Latest Medicare News

Obama Names Berwick to Medicare Post | July 7, 2010
While the U.S. Senate is on recess, President Barack Obama has appointed Donald Berwick as the head of the Centers for Medicare and Medicaid Services (CMS). There has not been a permanent administrator of CMS since October 2006.
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House Approves 6 Month Delay to Medicare Cut | June 25, 2010
The U.S. House of Representatives voted to delay the 21.2% Medicare reimbursement rate cut for six months. The House voted 417 to 1 to delay the cut that went into effect on June 1, 2010.
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21 Percent Medicare Pay Cut Goes Into Effect | June 18, 2010
The United States Senate has agreed to postpone the 21.2% Medicare physician pay cut for six months. The vote now goes to the House of Representatives with optimism that it will be passed quickly in the coming week. In the meantime, the Centers for Medicare and Medicaid Services (CMS) instructed Medicare Contractors to begin processing Part B claims, with the 21.2% pay cut, that have been on hold since June 1, 2010.
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CMS is Helping DME Suppliers Clean Claims | June 10, 2010
The Centers for Medicare and Medicaid Services (CMS) are changing their approach to provider education after a rise in Durable Medical Equipment (DME) claim denial rates. CMS is hosting educational calls, titled “listening sessions” where representatives from the DME Medicare Administrative Contractors (DME MACs) discuss the most common reasons for denied claims and how changes in processing can help get a claim approved.
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    » Watch an Informational Webinar on Lowering Claim Denial Rates

New Bill to Push Medicare Pay Cuts to 2014 | May 21, 2010
Congress has amended to the unemployment and tax extenders bill, a fix to postpone the 21% Medicare physician pay cut scheduled for June 1, 2010. The cut will be replaced with a 1.3% Medicare physician pay increase in 2010 and a 1% increase in 2011, with potential increases in 2012 and 2013.
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New Medicare Claim Filing Requirements | May 14, 2010
The Centers for Medicare and Medicaid Services (CMS) updated their claims systems to process claims with a date of service within one calendar year. Medicare claims with date of service after January 1, 2010 can only be submitted for up to one year. Claims submitted more than a year from the date of service will be denied.
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Medicare Pay for Performance Program Saves $15 Million | May 7, 2010
Between January 2008 and December 2009, home health agencies saved over $15 million under the Centers for Medicare and Medicaid Services (CMS) pay for performance program. Due to the success of the program, CMS is sharing the savings with home health agencies that received high ratings for their quality of care.
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States Awarded Federal Funds for EHR Planning | April 27, 2010
The Centers for Medicare and Medicaid Services (CMS) awarded the states of New Mexico and Washington federal funding to implement electronic health records. New Mexico and Washington will receive $405,000 and $967,000, respectively.
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View more in our News Archive

