Month: January 2016

Following up on a previous Smart Brief announcement, regarding upcoming changes in the contractors who will serve as the Durable Medical Equipment Medicare Administrative Contractors (DME MACs), AOPA has learned about additional details regarding the transition of DME MAC Jurisdiction A and Jurisdiction B responsibilities.

The denial of the NGS protest of the Jurisdiction B DME MAC contract award clears the way for CGS to begin transition work in preparation for its June 27, 2016 start date as the new Jurisdiction B DME MAC. CGS has announced that as of June 27, 2016, Jurisdiction B claims will be processed out of CGS existing operations center in Nashville, TN. CGS has announced that it intends to hire at least 150 staff members in Nashville to ensure that they have adequate capability to begin processing claims as of June 27th. In addition, CGS has announced that Doran Edwards, MD will serve as the Jurisdiction B DME MAC Medical Director once CGS takes over responsibility for Jurisdiction B. Dr. Edwards currently serves as an associate medical director for the Jurisdiction C DME MAC and has previously served as the medical director of the SADMERC. CGS has established a transition website where providers may learn more about the transition process. The transition website may be accessed by clicking on the following link: www.cgsmedicare.com/jb

In other news, Medicare NHIC has elected not to file a protest of the recent award of the Jurisdiction A DME MAC contract to Noridian Health Services, LLC, the current contractor responsible for Jurisdiction D and the PDAC. While this decision means that transition activities will begin shortly, Noridian has made no announcements as of yet. AOPA will continue to follow developments in both of these transitions closely.

Questions regarding this issue may be directed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org

As AOPA reported earlier, CGS, the current Jurisdiction C DME MAC contractor, was awarded the Jurisdiction B contract on September 3, 2015. However, National Government Services (NGS), the current Jurisdiction B DME MAC, filed a formal protest causing CMS to halt the transition pending a review of the contract award by the Government Accountability office (GAO). The GAO upheld the contract award and CGS will be the new DME MAC for Jurisdiction B beginning June 27, 2016. NGS will continue to serve as the Jurisdiction B contractor until the June 27 deadline; and any questions about current claims/audits should still be directed and handled by NGS until June 24, 2016.

CGS has created a help desk; to contact the help desk dial 877-363-8895, to answer any questions suppliers may have about the transition or you may visit www.cgsmedicare.com/jb. Questions regarding this issue may be directed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org

On December 16, 2015, the Centers for Medicare and Medicaid Service (CMS) announced that Noridian HealthCare Solutions, LLC. was awarded a contract to serve as the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC).  Noridian currently holds contracts to serve as the Jurisdiction D DME MAC as well as the Pricing, Data Analysis, and Coding Contractor (PDAC) and will replace National Heritage Insurance Corporation (NHIC) as the Jurisdiction A DME MAC contractor.

While no contract award protests have been filed as of yet, it is highly likely that one or more of the companies that submitted proposals to CMS to serve as the Jurisdiction A DME MAC will formally protest the award to Noridian which will result in a delay in the final award of the contract.

With the December 16^th announcement, the number of contractors responsible for processing Medicare DMEPOS claims may ultimately be reduced to two, as CMS announced in September of 2015 that the contract to serve as the Jurisdiction B DME MAC was awarded to CGS, which currently serves as the Jurisdiction C DME MAC. This award was immediately protested by National Government Services, the incumbent contractor for Jurisdiction B and the protest has not yet been resolved.

AOPA will continue to follow developments regarding both of these contract awards and will communicate any new information to its members as it becomes available.

Questions regarding this issue may be directed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.