MAC Reform Presentation for Home Care Providers in NJ

1. Medicare Contracting Reform Update: Pending Changes Affecting Home Health and Hospice Providers Ben Hyman Minneapolis, MN VisionShare ® Inc.

11. Once MAC Reform is Completed Before After

12. Specialty Medicare Jurisdictions for DME Noridian NHIC Noridian

13. Specialty Medicare RHHI Jurisdictions Jurisdiction D Includes New Jersey

15. Here is how Medicare will be handled in Home Health Region D RHHI Region D will be handled by the MAC for Jurisdiction 6 Note: awarded to Noridian and still under protest Jurisdiction 6 Will handle the workload of Region D

16. MAC transitions - startup cycle Noridian took over J 3 in 2006 A/B MAC Jurisdictions - 2006 3

17. MAC Transitions - cycle one Cycle one, phase II = J1, J2, J7, J13 A/B MAC Jurisdictions – 2007-8 Cycle one, phase I = J4, J5, J12 7 1 2 2 13 Cycle one, phase II = J1, J2, J7, J13 4 5 12 Cycle one, phase I = J4, J5, J12 1

18. MAC transitions - cycle two A/B MAC Jurisdictions – 2008-9 11 15 8 6 14 10 9

19. MAC Transitions – Current Status of all Jurisdictions

23. 15 primary Medicare data centers – “pre MAC” Regence BCBS OR EDS Chico EDS (2) Mutual of Omaha Arkansas BCBS NGS BCBS Alabama BCBS Florida Verizon PalmettoGBA Highmark IBM Empire CIGNA

24. Post MAC migration – 3 enterprise data centers CDS – Columbia SC EDS – Tulsa OK IBM – Southbury CT

26. Official CMS notification – 2/20/09 “ In order to provide a more scalable and secure Wide Area Network (WAN) to support current and future CMS business needs, CMS is phasing out the current Medicare Data Communications Network (MDCN). The MDCN is a legacy Frame Relay network that does not scale easily and does not meet current security requirements.” Effective Date: July 31, 2009 Implementation Date: July 31, 2009

27. Medicare connectivity today Medicare Products MAC (Claims & Remits) EDC (FISS) AT&T Frame Relay Network (AGNS/MDNS) HETS Eligibility Med A Provider Med B Provider Billing Services Clearing House Connectivity Vendor

28. WAN Modernization changes CMSnet AT&T MPLS Network EXTRAnet AT&T MPLS Network (EVPN) More reliable Greater Security More security requirements for providers and vendors EDCs FISS/DDE MACs Claims/Remits HETS Medicare eligibility “ POTS” for bulletin board claims/remits Provider Connectivity vendor or telephony provider Clearinghouse Bridge built by CMS between the CMSnet and EXTRAnet Region D providers will be asked to select a vendor to send and receive claims and remits

29. What may change after this is completed Provider Medicare Products HETS Eligibility AT&T Passport 3270 Emulator MAC (Claims & Remits) EDC (FISS) AT&T Frame Relay Network (AGNS/MDNS) Some legacy connectivity components not supported as part of WAN Modernization

30. What if You needed new emulation software for each workstation? $ You had to replace your modem or other connection support hardware to access the new Medicare Network? $$ Maintain two connections as you transition from the old to the new network? $$$ These changes caused delays in your Medicare reimbursements? $$$$ All of the above? $$$$$

32. VisionShare ® approach to Medicare access today Leverage your existing Internet connection Supports all interactive and batch submissions to Medicare Less expensive than standard lease line Provider Internet Secure Data Facility AT&T Frame Relay Network (AGNS/MDNS) EDC MAC HETS

33. Secure Data Facility VisionShare ® approach after WAN Modernization CMSnet AT&T MPLS Network EXTRAnet AT&T MPLS Network (EVPN) VisionShare® already connected to new EXTRANet Required encryption provided by VisionShare® connection VisionShare® will migrate providers to EXTRANet when required Provider Internet EDCs FISS/DDE MACs Claims/Remits HETS Medicare eligibility