Attachment J-19 Implementation Handbook redline.doc

CMS

Centers for Medicare & Medicaid services Durable Medical Equipment medicare administrative contractor

Workload implementation handbook

Medicare Contractor Management Group 01/11/10

TABLE OF CONTENTS

1-1Chapter 1:

INTRODUCTION

1-11.1 Durable Medical Equipment Medicare Administrative Contractor Workload Implementation Handbook

1-11.1.1 Chapters

1-31.1.2 Exhibits

1-31.1.3 Index

1-31.2 Transition Phases

1-41.3 Terminology

1-41.4 Goals of a Successful Workload Transition

2-1Chapter 2:

CMS ORGANIZATION

2-12.1 CMS Contract Administration Personnel – Incoming Medicare Administrative Contractor

2-12.1.1 Incoming MAC Contracting Officer

2-12.1.2 Incoming MAC Project Officer

2-22.1.3 Implementation Lead (IL)

2-22.1.4 Medicare Implementation Support Contractor (MISC)

2-32.1.5 Business Function Lead (BFL)

2-32.1.6 Technical Monitor (TM)

2-32.2 CMS Contract Administration Personnel – Outgoing Medicare Administrative Contractor

2-32.2.1 Outgoing MAC Contracting Officer

2-32.2.2 Outgoing MAC Project Officer

3-1Chapter 3:

GETTING STARTED

3-13.1 Contract Award

3-13.2 Initial Transition Activities

3-13.3 Contact with Outgoing Contractor

3-23.4 Outgoing Contractor Employee Notification

3-33.5 Jurisdiction Kickoff

3-33.5.1 Incoming MAC Pre-Meeting

3-43.5.2 Outgoing MAC Pre-Meeting

3-43.5.3 Jurisdiction Kickoff Meeting

3-63.5.4 Post-Award Orientation Conference

3-73.6 Transition Workgroups

3-73.6.1 General

3-73.6.2 Participants

3-73.6.3 Scope

3-83.6.4 Functions

3-93.6.5 Administration

4-1Chapter 4:

IMPLEMENTATION MANAGEMENT

4-14.1 Purpose

4-14.2 Project Management Approach

4-14.3 Jurisdiction Implementation Project Plan (JIPP)

4-14.3.1

4-24.3.2 Implementation Project Plan Structure

4-34.4 Interaction with the Outgoing DME MAC

4-34.5 Nomenclature

4-34.6 On-Site Presence

4-44.7 Communication

4-44.8 Identification Number

4-44.9 Access to Outgoing Contractor Information

4-54.10 Operational Assessment of Outgoing Contractor / Due Diligence

4-54.10.1 Initial Activity

4-64.10.2 Areas of Focus

4-64.10.3 Specific Assessment Activities

4-94.11 Implementing Assessment/Due Diligence Findings

4-94.12 Deliverables List

5-1Chapter 5:

OBTAINING RESOURCES AND ESTABLISHING INFRASTRUCTURE

5-15.1 Personnel

5-15.1.1 Recruitment of Outgoing DME MAC Staff

5-25.1.2 General Recruitment

5-25.1.3 Employment Report

5-25.1.4 Training

5-35.2 Site Acquisition/Facilities Preparation

5-35.3 Hardware/Software

5-45.4 Asset Inventory

5-45.5 Telecommunications – Data

5-45.5.1 Background

5-55.5.2 Requirements

5-65.5.3 Obtaining Telecommunication Services

5-65.5.4 Points of Emphasis

5-75.6 Telecommunications – Voice

5-75.7 Data Center

5-85.8 Electronic Data Interchange (EDI)

5-85.8.1

5-95.8.2 DME MAC Common Electronic Data Interchange (CEDI) System

5-95.8.3 EDI Assessment

5-95.8.4 Connectivity

5-105.8.5 Help Desk/Customer Support

5-105.8.6 EDI Enrollment

5-115.8.7 EDI Communication

5-115.9 Electronic Funds Transfer

5-115.10 Access to CMS Systems

6-1Chapter 6:

TRANSFER OF DME OPERATIONS

6-16.1 Overview

6-16.2 Claims Processing

6-26.2.1 Customer Service

6-36.2.2 Medicare Secondary Payer (MSP)

6-36.3 Appeals

6-36.4 Provider Education/Training

6-46.5 Print/Mail Operations

6-56.6 File Inventory

6-56.6.1

6-56.6.2 Mainframe

6-66.6.3 LAN/PC-Based Files

6-66.6.4 Hardcopy

6-66.7 Encryption

6-76.8 Disposition of Files

7-1Chapter 7:

INTERACTION WITH OTHER TRANSITION ORGANIZATIONS

7-17.1

7-17.2 Enterprise Data Center (EDC)

7-27.3 National Supplier Clearinghouse (NSC)

7-37.4 Pricing Data Analysis and Coding (PDAC) Contractor

7-37.5 Common Electronic Data Interchange (CEDI) Contractor

7-47.6 Program Safeguard Contractor (PSC)/Zone Program Integrity Contractor (ZPIC)

7-47.6.1 Background

7-47.6.2 Implementation Activities

7-57.6.3 PSC Contract Meetings

7-57.6.4 Joint Operating Agreement

7-57.6.5 Communication/Coordination

7-67.7 Beneficiary Contact Center

7-67.8 Qualified Independent Contractor (QIC)

7-77.9 Administrative Qualified Independent Contractor (AdQIC)

