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New Medicare administrative contractor will soon handle your claims
e-Reports, Feb. 21, 2012
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As in the past, the ISMA staff will help you with questions and concerns Untitled document

The Centers for Medicare & Medicaid Services (CMS) recently confirmed a new Medicare administrative contractor (MAC) for Indiana and Michigan, Jurisdiction 8 (J8). In the end, the government agency upheld its original September decision: National Government Services (NGS) is out and Wisconsin Physicians Service (WPS) is in.

When the contracts were first announced last fall, NGS protested the J8 award. The Government Accountability Office then conducted a review, which resulted in a decision, announced Jan. 30, to go forward with the award designating Indiana and Michigan to WPS.

new MAC“The changeover to WPS will impact every physician and hospital in our state that takes Medicare,” said Dan Kelsey, director of ISMA’s Practice Advisory Group. “Over the years, we have been fortunate with the services and assistance NGS provided us. Now, we will work to build a cooperative relationship with WPS to minimize problems and claims delays for our members.”

While specific timelines for the changeover have not been announced, WPS officials noted they are already working to ensure a smooth and seamless implementation.

“The ISMA will keep you advised about the changeover process as soon as information becomes available,” added Kelsey. The new Medicare administrative contractor will also handle enrollment, education, auditing, appeals and more.

In fact, when the new five-year contract is fully implemented, WPS will serve more than 2.2 million Medicare beneficiaries in Indiana and Michigan, as well as 350 hospitals and approximately 41,000 physicians. Jurisdiction 8 will administer approximately 5.8 percent of national fee-for-service Medicare claims volume.

Why the contractor change?
Initially, CMS implemented MAC contracts as a way to consolidate state workloads and find operational savings. CMS now seeks further consolidation of smaller areas into larger jurisdictions to improve efficiency and effectiveness. The agency currently has 10 MAC contractors and a goal to form five consolidated Part A and B MACs over the next several years.

As further consolidation occurs, a new bidding process will begin before current contracts run out. At that time, the jurisdictions will no longer be referred to with numerals but will change to alphabetical designations. Indiana will become part of Jurisdiction I and our MAC may again change.

To read more about the MAC consolidation, see the CMS website.

How will this impact my office?
“At some point, a break-off date will be announced, after which you will begin sending your Medicare claims to WPS,” advised Jeri Biedenkopf, R.N., ISMA practice advisor. “Also at that time, all paper checks, EFTs (electronic funds transfers), and checks to patients will come from WPS.” That date is not yet known.

Biedenkopf urged practices to read, listen carefully and follow instructions. “No transition is easy and – even with the best intentions – glitches and errors could occur. At those times, you can call us at the ISMA and, as always, we will make every effort to resolve issues for you.”

If you have revalidated your enrollment with Medicare, you need not revalidate your enrollment with WPS – unless requested to do so, Biedenkopf noted. However, the ISMA practice advisor suggested you do two things:

  • • Make sure you are on the NGS listserv to get notices of changes; visit NGS.
  • • Start familiarizing yourself with the WPS website.

“Keep reading ISMA Reports for updates on this important transition,” Biedenkopf said, “especially since there is a chance local medical policy may also undergo some change.”

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