Full Answer
What is a MAC in Medicare?
MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. MACs perform many activities including: Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003 directed CMS to replace the Part A Fiscal Intermediaries (FIs) and Part B carriers with 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.
How many Macs are in the Medicare FFS program?
Currently there are 12 A/B MACs and 4 DME MACs in the program that process Medicare FFS claims for nearly 60% of the total Medicare beneficiary population, or 37.5 million Medicare FFS beneficiaries. In Fiscal Year 2020 (FY2020), the MACs served more than 1.1 million health care providers who are enrolled in the Medicare FFS program.
What states are covered by DME Mac?
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 is Medicare Mac?
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.
Who is my Medicare fiscal intermediary?
Medicare Part B Services. Medicare Administrative Contractors (MACs) regionally manage policy and payment related to reimbursement and act as the fiscal intermediary for Medicare.
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.
Who is the Mac for Michigan?
Welcome to MAC (Michigan Association of Counties) MAC is a nonpartisan, nonprofit organization that advances education, communication and cooperation among county government officials in Michigan. MAC is the counties' voice at the state and federal level, providing legislative support on key issues affecting counties.
Who is the Mac for Indiana?
WPS Health Solutions (WPS) has been the Medicare Administrative Contractor (MAC) for Jurisdiction 5, which includes Parts A/B for the states of Iowa, Kansas, Missouri, and Nebraska, since September 2007, J5 National since October 2012, and Jurisdiction 8, which includes Parts A/B for the states of Indiana and Michigan, ...
Who is the Mac for Florida?
First CoastFirst 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.
How are RACs paid?
RACs are paid on a contingency fee basis, which means they are reimbursed based on a percentage of the improper payments they find or collect. The amount of the contingency fee is based on the amount of money from, or reimbursed to, providers.
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 triggers a Medicare audit?
What Triggers a Medicare Audit? A key factor that often triggers an audit is claiming reimbursement for a higher than usual frequency of services over a period of time compared to other health professionals who provide similar services.
What jurisdiction is Michigan in for Medicare?
Jurisdiction BJurisdiction B is serviced by CGS and includes Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.
Is national government services the same as Medicare?
National Government Services, Inc., a subsidiary of Anthem, Inc., has a long history of supporting federal health agencies, including the CMS . Throughout the country, NGS has served as a Medicare contractor since the inception of the Medicare Program over 56 years ago.
Who is the Medicare MAC for Minnesota?
NGS will administer all of the Medicare Part A and Part B claims for Medicare covered services in Minnesota, Illinois and Wisconsin. NGS will also replace Wisconsin Physicians Service (WPS) which has served as the Part B Medicare carrier for MN since 2000.
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.
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
Who were the former contractors in this jurisdiction?
Learn about the former contractors in this jurisdiction at Archives: DME MAC Jurisdiction D.
