Medicaid alternative care (MAC) is a Washington apple health benefit authorized under section 1115 of the Social Security Act. It enables the medicaid agency and the agency's designees to deliver an array of person-centered long-term services and supports (LTSS) to unpaid caregivers caring for a medicaid-eligible person who meets nursing facility level of care under WAC 388-106-0355 .
Full Answer
Does Washington Apple Health classic Medicaid cover Medicare?
You may still be eligible for Washington Apple Health Classic Medicaid coverage, even if you have Medicare coverage. This coverage could include Apple Health coverage, help paying for Medicare premiums, or long-term services and supports.
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.
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 is my Medicare Mac?
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.
What is the MAC for Washington?
MAC is a program available for governmental entities that interact with individuals who are, or may be, eligible for Washington Apple Health (Medicaid). Partial reimbursement is available for the time that governmental entities spend helping individuals: Apply for Apple Health (Medicaid), including renewals.
How many part a B MAC jurisdictions are there?
Centers for Medicare and Medicaid Services (CMS) announced in 2010 plans to reduce the number of A/B Medicare Administrative Contractors (MACs) from the current numbered 15 jurisdictions to 10 alphabetical jurisdictions over the next several years.
What states are in Medicare jurisdiction F?
JF processes FFS Medicare Part A and Part B claims for Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming.
What is the Mac program?
MAC provides support services and respite to family caregivers when the care is provided to current recipient of a Categorically Needy or Alternative Benefit Plan (CN/ABP) Medicaid program who resides in an at home setting.
How many MACs are there?
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.
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 states are in Medicare Region B?
Jurisdiction B is serviced by CGS and includes Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.
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 is Medicare jurisdiction F?
Jurisdiction F - Medicare Part B Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming.
What states are in Medicare jurisdiction D?
DME MAC Jurisdiction D – DME Facts JD processes FFS Medicare DME claims for Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming.
What are Medicare regions?
CMS Regional OfficesRegionRegional Office LocationContactRegion [email protected] 2New [email protected] [email protected] [email protected] more rows•Dec 1, 2021
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 MAC in Medicaid?
MAC creates a new optional choice for people who are eligible for CN or ABP Medicaid but not currently accessing Medicaid-funded LTSS and provides services to unpaid caregivers designed to assist them in providing quality care to family members while also improving their own well-being. MAC offer services to support the needs of the person who is providing care to a family member so they are able to continue to provide care.
What is MAC in healthcare?
Medicaid alternative care (MAC) is a Washington apple health benefit authorized under section 1115 of the Social Security Act. It enables the medicaid agency and the agency's designees to deliver an array of person-centered long-term services and supports (LTSS) to unpaid caregivers caring for a medicaid-eligible person who meets nursing facility ...
How old do you have to be to be a MAC?
The person providing care must be age 18 or older and meet the criteria under WAC 388-106-1905 WAC. A person may be prescreened for MAC services by either Home and Community Services or by the Area Agency on Aging (AAA) office. However all services are authorized at the AAA.
How old do you have to be to be eligible for MAC?
To be eligible for MAC services, the person receiving care must: Be age fifty-five or older; Be assessed as meeting nursing facility level of care under WAC 388-106-0355, and choose to receive services under the MAC program instead of other long-term services and supports;
What is the HCA 18-005?
If a person wants to apply for MAC services and the person is not already eligible for Medicaid, they must submit an HCA 18-005 Application for Aged, Blind, Disabled/Long-term care, or may apply for MAGI coverage by applying through the Washington Healthplanfinder.
How to contact Apple Health in Washington?
Online: Visit the SHIBA webpage. Health Care Authority. For questions about Washington Apple Health: Phone: 1-800-562-3022. Washington Healthplanfinder.
What is Apple Health eligibility?
Apple Health eligibility is determined by income and resource limits . You may have other private coverage options such as Medicare Supplemental insurance, Tri-Care, or insurance from a former employer. For help deciding on options that may work for you, contact SHIBA at the number below.
How to contact DSHS?
For help applying for health coverage : Phone: 1-877-501-2233. DSHS Home and Community Services. For questions about long-term services and supports (if you need nursing home or help with personal care needs): Phone: 1-800-422-3263.
Does Apple Health cover medical expenses?
While Medicare covers many medical expenses, it does not cover everything. If you meet the income and resource limits, Apple Health may help pay for any expenses Medicare does not.
Does Apple Health work with Medicare?
Check with your provider to see if they accept your new Medicare coverage. Some providers may not accept your new coverage. Any Apple Health coverage you are approved for when you are receiving Medicare will work as a secondary insurance to Medicare.
Facility Setting Payment Differential
As part of the resource-based practice expense initiative, CMS has replaced the previous policy that systematically reduced the practice expense relative value units (RVUs) by 50%for certain procedures performed in facilities with a policy that would generally identify two different levels (facility and non-facility) of practice expense RVUs for each procedure code depending on the location of the service..
Non-physician Practitioner Fee Schedule
Sections 4511 and 4512 of the Balanced Budget Act of 1997 (BBA) provide that payment for the professional services of these non-physician practitioners will be linked to the physician fee schedule.
Practitioners Subject to Mandatory Assignment
Some practitioners who provide services under the Medicare program are required to accept assignment for all Medicare claims for their services. This means that they must accept the Medicare allowed charge amount as payment in full for their practitioner services.
