Presentation to National Presentation to National Association of - - PowerPoint PPT Presentation

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

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March 24, 2009

15 A/B MAC Jurisdictions

2 14 8 13

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12 3 1 5 11 12 15 11 10 4 7 1 2 9

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MAC Award Status

as of March 20, 2009

J14 National Heritage Insurance Corp. J8 J13 National Government Services J6 Noridian Administrative S i J3 Noridian Administrative J2

TBD

J8 National Government Services (NGS) Services J5 Wi i Services J15 Highmark J12 Highmark Medicare Services J1 Palmetto Government B fit Wisconsin Physicians Service J11 Palmetto Government Benefits Highmark Medicare Services Services Benefits Administrator Administrator J10 Cahaba Government Benefit

Administrators

J4 TrailBlazer Health Enterprises J7

TBD

J9 J9 First Coast Service Options, Inc.

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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

t d i l M expected in early May

• CMS will supply information to providers

shortly after the decisions are available

• CMS continues to evaluate J2 and J7

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Transition of Legacy RHC Workloads

as of March 20, 2009

Jurisdiction/ MAC Implementation Jurisdiction/ Legacy FI MAC Organization Implementation Status

4 / Trailblazer

Trailblazer Completed

12 / Hi h k

Highmark Completed

12 / Highmark

Highmark Completed

14 / NGS

NHIC 5/15/2009

14 / NGS

NHIC 5/15/2009

10 / Riverbend

Cahaba 8/3/2009

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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

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least for the near-term and mid-term

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

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Initial Enrollments Initial Enrollments

A freestanding RHC joining the A freestanding RHC joining the Medicare program for the first time ill ll ith th FI MAC th t will enroll with the FI or MAC that covers the state where the RHC is

• located. Link to enrollment contact

chart: chart:

http://www.cms.hhs.gov/MedicareProviderSupEnroll/

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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

• r MAC that services the main

provider provider.

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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 t d t it M di ll t to update its Medicare enrollment

• 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.

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p

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

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ads/SE0837.pdf