The Centers for Medicare and Medicaid has contracted with National Government Services (NGS) to serve as the first point of contact for the processing and payment of Medicare fee-for-service claims from hospitals, skilled nursing facilities, physicians and other healthcare practitioners in Connecticut and New York, beginning no later than November 2008.
"This is another step toward improving service to beneficiaries and healthcare providers, as well as giving CMS greater oversight of the Medicare contractors that process and pay Medicare claims," said Kerry Weems, acting CMS administrator. "In awarding these contracts, CMS is ensuring that each Medicare contractor continues to provide the best overall value to the government, and the American taxpayers, from both a cost and technical perspective."
NGS will take claims payment work now being performed by two fiscal intermediaries and four carriers in the two states. The A/B MAC contract, which has an approximate value of $323 million over five years, will fulfill the requirements of the Medicare Modernization Act's contracting reform provisions.
Under the current system, fiscal intermediaries process claims for Medicare Part A providers, such as hospitals, skilled nursing facilities and other institutional providers. Carriers process claims for physicians, laboratories and other practitioners under Medicare Part B.
The NGS contract includes a base period and four one-year options and will provide NGS with an opportunity to earn award fees based on its ability to meet or exceed the performance requirements set by CMS.
These requirements are rooted in CMS' key objectives for the MACs, including enhanced provider customer service, increased payment accuracy, improved provider education and training leading to correct claims submissions, and realized cost savings resulting from efficiencies and innovation.
In accordance with the MMA, MAC contracts will be re-competed at least every five years.
When it becomes operational, the A/B MAC for Connecticut and New York will be the contact for all Medicare providers and physicians in the two states, while beneficiaries will pose their claims-related questions to a Beneficiary Contact Center.