The Medicare Administrative Contractor project: What does it mean for your practice?

April 1, 2008

The Medicare Administrative Contractor is a new contract reform project that will enhance the flow of data for services charged to Medicare.

The Centers for Medicare & Medicaid Services considers Medicare contracting reform, which can be found in sections 9 through 11 of the Medicare Prescription Drug Improvement and Modernization Act of 2003, a major component of its move to be more successful in administering Medicare fee-for-service contracts. Why does Medicare look at this as such a big part of its future success to ensure health care security for Medicare beneficiaries? The answer is quite simple. There was very little data exchange between Part A and Part B payers. Originally, there were different contractors for Part A and Part B in each state. Over the past several years, there has been a consolidation of contracts, with a single contractor administering several different states for Part B Medicare. In addition, some of the same carriers had been awarded contracts to administer Part A Medicare, but not necessarily in the same states in which they were assigned the Part B contract.

The contract awards began in 2005 and will continue through 2009. As of this writing, all jurisdictions have been awarded for Parts A/B except 8, 9, and 10, which are scheduled to be awarded in September 2008.

Although they have encountered a few bumps in the road, the MACs are beginning the process of operation. The Part A/B MACs are required to develop an integrated and consistent approach to medical coverage across the service areas that benefits both beneficiaries and providers.