Health Law

Major Changes are Afoot at Centers For Medicare and Medicaid Services

By Todd A. Rodriguez

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on November 26, 2006 enacting Section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. Section 911 of the MMA required the (CMS) to replace the current fiscal intermediary and carrier contracts for the administration of Medicare benefits with new contracts with Medicare Administrative Contractors (MACs) who will administer both Part A and Part B. The duties of the selected MACs will include not only claims processing but also customer service, provider education, financial management, payment safeguards, and information systems security.

Per the final rule, the country will be divided into fifteen “A/B Jurisdictions” and each A/B Jurisdiction will be assigned to one MAC, who will administer both Part A and Part B claims. Pennsylvania, New Jersey, Delaware, Maryland, and the District of Columbia have been assigned to A/B Jurisdiction 12. CMS recently awarded the MAC contract for A/B Jurisdiction 12 to Highmark Medicare Services. Implementation plans for Highmark began in November of 2007 and are expected to be completed by September 2008.  For more infomration on these major changes, contact Anne Jorgensen.

Full post as published by Physician Law on December 11, 2007 (boomark / email).