Frequently Asked Questions (FAQ)

• What are the major contractual differences of the new A/B MACs compared to the current FIs and carriers?
• How will existing carrier/FI Local Coverage Determinations (LCDs) be combined into a single policy for the A/B MAC?
• Will the provider community be able to comment on the consolidated policies through the Carrier Advisory Committee (CAC) process?
• During the policy consolidation phase that occurs after each MAC contract has been awarded, which policy will be used for coverage decisions?
• Once a MAC contract has been awarded in a given area, what should providers do to prepare themselves for the transition?

Question: What are the major contractual differences of the new A/B MACs compared to the current FIs and carriers?

Answer: Historically, the FI and carrier contracts have been limited to a number of contractors that may or may not have been the best qualified organizations to do the work. In addition, the carriers have had to be chosen from health insurance companies. The contracts for the FIs and carriers do not allow for performance incentives; rather, they pay the contractor the costs incurred in conducting their operations.

The workload for each new A/B MAC is being awarded through full and open competition conducted in accordance with the Federal Acquisition Regulation. Based on structured evaluation criteria, the proposal with the best value for the government will be selected in each procurement. Also, the new A/B MAC contracts are for the administration of both Medicare Part A and Part B claims in a specific geographic jurisdiction. Further, the new MACs are able to earn performance incentives.

Question: How will existing carrier/FI Local Coverage Determinations (LCDs) be combined into a single policy for the A/B MAC?

Answer: Each MAC will develop a unique policy. In the MAC Implementation Handbook, CMS states that the MAC must consolidate and standardize the existing LCDs of the outgoing carriers/intermediaries within its jurisdiction. Further, the MACs must implement the most clinically appropriate LCD within the region and consolidate the active edits in the system related to the consolidated LCDs. The MAC must provide a minimum notice period of 45 days on any proposed revision.

Question: Will the provider community be able to comment on the consolidated policies through the Carrier Advisory Committee (CAC) process?

Answer: MACs are not required to consult CACs during the consolidating process, although the contractor has the discretion to involve the provider community in the selection of least restrictive policies. However, due to the short time frames involved, they are not required to go through a formal CAC.

Question: During the policy consolidation phase that occurs after each MAC contract has been awarded, which policy will be used for coverage decisions?

Answer: During the transition period, the MACs will consolidate all LCDs within a jurisdiction into a new set of LCDs that will be issued when the transition has been finalized. Until the new LCDs are implemented, CMS has stated that MACs may not revise LCDs. CMS expects implementation of the consolidated LCDs to be completed when the MAC transition is finalized in 2011.

Question: Once a MAC contract has been awarded in a given area, what should providers do to prepare themselves for the transition?

Answer: According to Medlearn Matters article SE0837, once a MAC contract has been awarded, providers should take the following steps to prepare for the transition:

• Pay attention to the mail you receive from your outgoing Medicare contractor and your new MAC—you will be receiving letters and listserv messages about the transition from both.
• Sign up for your new MAC’s listserv. While in many cases the list of providers that were in the jurisdiction of the outgoing Medicare contractor will be shared with the incoming MAC, that may not always be the case.
• Access and bookmark the MAC’s website and visit it regularly. The MAC will have a new website that will have general information, news and updates, information on the MAC’s requirements of providers, copies of newsletters, and information on meetings and conference calls that are being conducted by the MAC.