MEDICARE NEWS - FOR IMMEDIATE RELEASE January 6, 2006
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Collection
Title:
MEDICARE NEWS - FOR IMMEDIATE RELEASE January 6, 2006
Text:
Department of Health & Human Services
Centers for Medicare & Medicaid Services
Room 303-D
200 Independence Avenue, SW
Washington, DC 20201
Office of External Affairs
MEDICARE NEWS
FOR IMMEDIATE RELEASE
January 6, 2006
CMS MAKES FIRST AWARDS TO
MEDICARE ADMINISTRATIVE CONTRACTORS
CONTRACTING REFORM WILL LOWER ADMINISTRATIVE COSTS, IMPROVE QUALITY AND
SERVICE FOR DURABLE MEDICAL EQUIPMENT BENEFITS
The Centers for Medicare & Medicaid Services (CMS) announced today that it
has awarded contracts for four specialty contractors who will be responsible
for handling the administration of Medicare claims from suppliers of durable
medical equipment, prosthetics and orthotics. The new contracts awarded
represent a first step in CMS’ initiatives designed to improve service to
beneficiaries and providers, support the delivery of coordinated and quality care, and
provide greater administrative efficiency and effectiveness for
fee-for-service Medicare.
The new Durable Medical Equipment Medicare Administrative Contractors (DME
MACs), which were selected through a competitive bidding process, will replace
the current Durable Medical Equipment Regional Carriers (DMERCs). The
geographic jurisdictions are slightly realigned from those serviced by the DMERCs.
The DME MAC contracts, which have a combined potential value of $542
million, are the first of 23 that will be awarded by 2011 to fulfill requirements of
the contracting reform provisions of the Medicare Modernization Act of 2003.
“As a result of the recent Medicare reforms, for the first time in Medicare’
s 40-year history, we have been able to select our administrative
contractors through a full and open competition to provide the best service at the
lowest cost,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “These
competitive reforms will lead to better quality, more efficiency, and greater
accountability in the administration of the traditional Medicare program.”
CMS awarded the DME MAC contracts to companies who offered the best overall
value to the government, in light of costs, technical qualifications, and
other considerations such as past performance, corporate responsibility, and
their understanding of the special requirements involved in processing claims
for medical equipment and prosthetics provided to beneficiaries. A list of the
new DME MAC jurisdictions appears below.
Under the current system, fiscal intermediaries process claims for Part A
providers such as hospitals, skilled nursing facilities, and other
institutional providers. Carriers process claims for physicians, laboratories and other
suppliers under Medicare Part B. When contracting reform is fully
implemented, the fiscal intermediaries and carriers will be replaced by MACs that will
be responsible for both Part A and Part B claims. For beneficiaries and
providers, the new structure will mean that they each have a single point of
contact with the Medicare program. Once they become operational, the DME MACs
will serve as the point of contact for all Medicare suppliers, whereas
beneficiaries will pose their claims related questions to Beneficiary Contact
Centers.
Each DME MAC contract is being awarded in January 2006 and will include a
base period and four 1-year options. The DME MACs will have the opportunity to
earn award fees based on their ability to meet or exceed the performance
requirements set by CMS. Those performance requirements are rooted in CMS’ key
objectives for DME MACs: enhanced provider customer service, increased
payment accuracy, improved provider education and training leading to correct
claims submissions, and realized cost savings resulting from efficiencies and
innovation. In accordance with the MMA, MAC contracts must be put up for
competitive bidding at least every 5 years.
The DME MACs will immediately begin transition activities and will assume
full responsibilities for the claims processing work currently performed by the
DMERCs on July 1, 2006. However, the DME MACs will not take over any
pre-pay or post-pay medical review function or benefit integrity function performed
by a DMERC. CMS awarded separate payment safeguard contracts for these
functions in early December.
