First Quarter 2008 - Issues in Hematology - ION Solutions

oncologistics reimbursement watchTHE IMPACT OFMEDICARE ADMINISTRATIVECONTRACTOR REFORM ONPHYSICIAN PRACTICESby: Emily PhillipsIn the next 2 years, oncology and hematology practices across the United Stateswill experience dramatic changes in their regional Medicare contractors’ operationalrequirements, claims processing, and coverage policies. Yet with this rapidtransformation already starting, few healthcare providers have given much thoughtto the impact Medicare Administrative Contractor (MAC) reform will have on theirpractices. Providers who fail to take notice of these important changes could see claimdenials, payment delays, or missed opportunities to weigh in on proposals for newcoverage policies that could impact patient care.BACKGROUNDMAC reform is part of the Medicare ModernizationAct (MMA) of 2003, which was passed byCongress in an effort to stem rising Medicarecosts. Under MAC reform, Medicare carriers andfi scal intermediaries will be replaced by 15 PartA/B MACs divided into multi-state jurisdictions.Prior to MAC reform, there were nearly 50operational Medicare fi scal intermediaries andcarriers operating across the United States. Theend result of MAC reform will be one contractorper jurisdiction. The goal is to simplify the numberof Medicare processes and requirements onthe local level through consolidation of multipleMedicare administrators. The transitions, whichstarted in 2006 with the award for J3 to Noridian,and most recently, in J4 and J5, are intendedto improve the consistency of coverage andclaims processing requirements. Previously,CMS contracted with nearly 50 private insurersto process Medicare claims and administerMedicare benefi ts. That ultimately hamperedMedicare’s ability to meet healthcare deliverychallenges. Some issues with the formerMedicare contracting structure included a lack ofcompetition, specialization restrictions, separateprocessing for Part A and B claims, and anabsence of performance-based incentives.oncologistics 25