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.

Read more on Medicare Administrative Contractor report

The Medicare Administrative Carrier (MAC) Highmark is reporting they processed Medicare claims with a conversion factor using the 21% sustainable growth rate (SGR) cut.  Initially, Highmark announced no claims were processed at the reduced rate. The MAC now says the cut went through because of an "internal system error."

"Systems corrections have been made, and claims paid at the incorrect -21% fee will be reprocessed automatically," Highmark says. "[The MAC] plans to continue releasing held claims on a first in first out basis, which will process with the correct fee schedule."

The error effects claims with dates of service from April 1 through April 7.  

Highmark is the MAC for Pennsylvania, Delaware, Maryland, New Jersey and the District of Columbia metro area.

Erase any thought you had of Donald Berwick, MD, breezing through the Senate confirmation process and into a corner office at CMS HQ. He's received support from Democrats and medical associations, but Republicans are mounting opposition to his bid for CMS administrator. 

Sen. John Barrasso, MD, (R-Wyo.) took to the Senate floor April 21 and warned Americans that Dr. Berwick supports rationing patient care. "He has a history of support for government rationing of health care resources on the grounds of cost," said Sen. Barrasso, who is a trained orthopedic surgeon. "Not on the grounds of quality, not on the grounds of survivability but on the grounds of cost. And he has said, as recently as last June, ‘the decision is not whether or not we will ration care.' he said, ‘the decision is whether we will ration with our eyes open.' So here we are, the newly nominated person has said, I'm going into this to ration care." [emphasis mine, CF]

Read more on Berwick opposition

A little known tweak to privacy rules will mean private practices get more unwanted publicity when they experience a HIPAA slip up.  

President Barack Obama nominated Donald Berwick, MD, of Massachusetts to be the next CMS administrator on April 19.

"Dr. Berwick has dedicated his career to improving outcomes for patients and providing better care at lower cost," Obama said in a statement from the White House. "That's one of the core missions facing our next CMS Administrator, and I'm confident that Don will be an outstanding leader for the agency and the millions of Americans it serves."

Dr. Berwick is president of the think tank the Institute for Healthcare Improvement and he is a professor at Harvard Medical School and the Harvard School of Public Health.

Read more on CMS nominee Berwick