National Government Services (NGS) was awarded a five-year contract by the Centers for Medicare & Medicaid Services (CMS) to administer Medicare Part A and Part B claims payments in Connecticut and New York. This significant move aims to streamline the claims process for beneficiaries and healthcare providers in both states.
Streamlining Medicare Claims Processing with NGS
The selection of NGS as the single point of contact for Medicare claims processing marks a shift towards greater efficiency and oversight. This transition consolidates the responsibilities previously held by multiple fiscal intermediaries and carriers. NGS will handle claims from various providers, including hospitals, skilled nursing facilities, physicians, and other healthcare practitioners.
Modernizing Medicare with the A/B MAC Contract
The contract, valued at approximately $323 million over five years, aligns with the Medicare Modernization Act’s (MMA) contracting reform provisions. This act mandates the consolidation of claims processing under Medicare Administrative Contractors (MACs). NGS’s role as an A/B MAC exemplifies this reform, streamlining operations and enhancing service delivery. The five-year contract includes a base period and four one-year options, allowing for flexibility and continued performance evaluation.
Performance-Based Incentives for Enhanced Service
CMS has implemented performance-based incentives to ensure NGS meets stringent requirements. These requirements focus on crucial areas such as:
- Improved Customer Service: Providing enhanced support to providers.
- Accurate Payments: Ensuring timely and precise claim processing.
- Provider Education: Offering training and resources to facilitate accurate claim submissions.
- Cost Savings: Identifying and implementing efficient practices to reduce expenses.
NGS’s performance will be regularly assessed based on these criteria, with the possibility of earning award fees for exceeding expectations.
A Nationwide Transition to Streamlined Medicare Administration
The selection of NGS is part of a broader national initiative. By 2011, CMS projects a total of 15 A/B MACs will manage Medicare claims processing across all states and the District of Columbia. This comprehensive restructuring simplifies the Medicare system, providing a single point of contact for both providers and beneficiaries. A dedicated Beneficiary Contact Center will address beneficiary inquiries regarding claims. This transition represents a significant step toward a more efficient and user-friendly Medicare system.
NGS: Implementation and Future of Medicare Claims
NGS, headquartered in Indianapolis, Indiana, is the sixth A/B MAC appointed by CMS. Implementation activities will begin immediately, with NGS assuming full responsibility for claims processing in Connecticut and New York by November 2008. This initiative promises a more streamlined and efficient experience for both beneficiaries and providers navigating the Medicare system.
