare & Medicaid Services is replacing the carriers and intermediaries with Medicare Administrative Contractors (MACs) for both Part A and Part B.

There will be just 15 MACs serving the whole country. In late June, CMS will award its first MAC contract, for a district that includes Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming. The new contractor will take over those states in July 2007.

And CMS is going to be soliciting bids for three other areas, each of which covers four states. Now providers will have a chance to comment on the work documents that CMS is using to solicit bids. Providers can view CMS' Request for Information online at www.FedBizOpps.gov. CMS welcomes comments from providers on this document and its planned transition.

Medicare Will Cover Pancreas Transplants Under Certain Conditions

Physicians can soon start billing for pancreas transplantation alone, thanks to a national coverage decision from CMS.

Medicare will cover pancreas transplants only in facilities that are approved for kidney transplants. Medicare also will cover the procedure only for patients with certain types of diabetes, including medically-uncontrollable labile (brittle) insulin-dependent diabetes, with life-threatening complications that require hospitalization.

An endocrinologist must have managed the patient for 12 months previously. Patients must be suitable transplant candidates and have the mental capacity to understand the significant risks of the procedure, CMS says.

In Other News ...

• Physicians must recertify. Physicians will have to recertify their enrollment information with Medicare every five years, under a new proposed rule CMS published in the April 21 Federal Register. Physicians must also report enrollment information changes within 90 days, CMS says. The agency also plans to streamline the CMS-855 enrollment forms soon.

• The government wants to help with direct-care worker shortages. CMS has created the National Direct Service Workforce Resource Center "to respond to the large and growing shortage of workers who provide direct care and personal assistance to individuals who need long-term supports and services in the United States," the agency's Web site says.

The Resource Center provides technical assistance to state and local governments, non-profits, employers and professionals who want to improve the recruitment and retention of direct care workers in their states. The Web site is www.dswresourcecenter.org.