Medicare Contractor Jurisdictions

State	A/B Jurisdiction	A/B MAC	DME Jurisdiction	DME MAC	HH&H Jurisdiction	HH&H MAC
Alabama	10	Cahaba GBA	C	CIGNA Government Services	C	Palmetto GBA
Alaska	2	NHIC, Corp.	D	Noridian Administrative Services	D	Noridian Administrative Services
American Samoa	1	Palmetto GBA	D	Noridian Administrative Services	D	Noridian Administrative Services
Arizona	3	Noridian Administrative Services	D	Noridian Administrative Services	D	Noridian Administrative Services
Arkansas	7	TrailBlazer Health Enterprises	C	CIGNA Government Services	C	Palmetto GBA
California	1	Palmetto GBA	D	Noridian Administrative Services	D	Noridian Administrative Services
Colorado	4	TrailBlazer Health Enterprises	C	CIGNA Government Services	B	Highmark Medicare Services
Connecticut	13	National Government Services	A	NHIC, Corp.	A	NHIC, Corp.
Delaware	12	Highmark Medicare Services	A	NHIC, Corp.	B	Highmark Medicare Services
Dist. of Columbia	12	Highmark Medicare Services	A	NHIC, Corp.	B	Highmark Medicare Services
Florida	9	First Coast Service Options	C	CIGNA Government Services	C	Palmetto GBA
Georgia	10	Cahaba GBA	C	CIGNA Government Services	C	Palmetto GBA
Guam	1	Palmetto GBA	D	Noridian Administrative Services	D	Noridian Administrative Services
Hawaii	1	Palmetto GBA	D	Noridian Administrative Services	D	Noridian Administrative Services
Idaho	2	NHIC, Corp.	D	Noridian Administrative Services	D	Noridian Administrative Services
Illinois	6	Noridian Administrative Services	B	National Government Services	C	Palmetto GBA
Indiana	8	National Government Services	B	National Government Services	C	Palmetto GBA
Iowa	5	Wisconsin Physicians Health Insurance Corp.	D	Noridian Administrative Services	B	Highmark Medicare Services
Kansas	5	Wisconsin Physicians Health Insurance Corp.	D	Noridian Administrative Services	B	Highmark Medicare Services
Kentucky	15	Highmark Medicare Services	B	National Government Services	C	Palmetto GBA
Louisiana	7	TrailBlazer Health Enterprises	C	CIGNA Government Services	C	Palmetto GBA
Maine	14	NHIC, Corp.	A	NHIC, Corp.	A	NHIC, Corp.
Marina Islands	1	Palmetto GBA	D	Noridian Administrative Services	D	Noridian Administrative Services
Maryland	12	Highmark Medicare Services	A	NHIC, Corp.	B	Highmark Medicare Services
Massachusetts	14	NHIC, Corp.	A	NHIC, Corp.	A	NHIC, Corp.
Michigan	8	National Government Services	B	National Government Services	D	Noridian Administrative Services
Minnesota	6	Noridian Administrative Services	B	National Government Services	D	Noridian Administrative Services
Mississippi	7	TrailBlazer Health Enterprises	C	CIGNA Government Services	C	Palmetto GBA
Missouri	5	Wisconsin Physicians Health Insurance Corp.	D	Noridian Administrative Services	B	Highmark Medicare Services
Montana	3	Noridian Administrative Services	D	Noridian Administrative Services	B	Highmark Medicare Services
Nebraska	5	Wisconsin Physicians Health Insurance Corp.	D	Noridian Administrative Services	B	Highmark Medicare Services
Nevada	1	Palmetto GBA	D	Noridian Administrative Services	D	Noridian Administrative Services
New Hampshire	14	NHIC, Corp.	A	NHIC, Corp.	A	NHIC, Corp.
New Jersey	12	Highmark Medicare Services	A	NHIC, Corp.	D	Noridian Administrative Services
New Mexico	4	TrailBlazer Health Enterprises	C	CIGNA Government Services	C	Palmetto GBA
New York	13	National Government Services	A	NHIC, Corp.	D	Noridian Administrative Services
North Carolina	11	Palmetto GBA	C	CIGNA Government Services	C	Palmetto GBA
North Dakota	3	Noridian Administrative Services	D	Noridian Administrative Services	B	Highmark Medicare Services
Ohio	15	Highmark Medicare Services	B	National Government Services	C	Palmetto GBA
Oklahoma	4	TrailBlazer Health Enterprises	C	CIGNA Government Services	C	Palmetto GBA
Oregon	2	NHIC, Corp.	D	Noridian Administrative Services	D	Noridian Administrative Services
Pennsylvania	12	Highmark Medicare Services	A	NHIC, Corp.	B	Highmark Medicare Services
Puerto Rico	9	First Coast Service Options	C	CIGNA Government Services	D	Noridian Administrative Services
Rhode Island	14	NHIC, Corp.	A	NHIC, Corp.	A	NHIC, Corp.
South Carolina	11	Palmetto GBA	C	CIGNA Government Services	C	Palmetto GBA
South Dakota	3	Noridian Administrative Services	D	Noridian Administrative Services	B	Highmark Medicare Services
Tennessee	10	Cahaba GBA	C	CIGNA Government Services	C	Palmetto GBA
Texas	4	TrailBlazer Health Enterprises	C	CIGNA Government Services	C	Palmetto GBA
U.S. Virgin Islands	9	First Coast Service Options	C	CIGNA Government Services	D	Noridian Administrative Services
Utah	3	Noridian Administrative Services	D	Noridian Administrative Services	B	Highmark Medicare Services
Vermont	14	NHIC, Corp.	A	NHIC, Corp.	A	NHIC, Corp.
Virginia	11	Palmetto GBA	C	CIGNA Government Services	B	Highmark Medicare Services
Washington	2	NHIC, Corp.	D	Noridian Administrative Services	D	Noridian Administrative Services
West Virginia	11	Palmetto GBA	C	CIGNA Government Services	B	Highmark Medicare Services
Wisconsin	6	Noridian Administrative Services	B	National Government Services	D	Noridian Administrative Services
Wyoming	3	Noridian Administrative Services	D	Noridian Administrative Services	B	Highmark Medicare Services

