CMS Redraws Medicare Carrier Map

BALTIMORE–Medicare has announced new carrier jurisdictions,
including those for the four DMERCs, to be used when it puts DME
claims processing business up for bid next month.

Part of an overall change in Medicare’s claims processing
program, the reconfiguration is designed to “balance the
allocations of workloads, promote competition, account for
integration of claims-processing activities and mitigate the risk
to the Medicare program during the transition to the new
contractors,” according to a CMS statement issued last
Thursday.

As mandated by the Medicare Modernization Act, CMS must put all
fee-for-service claims processing business up for bid–including
Part A, Part B, DME and home health and hospice–and award all
contracts by 2011. The new claims payment contractors will be
called Medicare Administrative Contractors, or MACs. The agency
will award four “specialty” DME MACs, 15 primary MACs and four
other specialty MACs serving home health and hospice providers.

Next month, the agency will begin the contractor reform process
with the DMERCs, and will issue a DME MAC request for proposal.
Winners, to be chosen by December, will cover geographic areas that
resemble current DMERC regions, but with several realignments. For
example, CMS has switched Maryland and the District of Columbia
from Region B to Region A, and Virginia and West Virginia from
Region B to Region C. The new MAC jurisdictions include:

Region A–Connecticut, Delaware, District of Columbia, Maine,
Maryland, Massachusetts, New Hampshire, New Jersey, New York,
Pennsylvania, Rhode Island and Vermont.

Region B–Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio
and Wisconsin.

Region C–Alabama, Arkansas, Colorado, Florida, Georgia,
Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma,
Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands,
Virginia and West Virginia.

Region D–Alaska, American Samoa, Arizona, California, Guam,
Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada,
North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah,
Washington and Wyoming.

CMS said the DME carrier regions were altered to coordinate with
new regions for handling Part A and B claims, and that an analysis
shows the changes will “affect a relatively small percentage of
providers and beneficiaries in these areas.” Currently, Part A and
B carriers operate in 51 overlapping jurisdictions. In the coming
years, CMS plans to award contracts for MACs that will process both
Part A and B claims within only 15 jurisdictions.

More information, including a map of all new MAC jurisdictions
and a timeline for contract awards, is available at www.cms.hhs.gov/medicarereform/contractingreform.

For more news, visit this week’s HomeCare Monday,
available at www.homecaremonday.com.