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
Fee-for-service
Fee-for-service is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. However evidence of the effectiveness of pay-for-performance in improving health care quality is mixed, without conclusive proof that these programs either succe…
Most people get Part A for free, but some have to pay a premium for this coverage. To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child.
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.
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 do Medicare Prescription Drug Plans work?
All Medicare prescription drug plans are private insurance plans, and most participants pay monthly premiums to access discounted prices. A prescription drug plan has a list of drugs it covers, called a formulary, often structured in payment tiers.
How long do I have to file a Medicare claim?
Medicare law requires claims to be filed within one calendar year after the date of service. THIS SET IS OFTEN IN FOLDERS WITH... YOU MIGHT ALSO LIKE... Medical insurance chapter 17 workers comprehensati…
What is the role of Medicare administrative contractors quizlet?
Insurance companies that process claims are called Medicare administrative contractors (MACs). 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.
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.
What does CCP stand for quizlet?
Unexpected illness or injury that requires immediate treatment. CCP is the abbreviation for. Medicare coordinated care plans.
Which of the following are parts of the Medicare program select all that apply?
There are four parts of Medicare: Part A, Part B, Part C, and Part D.Part A provides inpatient/hospital coverage.Part B provides outpatient/medical coverage.Part C offers an alternate way to receive your Medicare benefits (see below for more information).Part D provides prescription drug coverage.
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. There are 42 functional G-codes that are comprised of 14 functional code sets with three types of codes in each set.
What is CPT G0427?
G0427. Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth.
What does CCP stand for?
Read a brief summary of this topic. Chinese Communist Party (CCP), also called Communist Party of China (CPC), Chinese (Pinyin) Zhongguo Gongchan Dang or (Wade-Giles romanization) Chung-kuo Kung-ch'an Tang, political party of China.
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.
Which of the following is excluded under Medicare?
Non-medical services, including a private hospital room, hospital television and telephone, canceled or missed appointments, and copies of x-rays. Most non-emergency transportation, including ambulette services. Certain preventive services, including routine foot care.
What are Medicare Parts A and B?
Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Part B (Medical Insurance): Helps cover: Services from doctors and other health care providers. Outpatient care.
What are the 4 parts of Medicare?
Thanks, your Guide will be delivered to the email provided shortly.Medicare Part A: Hospital Insurance.Medicare Part B: Medical Insurance.Medicare Part C: Medicare Advantage Plans.Medicare Part D: prescription drug coverage.
What's the difference between Medicare Part A and Part B?
If you're wondering what Medicare Part A covers and what Part B covers: Medicare Part A generally helps pay your costs as a hospital inpatient. Medicare Part B may help pay for doctor visits, preventive services, lab tests, medical equipment and supplies, and more.
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.
Basic MAC Facts
So, what are Medicare Administrative Contractors, anyway? Essentially, MACs are companies (like Palmetto GBA or Noridian) that work as intermediaries between you and Medicare. Broadly, MACs do the following:
Final MAC Overview
Hopefully, any confusion about what a MAC is, what it does, and how it affects you as a PT has been put to rest. But, just to review, here are your Medicare Administrative Contractors takeaways: