One of the key changes CMS made recently is that currently, CMS contracts with private insurers to process claims for Medicare beneficiaries. By 2011, these "intermediaries" will be replaced by Medicare Administrative Contractors (MACs).

Medicare Contracting Reform (or section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) mandates that the Secretary for Health & Human Services replace the current contracting authority to administer the Medicare Part A and Part B Fee For Service (FFS) programs, contained under Sections 1816 and 1842 of the Social Security Act, with the new Medicare Administrative Contactor authority. Medicare Contracting Reform requires that CMS conduct full and open competitions, in compliance with general federal contracting rules, for the work currently handled by FIs and carriers in administering the Medicare fee-for-service program.

When completed there will be 15 new MACs processing Part A and Part B claims. Each MAC will handle roughly the same volume of work. Because of this, the MACs will vary in geographic size but not necessarily in the amount of work they handle. This should result in greater consistency in the interpretation of Medicare policies.

MAC Implementation Milestones Definitions
There are specific milestones in the cutover from carrier or FI work to MAC. In this article, providers are advised to be aware of, and to take specific action, relative to the milestones defined below:

Award - this is the point at which a MAC is announced as having won the contract for specific FI or carrier work.

Cutover - This is the date on which carrier or FI work ceases and MAC work begins. Cutover is often done in phases by State-level jurisdictions.

Pre - Award
If you are in a jurisdiction where a new MAC has not yet been awarded, you can remain current with updates on Medicare contracting reform by visiting on the CMS website.

Timeline and Checklist for Preparing for MAC Implementation

90 days before Cutover

  1. Visit MAC website and bookmark for future use.
  2. Join the MAC Listserv.
  3. Monitor: LCDs Published by the new MAC; compare current LCD's that affect your practice's services.
  4. Review:
    • Provider enrollment status for all providers, update as needed.
    • Pay-to address information for practice/providers, update as needed.
  5. Contact:
    • Your Practice Management/Billing software vendor to determine if your system will be able to send & receive data to/from the new MAC.
    • Claims Clearinghouse (if used) to confirm they are or will be able to send and receive data to/from the new MAC.

75 Days Before Cutover

  1. Continue to check the MAC's website and/or Listserv for outreach programs, educational and informational events, and conference calls.
  2. Check your state's Medical Society or local provider organization website for MAC transition information, MAC Coordinators.

60 Days Before Cutover

  1. If needed, submit CMS Form 588 - EDI form(s) to the new MAC.
  2. Consider registering for Electronic Remittance Advice (ERA) enrollment, if you are not already enrolled.
  3. Download or request a sample Remittance Advice (RA). RA codes are standard, but use of codes may vary across contractors.

45 Days Before Cutover

  1. Monitor current carrier/FI claim submissions and follow-up any open or unanswered claims that are more than 30 days past submission date.
  2. Begin staff training on the MAC transition, covering locations, LCDs, telephone and fax numbers and other changes.
  3. Verify readiness of software vendor, clearinghouse(s) and other trading partners.

30 Days Before Cutover

  1. Continue to monitor current carrier/FI claim submissions and follow-up any open or unanswered claims that are more than 30 days past submission date.
  2. New EDI Submitter ID number and password should be received.
  3. New ERA enrollment confirmation should be received.
  4. Submit test electronic claims.
  5. Address and resolve any electronic claim issues within 10 business days.
  6. Begin daily monitoring of e-mail from the MAC Listserv.

15 Days Before Cutover

  1. Continue to monitor current carrier/FI claim submissions.
  2. Verify EDI and ERA connections are operational.
  3. Collect and record all MAC telephone and fax numbers for: General Inquiry Customer Service, Provider Enrollment, Provider Relations, EDI and ERA.
  4. Place test calls and become familiar with the MAC IVR query system.
  5. Continue daily monitoring of the MAC Listserv.

10 Days Before Cutover

  1. Address any existing open items.
  2. Continue daily monitoring of the MAC Listserv.

5-10 Days After Cutover

  1. Begin submitting claims to the new MAC.
  2. Continue daily monitoring of the MAC listserv.
  3. Monitor and follow up on the MAC Open Item list.

30 Days After Cutover

  1. Electronic payments should be arriving by now.
  2. Payments for paper claims may be arriving by now.

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Publication Date: Wednesday, February 11, 2009