November 2008 Newsletter

Transitioning to MACs

By: Tom Fabik, Technical Writer

New entities, Medicare Administrative Contractors (MACs), are replacing the Medicare claims payment contractors known as fiscal intermediaries (FI) and carriers. As part of the transition to MACs, new jurisdictions have been established and new contractors are being selected. Part A and Part B claims are aligned by state so the same contractor will process both institutional (UB-04) and professional (CMS1500) claims for a state.  On the institutional side, some specialty services, such as home health and hospice, may go to a regional MAC that is different from the contractor for Part A and B claims. Several of the jurisdictions have already transitioned to the new MACs. This article describes what Quadax is doing to ensure a smooth transition, as well as provides some details on the benefits of MACs and the new jurisdictions.

Benefits of MACs

MACs are responsible for the receipt, processing, and payment of Medicare fee-for-service claims. By integrating the operations for Parts A and B, information that was once held separately will be centralized, allowing for improved delivery of comprehensive care and support to Medicare beneficiaries and healthcare providers.

Some specific benefits of the implementation of MACs include:

Improved Beneficiary Services

• Most beneficiaries will have their claims processed by only one contractor, reducing the number of separate EOBs a beneficiary will receive.
• A/B MACs will be required to develop an integrated and consistent approach to medical coverage across its service area, which benefits both beneficiaries and providers.
• Beneficiaries will be able to have their questions on claims answered by calling 1­800-MEDICARE, their single point of contact.

Improved Provider Services

• A simplified interface with a single MAC for Part A and Part B processing and other services will benefit providers.
• Competition will encourage MACs to deliver better service to providers.
• Requiring MACs to focus on financial management will result in more accurate claims payments and greater consistency in payment decisions.

MAC Jurisdictions

CMS designed the new MAC jurisdictions to balance the allocation of workloads, promote competition, account for integration of claims processing activities, and mitigate the risk to the Medicare program during the transition to the new contractors. The resulting jurisdictions balance the number of fee-for-service beneficiaries and providers. While these jurisdictions vary in size and workload, they are more evenly divided than the existing fiscal intermediary and carrier workload.

CMS plans to award 19 MACs through a competitive bidding process during the initial implementation phase. These include 15 A/B MACs servicing the majority of all types of providers (both Part A and Part B), and four specialty MACs servicing durable medical equipment suppliers. Since January 2006, CMS has awarded thirteen contracts to companies to serve as Medicare Administrative Contractors (MACs). Four of the contracts, awarded in January 2006, were for Durable Medical Equipment.

Transition/implementation activities begin immediately after the contract is awarded. The specific transition/implementation timelines for each MAC depend on the date the contract is awarded as well as the various factors of the specific contract, including the amount and type of workload, the number of current intermediaries and carriers, and any specialty work to be handled.

For more details and the latest information from CMS regarding the MAC transition and implementation, see http://www.cms.hhs.gov/MedicareContractingReform/.

Jurisdiction #	States included in Jurisdiction	Contract Awarded to	Go-Live Dates
1	American Samoa, California, Guam, Hawaii, Nevada, and Northern Marianas	Palmetto GBA	August 2008
2	Alaska, Idaho, Oregon, and Washington	National Heritage Insurance Corp.	December 2008
3	Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming	Noridian Administrative Services	March 2007
4	Colorado, New Mexico, Oklahoma, and Texas	TrailBlazer Health Enterprises	March to June 2008
5	Iowa, Kansas, Missouri, and Nebraska	Wisconsin Physicians Health Insurance Corp.	December 2007 to June 2008
6	Illinois, Minnesota, and Wisconsin	TBD	TBD
7	Arkansas, Louisiana, and Mississippi	Pinnacle Business Solutions, Inc	February 2009
8	Indiana and Michigan	TBD	TBD
9	Florida, Puerto Rico, and U.S. Virgin Islands	First Coast Service Options, Inc	March 2009
10	Alabama, Georgia, and Tennessee	TBD	TBD
11	North Carolina, South Carolina, Virginia and West Virginia	TBD	TBD
12	Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania	Highmark Medicare Services	July to December 2008
13	Connecticut and New York	National Government Services	July to November 2008
14	Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont	TBD	TBD
15	Kentucky and Ohio	TBD	TBD

Quadax Makes It a Smooth Transition

Quadax is working proactively to ensure a seamless transition for our clients. We are closely monitoring the transition process as it evolves, tracking when contracts are assigned and when “go-live” dates are scheduled. We then identify any issues and make the necessary changes so the process occurs without interruption.

Specifically, we test transmissions and check response files to eliminate any issues before the “go-live” date. In some cases, providers may need to complete new Electronic Data Interchange Enrollment Forms or ERA Enrollment forms. Our service representatives contact providers if they need to complete these forms.

On the UB side, specialty services (home health and hospice) may go to a regional MAC, which is different than the contractor for part A and B claims. When this occurs, a new claim type is needed for UB billing. We identify these situations and make the necessary changes so the claims go to the correct MAC.

As the “go-live” date nears, the MAC may impose “dark days,” on which the Medicare claims processing system will not be available for normal business operations and claims will not be processed. The MAC may require this period in order to switch their systems to the new provider.

The MAC may also require a “payment floor release” to insure all provider payments are cleared from the previous system by the end of the transition period. During this time, usually two weeks, providers will see increased payments. However, providers will see smaller checks as the system starts up for the new workloads because the payment floor will be beginning in the new processing environment.

As this process continues, you can rest assured that Quadax is staying on top of the transition and will keep you informed as issues arise. If you have any questions about how the transition will affect you, contact your Quadax Service Representative.

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