Palmetto GBA awarded Jurisdiction J MAC Contract – Implications for Physician Practices

by | Last updated Jun 30, 2023 | Published on Dec 8, 2017 | Medical Billing

Physician Practices
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On September 8, 2017, the Centers for Medicare and Medicaid Services (CMS) announced a change in Medicare processor from Cahaba to Palmetto GBA in the three states of Alabama, Georgia, and Tennessee. Palmetto GBA was selected by CMS as the Medicare Administrative Contractor for Jurisdiction J in these three states. Medical practices that submit Medicare claims in these states need to work with their clearinghouse to update the payer IDs for the existing insurance plans in their medical billing software on these two dates. An experienced medical billing company can help physicians handle this transition more easily. A medical billing expert can ensure smooth changeover of claims processing and all other MAC-directed operations to the new Medicare processor.

With the award of the A/B MAC Jurisdiction J Contract, Palmetto will be responsible for processing and paying Medicare Part A and Part B provider claims in Alabama, Georgia, and Tennessee, enrolling and auditing Medicare providers, and educating providers on Medicare coverage requirements, and other duties.

Key points to note:

  • The transition from Cahaba GBA to Palmetto GBA is effective on January 29, 2018 for Part A claims and on February 26, 2018 for Part B claims.
  • According to CMS, Jurisdiction J comprises about 7.0% of the overall national Medicare Fee-for- Service Part A and Part B claims volume, which amounts to more than $17 billion in Medicare benefit payments annually.
  • While Medicare Part A covers fees from hospitals, skilled nursing facilities and other institutional providers, Part B covers fees from physicians, laboratories and other practitioners.
  • The A/B MAC Jurisdiction J contract will provide Medicare services to more than 400 hospitals, 52,000 physicians, and 2.5 million Medicare beneficiaries.
  • The contract is for a maximum of five years.

To stay updated with Medicare program information and updates, providers can visit Palmetto’s Transition Website. As part of the transition, Palmetto GBA has auto-registered all providers currently registered in Cahaba’s portal. Medical billing companies are helping practitioners update the payer IDs for the existing insurance plans in their billing software on the two implementation effective dates – January 29, 2018 for Part A and February 26, 2018 for Part B. Partnering with a reliable medical billing service company can also help practices ensure smooth and accurate claim submission to Palmetto.

Experienced medical billing companies are knowledgeable about the claim submission guidelines and payer rules of both private and government insurance companies. Their comprehensive solutions can be a great support to physician practices transitioning claims to the new Medicare processor. They can help them avoid questionable billing practices that could lead to tedious claims appeal processes. They are well-versed in Medicare fee-for-service claims-related matters for billing under Medicare Part A or Part B as well as the claims submission process.

Well-informed about ever-changing Medicare policies, an experienced medical billing company can ensure accurate electronic filing of claims. The end-to-end services they provide include:

  • Patient enrollment
  • Insurance verification and authorization
  • Coding and audit
  • Charge entry, cash posting and reconciliation
  • A/R follow up
  • Denial management

Insurance verification services provided by these companies help physicians determine whether a patient is eligible for Medicare benefits, has met his/her Medicare deductible, is enrolled in a health maintenance organization, or is entitled to Medicare under the Medicare Secondary Payer provision. With the support of a knowledgeable medical billing service provider, healthcare practitioners can worry less about potential rejections and denials and focus better on providing efficient patient care.

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