7-77.10 Recovery Audit Contractor

7-87.11

HIGLAS

7-87.12 Medicare Secondary Payer Recovery Contractor

7-87.13 Coordination of Benefits Contractor (COBC)

8-1Chapter 8:

TESTING

8-18.1

8-18.2 Test Plan

8-28.2.1 Scope/Approach

8-28.2.2 Roles and Responsibilities

8-28.2.3 Types of Tests

8-58.2.4 Resources

8-68.2.5 Schedule

8-68.2.6 Processes and Documentation

8-68.2.7 Risks

9-1Chapter 9:

CUTOVER

9-19.1 Definitions

9-19.2 Cutover Plan

9-29.3 Cutover Workgroup

9-39.4 Daily Cutover Meeting

9-39.5 “Go/No-Go” Call

9-49.6 Cutover Simulation

9-59.7 Electronic Funds Transfer (EFT) Progress Report

9-59.8 System Dark Days

9-69.9 Release of the Payment Floor

9-79.10 Data Migration

9-79.10.1 Final Inventory

9-79.10.2 File Transfer Plan

9-89.10.3 File Format

9-89.10.4 Packing

9-89.10.5 Transfer of Hardcopy Files and Physical Assets

9-89.11 Sequence of System Cutover Activities

9-99.11.1 System Closeout

9-99.11.2 Back Up

9-99.11.3 Transfer and Installation

9-99.11.4 Initial System Checkout

9-99.11.5 Functional Validation of System

9-109.11.6 First Incoming MAC Production Cycle

9-109.12 Reporting

9-109.13 Cutover Communication

10-1Chapter 10:

POST-CUTOVER

10-110.1

10-110.2 First Day of Operations

10-110.3 Post-Cutover Monitoring

10-210.4 Workload Reporting

10-310.5 Assistance with Outgoing Contractor Closeout Activities

10-310.6 Access to Files and Records after Cutover

10-310.7 Lessons Learned

10-410.8 Post-Project Review Meeting (Lessons Learned)

10-410.9 Implementation Project Closeout

11-1Chapter 11:

CMS MONITORING REQUIREMENTS

11-111.1 Meetings

11-111.1.1 Post-Award Orientation Conference

11-111.1.2 Incoming DME MAC Pre-Meeting

11-211.1.3 Jurisdiction Kickoff Meeting

11-211.1.4 Project Status Meeting

11-211.1.5 Transition Workgroup Meeting

11-211.1.6 Cutover Meeting

11-311.1.7 Post-Project Review Meeting (Lessons Learned)

11-311.2 Documentation

11-311.2.1 Jurisdiction Implementation Project Plan (JIPP)

11-411.2.2 Jurisdiction Implementation Project Plan Update

11-411.2.3 Implementation Project Status Report

11-511.2.4 Workgroup Meeting Minutes

11-511.2.5 Issues Log/Action Items

11-611.2.6 Test Plan

11-611.2.7 Test Plan Update

11-611.2.8 Cutover Plan

11-611.2.9 Production Workload Reports

11-711.2.10 Communication Plan

11-711.2.11 Communication Plan Update

11-711.2.12 Risk Management Plan

11-711.2.13 Risk Management Plan Update

11-711.2.14 Electronic Funds Transfer (EFT) Progress Report

11-811.2.15 Employment Report

11-811.2.16 Lessons Learned

12-1Chapter 12:

COMMUNICATIONS

12-112.1

12-112.2 Communication Plan

12-212.3 Public Announcement

12-212.4 Congressional Contact

12-212.5 State and Local Contact

12-312.6 Provider Communication

12-312.6.1 Professional Organization Contact

12-412.6.2 Provider Contact

12-412.6.3 Provider Workshops/Seminars/Teleconferences

12-512.7 Beneficiary Communication

12-512.8 Social Security Administration

12-612.9 Transition Partners

12-612.10 Internal Communications

12-612.11 Website

12-612.12 Listserv

12-712.13

ARU/IVR

12-712.14 Cutover

13-1Chapter 13:

FINANCIAL PROCESSES

13-113.1

13-113.2 Banking

13-213.3 Accounts Receivable Reconciliation

13-213.3.1

13-213.3.2 Accounts Receivable Reconciliation Process

13-313.3.3 Financial Reporting

13-313.4 Payment Cycles

13-413.5 Post-Cutover Financial Coordination

13-413.5.1 Outstanding Provider Payment Checks

13-413.5.2 Cash Receipts/Cash Refunds

13-513.6 Voucher Submission and Protocol

13-513.7 Implementation Costs

13-613.8 IRS Form 1099 Responsibilities

14-1Chapter 14:

RISK MANAGEMENT

14-114.1

14-114.2 Risk Management Processes

14-114.2.1 Risk Identification

14-114.2.2 Risk Analysis

14-214.2.3 Risk Response

14-214.2.4 Risk Management Plan

14-314.2.5 Risk Monitoring

Exhibits………………………………………………………………………………………….

Index ……………………………………………………………………………………………..

Chapter 1: INTRODUCTION

1.1 Durable Medical Equipment Medicare Administrative Contractor Workload Implementation Handbook This handbook was prepared by CMS to assist an incoming Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) in the transfer of claims administration functions from a DME MAC whose contract is ending. The handbook represents a compilation of best practices, lessons learned, and over 25 years of CMS experience in overseeing Medicare workload transitions. It describes the basic responsibilities and processes required to move Medicare data, records, and operational activities from an outgoing MAC so that the incoming MAC will be able to perform its Medicare contractual obligations. While both the incoming and outgoing MACs are responsible for accomplishing various activities during the transition, this handbook is intended for use by the incoming MAC. A similar DME MAC Workload Closeout Handbook has been developed for the outgoing DME MAC.

