Contracting reform, the most sweeping change in Medicare’s 43-year existence, is about half done. At the end of 2008, the Centers for Medicare & Medicaid Services had chosen Medicare administrative contractors, or MACs, for 10 jurisdictions covering 29 states.
By the end of 2011, the original patchwork system of Medicare carriers and fiscal intermediaries will be entirely replaced by 15 MACs, each serving a specific area of the country. Those contractors will handle all Medicare Part A and B claims for hospitals and physicians within their jurisdiction.
So – midway through the process, what have providers who have completed the transition learned? What they’ve learned may help counterparts in the remaining 21 states avoid serious cash flow problems, operate more efficiently and devote more time and attention to patients.
Here are five big things we have been hearing in the field:
Move fast. Take advantage of early on-boarding to avoid possible lengthy cash-flow disruptions.
Palmetto GBA, the MAC that took over claims processing for California, Nevada and Hawaii in September 2008, offered early on-boarding. Thousands of physicians and practices who later reported payment disruptions due to the sheer volume of claims during the transfer probably wish they had accepted the offer. Providers are connected with their new MACs on a first come, first served basis. The lesson: use the channels available to get on board as soon as your MAC is assigned.
Avoid payment delays that can result from paper claims.
Continuing to file paper claims after the on boarding deadline with your new MAC virtually guarantees payment delays. That’s partly because some MACs use different guidelines to process paper claims. The solution is to move to online billing as quickly as possible.
Explore and evaluate alternatives that allow you to eliminate using a modem to access your Medicare contractor, Fiscal Intermediary Standard System (FISS) for DDE or Professional Provider Telecommunications Network (PPTN).
Next to paper billing, a telephone modem is the slowest, most inefficient and unreliable way to connect with your new MAC, FISS or PPTN. You have much faster, more efficient alternatives available, and you should evaluate each one based on the answers to key questions related to your practice and long-term plans.
Don’t automatically assume your MAC is responsible for all Medicare billing problems.
Many payment disruptions are related to the final switchover in late May to the National Provider Identifier System. A good share of those reports are coming from California, where Palmetto GBA is working hard to resolve the problems they have inherited.
Work through the system to resolve payment problems.
If you’re experiencing billing problems, contact your new MAC to get them resolved. If that doesn’t work, your CMS regional office may be able to help.
All in all, the best advice for providers is to face transitions issues now. Connect with your new MAC as soon as they have been named and get on board as soon as possible to keep your cash flow running smoothly. n
Garry Keute is director of business development for Minneapolis-based VisionShare Inc. The company offers software and services to reduce cost, increase speed, and ensure security of data connections for healthcare providers, healthcare payers, government agencies, and financial service organizations.