Presentation to National Presentation to National Association of Rural Health Clinics Update on MAC Implementation for Rural Health Clinics Christopher Klots Mark Zobel Division of MAC Strategy & Development Centers for Medicare & Medicaid Services March 24, 2009 1
14 2 13 12 12 11 11 15 A/B MAC Jurisdictions 9 15 10 8 7 6 5 4 1 1 3 2 2 1
MAC Award Status as of March 20, 2009 J14 National J2 Heritage J13 J6 Insurance National TBD J3 Noridian Corp. Government Noridian Administrative Services Administrative Services S i J8 J8 (NGS) Services National Government Services J12 J1 Highmark Palmetto Medicare J15 Government J5 Services Services Highmark Highmark B Benefits fit Wisconsin Wi i Medicare Administrator Physicians Services Service J11 Palmetto Government Benefits J10 Administrator J4 Cahaba TrailBlazer Government J7 Health Benefit Enterprises TBD Administrators J9 J9 First Coast Service Options, Inc. 3
Post-Award Administration Post Award Administration • Awards for Jurisdictions 6 8 11 & 15 Awards for Jurisdictions 6, 8, 11, & 15 have been protested • Mandatory stay of performance • Mandatory stay of performance • General Accountability Office decisions expected in early May t d i l M • CMS will supply information to providers shortly after the decisions are available • CMS continues to evaluate J2 and J7 4
Transition of Legacy RHC Workloads as of March 20, 2009 Jurisdiction/ Jurisdiction/ MAC MAC Implementation Implementation Organization Status Legacy FI Trailblazer Completed 4 / Trailblazer Highmark Highmark Completed Completed 12 / Hi h 12 / Highmark k NHIC NHIC 5/15/2009 5/15/2009 14 / NGS 14 / NGS Cahaba 8/3/2009 10 / Riverbend 5
Jurisdiction 10 Implementation Jurisdiction 10 Implementation • Riverbend Part A moves to J10 on August 3, 2009 • All freestanding RHCs currently in that workload will be moved to Cahaba, workload will be moved to Cahaba, the J10 MAC • Those RHCs will be serviced by J10 at least for the near term and mid term least for the near-term and mid-term 6
CMS Implementation Approach CMS Implementation Approach • Ensure contractors work well together • Ensure contractors work well together • Provide advance notice of change to • Provide advance notice of change to providers • See MLM Article SE0837 • Manage implementations carefully 7
Initial Enrollments Initial Enrollments A freestanding RHC joining the A freestanding RHC joining the Medicare program for the first time will enroll with the FI or MAC that ill ll ith th FI MAC th t covers the state where the RHC is located. Link to enrollment contact chart: chart: http://www.cms.hhs.gov/MedicareProviderSupEnroll/ 8
Initial Enrollments (cont.) A provider-based RHC joining the Medicare program for the first time will enroll with the FI first time will enroll with the FI or MAC that services the main provider provider. 9
Updating an Existing Enrollment Record An e isting RHC ( ith a claims histor An existing RHC (with a claims history and a current assignment) may need to update its Medicare enrollment t d t it M di ll t record. The updated 855 enrollment application will be filed with the FI or MAC where the RHC currently y submits its claims and files its cost report. p 10
Helpful Resources • Contracting Reform Web Pages: http://www.cms.hhs.gov/MedicareContractingReform/ • 42 CFR 421.404: http://www.cms.hhs.gov/quarterlyproviderupdates/dow nloads/cms1506fc pdf nloads/cms1506fc.pdf • Article on implementation of geographic assignment: http://www.cms.hhs.gov/MLNMattersArticles/downlo http://www cms hhs gov/MLNMattersArticles/downlo ads/MM5979.pdf • Article on the sequence of events that attend the Article on the sequence of events that attend the transfer of an individual provider http://www.cms.hhs.gov/MLNMattersArticles/downlo ads/SE0837 pdf ads/SE0837.pdf 11
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