What is a Mac Medicare Administrative Contractor?
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 a Mac do for Medicare?
Medicare Administrative Contractors (MACs) regionally manage policy and payment related to reimbursement and act as the fiscal intermediary for Medicare. MACs manage provider claims for payment and establish regional policy guidelines, called Local Coverage Determinations (LCDs).
How many Medicare claims do Macs process each year?
Collectively in FY2020, the MACs processed more than 1.1 billion Medicare FFS claims, comprised of approximately 203 million Part A claims and 909 million Part B claims, and paid out approximately $400 billion in Medicare FFS benefits.
What are the Medicare Part B Macs?
THe MACs are the primary resource for audiologists and speech-language pathologists providing and billing for services to Medicare beneficiaries. The table below includes the following information for each of the Medicare Part B MACs: Link to the MAC website for Part B (outpatient) services, by state
What is a Mac Medicare administrative contractor?
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.
Which has been replaced with Medicare administrative contractors?
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 ...
What is an administrative contractor?
Administrative Contractors means the persons or entities engaged by the Administrators, if any, and to whom the Administrators may delegate duties assigned to the Administrators under this Agreement, including, without limitation, duties associated with provision of Notice, calculation of Claims, and preparation and ...
What are the different Medicare MACs?
A/B MACs and HH+H Areas A/B MACs process Medicare Part A and Medicare Part B claims for a defined geographic area or “jurisdiction,” servicing institutional providers, physicians, practitioners, and suppliers. Four of the A/B MACs also process HH+H claims in addition to their typical Medicare Part A and Part B claims.
What is the difference between RAC and MAC?
MAC audits are powerful and intrusive procedures that have the potential to lead to serious federal charges for healthcare entities. A Recovery Audit Contractor (“RAC”) reviews claims and identifies overpayments from Medicare so that CMS and other auditors are able to prevent improper payments in the future.
What is the MAC for Oklahoma?
The Blue Cross and Blue Shield of Oklahoma (BCBSOK) Mobile Assistance Center (MAC) is a licensed team of Oklahomans who provide one-on-one assistance with health insurance education, questions and enrollment.
Who is the Medicare Administrative Contractor Mac for Northern California?
Noridian Healthcare SolutionsNoridian Healthcare Solutions is the Medicare Administrative Contractor for California and is responsible for processing all Medicare fee-for-service Part A and B claims.
What is the MAC for Texas?
The Medicaid Administrative Claiming (MAC) program provides Texas School Districts, including public charter schools, the opportunity to obtain reimbursement for certain costs related to administrative activities that support the Medicaid program.
What is the MAC for Florida?
First Coast has proudly served as one of the nation's largest Medicare administrators for 50 years, and is the current Medicare Administrative Contractor (MAC) for Jurisdiction N (JN), which includes Florida, Puerto Rico and the U.S. Virgin Islands.
Which of the following claims are handled by the DME MACs?
DME MACs handle claims for durable medical equipment, supplies, and drugs billed by physicians.
What does a Zone Program Integrity Contractor do?
The Zone Program Integrity Contractor (ZPIC) is an entity established in the United States by the Centers for Medicare & Medicaid Services (CMS) to combat fraud, waste and abuse in the Medicare program.
What is the primary function of Mac?
The basic function of MAC is to provide an addressing mechanism and channel access so that each node available on a network can communicate with other nodes available on the same or other networks. Sometimes people refer to this as the MAC layer.
What's a MAC and what do they do?
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.
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 DME MACs at Who are the MACs.
Relationships between MACs and Functional Contractors
MACs work with multiple functional contractors to administer the full FFS operational environment. Learn more about the relationships between the MACs and the functional contractors by viewing the diagram of MACs: The Hub of the Medicare FFS Program (PDF) and reading about what the functional contractors do at Functional Contractors Overview (PDF).
What Is a MAC?
Think of a MAC as a middleperson between you, your doctor and the Centers for Medicare & Medicaid Services (CMS). Each geographic region (also known as jurisdiction) has a specific MAC that handles the payment side of the Medicare fee-for-service program. MACs are also charged with conducting audits and educating providers.
How Many Macs Exist?
Currently, there are 12 Medicare Part A and B MACs that assist with Original Medicare (Medicare Parts A and B). Four of these MACs also process home health and hospice claims in addition to their typical Medicare Part A and Part B claims. There are also four durable medical equipment (DME) MACs.
Why Are MACs Important?
MACs are important because they ensure your doctor gets paid correctly. They also create what’s called local coverage determinations (LCD) based on whether an item or service is considered reasonable and necessary. LCDs exist in the absence of a national coverage policy, and they may vary from jurisdiction to jurisdiction.
When Would I Need to Find a Specific LCD?
You might need to find an LCD if you’re filing an LCD challenge. You can do this if you have Medicare Part A, Medicare Part B (or both), and you need the item or service that’s not covered by the LCD. However, you need to file your request within six months of the date of the treating doctor’s written statement that you need the item or service.
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.