Medicare contractor changes slow payment for some doctors

In theory, the changes CMS is making to its network of reimbursement contractor firms were supposed to make things easier for doctors. The agency is in the process of replacing a ragtag group of fiscal intermediaries and Medicare carriers with "Medicare administrative contractors" (MACs) serving 15 jurisdictions across the country. Ultimately, by 2011, each of the physicians and hospitals in an area will have a single MAC that handles all Part A and Part B claims for their region.

So far, however, many doctors are complaining that the change have caused more confusion and payment delays, not less. By switching from familiar Medicare carriers to a new MAC with which they have no prior relationship, many doctors have found that it's more difficult to handle administrative issues when they arise, as they don't know who to contact or how to work the system. Meanwhile, some problems may stem from the fact that CMS is choosing MACs through a competitive bidding process. The MACs who were the low bidders may lack the money to offer good customer service, observers say.

On top of everything else, providers continue to struggle with the transition to the National Provider Identifier number and the switch to ICD-10 coding, issues with which can also delay Medicare payments. Stresses like these have forced some physicians and hospitals to add or expand credit lines to cover themselves as they wait for Medicare issues to work themselves out. All in all, a messy situation that is likely to get worse before it gets better.

To learn more about this issue:
- read this AMNews piece

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