Medicare Names New DMEPOS Contractors

Baltimore

CMS has named four specialty contractors that will replace the current Durable Medical Equipment Regional Carriers beginning July 1.

The new DMEPOS Medicare Administrative Contractors, or DME MACs, will be responsible for handling the administration of durable medical equipment, prosthetics and orthotics claims.

The new contractors are as follows:

• Region A, National Heritage Insurance Company, replacing HealthNow;
• Region B, AdminaStar Federal;
• Region C, Palmetto GBA; and
• Region D, Noridian Administrative Services, replacing Cigna.

Under the new the new system, the MACs, which were selected through a competitive bidding process, will only be responsible for claims processing in each of the four DME regions. Separate program safeguard contractors (PSCs) for each region will handle benefit integrity medical review and medical policy. The PSCs, announced late last year, are: TriCenturion for Regions A and B; TrustSolutions for Region C; and for Region D, EDS and subcontractor IntegriGuard.

The DME MAC contracts, which, according to CMS have a combined potential value of $542 million, are the first of 23 contracts that will be awarded by 2011 to fulfill requirements of contracting reform provisions that were included in the Medicare Modernization Act.

Each DME MAC contract will include a base period and four one-year options. The MACs will have the opportunity to earn award fees based on their ability to meet or exceed performance requirements set by CMS.

According to the agency, those requirements are rooted in CMS’ key objectives for the DME MACs: enhanced provider customer service, increased payment accuracy, improved provider education and training leading to correct claims submissions and realized cost savings resulting from efficiencies and innovation. In accordance with the MMA, MAC contracts must be put up for bid at least every five years.

For more information on Medicare contracting reform, visit www.cms.hhs.gov/MedicareContractingReform.