MAC transition hits snag

Friday, March 31, 2006

WASHINGTON - Medicare's transition from the DMERCs to the Medicare Administrative Contractors (MACs)--scheduled to occur July 1--has hit a pothole that could delay the transfer of claims processing, customer service and other administrative tasks.
Current Region D DMERC, Cigna Government Services, bid on the MAC contracts for Regions D and C but lost both bids. Palmetto GBA won the Region C bid. Noridian Administrative Services won the Region D bid and replaced Cigna.
Cigna has protested the awarding of the Region D and C bids, and Noridian and Palmetto have stopped work on the transition until CMS rules on the protest. CMS has until May 4 to do that.
Cigna declined to comment on the protest.
Given the amount of work required, the protest makes meeting the July 1 deadline tenuous, say some industry watchers.
"I'm confident they will have the transition teams ready to go as soon as the decision is made, but it will be tight," said former Region D medical director Dr. Robert Hoover, Sunrise Medical's senior vice president of global clinical services.
Even if CMS resolves the protest quickly, consultant Andrea Stark has concerns that providers don't have enough information about the transition and how it will work.
"CMS still has not published a lot of things from an official Medicare standpoint," said Stark, a billing specialist with MiraVista. "Without the published information out there, the transition will not go as smoothly."
CMS has stated that it will hold meetings prior to the transition to educate providers and other stakeholders.
When CMS transitioned to the DMERCs in 1993, providers experienced cash flow problems related to billing snafus. The move to MACs, however, is not nearly as drastic, and the new contractors all have experience with electronic billing. A number of industry watchers expect the transition to be, if not painless, at least tolerable.
"When they went to the DMERCs, it was a mess," said industry attorney Ann Berriman. "But they had to create organizations that didn't exist.Transitioning to the MACs is a little bit like a Chinese fire drill, but it shouldn't be as bad."