Each DME workload transition will vary depending on the unique circumstances and environment of the Medicare Administrative Contractors involved. There may be activities and processes described in this handbook that will not be applicable to a specific implementation. There may also be activities that will need to be performed that the handbook does not cover. It should also be noted that the handbooks are written from the perspective of a MAC leaving the Medicare program. Not all of the activities described in the handbook will be applicable to a MAC who is only moving its DME workload to another MAC and will continue to process Medicare claims under other contracts. The handbook cannot identify and address all of the variations that may occur during a workload transition, nor all of the tasks for which the DME MAC will be responsible. However, it will provide the framework for a successful workload implementation and guidance in addressing situations as they arise.

This handbook is modified from a handbook that was developed for Part A/Part B MACs. Every effort has been made to modify the text so that it pertains solely to the Medicare functions that a DME Medicare Administrative Contractor will perform. However, there may be some instances where information in this handbook does not apply to a DME MAC.

This 12/01/09 version of the DME MAC Workload Implementation Handbook is comprised of 14 chapters, 10 exhibits, and an index. It supersedes all other versions.

1.1.1 Chapters

1. Chapter 1: Introduction provides an introduction to the Handbook and the goals for a successful workload transition.

2. Chapter 2: CMS Organization provides information on the duties and responsibilities of CMS’s transition oversight staff.

3. Chapter 3: Getting Started describes the activities that are necessary to start the implementation process. It discusses establishment of the implementation team, kickoff meetings, and the organization and function of transition workgroups. The chapter also addresses initial notification activities.

4.

Chapter 4: Implementation Management discusses the approach that a DME MAC should take for the implementation project. It includes the assessment of the outgoing DME MAC’s Medicare operation and a discussion on information and deliverables required from the outgoing MAC.

5.

Chapter 5: Obtaining Resources and Establishing Infrastructure provides helpful information about personnel and facilities preparation. The chapter also covers hardware/software and telecommunication requirements, data center information, and electronic data interchange (EDI).

6.

Chapter 6: Transfer of DME Operations describes the activities associated with moving the actual workload and Medicare functions of the DME MAC. This includes analyzing the various functional areas, file transfer activities, asset inventory, and miscellaneous operational considerations.

7.

Chapter 7: Interaction with Other Transition Organizations discusses the major organizations with which the DME MAC will work during the implementation and the basic responsibilities of each.

8.

Chapter 8: Testing discusses the establishment of a test plan. It also describes the various tests that the DME MAC may perform in order to ensure that it will be able to process claims and perform its Medicare functions.

9.

Chapter 9: Cutover covers the actual migration of records, files, and data (both physically and electronically) to the DME MAC, as well as any resources and infrastructure. The chapter also provides information on cutover plans, system dark days, and the release of the payment floor.

10.

Chapter 10: Post-Cutover describes the activities that occur after cutover, including workload reporting and lessons learned.

11.

Chapter 11: CMS Monitoring Requirements provides information on the various meetings that are necessary during a transition. It also describes the reporting requirements so that CMS may monitor the DME MAC’s implementation progress.

12.

Chapter 12: Communications discusses the approach and tasks associated with providing information about the transition to all direct and indirect stakeholders in the transition. This includes providers, beneficiaries, trading partners, medical and specialty groups, government officials, advocacy groups, and other interested parties.

13.

Chapter 13: Financial Processes provides information on the financial activities required to move the Medicare workload. It discusses cash management and banking tasks, the accounts receivable reconciliation, and 1099 issues. There is also a section that provides information on vouchering protocols.

14.

Chapter 14: Risk Management discusses risk management processes including risk assessment, risk mitigation, and contingency plans.

1.1.2 Exhibits

Exhibit 1 Transition Phases and Terminology

Exhibit 2 MAC Contract Administrative Structure

Exhibit 3 Major Tasks and Activities Associated with a Workload Transition

Exhibit 4 Outgoing Contractor Information/Documentation

Exhibit 5 Files to be Transferred to a Medicare Administrative Contractor

Exhibit 6 Sample Post-Cutover Workload Report

Exhibit 7 MAC Workload Implementation Meeting and Documentation Guide

Exhibit 8 Workload Transition Lessons Learned

Exhibit 9 Glossary

Exhibit 10 Acronyms

1.1.3 Index

The index is found at the end of the handbook.

1.2 Transition Phases

While there are multiple parties involved in a Medicare workload transition, there are three major participants: the incoming contractor, the outgoing contractor, and CMS. Each transition has three phases. For an incoming DME MAC, the three phases of a Medicare workload transition are identified as: pre-award, implementation, and post-cutover.

The pre-award phase is comprised of the activities associated with preparing and submitting a DME MAC proposal. The implementation phase covers the activities associated with establishing a DME MAC operation and the transfer of data, records, and functions from the outgoing MAC. It begins with the award of a DME MAC contract and ends at the cutover from the outgoing MAC. The post-cutover phase begins with the incoming MAC’s operational start date and usually lasts for 3 months. During this time CMS closely monitors DME MAC operations to determine the success of the implementation and to ensure that all implementation issues have been resolved.

This handbook provides information that will assist the DME MAC in all three phases of the transition. However, its primary focus is on the implementation and post-cutover phases of the incoming contractor. Exhibit 1 provides a graphic representation of terminology for the major transition participants.

