Ask the expert: What is the most recent development regarding Medicare Administrative Contractors?
HIM Connection, June 24, 2008
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A: CMS announced June 11 that it has selected Pinnacle Business Solutions, Inc. (PBSI) as the Medicare Administrative Contractor (MAC) that will process Parts A and B Medicare claims in Arkansas, Louisiana, and Mississippi no later than February 2009. By 2011, a total of 15 new MACs will cover every state and the District of Columbia.
“This is another step toward improving service to beneficiaries and health care providers, as well as giving CMS greater oversight of the Medicare contractors that process and pay Medicare claims,” said Acting CMS Administrator Kerry Weems in a CMS press release. “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.”
Currently, fiscal intermediaries process Part A claims (i.e., claims from hospitals, skilled nursing facilities, and other institutional providers), and carriers process Part B claims (i.e., claims from physicians, labs, and other practitioners). MACs will process both types of claims, which will have an approximate value of $178 million over the next five years during which the MAC contract will be valid, according to the CMS press release.
For more information on the new contractors and the states they cover, visit www.cms.hhs.gov/MedicareContractingReform/.
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