Medicare Links

Useful Medicare Links

• CMS' Medicare Contracting Reform Page
• General Fact Sheet for MAC Jurisdictions
• A/B MAC Jurisdictions Map
• A/B MAC Jurisdiction Fact Sheets
• Durable Medical Equipment MAC Jurisdiction Map
• Durable Medical Equipment MAC Jurisdiction Fact Sheets
• Home Health & Hospice MAC Jurisdictions Map
• Home Health & Hospice MAC Jurisdiction Fact Sheets

News Archive

Donald Berwick Announced as Nominee To Head CMS | April 20, 2010
On Monday, April 19, 2010, President Obama formally announced his nomination of Donald M. Berwick to be the chief of the Centers for Medicare and Medicaid Services (CMS). The Senate now decides if Berwick will be the first permanent chief executive to lead CMS since 2006.
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CMS Proposes Rate Changes to 2011 Inpatient Hospital Stays | April 20, 2010
The Centers for Medicare and Medicaid Services (CMS) proposed a 0.1%, or $142 million, decline in payment for acute care hospital stays in fiscal year 2011. This measure is to recoup the cost of excess spending in 2008 and 2009 due to changes in hospital coding procedures. CMS also has estimated an increase in long-term care hospital rates by 0.8% or $41 million in fiscal year 2011, when compared to 2010.
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Doctor Pay Cut Delayed | April 15, 2010
President Obama signed legislation to push back the 21.2% physician pay cut until June 1, 2010. The House and Senate passed the $18 billion package 289-112 and 59-38, respectively. The vote came on the day the pay cut went into affect, making it possible that some claims filed on April 15, 2010 may be processed with the cut in place.
    » Read More

Jurisdiction 1 WPS Transition "Dark Days" | April 12, 2010
On April 19, 2010, healthcare providers processing Part A claims through WPS in the states of California, Nevada, Hawaii, Guam, American Samoa and the Northern Mariana Islands will transition to Palmetto GBA. Providers are required to obtain a new submitter ID from Palmetto GBA to submit claims. "Dark Days" are scheduled for Friday, April 16 through Tuesday, April 20, 2010. A "Dark Day" is defined as a day in which the Medicare claims processing system is not available for normal business operations.
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CMS Launches Site to Analyze Medicare Treatment Cost | April 6, 2010
The Centers for Medicare and Medicaid Services (CMS) launched a website titled CMS Dashboard to give healthcare providers a view into statistics around Medicare claims payment. The site includes information for approximately 40 million hospital visits, is segmented by year and state, and is updated monthly.
    » Read More

Health Reform Amendments Will Provide Additional Funding for Primary Care | April 5, 2010
Primary Care Physicians will receive more support under to the health reform law. The final amendments to the law will:

• increase Medicaid primary care pay to 100% of Medicare rates in 2013 and 2014; and
  
• provide a 10% Medicare bonus from 2011 to 2015 for certain primary care and major surgical procedures.

