A Medical Device Daily

The Centers for Medicare & Medicaid Services reported awarding two contracts for the combined administration of Part A and Part B Medicare claims payment in seven states, the District of Columbia and three U.S. territories. These awards represent the fourth and fifth new Medicare Administrative Contractors (MACs) to be named by CMS as required by the Medicare Modernization Act of 2003. The MAC contracts are part of an effort to streamline the fee-for-service payment system. The two contracts are among the largest, in terms of claims volume, of the 15 MACs that CMS will award.

Highmark Medicare Services (Camp Hill, Pennsylvania) will be responsible for Jurisdiction 12, which includes the states of Delaware, Maryland, New Jersey and Pennsylvania, as well as the District of Columbia. Palmetto GBA (Columbia, South Carolina) will serve Jurisdiction 1, which includes California, Hawaii, Nevada, American Samoa, Guam and the Northern Mariana Islands. By 2011, a total of 15 new MACs will cover every state and the District of Columbia. The first three MACs are processing Medicare claims in 10 western and four midwestern states.

The MACs will serve as the primary point of contact for the processing and payment of fee-for-service claims from providers, such as hospitals, nursing facilities, physicians and other practitioners. The MACs were selected in open competition under federal procurement rules. Under the current system, fiscal intermediaries process claims for Medicare Part A providers, such as hospitals, skilled nursing facilities and other institutional providers. Carriers process claims for physicians, laboratories and other practitioners under Medicare Part B.

The contracts awarded include a base period and four one-year options and will provide Highmark Medicare Services and Palmetto GBA with an opportunity to earn award fees based on their ability to meet or exceed the performance requirements set by CMS. These requirements are rooted in CMS’ key objectives for the MACs, including enhanced provider customer service, increased payment accuracy, improved provider education and training leading to correct claims submissions, and realized cost savings resulting from efficiencies and innovation. In accordance with the Medicare Modernization Act, MAC contracts are to be open for bidding at least once every five years.

As MAC contractors, Highmark Medicare Services and Palmetto GBA will immediately begin implementation activities. Highmark Medicare Services will assume full responsibility for the claims processing work in its jurisdiction no later than September 2008. Palmetto GBA will assume full responsibility for the work in its jurisdiction no later than June 2008.

When Medicare contracting reform is fully implemented, all the fiscal intermediaries and carriers will be replaced by MACs that will be responsible for both Part A and Part B claims. For beneficiaries and providers, the new structure will mean that they each will have a single point of contact with the Medicare program. When they become operational, the MACs will be the contact for all Medicare providers and physicians in the states included in their jurisdiction, while beneficiaries will pose their claims-related questions to a Beneficiary Contact Center.

NIBIB, DBT to providecare to India’s needy

The National Institute of Biomedical Imaging and Bioengineering (NIBIB), part of the National Institutes of Health, and the Department of Biotechnology (DBT) of the Ministry of Science and Technology (New Delhi, India), have entered into a bilateral agreement to develop low-cost healthcare technologies aimed at the medically underserved.

The agreement is based on a shared commitment to improve the health and well-being of the people of both countries by encouraging collaborations and cooperation on the development of diagnostic and therapeutic medical technologies that are inexpensive and operate at the initial point of physician contact, or point of care.

“We are very pleased to officially establish this groundbreaking effort between NIH/NIBIB and the Department of Biotechnology,” said NIBIB director Roderic Pettigrew, PhD, MD. “This agreement will create a working partnership designed to help address global health disparities by encouraging the development of improved methods and technologies to diagnose and treat illness and injury across geographic and economic borders.”

Areas of cooperation outlined in the agreement include low-cost innovations in X-ray technology; nanotechnology-based biosensors; point-of-care diagnostic technologies; telehealth and telecommunication technologies; and neonatal health technologies. The disease areas and conditions likely to be affected by the successful development of the technologies are infectious diseases, cardiovascular disease, liver disease, trauma and injury, and conditions associated with infant mortality.

“Developing low-cost health technologies that are unique in design to be affordable and useable in disease prevention and management is a high priority in India,” said Maharaj Bhan, MD, DBT director. “The partnership with NIH, and through them, with U.S. institutions, is critical for us to make progress. We are excited about this agreement with NIH to bring multiple disciplines and teams together to find innovative solutions.”

NIBIB and the DBT will encourage workshops and meetings to share experiences and scientific information; link appropriate centers of excellence and institutes; engage in bilateral cooperation on the assessment and application of new diagnostic technologies; and generate collaboration among scientists and engineers in the conduct of research, research training, and technology development.