U S Department of Health and Human Services www.hhs.gov
  CMS Home > About CMS > CMS Leadership > Center for Medicare Management

Center for Medicare Management

Jeffrey Rich, MD Director

Elizabeth Richter, Deputy Director

Business Operations Staff - Robert Ventura, Director

Hospital & Ambulatory Policy Group - Amy Bassano, Director
Division of Acute Care - Tzvi Hefter, Director
Division of Practitioner Services - Cassandra Black, Director
Division of Outpatient Care - Carol Bazell, Director
Division of Ambulatory Services - John Warren, Director

Chronic Care Policy Group - Laurence Wilson, Director
Division of Chronic Care Management - Janet Samen, Director
Division of Cost Reporting - Susan Burris, Director
Division of Institutional Post Acute Care - Sheila Lambowitz, Director
Division of Technical Payment Policy - Lisa Ohrin, Director
Division of DMEPOS Policy - Martha Kuespert, Director
Division of Home Health, Hospice & HCPCS - Lori Anderson, Director

Provider Billing Group - Stewart Streimer, Director
Division of Institutional Claims Processing - Lorraine Zicha, Director
Division of Practitioner Claims Processing - Patricia Gill, Director
Division of Supplier Claims Processing - Glenn Kendall, Director
Division of Data Systems - Dan McGrane, Director
Division of Chronic Care Improvement Programs - Tricia Rogers, Director

Medicare Contractor Management Group - Karen Jackson, Director
MAC Information Exchange Staff - Ralph Sette, Acting Director
MAC Budget & Data Analysis Staff - Ralph Sette, Director
Eastern MAC Program Management Division - Pat Williams, Director
Division of Change & Operations Management - Diane Maupai, Director
Division of MAC Strategy & Development - Chris Klots, Acting Director
Division of Performance Assessment - Richard Morrison, Acting Director
Southern MAC Program Management Division - John Delaney, Director
Western MAC Program Management Division - Jody Kurtenbach, Director

Provider Communications Group - Gerry Nicholson, Director
Division of Provider Information Planning & Development - Valerie Haugen
Division of Provider Relations & Evaluations - Gay Burton, Acting Director
Division of Contractor Provider Communications - Shana Olshan, Director
Division of Provider Communications Technology - Carol Plum, Director

Functional Statement

  • Serves as the focal point for all Agency interactions with health care providers, intermediaries, carriers, and Medicare Administrative Contractors (MACs) for issues relating to Agency fee-for-service (FFS) policies and operations.
  • Responsible for policies related to scope of benefits; and other statutory, regulatory, and contractual provisions.
  • Based on program data, develops payment mechanisms, administrative mechanisms, and regulations to ensure that CMS is purchasing medically necessary items and services under Medicare FFS.
  • Develops, evaluates and maintains policies, regulations, and instructions that define the scope of benefits and payment amounts for:
  1. hospitals for inpatient services under the inpatient prospective payment system and the long-term care hospital prospective payment system;
  2. inpatient services in hospitals and units excluded from the prospective payment systems;
  3. physicians and non-physician practitioners;
  4. hospital outpatient departments, comprehensive outpatient rehabilitation facilities and ambulatory surgical centers;
  5. clinical laboratory services;
  6. ambulance services;
  7. prescription drugs and blood, blood products and hemophilia clotting factor; and
  8. telemedicine services, rural health clinics, and federally qualified health centers.
  • Formulates CMS policy for development, analysis, and maintenance of new and revised medical codes and medical classification systems (including ICD-9-CM, Healthcare Common Procedure Coding System, Diagnosis Related Groups, and Ambulatory Payment Classifications) and develops common medical coding standards and policy.
  • Participates in the development and evaluation of proposed legislation pertaining to assigned subject areas.
  • Coordinates with the Office of Clinical Standards and Quality on coverage issues in assigned areas.
  • Develops, evaluates, and reviews regulations, manuals, program guidelines, and instructions required for the dissemination of program policies to program contractors and the health care field.
  • Identifies, studies, and makes recommendations for modifying Medicare policies to reflect changes in beneficiary health care needs, program objectives, and the health care delivery system
  • Develops, evaluates and maintains policies, regulations, and instructions that define the scope of benefits and payment amounts for skilled nursing facilities, home health agencies, hospice, durable medical equipment, orthotics, prosthetics, and supplies.
  • Develops and evaluates national Medicare policies and principles for applying limitations to the costs of skilled nursing facilities and home health agencies. Develops criteria for exceptions to the cost limitations for skilled nursing facilities and exceptions to the cost limitations for skilled nursing facilities. Reviews and makes decisions on requests for such exceptions.
  • Analyzes payment data, develops, maintains and updates payment rates for End Stage Renal Disease (ESRD) services and PACE sites.
  • Manages designation process for Medicare organ transplant centers, organ procurement organizations and for hospitals seeking out-of-service-area waivers.
  • Develops, issues, and administers the specifications, requirements, methods, standards, policies, procedures, and budget guidelines for Medicare claims processing related activities, including detailed definitions of the relative responsibilities of providers, contractors, CMS, other third-party payers, and the beneficiaries of the Medicare program.
  • Develops and releases the coding and pricing data bases and software for physician, laboratory, SNF, Home Health, Inpatient, Outpatient and supplier services in the Medicare claims processing standard systems.
  • Develops policies related to the integration of health care services, including policies on ownership and referral arrangements, business relationships and conflict of interest.
  • Serves as the CMS lead for management, oversight, budget, and performance issues relating to Medicare carriers, fiscal intermediaries, and MACs.
  • Functions as CMS liaison for all Medicare carrier, fiscal intermediary, and MAC program issues and, in close collaboration with the regional offices and other CMS components, coordinates the agency-wide contractor activities.
  • Manages contractor instructions, workload, and change management process.
  • Manages and oversees Medicare contractor provider inquiry, outreach and education activities including specifying Budget Performance Requirements (BPRs), allocation and management of budget dollars across contractors, evaluating supplemental budget requests, issuing program instructions and participating in contractor performance evaluation activities.
  • In conjunction with CMS program area experts, develops training programs and materials, and training tools to educate providers, physicians, suppliers, and Medicare contractor provider education staff on new initiatives and changes to the Medicare program.
  • Develops national provider/supplier education products and training tools for Medicare contractors as well as for provider education provided directly by CMS.
  • Supports communication between CMS and the provider/supplier community through facilitation of "open door" and Participating Physician Advisory Committee (PPAC) meetings, other listening sessions and promotes awareness of Agency initiatives by sponsoring exhibit programs at industry conferences.
  • Develops system requirements and computer software for select portions of Medicare FFS claims processing systems
  • Develops and implements Medicare FFS program requirements for provider billing and for claims processing systems.
    Implements the Medicare Health Support Program.


There are no Downloads.
Related Links Inside CMS

There are no Related Links Inside CMS
Related Links Outside CMSExternal Linking Policy

There are no Related Links Outside CMS


Page Last Modified: 12/22/2008 7:57:51 AM
Help with File Formats and Plug-Ins

Submit Feedback