CMS COMPETES ADDITIONAL MEDICARE ADMINISTRATIVE CONTRACTORS
MOVE AIMED AT IMPROVED SERVICES TO BENEFICIARIES, PROVIDERS, AND SUPPLIERS
The Centers for Medicare & Medicaid Services (CMS) today released a Request for Proposal (RFP) for new Medicare Administrative Contractors (MACs) that will streamline the processes to pay Medicare claims and answer providers’ questions about Medicare payments for services.
This RFP is for three of 15 separate contracts that will be issued as part of the Medicare contracting reform created by the Medicare Modernization Act. Under these improvements, Medicare will continue its move from a network of Part A fiscal intermediaries who process claims for hospitals and other institutional providers, and Part B carriers who process claims for physicians, laboratories, and other suppliers to one that will combine responsibility for both Part A and Part B claims. This will allow for a greater coordination of claims processing when a beneficiary receives services in different settings. For providers, this will also mean having one place to go for questions about claims.
CMS expects to achieve high performance from MACs for claims administration, with the focus, through competition, on greater efficiency, innovation and outstanding performance.
“The announcement of this RFP is a major step forward in CMS’s efforts to bring the benefits of full and open competition into play in selecting the contractors who carry so much responsibility for the proper administration of the Medicare program,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “We’re continuing to work to improve service for the providers and suppliers who treat Medicare beneficiaries.”
Together these contractors will be responsible for 23 percent of the total Medicare fee-for-service workload, comprised of claims from the following jurisdictions:
- Jurisdiction 4 – Colorado, New Mexico, Oklahoma, and Texas
- Jurisdiction 5 – Iowa, Kansas, Missouri and Nebraska
- Jurisdiction 12 – Delaware, the District of Columbia, Maryland, New Jersey and Pennsylvania
The RFP also contains unique requirements for specific MACs. These include:
- Jurisdiction 4 has special requirements for Indian Health Services, the Veterans Affairs Medicare Equivalent Remittance Advice, centralized billing for mass immunizers, rural community hospitals, and a chiropractic demonstration.
- Jurisdiction 5 has special requirements for rural community hospitals, a chiropractic services demonstration, and a low vision demonstration.
Fact Sheets about Jurisdictions 4, 5 and 12 are appended to this release. CMS expects to award these contracts in July 2007. CMS intends to issue a separate RFP for four other MAC jurisdictions in December 2006, and additional RFPs will be issued in 2007 for the remainder of the 15 MAC jurisdictions.
CMS previously awarded an A/B MAC contract for Jurisdiction 3, covering Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming, as well as four specialty contracts for the Durable Medical Equipment MACs. The Government Accountability Office sustained a protest of the award for DME MAC Jurisdiction C. After that decision, CMS undertook corrective action. After evaluation of final proposal revisions under the corrective action, CMS today also announced that it had awarded the contract for DME MAC Jurisdiction C to CIGNA Government Services, LLC (CIGNA).
Fact sheets for Jurisdictions 4, 5, and 12 along with additional information on Medicare contracting reform can be found on the Medicare contracting reform webpage at:
http://www.cms.hhs.gov/MedicareContractingReform/
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