    » Read More

Donald Berwick Nominated To Head CMS | March 29, 2010
The Obama administration nominated Donald M. Berwick, president of the Institute for Health Care Improvement, to be the chief of the Centers for Medicare and Medicaid Services (CMS). Berwick will be the first permanent chief executive to lead CMS since 2006 and is an advocate of delivering quality patient care at a low cost.
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Health Reform Reconciliation Bill Passed By Senate | March 25, 2010
Provisions to the health reform bill have been passed by the U.S. Senate on a 56-43 vote. The reconciliation bill now awaits approval by the House of Representatives. The President signed the health reform bill into law on March 23, 2010.
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Healthcare Reform Bill Signed Into Law | March 23, 2010
President Barack Obama signed into law a bill that will expand healthcare insurance coverage to 32 million American citizens. "Today, after almost a century of trying; today, after over a year of debate; today, after all of the votes have been tallied, health insurance reform becomes law in the United States of America," President Obama said.
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CMS Expands ICD-9 Codes | March 23, 2010
The Centers for Medicare & Medicaid Services (CMS) will increase the number of ICD-9 codes they accept beginning in 2011. This increase will allow for additional diagnosis and procedure codes to be used. On October 1, 2013, healthcare providers will need to move to the new ICD-10 code system.
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House Passes Healthcare Reform Bill | March 22, 2010
On March 21, 2010 the House of Representatives voted to pass the healthcare reform bill. The 219-212 House vote will assure that approximately 32 million Americans get healthcare insurance and will protect the insured from losing their insurance.
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Sixteen States Awarded $162 million in HIE Grants | March 15, 2010
As part of the American Recovery and Reinvestment Act (ARRA), the Department of Health and Human Services (HHS) awarded 16 states $162 million to facilitate the adoption of healthcare IT. "These critical investments will help unleash the power of health information technology to cut costs, eliminate paperwork and help doctors deliver high-quality, coordinated care to patients," HHC Secretary Kathleen Sebelius said.
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Senate Passes Legislation to Delay Medicare Payment Cut until Oct. 1 | March 11, 2010
The U.S. Senate voted on March 10, 2010 to delay the 21.2 percent payment cut that would affect Medicare physicians. The bill was passed by the Senate with a 62-36 margin.
    » Read More

Increase in Health IT Spending in the Year Ahead | March 8, 2010
Healthcare providers are looking to increase their IT spending in the next year according to the Annual Healthcare Information and Management Systems Society (HIMSS) Leadership survey. New investments in health IT are to meet the government's meaningful use requirements.
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Bill Signed to Delay Medicare Cut | March 4, 2010
On Tuesday March 2, President Obama signed a bill to delay the scheduled Medicare pay cut for one month. The bill also extends COBRA premium subsidies and insurance for the unemployed.
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Jurisdiction 1 WPS Transition | March 1, 2010
On April 19, 2010, healthcare providers processing Part A claims through WPS in the states of California, Nevada, Hawaii, Guam, American Samoa and the Northern Mariana Islands will transition to Palmetto GBA. Providers are required to obtain a new submitter ID from Palmetto GBA to submit claims.
    » Read More

