Medicare Administrative Contractors (MACs) have been implemented across the country to process fee-for-service claims for both Medicare Part A and B, replacing fiscal intermediaries that administered Part A and carriers that administered Part B. Part A Medicare helps cover fees from hospitals, skilled nursing facilities and other institutional providers. Part B covers fees from physicians, laboratories and other practitioners.
Below is an overview of the conversion from 15 Medicare Administrative Contractors (MACs) to 10 within the next several years.
Through the initial series of A/B MAC procurements, Medicare’s claims processing operations have realized significant operational savings from the consolidation of state workloads and the efficiencies gained through integrating Part A and Part B functionality. CMS believes that the efficiency and effectiveness of its contracted Medicare claims operations can be further increased by consolidating some of the smaller A/B MAC workloads to form larger A/B MAC jurisdictions, further reducing the size range among the A/B MACs. In addition, CMS believes that reducing the number of A/B MAC contracts to ten will improve the efficiency and effectiveness of CMS’s internal MAC procurement and contract administration processes.
To achieve its ultimate goal of ten A/B MAC contracts, over the next several years, CMS will consolidate the following ten A/B MAC workloads, comprising five pairings, to form five consolidated A/B MAC contracts.
o A/B MAC Jurisdictions 2 and 3 (Alaska, Washington, Oregon, Idaho, North Dakota, South Dakota, Montana, Wyoming, Utah, and Arizona)
o A/B MAC Jurisdictions 4 and 7 (Louisiana, Arkansas, Mississippi, Texas, Oklahoma, Colorado, and New Mexico)
o A/B MAC Jurisdictions 5 and 6 (Minnesota, Wisconsin, Illinois, Kansas, Nebraska, Iowa, and Missouri)
o A/B MAC Jurisdictions 8 and 15 (Kentucky, Ohio, Michigan, and Indiana)
o A/B MAC Jurisdictions 13 and 14 (New York, Connecticut, Massachusetts, Rhode Island, Vermont, Maine, and New Hampshire)
Jurisdictions 2 and 7 were originally solicited in 2006, but will not be implemented based on their original solicitations. Rather, CMS will integrate these workloads into new solicitations that will, respectively, also incorporate the Medicare workloads performed by the existing A/B MAC Jurisdictions 3 and 4. The first solicitation will consolidate A/B MAC Jurisdictions 2 and 3, and the second solicitation will consolidate A/B MAC Jurisdictions 4 and 7.
CMS intends to re-compete five A/B MAC contracts/jurisdictions based on their present area boundaries, as the current A/B MAC contracts run their course. These five contracts/jurisdictions will not be increased or reduced in size by CMS’s consolidation strategy. The five A/B MAC contracts/jurisdictions that will not be further consolidated are:
o A/B MAC Jurisdiction 1 (California, Hawaii, Nevada, Pacific Islands)
o A/B MAC Jurisdiction 9 (Florida, Puerto Rico, US Virgin Islands)
o A/B MAC Jurisdiction 10 (Alabama, Georgia, Tennessee)
o A/B MAC Jurisdiction 11 (North Carolina, South Carolina, Virginia, West Virginia)
o A/B MAC Jurisdiction 12 (Delaware, Maryland, Pennsylvania, New Jersey, Washington DC)