A Medicare Administrative Contractor (MAC) is a private healthcare insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Medicare Part B medical claims. They also process Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.
Full Answer
What is a Medicare Administrative Contractor (MAC)?
In 2003 the Centers for Medicare & Medicaid Services (CMS) was directed via Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003 to replace the Part A FIs and Part B carriers with A/B Medicare Administrative Contractors (MACs) in accordance with the Federal Acquisition Regulation (FAR).
Do administrative assistants have to file Medicare claims?
All Medicare providers MUST file claims on behalf of patients at no cost to the patients. Medical administrative assistants file claims under Part B for physician services, even if the services are performed in hospital settings. They do not usually file claims for Part A benefits.
How does a Mac file a Medigap claim?
After a MAC processes a claim for a patient with Medigap coverage, the MAC automatically forwards the claim to the Medigap payer, indicating the amount Medicare approved and paid for the procedures. Once the Medigap carrier adjudicates the claim, the provider is paid directly, eliminating the need for the practice to file a separate Medigap claim.
How many Macs are in the Medicare FFS program?
Currently there are 12 A/B MACs and 4 DME MACs in the program that process Medicare FFS claims for nearly 60% of the total Medicare beneficiary population, or 37.5 million Medicare FFS beneficiaries. In Fiscal Year 2020 (FY2020), the MACs served more than 1.1 million health care providers who are enrolled in the Medicare FFS program.
How are providers assigned to a Mac quizlet?
Providers are assigned to a MAC based on the state in which they are physically located. Durable Medical Equipment (DME) MACs handle claims for durable medical equipment, supplies, and drugs billed by physicians.
What does the abbreviation MSA stand for in the Medicare program quizlet?
MSA is the abbreviation for. Medicare medical savings account. MAO is the abbreviation for. Medicare advantage organization. Urgently needed care is defined in the Medicare program as.
When did Medicare stop paying for all consultation codes from CPT evaluation and management except for telehealth consultation G codes?
2010NOTE: Beginning January 1, 2010, CMS eliminated the use of all consultation codes, except for inpatient telehealth consultation G-codes.
Which of the following services are covered by Medicare Part B quizlet?
Part B helps cover medically-necessary services like doctors' services, outpatient care, durable medical equipment, home health services, and other medical services.
What does MAC stand for in healthcare?
A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.
What does the acronym ABN stand for quizlet?
Advance Beneficiary Notice (ABN)
What CPT codes are used for telemedicine?
Telehealth CPT codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (20-30 minutes)
What are G CPT codes used for?
G-codes are used to report a beneficiary's functional limitation being treated and note whether the report is on the beneficiary's current status, projected goal status, or discharge status.
What is CPT G0427?
G0427. Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth.
Which of the following can be covered by Medicare Part B?
Medicare Part B helps cover medically-necessary services like doctors' services and tests, outpatient care, home health services, durable medical equipment, and other medical services. Part B also covers some preventive services.
What does Medicare Parts A and B cover?
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Helps cover the cost of prescription drugs (including many recommended shots or vaccines).
Which of the following types of care would be covered under Medicare?
What's covered?Inpatient care in a hospital.Skilled nursing facility care.Nursing home care (inpatient care in a skilled nursing facility that's not custodial or long-term care)Hospice care.Home health care.
Current Maps and Lists
To find out who the current A/B and DME MACs are, use these maps and lists to help you determine which MAC is of most interest to you.
DME MACs
The DME MACs process Medicare Durable Medical Equipment, Orthotics, and Prosthetics (DMEPOS) claims for a defined geographic area or "jurisdiction," servicing suppliers of DMEPOS. Learn more about the DME MAC in each jurisdiction.
What are the guidelines for MACs?
In designing their websites, MACs shall adhere to basic, research-based website usability guidelines, including the use of plain language, a task-based design, and the elimination of redundant, outdated, and trivial content detected in periodic content audits.
What information does a MAC use?
MACs shall use various. sources of information, including provider feedback, policy and procedure changes, and MAC data analysis to determine these topics; however, at a minimum, MACs shall educate providers on the topics outlined in this section. MACs shall use CMS-developed materials, including MLN.
How long do MACs retain recordings?
MACs shall retain recordings for a period of at least one year.
What is MAC protection?
MACs shall protect electronic mailing list(s) addresses from unauthorized access or inappropriate usage. Electronic mailing list(s), or any portions or information contained therein, shall not be shared, sold, or in any way transferred to any other organization or entity. In special or unique circumstances where .
How long does it take to respond to a provider's request?
All general written provider inquiries (including those received by fax or e-mail) shall be responded to in writing or by telephone within 45 business days of receipt. This timeframe begins the day the inquiry is originally received and date-stamped by the MAC and ends the day the MAC sends the final response.