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.
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.
How many a/B Macs process home health and hospice claims?
There are four A/B MACs that process home health and hospice claims in addition to their typical Medicare Part A and Part B claims. Please note that the four HH+H areas do not coincide with the jurisdictional areas covered by these four A/B MACs.
What are the 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. MACs work with multiple functional contractors to administer the full FFS operational environment.
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.
In what year did Medicare stop paying for all consultation codes from the 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 is considered the best defense under the Medicare Integrity Program quizlet?
Which of the following is considered the best defense under the Medicare Integrity program? Having a strong compliance plan.
Who has the right to appeal denied Medicare claims quizlet?
Only the provider has the right to appeal a rejected claim. You just studied 50 terms!
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.
Who can bill CPT 98960?
Lactation consultations (98960) are separately reimbursed when filed by a licensed MD/DO or mid-level practitioner when the lactation consultation is the only service provided and performed by a certified lactation consultant under the general supervision of a licensed MD/DO or midlevel practitioner.
Which of the following is a responsibility of Medicaid Integrity Contractors?
CMS has broad responsibilities under the Medicaid Integrity Program to: Hire contractors to review Medicaid provider activities, audit claims, identify overpayments, and educate providers and others on Medicaid program integrity issues.
What is the Medicare Integrity Program quizlet?
Medicare Integrity Program (MIP) authorizes CMS to enter into contracts with entities to perform cost report auditing, medical review, anti-fraud activities, and the Medicare Secondary Payer (MSP) 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.
Who has the right to appeal denied Medicare claims?
You have the right to appeal any decision regarding your Medicare services. If Medicare does not pay for an item or service, or you do not receive an item or service you think you should, you can appeal. Ask your doctor or provider for a letter of support or related medical records that might help strengthen your case.
Which of the following is the highest level of the appeals process of Medicare?
The levels are: First Level of Appeal: Redetermination by a Medicare Administrative Contractor (MAC) Second Level of Appeal: Reconsideration by a Qualified Independent Contractor (QIC) Third Level of Appeal: Decision by the Office of Medicare Hearings and Appeals (OMHA)
Which of the following is the highest level of the appeals process of Medicare quizlet?
Which of the following information is the highest level of the appeals process of Medicare? Judicial Review. The final level of appeal for Medicare is to request a Judicial Review in Federal District Court.
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).