reimbursement@wiki

Medicare Contracting Reform

MAC Reform Analysis/Summaries

• The Medicare Administrative Contractor project: What does it mean for your practice? (Urology Times, April 2008)
• Medicare Contractor Reform: Upcoming Changes in Medicare and How it Will Affect Medicare Providers (December 2006)
• • only slides 1-10
    

Impact of MAC reform

• As part of the MAC transition, local coverage determinations (LCDs) must be consolidated within each MAC region.  The CMS Statement of Work for A/B MACs initially instructed MACs to accept the "least restrictive" policy and to allow the public an opportunity to comment, but later Statements of Work indicated the contractor should use the "most clinically relevant policy currently in place."

A/B MAC Jurisdictions

• A/B MAC Jurisdictions Map
• General Fact Sheet for MAC Jurisdictions
• A/B MAC Jurisdiction Fact Sheets 
• A/B MAC Procurement and Implementation 

15 Part A/Part B MAC Jurisdictions:

• 1.  Palmetto GBA (March 2008) -- CMS award announcement
• • American Samoa, California, Guam, Hawaii, Nevada, Northern Marianas Islands
• 2.  National Heritage Insurance Corporation [NHIC] (May 2008) -- CMS award announcement
• • Washington, Alaska, Idaho, Oregon
• 3.  Noridian Administrative Services (July 2006)
• 4.  Trailblazer Health Enterprises [Trailblazer] (August 2007)
• 5.  Wisconsin Physicians Services Health Insurance Corporation [WPS] (September 2007)
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• 12.  Highmark Medicare Services, Inc. [HMS] (October 2007)
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