1.3 Terminology

For purposes of this handbook, the DME Medicare Administrative Contractor who will be assuming the Medicare functions of a jurisdiction is referred to as the “incoming DME MAC”, the “incoming MAC”, or the “incoming contractor”. All three terms are used interchangeably.

The DME MAC who will be ending its contract and transferring its Medicare functions to a new DME MAC contractor is referred to as the “outgoing DME MAC”, the “outgoing MAC”, or the “outgoing contractor”. All three terms are used interchangeably.

In this handbook, use of the term “MAC” specifically means a Durable Medical Equipment MAC unless otherwise noted.

A “transition” is defined as the period of time that encompasses the process of moving Medicare operations from one DME MAC to another. The term “implementation” is used for those activities performed by the incoming DME MAC during a transition. The term “closeout” is used for those activities performed by the outgoing DME MAC. However, in general usage, the term “transition” will often be applied to the incoming contractor’s “implementation” activities and the outgoing contractor’s “closeout” activities.

The term “provider” is used in the broad sense of the word, meaning anyone providing a Medicare service; i.e., institutional provider (hospital, skilled nursing facility, rural health clinic, federally qualified health center, or home health agency), physician, non-physician practitioner, or supplier.

The term “biweekly” means every two weeks.

Any reference to days in this handbook refers to business days unless otherwise noted or instructed by CMS.

1.4 Goals of a Successful Workload Transition

All of the organizations involved in a workload transition have a responsibility to ensure that the transition is conducted properly and that their contractual obligations are met. While each component has different roles and responsibilities during a transition, the goals remain the same:

· The transition is transparent to beneficiaries;

· There is minimal disruption to providers, physicians and suppliers;

· There is no disruption of claims processing and Medicare operations;

· The transition is completed on schedule within the required time period;

· Actual costs represent effective and efficient use of resources; and,

· All parties with an interest in the transition (whether direct or indirect) are kept informed of the transition’s status and progress.

In order to accomplish these goals, there must be proper project planning and management by the incoming DME Medicare Administrative Contractor, maintenance of existing Medicare operations by the outgoing DME MAC, and comprehensive oversight by CMS. All parties involved in the transition must cooperate fully and communicate constantly with all other parties at every level. This handbook will help the incoming DME MAC achieve the above-mentioned transition goals and meet its contractual obligations during the implementation period of performance.

Chapter 2: CMS ORGANIZATION There will be a number of CMS staff responsible for overseeing the transfer of Medicare data, files, and operations from the outgoing DME MAC to the incoming DME MAC. Listed below are the individuals who will monitor MAC implementation activities, along with a description of their responsibilities. Also discussed are the individuals who will be responsible for the closeout activities of the outgoing MAC. A CMS administrative organizational chart for the MAC contracts is shown in Exhibit 2.

2.1 CMS Contract Administration Personnel – Incoming Medicare Administrative Contractor

The following individuals will be responsible for monitoring the implementation and/or operational activities of the incoming Medicare Administrative Contractor. They will also interact with the outgoing Medicare Administrative Contractor in various meetings and workgroups.

2.1.1 Incoming MAC Contracting Officer

The incoming MAC Contracting Officer (CO) has the overall responsibility for the incoming DME Medicare Administrative Contractor and is the only person authorized to enter into and bind the government by contract. He/she is the individual that negotiates and prepares the DME MAC contract document, modifies any terms or conditions of the contract, accepts delivered services, and approves vouchers for payment. While a single person could serve as both the incoming Contracting Officer and the outgoing Contracting Officer, they are normally two different individuals.

2.1.2 Incoming MAC Project Officer

The incoming MAC Project Officer (PO) serves as the first point of contact for the incoming DME MAC. He/she is the focal point for the exchange of information and the receipt of programmatic approvals on deliverables and other work specified under the incoming MAC’s contract. The incoming PO is the technical representative of the incoming Contracting Officer and provides technical direction to the incoming MAC, as necessary, for all of the business functions contained in the incoming MAC’s statement of work. He/she also monitors the contract performance of the incoming MAC and reviews payment vouchers. The incoming PO may designate various business function leads and technical monitors to support the administration of the MAC contract. The Project Officer position is also known as the Contracting Officer’s Technical Representative (COTR).

2.1.3 Implementation Lead (IL)

The DME MAC Implementation Lead (IL) will be the incoming PO’s representative for the incoming MAC’s implementation and will serve in a specialized technical capacity to the Project Officer. As a representative of the incoming PO, the IL will provide technical guidance and direction on implementation activities to the incoming MAC. The IL will manage CMS’s oversight of the DME MAC transition and will coordinate incoming MAC implementation activities with the outgoing MAC Project Officer and the functional contractor Project Officers. The Implementation Lead will also work with the Medicare Implementation Support Contractor to monitor and oversee the progress of the incoming MAC’s implementation and the related activities of the functional contractors involved in the transition.

The IL will work with Business Function Leads (BFLs) concerning implementation issues. He/she will also coordinate implementation activities with the Project Officers of the functional contractors involved in the MAC implementation. The Implementation Lead will conduct problem solving/trouble shooting during the implementation and be responsible for reporting to senior management. In addition, he/she will review vouchers for jurisdiction implementation activities and provide recommendations to the incoming Project Officer.

2.1.4 Medicare Implementation Support Contractor (MISC)

Because of the number of implementations and the limited staff available for oversight, CMS has entered into a contract with Chickasaw Nation Industries (CNI) for a Medicare Implementation Support Contractor (MISC). The MISC will provide the project management support and oversight services as necessary for CMS to monitor the implementation activities of the MACs and functional contractors.

