The headaches and hassles physician practices endured during Medicare Administrative Contractor (MAC) transitions in recent years are now detailed in a new Government Accountability Office (GAO) report. The transitions held up millions of dollars in Medicare reimbursements and caused backlogs of claims appeal cases for months, the GAO says.
Medicare contractor reform, mandated by the Medicare Modernization Act of 2003, will consolidate 51 Medicare "legacy" carrier jurisdictions into 15 MACs by 2011. So far, more than 30 states have transitioned to nine MAC jurisdictions. The GAO found MACs have not met performance standards during those transitions and ultimately physician practices suffered for it.
The report gives examples of "provider challenges" during the transitions. Here's one:
According to CMS, one MAC inherited approximately 27,000 pending provider enrollment applications from its legacy contractor. According to a provider association, about 11,000 of these had been pending for four to six months. More than 1,600 providers and provider groups reported to us delays of 6 months or more for payments of $40,000 to $80,000, and in one case, as high as $3.5 million.
The report doesn't name the state or the MAC, but the circumstances are close to what went on in California with the MAC Palmetto in 2008.
Sens. Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa) have weighed in on the report.
"Delays in payments and backlogged claims create real financial hardship for seniors and health care providers," Baucus said in a statement. "I am pleased to see CMS showing this initiative and moving quickly to streamline payments and reduce fraud, though, when it comes to reforming Medicare contracting, CMS needs to do a better job of improving quality and identifying ways to save money."
"This report also shows that CMS clearly needs to step up its oversight of meeting performance goals and saving taxpayer money, not only on the part of contractors, but also the agency itself," Grassley said.