What is an administrative contractor?
What is the primary function of Mac?
What is the role of the Medicare independent contractor in the claims process?
Who monitors the Medicare administrative contractors?
CMS conducts QASP reviews to ensure that MACs are providing the quality of services required in their contracts. MACs are expected to comply with stringent performance requirements for QASP standards; a number of standards require 100-percent performance compliance.
Do Medicare Administrative Contractors process Medicare Advantage claims?
Who handles Medicare claims?
What is the role of Medicare administrative contractors quizlet?
What is the role of the Medicare independent contractor in the claims process quizlet?
What are some common responsibilities of a Medicaid contractor?
...
- Process claims.
- Provide info for providers about particular gov. progs.
- Generate guidelines for claims process.
- Answer beneficiary questions about benefits, claims processing, appeals, and the explanation of benefits (EOB) document.
What does heat stand for in Medicare?
What is a ZPIC audit?
What does MAC stand for in hospice?
What jurisdiction is CMS in?
California, along with Nevada, Hawaii, and the U.S. territories of American Samoa, Guam and the Northern Mariana Islands, are under Jurisdiction E (previously called Jurisdiction 1).
What does a MAC do?
What do MACs do? MACs are the primary point of contact for: Provider enrollment. Medicare coverage and billing requirements. Training for providers. Receipt, processing and payment of fee-for-service claims. Medicare providers are assigned to the MAC serving their geographical region.
What is a program integrity contractor?
The Program Integrity Contractors perform functions to ensure the integrity of the Medicare Program. Most MACs will interact with one Program Integrity Contractor in support of the CMS audit, oversight, and antifraud, waste and abuse efforts.
What is the QIC in Medicare?
The QICs are responsible for conducting the second level of appeals of Medicare claims. The MAC is responsible for handling the first level of appeals. There are 5 QIC jurisdictions: Part A East, Part A West, Part B North, Part B South, and one DME Jurisdiction QIC.
What is SMRC medical review?
The SMRC conducts nationwide medical review as directed by CMS. The medical review will be performed on Part A, Part B, and DME providers and suppliers. Services/Provider Specialties to be reviewed will be selected by CMS. The SMRC will evaluate medical records and related documents to determine whether Medicare claims were billed in compliance with coverage, coding, payment, and billing practices. The SMRC will perform medical review in accordance with CMS regulations, CMS Publication 100-08 (known as the Program Integrity Manual) and other current and future CMS Provider Compliance Group/Division of Medical Review and Education initiatives.
What is CQISCO in healthcare?
The Division of Survey and Certification Operations resides in the Consortium for Quality Improvement and Survey and Certification Operations (CQISCO). The Consortium for Quality Improvement and Survey & Certification Operations has a dual mission: quality improvement and quality assurance. CQISCO’s work continues to be a crucial CMS component as the agency strives to improve health and the quality of care. In partnership with the Center for Clinical Standards and Quality, CQISCO serves as the field focal point for survey and certification, quality improvement, and clinical and medical science issues and policies for the agency’s programs.
What is a HIGLAS?
HIGLAS is the general ledger accounting system that replaced the former cash accounting systems used by Medicare Fiscal Intermediaries and carriers. All A/B MACs now utilize the HIGLAS system to account for Medicare benefit payments. Durable Medical Equipment (DME) MACs do not use HIGLAS.
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