The MISC will assign a business analyst (BA) to each DME MAC implementation. The MISC will have direct access and interaction with the incoming and outgoing MAC staff involved in the implementation. The BA will be a member of transition workgroups and attend all meetings associated with those workgroups. He/she will also attend general jurisdiction status meetings and teleconferences. The BA will work closely with the MAC Implementation Lead to ensure successful completion of the implementation.

The MISC will share comments, concerns and recommendations directly with the incoming MAC when appropriate. However, the MISC does not have authority to provide technical direction to the incoming MAC.

The MISC Government Task Leader (GTL) will be primarily responsible for managing the MISC contract. The GTL represents the MISC Project Officer for the technical aspects of the contract and may provide technical direction under the auspices of the PO. The GTL will interact with the IL throughout the implementation to obtain information on the MISC’s performance and to resolve any administrative issues that may occur.

2.1.5 Business Function Lead (BFL)

A Business Function Lead (BFL) may be called upon to assist the MAC Project Officer in the administration of the MAC contracts. BFLs are normally located in CMS Central Office and will assist the MAC Project Officer on an as needed basis, acting as a technical representative for their specific business function. BFLs may monitor technical progress and perform technical evaluations and inspections. They may also assist the PO with specific functional inquires and technical issues. In addition, BFLs will review monthly invoices and vouchers pertaining to their functional area and make payment recommendations to the PO. However, BFLs do not have the authority to provide technical direction or make any contractual commitments or changes on behalf of CMS.

2.1.6 Technical Monitor (TM)

Technical Monitors (TMs) are Regional Office personnel who may provide information on contractor performance and help the MAC Project Officer resolve issues, particularly those from beneficiaries and providers. The TM may assist the BFL in performing technical evaluations and inspections and may also provide input to monthly and quarterly contract administration meetings. In addition, Technical Monitors may perform on-site validations of accounts receivables and debts.

2.2 CMS Contract Administration Personnel – Outgoing Medicare Administrative Contractor Listed below are the key CMS individuals (along with the above-mentioned Implementation Lead) who will monitor outgoing Medicare Administrative Contractor closeout activities, along with a description of their responsibilities.

2.2.1 Outgoing MAC Contracting Officer

The outgoing Contracting Officer (CO) has the administrative responsibility for the outgoing MAC contract. The outgoing CO has overall responsibility for the DME MAC’s closeout activities and negotiating termination and transition costs.

2.2.2 Outgoing MAC Project Officer

The outgoing Project Officer (PO) is the CMS individual responsible for monitoring the day-to-day operational activities of the outgoing MAC and will be responsible for ensuring that the MAC continues to maintain its overall operation and performance during the closeout period. The outgoing PO will work closely with the Implementation Lead to ensure that the outgoing MAC cooperates with the incoming MAC during the transition and that all Medicare files, records, and data are successfully transferred to the incoming Medicare Administrative Contractor.

Chapter 3: GETTING STARTED

3.1 Contract Award

The incoming Contracting Officer will place a call to inform the successful offeror of its DME MAC contract award. This will start the implementation phase of the transition. Unsuccessful offerors will also be notified and CMS will issue a press release. The incoming MAC may also want to issue its own press release; if so, CMS will provide input and review the content prior to release.

3.2 Initial Transition Activities

The incoming MAC’s implementation team XE "Transition Team" will be composed of a Project Manager XE "Project Manager" and staff who are responsible for the major implementation tasks shown in the Jurisdiction Implementation Project Plan (see Chapter 4.3) XE "Implementation Plan" . A team member will usually be assigned to be the lead for each major implementation task or workgroup XE "Implementation Task" and will report directly to the Project Manager.

An internal meeting with all key MAC implementation members (project manager, business analysts, potential workgroup leaders, and subject matter experts) should be held after contract award to plan and prepare for the upcoming project and to handle administrative details. The project organization and workgroup structure may need to be revised and/or expanded. A final organization chart and contact list should be developed in preparation for the kickoff meeting. There may be additional transition tasks or CMS-directed schedule date changes that are identified. The MAC should also begin to baseline the Jurisdiction Implementation Project Plan. Tools to assist the team in managing the project should be identified and discussed. Team training in project management, financial tracking (data, cost analysis), and administration (software applications, reports, general project communication) may be helpful. Internal procedures for meetings and communications should be agreed upon.

The outgoing MAC will form a closeout team XE "Transition Team" composed of a Project Manager XE "Project Manager" and staff responsible for contract closeout activities. The outgoing MAC’s closeout team shall work directly with the incoming MAC for the orderly transfer of all Medicare functions. Information regarding the outgoing MAC’s closeout team will be provided to the incoming MAC at the kickoff meeting.

3.3 Contact with Outgoing Contractor

After CMS has publicly announced the contract award and implementation schedule, the incoming MAC may contact the outgoing MAC. Contact is usually made by upper management, and will serve as an introduction to the incoming organization. Areas of discussion may include the outgoing MAC’s plans for its Medicare employees, any proposed retention of staff by the incoming MAC, communication, commitment of the organizations, any schedule date changes that may have occurred after the RFP was issued, and any immediate problems or issues that need to be addressed before the kickoff meeting. The incoming MAC should make introductory calls to the major professional organizations (medical societies, supplier groups, etc.) within the jurisdiction, with follow-up calls as the implementation progresses. It may also want to make contact with the various state Congressional delegations.

