Here come the ‘Super MACs’

‘No transition is pretty’
Friday, January 29, 2016

YARMOUTH, Maine – Industry stakeholders are weighing the recent shake up in the DME MACs.

For the first time ever, there will be two contractors handling claims processing for all four jurisdictions: CGS Administrators and Noridian Healthcare Solutions.

“This is definitely a big change,” said Wayne van Halem, president of The van Halem Group. “The four jurisdictions have been around since 1993 and there have always been four unique companies doing it. (CGS and Noridian) have become Super MACs.”

Nashville-based CGS snagged the contract for Jurisdiction B— worth $77.7 million and representing 20.7% of the DME workload—in January. CGS, which already holds the contract for Jurisdiction C, replaces National Government Services.

Fargo, N.D.-based Noridian snagged the contract for Jurisdiction A—worth $90.9 million and representing 18% of the DME workload—in December. Noridian, which already holds the contract for Jurisdiction D, replaces NHIC.

It’s a little unsettling to think about two contractors “holding all the cards,” says Kim Brummett, vice president of regulatory affairs for AAHomecare.

“CMS was intentional in creating four MACs so not all of the eggs were in one basket,” she said. “Having Super MACs could be scary.”

The word on the street is, however, that CGS and Noridian will have separate operations for each jurisdiction, stakeholders say.

“They will still have two different medical directors and two different operations directors,” said Andrea Stark, a reimbursement consultant for MiraVista. “There will still be some autonomy.”

There could also be a few positives to having just two contractors, stakeholders say. First, there could be more consistency in how policies are applied, reducing the error rate for DMEPOS claims. Second, CGS and Noridian have better reputations for educating and providing resources to providers.

“Perhaps we’ll see increased service as a result of these transitions,” van Halem said.

One thing’s for sure: Providers can likely expect a few bumps in the road until the transition is complete, stakeholders say. CGS will begin processing claims in Jurisdiction B on June 27. There’s no word yet from Noridian on when it will take over in Jurisdiction A.

“No transition is pretty,” Brummett said. “If you think about all the pre-pay audits, all the claims in process—all of that has to be moved over. It’s never pretty.”