Healthcare Providers Increase Use of EHR | February 22, 2010
A survey was released finding that healthcare providers implementing electronic health records (EHR) in the past year have increased by 3.2% to 36.1%. The survey found that doctors are adopting components of EHR solutions, but not a complete solution from a single vendor.
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University Receives $12 Million in Stimulus Money for HIT | February 17, 2010
Purdue University, located in Indiana, has been given $12 million in stimulus funding to facilitate the adoption of healthcare IT. Perdue will be establishing regional extension centers which will help educate healthcare providers on the use of electronic medical records and e-prescribing.
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White House Releases $1 billion in HIT Stimulus Money | February 15, 2010
Approximately $1 billion in stimulus money is available now to hospitals and primary-care physicians to implement health information technology (HIT) solutions. In addition, the stimulus money will be used to train thousands of people to help facilitate HIT adoption. Seven-hundred million dollars is to aid hospitals and physicians in adopting electronic health records. Currently in the United States, only 20% of doctors and 10% of hospitals use electronic health records.
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Meaningful Use Criteria | December 30, 2009
HHS posted to their website lists containing "meaningful use" criteria to qualify for funding of information technology projects. Upwards of $27.3 billion has been made available under provisions of the American Recovery and Reinvestment Act of 2009 for healthcare provider to implement technology projects.
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House Delays Medicare Doc-Pay Cuts | December 16, 2009
The House of Representatives voted in majority to delay Medicare pay cuts for physicians until March 2010. This vote will prevent the 21% cut to be enacted until after Febrary 2010.
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Strive Force to Combat Medicare Fraud a Success | December 1, 2009
A group put together by the United States government to identify waste in the Medicare system has been successful in uncovering irregularities in Medicare claims submissions. Medicare costs hit approximately $800 billion this past year and somewhere between 3-10% can be attributed to waste, fraud or abuse. Data tracking has been the secret weapon in identifying irregularities. This task force could save the Medicare program approximately $2.7 billion over the next five years according to the Justice Department and HHS officials. Since the investigations started, 130 cases have been filed and more than 300 people have been charged.
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Technology Remedy for Ailing Healthcare System | November 12, 2009
A recent poll of healthcare providers indicates that as the country moves through healthcare reform and defining “meaningful use,” providers plan to make better use of healthcare information technology when it comes to their everyday practices.
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Federal Government Will Use Technology to Target Medicare Waste and Fraud | November 11, 2009
The Centers for Medicare and Medicaid (CMS) is working on a data warehouse to store all claims and payment data created by all of the federal health programs. This repository will allow the government to analyze data to pinpoint irregularities and trends. This new system will support the current Zone Program Integrity Contractors (ZPICs) which monitor jurisdictions, similar to the Medicare Administrative Contractor jurisdictions, for fraudulent or abusive behavior against the Medicare program.
    » Read More

HIT is Critical Part of Health Bill HR 3962 | November 9, 2009
With the House passing the health bill HR 3962 Saturday, November 7, the bill now goes to the Senate. Healthcare information technology (HIT) will play a critical part in this bill, which includes language that standardizes the HIPAA transaction sets for claims and related transactions, and the adoption of operating rules that are proposed to make financial and administrative transactions easier to conduct. For more information on HIT, HIPAA and their role in reform, see attached article. Also attached is a ten-page summary of HR 3962, and a more detailed summary (61 pages) which provides a section by section analysis.

CMS Proposes Changes to Physician Quality Reporting | November 5, 2009
The Centers for Medicare and Medicaid (CMS) proposed adding measures to the Physician Quality Reporting Initiative (PQRI) to report by group practice rather than individual physician and functionality for EHR-based reporting. PQRI is a voluntary program that provides incentives for reporting data on certain quality measures for services provided under Medicare Part B. CMS is looking to simplify the reporting process to increase adoption. In 2010, participants may earn an incentive payment of 2% of total charges for Medicare Part B covered services.
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U.S. Healthcare System Wastes Up To $800 Billion a Year | October 27, 2009
A report from Thompson Reuters announced that upwards of $800 billion is wasted in the U.S. healthcare system a year. The key findings stated that unnecessary care (40%), fraud (19%) and administrative inefficiency (17%) were the leading causes wasteful spending.
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Fighting Medicare Fraud | October 23, 2009
Federal authorities have charged 20 people in California and Las Vegas with Medicare fraud. Upwards of $26 million in either unneeded or undelivered durable medical equipment claims were filed. What used to be a white color crime has now found its way into gang activity. Currently Medicare fraud costs the nation an estimated $60 billion a year.
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Medicare Cuts Keep Doctors From Investing In EHR | October 16, 2009
As doctors are faced with the threat of Medicare reimbursement cuts, they may resist investing into electronic health records. CEO of the Medical Group Management Association, Willian F. Jessee, reiterated at a news conference at the annual MGMA convention that physicians face a 21.5% cut in Medicare payments on January 1 under the government's sustainable growth rate (SGR) formula.
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$404 Billion To Be Cut From Medicare, Medicaid | October 15, 2009
Healthcare bill presented by the U.S. Senate Finance Committee was reviewed by the non-partisan Congressional Budget Office. The bill states it would cut $404 Billion in Medicare and Medicaid funding. U.S. Rep. Elton Gallegly said "This bill will hurt seniors by limiting access, increasing costs and by lowering health care efficiencies. Medicare needs to be reformed, not gutted."
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