In the days immediately following the award announcement, the incoming MAC must understand that it may be difficult to have extensive contact with the outgoing MAC because the outgoing MAC may still be trying to deal with the loss of its DME contract. The outgoing MAC may be assessing its options, addressing employee concerns, or preparing to protest the award. It is also possible that the outgoing MAC is just losing its DME contract and will continue to be a Medicare claims processor, with the possibility that it may be competing against the incoming MAC for future jurisdictions. All of this may result in little information initially being provided to the incoming MAC.

The incoming MAC must take these possibilities into account when it initiates contact with the outgoing MAC and be cognizant of the outgoing contractor’s situation when communicating and requesting information. If the loss of the DME MAC jurisdiction will leave the outgoing contractor with no other Medicare claims processing contracts, either as a MAC or carrier/intermediary (i.e. the MAC is leaving the Medicare program), then general communication/interaction with the outgoing contractor will not normally be an issue.

3.4 Outgoing Contractor Employee Notification

After award announcement, the outgoing DME MAC will begin to plan for its contract closeout. If the incoming MAC has an interest in hiring any of the outgoing MAC’s Medicare employees, it should inquire about the outgoing contractor’s plans for those employees. If the outgoing contractor will not be retaining its Medicare staff, the incoming MAC should inform the contractor that it may be interested in making employment offers to some or all of its employees. Plans should be coordinated with the outgoing contractor to notify the affected employees and a face-to-face meeting should be scheduled as soon as possible. Commitment of the outgoing MAC’s employees is critical to the success of any transition. Obviously, knowledge that jobs will be retained will greatly facilitate the transition process and alleviate fears regarding employees’ futures.

If the incoming MAC will be hiring a significant number of outgoing contractor’s staff, a human resources representative from the incoming MAC may be able to be located at the outgoing MAC’s site to address employee concerns and provide detailed information about employment and benefits. An analysis of the outgoing MAC’s employee benefits will need to be done as soon as possible, and an explanation of the differences between the two organizations’ benefits should be available to outgoing contractor staff. Meetings should be scheduled with staff to be hired to discuss differences in benefits and provide information on what will occur at cutover. The incoming MAC may also be able to contribute transition-related articles to the outgoing MAC's employee newsletter.

3.5 Jurisdiction Kickoff

The DME jurisdiction kickoff is composed of 3-4 separate meetings that can normally be completed within a day. The kickoff is intended for all parties involved in DME transition, but not all parties will attend every meeting. There will be a minimum of three meetings held during the jurisdiction kickoff: the incoming MAC pre-meeting, the outgoing MAC pre-meeting, and the general jurisdiction kickoff meeting. In addition, the incoming MAC post-award orientation conference that is conducted by the incoming Contracting Officer may be held as part of the kickoff, if it has not already been held.

The jurisdiction kickoff is generally held within 30 days of contract award. The meetings normally will be held in the Baltimore, Maryland metropolitan area, unless CMS determines another location would be more appropriate. The incoming MAC will be responsible for providing facilities for all of the jurisdiction kickoff meetings that will take place, providing toll-free phone lines for off-site participants, developing an agenda (with input from other participants), and notifying potential attendees. In the unlikely event that the kickoff would be held at a CMS facility, then CMS would be responsible for making facility and teleconferencing arrangements. Meeting minutes and an attendance sheet/contact list shall be prepared by the incoming MAC and sent to all those in attendance.

Normally, each of the jurisdiction kickoff meetings can be completed in a half day (3-4 hours of concentrated meeting time). The exception would be the post-award orientation conference, which generally takes 1-2 hours. In-person attendance at each of the meetings will vary, depending on a number of factors. However, the general jurisdiction kickoff meeting will draw the largest number of attendees (usually 30-40 people). The incoming MAC should have a meeting room with tables that will accommodate the general jurisdiction meeting. There should also be several smaller rooms for the pre-meetings and any conferences or workgroup breakout sessions. The Implementation Lead will work with the incoming MAC in preparation for the kickoff activities.

3.5.1 Incoming MAC Pre-Meeting

3.5.1.1 Purpose

The incoming DME MAC pre-meeting is a meeting conducted by CMS and the Medicare Implementation Support Contractor (MISC) with the incoming MAC. It deals with information that pertains exclusively or primarily to the incoming contractor and will be held before the general jurisdiction kickoff meeting. The meeting will discuss issues that have arisen since contract award, review CMS’s expectations and administrative requirements for the project, and make final preparations for the conduct of the jurisdiction kickoff meeting.

3.5.1.2 Topics of Discussion

Topics for discussion will include:

· Introduction of the CMS implementation team and contract administration structure;

· CMS project monitoring: reporting requirements, meetings, and contract deliverables;

· Introduction of the MISC and discussion of its role in the project;

· Revision of the Jurisdiction Implementation Project Plan (if award has been delayed) and review of implementation schedule/cutover dates;

· Agreement on the key assumptions made in the DME MAC’s proposal;

· Workgroup discussions: number of workgroups, meeting times, toll-free numbers;

· Deliverables lists for outgoing DME MAC;

· New jurisdiction workload numbers;

· Due diligence/on-site visits;

· Lessons learned from previous MAC implementations;

· Discussion of MAC’s agenda and presentation for the kickoff meeting; and

· Areas of immediate focus: communications/provider relations, new EFT form CMS-588, Change Requests since proposal submission, and SOW changes.

The incoming MAC will have submitted its proposal using the implementation schedule provided in the Request for Proposals (RFP). It is possible that CMS may direct the MAC to revise its overall jurisdiction plan based on schedule changes or other considerations. Should this be necessary, CMS will negotiate with the MAC to reach agreement on a revised schedule and any additional costs associated with the changes. The contract will be modified accordingly.

