Why this Newsletter

Change to a new contractor could impact how future local Medicare coverage  decisions and other policy matters are made in California and nation and could have repercussions on companies’ sales and commercialization efforts.

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As a result of the Medicare Modernization Act of 2003, CMS (Center for Medicare and Medicaid Services) was required to determine methods to reduce costs. A cost targeted by CMS is those associated with processing the billion + Medicare claims each year.  To do this, CMS has started to consolidate the number of Medicare contractors from (40) to (15).

Recently CMS selected a new Region 1 contractor, Palmetto, to replace the current contractors, NHIC and UGS.  Region 1 includes California, Nevada, Hawaii, and the  U.S. Pacific territories.   NHIC and UGS have both been administrating the Medicare program in Region 1 for years.  Both contractors have a reputation of being progressive and demanding, when making coverage decisions for new medical technologies.  Palmetto, based in S. Carolina, is new to the Region and could have a different temperament, than NHIC, when it comes to making coverage decisions and other policy matters.

Soon after the Palmetto award, NHIC filed a protest with the Government Accountability Office (GAO).  The GAO has now reached a decision and has denied NHIC’s protest of the award to Palmetto.  As a result, CMS authorized Palmetto to resume work under Region 1. CMS is expecting Palmetto to assume full responsibility for the Region 1 work no later than October 1, 2008.

If you would like to discuss the changes and business impacts as a result of the  Medicare consolidation, contact us at info@rowinskigroup.com or call 1+(650) 522-8520

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About Rowinski Group

Founded in 2004, Rowinski Group LLC is a reimbursement and healthcare payer data analytics consulting firm for medical device, digital health, diagnostics, and imaging companies. Rowinski Group is based in Silicon Valley – San Francisco bay area with offices at selected client locations.

Rowinski Group has two core service offerings; securing codes and reimbursement on behalf of companies and applying healthcare payer data analytics to help solve companies’ complex business issues such as responding to questions from the FDA and U.S. Payers.

Through these service offerings Rowinski Group helps U.S. and international companies build their U.S. market share for the medical technology they are developing and selling. For more information visit www.rowinskigroup.com