MIR-2006-6AB, June 2006

Assignment of Physicians, Providers, and Suppliers to the Medicare Administrative Contractors (MAC)

Provider Types Affected
Providers, physicians, and suppliers who bill Medicare contractors (fiscal intermediaries (FI) including regional home health intermediaries (RHHI), and carriers, including durable medical equipment regional carriers (DMERC)) for their services

Key Points
The Centers for Medicare & Medicaid Services (CMS) is implementing significant changes to the Medicare fee-for-service program’s administrative structure. This Medicare Contracting Reform (MCR) will:

• Integrate and simplify the administration of Medicare Parts A and B with primary A/B MACs which will process both Part A and Part B claims for the fee-for-service benefit;
• Make contracting dynamic, competitive, and performance-based, resulting in more accurate claims payments and greater consistency in payment decisions; and
• Centralize information, creating a platform for advances in the delivery of comprehensive care.

Under MCR, there will be 23 Medicare Administrative Contractors (MAC) with no national MAC. These new MACs will include:

• Fifteen primary A/B MACs to serve the majority of all types of providers for Part A and Part B;
• Four specialty MACs to serve home health and hospice providers; and
• Four specialty MACs to serve durable medical equipment (DME) suppliers.

MACs will serve as the primary point of contact for provider enrollment, Medicare coverage, and billing requirements training for providers, and the receipt, processing and payment of Medicare fee-for-service claims for Medicare providers’ respective jurisdictions.

Medicare providers will be assigned to the local designated MAC based on their geographic location to the MAC which has jurisdiction for that benefit category and location.

The new MAC jurisdictions will be more similar to each other in size than the existing fiscal intermediary (FI) and carrier jurisdictions. The workload allocation and the number of fee-for-service beneficiaries and providers in each MAC jurisdiction will be reasonably balanced. The jurisdictions of the eight specialty MACs will overlay the boundaries of the fifteen primary A/B MAC jurisdictions.

Background
The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) (P.L. 108-173) allows the CMS to take appropriate steps to transition from agreements under Section 1816 of the Social Security Act to contracts with Medicare Administrative Contractors (MAC) under section 1874A. The changes to Medicare’s administration are designed to increase the efficiency of Medicare’s claims processing and related functions. They will benefit Medicare providers and Medicare’s enrollee population.

Additional Information
During the initial implementation phase (2005-2011) of the Medicare fee-for-service administrative contracting reform, CMS intends to issue Requests for Proposals (RFP) to compete and award contracts for 23 MACs (four DME and four Home Health/Hospice MACs, and 15 primary A/B MACs).

The transition to the MAC administrative structure will be implemented through a series of acquisition cycles (9-12 months from solicitation to award). The subsequent workload transition to the new MAC system is projected to take 6-13 months after contract award.

Medicare’s MAC Jurisdictions

MLN Matters Number: SE0624 Related Change Request Number: N/A

For additional information about the MCR process, please refer to http://www.cms.hhs.gov/MedicareContractingReform/   on the CMS Web site.

CR4002, Transmittal# 670, Realignment of States and Medicare Claims Processing Workload from DMERC Regions A, B, C, and D to the DME MAC Jurisdictions A, B, C, and D discusses phase 1 of the MAC acquisition and transition schedule. It can be found at http://www.cms.hhs.gov/transmittals/downloads/R670CP.pdf   on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: SE0624
Related Change Request (CR) #: N/A
Effective Date: N/A