3.5.2 Outgoing MAC Pre-Meeting

This meeting is conducted by CMS with the outgoing DME MAC. Since the outgoing MAC will be present for the jurisdiction kickoff meeting, it provides an opportunity for CMS to discuss issues of importance solely related to the outgoing MAC. The outgoing MAC pre-meeting may be scheduled before or after the incoming MAC pre-meeting, but generally both meetings are held concurrently. Topics will include closeout financial issues, reporting, staffing and workload issues, accounts receivable review, and file storage/transfer.

3.5.3 Jurisdiction Kickoff Meeting

While other kickoff meetings will have limited audiences, the jurisdiction kickoff meeting is intended for all parties involved in the DME MAC transition. This meeting is sometimes referred to as the general kickoff meeting.

3.5.3.1 Purpose

The purpose of the jurisdiction kickoff meeting is to understand, organize, and coordinate activities among all parties involved in the DME transition. It provides the opportunity to meet face-to-face to discuss the approach to the DME transition, go over the schedule, review roles and responsibilities, and address any concerns. Attendance would normally include the MAC’s operational and implementation project managers, as well as workgroup leads and functional/technical staff that the MAC may be assigning to the project.

3.5.3.2 Participants

All parties directly involved in the jurisdiction transition should be invited to attend. This includes CMS, the MISC, appropriate incoming and outgoing DME MAC personnel, applicable data centers, the VMS DME shared system maintainer, National Supplier Clearinghouse (NSC), Pricing and Data Analysis Contractor (PDAC), Common Electronic Data Interchange (CEDI) contractor, and functional contractors such as the Program Safeguard Contractor (PSC), Qualified Independent Contractor (QIC), and the Beneficiary Call Center (BCC). Attendance may be in person or via teleconference. CMS will work with the incoming DME MAC to develop the list of individuals/ organizations that should be invited to the meeting.

3.5.3.3 Topics of Discussion

The jurisdiction kickoff meeting will give a high level overview of the transition project. The DME MAC will be requested to make a corporate introduction and describe its Medicare organization and operation. The MAC should also discuss its implementation team/ organization, its implementation approach, and provide an overview of its Jurisdiction Implementation Project Plan (see Chapter 4.3). Much of the information presented will normally be drawn from the MAC’s proposal or any oral presentations supporting the proposal. The outgoing MAC will make a presentation regarding its organization, closeout plan, and project team. It will also discuss any pilot projects and unique working relationships or workloads. Other entities involved in the project will also be asked to provide an overview of their transition activities and interactions with the incoming MAC. In addition, CMS will discuss its implementation expectations, review reporting and meeting requirements (Chapter 11), and present its transition team organization.

The MAC’s due diligence review will be discussed, along with deliverables that are being requested from the outgoing contractors. Proprietary issues regarding the incoming MAC’s interaction with the outgoing MAC will also be discussed. Any Deliverables List, action item list, or problem/issue log that is developed as a result of the kickoff meeting should be distributed as soon as possible after the meeting. The Deliverables List will serve as documentation for all the information the outgoing contractor needs to provide to the incoming MAC (see Chapter 4.12). The coordination of communication activities will also be discussed.

Transition workgroups will be a key topic of discussion at the meeting (see Chapter 3.6).

The incoming DME MAC will be expected to work with the outgoing MAC and other attendees to establish transition workgroups and agree on their basic responsibilities. These workgroups and their functions will normally be in place for the entire implementation. The outgoing MAC will have to structure its closeout activities utilizing the workgroups. Therefore, it is critical that agreement be reached with the outgoing MAC as to what workgroups will be established and the major responsibilities of each. The incoming MAC should request a workgroup contact list (name, telephone number, e-mail address, office location, etc.) from the outgoing MAC and any other organization that will have membership in a transition workgroup.

During the jurisdiction kickoff, there should be breakout sessions of the various workgroups with as many members as possible. If there are not enough workgroup members available, a date and time should be agreed upon for the group to initially meet and organize. The breakout session will provide the opportunity for workgroup members to begin brainstorming, discuss transition strategy, and address any immediate issues. The group should also review implementation documents such as the JIPP, deliverables that have been requested, dependencies, and any action items already identified in order to better define and develop the direction of the workgroup. Members should also discuss methods for accomplishing their workgroup tasks. The group should try to reach agreement on administrative details such as each organization’s designated points of contact and workgroup meeting/teleconference dates and times, if possible.

Any deliverable, action item, or issues log that is developed or added to an existing document as a result of the kickoff meetings should be distributed as soon as possible. After all of the meetings occurring at kickoff are completed, the incoming MAC should review the project schedule, the JIPP, the risk management plan, and communication plan to make any appropriate revisions based on the discussions that took place during the meetings.

3.5.4 Post-Award Orientation Conference

A post-award orientation conference between the incoming DME MAC and the incoming MAC Contracting Officer is normally held 10-15 days after notification of contract award. The CO will determine the time and location of the meeting, prepare the agenda, and notify the participants. The conference may be held during the jurisdiction kickoff. If it is, it would normally be a part of the incoming MAC pre-meeting (Chapter 3.5.1), but could be held separately. The conference is usually not more than 1-2 hours in length.