For more information, see: <URL Redacted>
JURISDICTION INCLUDED STATES DME MAC
A Connecticut, Delaware, District of Columbia, Maine, Maryland,
Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and
Vermont - National Heritage Insurance Company
B Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin
- AdminaStar Federal
C Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana,
Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina,
Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia - Palmetto
Government Benefits Administrator
D Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho,
Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern
Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming - Noridian
Administrative Services
Centers for Medicare & Medicaid Services
Room 303-D
200 Independence Avenue, SW
Washington, DC 20201
Office of External Affairs
MEDICARE NEWS
FOR IMMEDIATE RELEASE
January 6, 2006
CMS MAKES FIRST AWARDS TO
MEDICARE ADMINISTRATIVE CONTRACTORS
CONTRACTING REFORM WILL LOWER ADMINISTRATIVE COSTS, IMPROVE QUALITY AND
SERVICE FOR DURABLE MEDICAL EQUIPMENT BENEFITS
The Centers for Medicare & Medicaid Services (CMS) announced today that it
has awarded contracts for four specialty contractors who will be responsible
for handling the administration of Medicare claims from suppliers of durable
medical equipment, prosthetics and orthotics. The new contracts awarded
represent a first step in CMS’ initiatives designed to improve service to
beneficiaries and providers, support the delivery of coordinated and quality care, and
provide greater administrative efficiency and effectiveness for
fee-for-service Medicare.
The new Durable Medical Equipment Medicare Administrative Contractors (DME
MACs), which were selected through a competitive bidding process, will replace
the current Durable Medical Equipment Regional Carriers (DMERCs). The
geographic jurisdictions are slightly realigned from those serviced by the DMERCs.
The DME MAC contracts, which have a combined potential value of $542
million, are the first of 23 that will be awarded by 2011 to fulfill requirements of
the contracting reform provisions of the Medicare Modernization Act of 2003.
“As a result of the recent Medicare reforms, for the first time in Medicare’
s 40-year history, we have been able to select our administrative
contractors through a full and open competition to provide the best service at the
lowest cost,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “These
competitive reforms will lead to better quality, more efficiency, and greater
accountability in the administration of the traditional Medicare program.”
CMS awarded the DME MAC contracts to companies who offered the best overall
value to the government, in light of costs, technical qualifications, and
other considerations such as past performance, corporate responsibility, and
their understanding of the special requirements involved in processing claims
for medical equipment and prosthetics provided to beneficiaries. A list of the
new DME MAC jurisdictions appears below.
Under the current system, fiscal intermediaries process claims for Part A
providers such as hospitals, skilled nursing facilities, and other
institutional providers. Carriers process claims for physicians, laboratories and other
suppliers under Medicare Part B. When contracting reform is fully
implemented, the fiscal intermediaries and carriers will be replaced by MACs that will
be responsible for both Part A and Part B claims. For beneficiaries and
providers, the new structure will mean that they each have a single point of
contact with the Medicare program. Once they become operational, the DME MACs
will serve as the point of contact for all Medicare suppliers, whereas
beneficiaries will pose their claims related questions to Beneficiary Contact
Centers.
Each DME MAC contract is being awarded in January 2006 and will include a
base period and four 1-year options. The DME MACs will have the opportunity to
earn award fees based on their ability to meet or exceed the performance
requirements set by CMS. Those performance requirements are rooted in CMS’ key
objectives for DME MACs: enhanced provider customer service, increased
payment accuracy, improved provider education and training leading to correct
claims submissions, and realized cost savings resulting from efficiencies and
innovation. In accordance with the MMA, MAC contracts must be put up for
competitive bidding at least every 5 years.
The DME MACs will immediately begin transition activities and will assume
full responsibilities for the claims processing work currently performed by the
DMERCs on July 1, 2006. However, the DME MACs will not take over any
pre-pay or post-pay medical review function or benefit integrity function performed
by a DMERC. CMS awarded separate payment safeguard contracts for these
functions in early December.
For more information, see: <URL Redacted>
JURISDICTION INCLUDED STATES DME MAC
A Connecticut, Delaware, District of Columbia, Maine, Maryland,
Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and
Vermont - National Heritage Insurance Company
B Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin
- AdminaStar Federal
C Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana,
Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina,
Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia - Palmetto
Government Benefits Administrator
D Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho,
Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern
Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming - Noridian
Administrative Services
Citation
“MEDICARE NEWS - FOR IMMEDIATE RELEASE January 6, 2006,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/226011.
