In the A/B MAC Statement of Work for the Round II A/B MAC procurements, the Centers for Medicare and Medicaid Services (CMS) discussed its intent to expand the role of the CMD. CMS will:

• Require that each Round II A/B MAC contractor dedicate at least one full-time CMD, fully to each A/B MAC jurisdiction;
• Establish requirements for increased involvement of the A/B MAC CMD’s role in the claims review and claims error trends analysis process ; and
• Require CMD participation in activities that are determined by CMS “to facilitate greater LCD consistency across A/B MACs when warranted by medical evidence.”

As more information becomes available over the next several years, GIRS will track the evolution of the Round II A/B MAC awards and the CMD role. Please contact GIRS to advocate with payer medical directors and educate them about your product’s clinical data, any LCD issues, and claims denial issues.

Sources:
CMS, 2012. Medicare Contracting Reform, Round II Procurement Background.

Federal Business Opportunities, 2012. Medicare Administrative Contractor Part A and Part B Competitions. A/B MAC Request for Information (RFI).