The purpose of the conference is to achieve a clear and mutual understanding of all contractual provisions and requirements. The CO must ensure that the incoming MAC understands the roles of Government personnel who will be involved in administering the MAC contract and the quality assurance procedures that will be applied. Participants may discuss special contract provisions, identify and resolve any potential problems, and review the implementation schedule. Procedures for vouchering and the processing of change orders will also be reviewed.

3.6 Transition Workgroups

Transition workgroups are the basic organizational structure for conducting the day-to-day activities of the transition. They are the key to a successful workload transition.

3.6.1 General

Transition workgroups are established to facilitate the process of transferring the outgoing DME MAC’s Medicare workload to the incoming DME MAC. The scope of a particular workgroup may vary from one workload transition to another for a variety of reasons, including the incoming MAC’s business structure, the jurisdiction project plan/approach, and outgoing MAC considerations. However, there must be agreement between the incoming and outgoing MACs as to what workgroups will be established and what their specific responsibilities will be. Workgroups are generally established for infrastructure activities (facilities, hardware, human resources, telecommunications, etc.), functional program areas (MSP, audit and reimbursement, medical review, etc.), and overall project administration tasks (project management, financial, etc.).

3.6.2 Participants

Experienced staff from the incoming MAC, the outgoing MAC, and other involved organizations should be assigned to the various workgroups. Of course, members will only be assigned if the organization has some involvement with a particular workgroup’s function. CMS or the MISC will normally be represented on every workgroup. The incoming and outgoing MACs should try to keep the same workgroup members for the duration of the implementation, especially the workgroup heads.

The incoming MAC will be responsible for appointing the workgroup head. Duties of the workgroup head include: 1) organizing, directing and coordinating all workgroup activities; 2) maintaining the applicable portions of the implementation project plan and associated action items; 3) analyzing and comparing workflow processes and documentation; 4) developing and responding to deliverables/action items; and 5) reporting and documentation.

3.6.3 Scope

XE "Transition Workgroup" The scope or area of responsibility for the individual workgroups XE "Transition Workgroup" will vary depending on a number of factors such as the incoming MAC’s organization or business structure, size of the outgoing contractor, business processes, and workflow structure. The actual number of workgroups varies from transition to transition, but it has been found that 8-10 workgroups generally work best. Workgroups have been established for the areas shown below, but occasionally, more specialized workgroups have been established. Some MACs have found it advantageous to establish subgroups within a workgroup to focus on specific areas or issues. MACs have also combined workgroups based on convenience or practicality.

Workgroups established in past DME transitions include:

· Project Management

· Communications

· Systems/IT

· Telecommunications XE "Telecommunication"

· Provider Relations

· EMC XE "EMC" /EDI XE "EDI"

· Medical Review XE "Medical Review"

· MSP

· Operations/Claims Processing

· Hardware/Software

· Facilities

· Human Resources

· Financial

· Print/Reports

· File Transfer

· Cutover An established workgroup may not necessarily correspond directly to a major task in the MAC’s Jurisdiction Implementation Project Plan. For example, a financial workgroup may be established, but financial activities and tasks may be listed under the project management task in the Jurisdiction Implementation Project Plan.

The workgroups and their functions should be in place for the entire implementation. However, in a number of transitions, some or all of the workgroups and their remaining activities have been consolidated into the cutover workgroup when the cutover period gets underway. This expanded cutover workgroup then addresses all remaining issues and tasks as the workgroup coordinates the remaining cutover activities.

3.6.4 Functions

Each workgroup will identify the tasks and action items necessary to successfully transfer the Medicare records, data, and operations related to that specific workgroup. The group will be responsible for monitoring and updating the tasks listed in the Jurisdiction Implementation Project Plan that are applicable to its workgroup. Throughout the transition period, the workgroup will report its progress to the MAC’s implementation project manager, resolve policy and transition issues regarding its area of expertise, and ensure that all specific activities and deliverables have been accomplished.

Each workgroup XE “Transition Workgroup" is charged with defining the basic functions of the workgroup and establishing a work plan to address its objectives, work responsibilities, ground rules, and reporting requirements XE "Reporting Requirements" . The workgroup should maintain an issues/action item list and a deliverables log throughout the transition to insure that all items relating to the workgroup are resolved. The workgroup must have a clear understanding of the information that it must provide to other entities, as well as information and deliverables that it has requested from others. It is important that requests are precise so that time will not be lost due to misunderstanding exactly what is being asked for. The workgroups should reach an understanding of the types of issues for which they have the authority to resolve and obtain approval from the project managers of those organizations represented in the workgroup.

Initial activities for the workgroups will include brainstorming, discussion of transition strategy, identifying workgroup members, reaching agreement on meeting dates and times, and taking action on any immediate issues. The workgroup should also discuss how it will accomplish workgroup tasks. The group will review transition materials and meeting documentation, the Jurisdiction Implementation Project Plan, any deliverables that have been requested, dependencies, action items, etc., in order to better define and develop the direction of its workgroup. All of these activities will be coordinated through the incoming MAC’s implementation Project Manager

3.6.5 Administration XE "Transition Workgroup:Communication"

Workgroups should generally meet on a weekly basis, either in person or via teleconference. It will be the responsibility of the incoming MAC to provide toll-free teleconference capability for all participants in workgroup meetings, as well as any ad hoc teleconferences or meetings. A comprehensive workgroup meeting schedule must be developed for the transition. The schedule should provide a listing of all the workgroups that have been established, the workgroup leads, members, meeting days and times (normally scheduled for one hour), and the call-in numbers with corresponding pass codes. Membership of the workgroups should be finalized within a week after the kickoff meeting.

A workgroup agenda should normally be distributed…