Hughes: Transition to PSCs 'mostly invisible to providers'

Sunday, March 5, 2006

WASHINGTON - CMS's new Program Safeguard Contractors, which handle fraud and abuse, medical review and medical director duties, assumed their jobs March 1.

The PSAs are part of Medicare's reconfiguring of the DMERCs into two specialty contractors: the PSAs and Medicare Affiliated Contractors (MACs). The MACs will handle claims processing, customer service and other duties not covered by the PSA. The transition to the MACs takes place July 1, 2006.

The transition to PSAs should be "mostly invisible to providers" since the PSAs do not handle routine claim flow, said Dr. Paul Hughes, medical director for Tricenturion, the PSA for Regions A and B.

"If you are being audited, you will see a new name and address on the request-for-information letters--that is the big thing suppliers need to know," he said. "If you are in Region A or Region B, for example, and we choose to do an audit on you or develop your claim, instead of getting a letter from HealthNow in Region A or AdminaStar in Region B, you are going to get a letter from Tricenturion saying please send the records."

The PSAs are Tricenturion (Regions A and B); TrustSolutions (Region C) and EDS/IntegriGuard (Region D). The Region C medical director is Dr. Adrian Oleck, who previously handled those duties in Region B. The Region D medical director is Dr. Mark Pilley, who replaces Dr. Robert Hoover.

The switch to PSAs will not impact or change Medicare policy, Hughes said.