Corporate Compliance

Preparing for an A/B MAC transition

Medicare Insider, November 25, 2008

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Editor's Note: Kimberly Anderwood Hoy, director of Medicare and compliance for HCPro, is the author of this week's "Note from the Instructor."

This week, CMS announced National Heritage Insurance Company (NHIC) as the A/B MAC for the New England jurisdiction (Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont). NHIC was primarily a Part B carrier prior to its selection as an A/B MAC for the northwest (Washington, Oregon, Idaho and Alaska), and now for New England. Many former students have discussed with me the difficulties they have experienced transitioning to a new contractor. This difficulty has been exaggerated in locations where the new contractor was formerly Part B carrier focused. This is presumably due to the very different coding, reimbursement, and even coverage environments of the services provided by suppliers (formerly billed to carriers) and those provided by institutional providers, such as hospitals. 

I encourage everyone in these states, and anyone affected by a MAC transition, to review the Special Edition MLN Matters Article SE0837, noted in last week’s Medicare Weekly Update. It discusses steps a provider can take to minimize problems during the transition, what to expect for process changes and possible disruptions to cash flow, and how to avoid them. I encourage everyone to pay particular attention to the possible changes to the local coverage determinations, including determinations of self-administered drugs.  These may change under a new MAC, and the effective dates of changes can be confusing and have to be monitored closely to ensure you are notifying your patients appropriately of non-covered services. 

One last note: Over the next couple of months, you will begin to see all the Medicare Boot Camp – Hospital Version instructors write the note in Medicare Weekly Update. This will allow all of our regulatory specialists an opportunity to share their views on the many changes CMS makes throughout the year.


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