AMS to improve Medicare appeals, reimbursement methods

American Management Systems Inc. will develop a system to speed and streamline the appeals processes for Medicare recipients. AMS will also upgrade the Medicare and Medicaid provider reimbursement and reporting systems, officials of the Fairfax, Va., company announced Dec. 3.

AMS will perform the work under two task orders awarded by the Centers for Medicare and Medicaid Services. The combined value of the task orders is as much as $28 million.

The task orders were awarded under a multiple-award, indefinite delivery, indefinite quantity contract called Professional IT Services, which was awarded to AMS and eight other companies in 2002. AMS has supported the Centers for Medicare and Medicaid Services since 1998.

AMS will build the new Medicare Appeals System over two years, company officials said. The system will support Medicare managed care and traditional fee-for-service appeals, and will result in more efficient administrative review processes and real-time status on appeals to Medicare beneficiaries and providers.

AMS will replace the current Provider Statistical & Reimbursement System over the next five years, according to company officials. The redesigned, Web-based system that will allow Medicare to better accumulate and report the statistical and reimbursement data needed to conduct settlements and audits.

Officials said the new system also will keep better pace with legislative changes in Medicare cost reporting and payment requirements, and will comply with security standards and federal patient privacy laws.