Is Your Medicare Carrier Changing?
by Government Relations Staff
April 28, 2008-The Centers for Medicare and Medicaid Services (CMS) has begun to shift away from using separate regional carriers for Part A and Part B claims processing, replacing them with 15 Medicare Administrative Contractors (MACs) responsible for all Part A and Part B claims processing in contiguous geographic areas or jurisdictions.
MACs are gradually being phased into service with full implementation due to be completed in 2009. As a result, psychologists may find their claims, provider relations and local coverage policies handled by a new company.
The Medicare Modernization Act of 2003 initiated these changes, which CMS expects to streamline claims processing and reduce administrative costs.
As an example, Trailblazer was the Part B regional carrier for Maryland, Virginia, the District of Columbia and Texas. The four states had different fiscal intermediaries handling Medicare Part A claims processing. Effective March 1, Trailblazer became responsible for MAC jurisdiction 4, covering all Part A and B claims for Colorado, New Mexico, Oklahoma and Texas
While local carriers often have different policies, MACs are required to adopt the most generous coverage policy for psychological services in all the states in the new jurisdiction. For example, if Oklahoma's coverage policy for psychological testing paid for a greater number of hours of testing and assessment than any of the other states in jurisdiction 4, then Trailblazer's local coverage determination for psychological testing will reflect Oklahoma's prior policy.
For maps of each MAC jurisdiction and information about the contractors who have been awarded jurisdictions to date, visit the CMS Web site at: http://www.cms.hhs.gov/MedicareContractingReform/05_PartAandPart%20BMACJurisdictions.asp#TopOfPage.
For further assistance, contact government relations staff for the APA Practice Organization at pracgovt@apa.org or (202) 336-5889.
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