November 20, 2008
Central to the contracting reform plan in the Medicare Modernization Act of 2003 was to obtain competitively procured contracts that conform to the Federal Acquisition Regulation (FAR). Fifteen new Medicare Administrative Contractors (MACs), processing both Part A and B claims, will handle about the same volume of work in mostly geographically contiguous parts of the US resulting in greater consistency in interpreting Medicare policies. in addition, the they will serve as the central agency through which subsidiary contractors provide additional services.
While the transition from Carriers and Fiscal Intermediaries to Medicare Administrative Contractors (MACs) began in March 2007, recently the Centers for Medicare and Medicaid Services (CMS) released a guide for Medicare providers on how to prepare for a switch to a MAC. MACs commence their work on a cutover date, often taking a phased state by state approach. CMS recommends that providers pay attention to all forms of communication from their old Carrier or FI and the new MAC. Several electronic methods of communication help providers stay current with announcements including email listservs and the MAC's website, especially the FAQs. For example, First Coast Service Options was awarded the J9 jurisdiction September 12, 2008. They have a new transition site. which includes a FAQs page and an email updates listserv.
Providers can also participate in advisory group or "Ask the Contractor" conference calls or meetings to ask questions and obtain information. Specifically, providers should examine the MAC's local coverage decisions (LCDs) since they may differ from their current contractor's.
Prior to Cutover
Complete and return your Electronic Funds Transfer (EFT) agreements with form CMS-588 at least 60 days prior to cutover.
The new MAC may also request a new Electronic Data Interchange (EDI) Trading Partner Agreement. If you do receive a new ID and password, contact the incoming MAC to test these IDs.
Contact your claims processing vendor and clearinghouse and ask "Are you using the new contractor number or ID of the new MAC, submitter number and logon ID?"
CMS may have the outgoing Medicare contractor release claims payments a few days early in preparation for implementation weekend.
Dark days may occur around or over cutover weekends where the Part A provider will have limited EDI processing and no access to Fiscal Intermediary Standard System (FISS) to conduct claim entry or claim correction, verify beneficiary eligibility and claim status, and interactive voice response (IVR) systems may also be unavailable. Providers who currently bill carriers may also experience some limited access.
The first 1-2 weeks may be extremely busy at the MAC, which may have new mailing addresses and telephone numbers. Be prepared for some delays service.
Learn the IVR as soon as you can to say time.
There may be changes in faxing policies (e.g., for medical records) and in Remittance Advice (RA) coding.
The preparation document contains checklists prepared by time before cutover date to help providers transition and has documents to help track trainings and other resources. Better late than never, providers who are still awaiting their MAC transitions will greatly benefit from this resource.
Dr. Carter's Corner Darren Carter, MD, founder and President of Provistas, has a personal commitment to alleviating uncertainties in the health compliance environment. He has authored dozens of articles, presents to professional and hospital associations, serves on several editorial boards, and provides consulting and expert witness testimony.