Who are the administrative contractors for Medicare?
Medicare Administrative Contractors Since Medicare’s inception in 1966, private health care insurers have processed medical claims for Medicare beneficiaries. Originally these entities were known as Part A Fiscal Intermediaries (FI) and Part B carriers.
Is a Fiscal Intermediary the same thing as a Medicare Administrative Contractor?
Is a fiscal intermediary the same thing as a Medicare Administrative Contractor (MAC)? A Medicare Administrative Contractor (MAC) is a type of fiscal intermediary that works with the Medicare program.
What does it mean to be a Medicare contractor?
Definition of Contractors. Medicare Administrative Contractor is a contractor that performs Medicare fee-for-service claims administration services that is awarded a contract through competitive procedures in keeping with Section 1874A of the Social Security Act.
Who are the approved Medicare intermediaries for home health and hospice claims?
As of December 2020, the approved Medicare intermediaries for home health and hospice claims and the states and territories they work in are: National Government Services, Inc.
What is a 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.
Which has been replaced with Medicare administrative contractors?
In 2003 the Centers for Medicare & Medicaid Services (CMS) was directed via Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003 to replace the Part A FIs and Part B carriers with A/B Medicare Administrative Contractors (MACs) in accordance with the Federal Acquisition ...
How many Medicare contractors 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 Medicare jurisdiction is Georgia in?
Jurisdiction CJurisdiction C is serviced by CGS and includes Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, West Virginia and the US Virgin Islands.
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 my Medicare carrier?
You can find the name of your plan provider on your Medicare plan Member ID card (for instance, you may read: Humana, Aetna, WellCare, Cigna, or United Healthcare/AARP).
Who adjudicates Medicare claims?
Administrative Law Judge (ALJ) – Adjudicator employed by the Department of Health and Human Services (HHS), Office of Medicare Hearings and Appeals (OMHA) that holds hearings and issues decisions related to level 3 of the appeals process.
What does a Zone Program Integrity Contractor do?
The Zone Program Integrity Contractor (ZPIC) is an entity established in the United States by the Centers for Medicare & Medicaid Services (CMS) to combat fraud, waste and abuse in the Medicare program.
What is Medicare contracting reform?
The fee-for-service contracting reform also integrates Medicare Parts A and B under a single contractor, known as a Medicare administrative contractor (MAC). With this change, providers will have one contractor per designated region that will process both Part A and Part B claims.
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 states are in Medicare Region B?
DME MAC Jurisdiction B - DME FactsJB processes FFS Medicare DME claims for Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.Total Number of Fee-for-Service Beneficiaries: 6,148,172 (as of 9/30/2021)Total Number of Suppliers: 16,106 (as of 9/30/2021)More items...•
What is Medicare jurisdiction?
United StatesCenters for Medicare & Medicaid Services / Jurisdiction
Current Maps and Lists
To find out who the current A/B and DME MACs are, use these maps and lists to help you determine which MAC is of most interest to you.
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 the DME MAC in each jurisdiction.
What is Medicare Administrative Contractor?
Medicare Administrative Contractor is a contractor that performs Medicare fee-for-service claims administration services that is awarded a contract through competitive procedures in keeping with Section 1874A of the Social Security Act.
What is CMS review contractor directory?
The Review Contractor Directory - Interactive Map allows you to access state-specific CMS contractor contact information. You may receive correspondence from one or several of these contractors in your state. They may request medical records from you, as they perform business on behalf of CMS. You can use this website to access their contact information including emails, phone numbers and websites.
What is DPDA in Medicare?
The Division of Prescription Drug Audits (DPDA) serves as the focal point for Fraud, Waste, and Abuse oversight of Medicare Advantage and Prescription Drug Plans. DPDA also performs oversight of the PPI MEDIC and the Part D RAC.
How to ensure the integrity of Medicare Trust Fund dollars?
To assure the integrity of Medicare Trust Fund dollars through program integrity and compliance efforts by actively seeking out suspected Medicare program vulnerabilities through a variety of methods, assessing scope and severity of risks, and working collaboratively within and outside CMS to develop, help implement, and monitor corrective actions.
What is a Supplemental Medical Review Contractor?
The Supplemental Medical Review Contractor is a contractor that performs Medicare medical review activities as directed by CMS. This is a contract that is awarded through competitive procedures in keeping with Section 1874A of the Social Security Act. Top.
What is a durable medical equipment contract?
Durable Medical Equipment - Medicare Administrative Contractor is a specialty MAC whose contract is awarded through competitive procedures and which provides for the processing of Medicare claims for durable medical equipment, prosthetics, orthotics, and supplies in keeping with 42 CFR 421.210.
Final Reminder! Hospice Mandatory Reporting Reminder: Deadline for Self-reporting of Aggregate Cap is Feb 28
Hospice providers are required to self-calculate and submit their Aggregate Cap Report for the 2021 Cap year no later than February 28, 2022. Failure to file the self-determined cap report with your Medicare Administrative Contractor (MAC) in a timely fashion may result in payment suspension.
Update! Home Health Claims Processing Issues
NAHC became aware of home health claims processing problems in the last several weeks, caused by a Centers for Medicare & Medicaid (CMS) Service systems issue and some Medicare Administrative Contractor (MAC)-specific issues.
Hospice Mandatory Reporting Reminder: Deadline for Self-reporting of Aggregate Cap is Feb 28
Hospice providers are required to self-calculate and submit their Aggregate Cap Report for the 2021 Cap year no later than February 28, 2022. Failure to file the self-determined cap report with your Medicare Administrative Contractor (MAC) in a timely fashion may result in payment suspension.
Hospice Mandatory Reporting Reminder: Deadline for Self-reporting of Aggregate Cap is Feb 28
Hospice providers are required to self-calculate and submit their Aggregate Cap Report for the 2021 Cap year no later than February 28, 2022. Failure to file the self-determined cap report with your Medicare Administrative Contractor (MAC) in a timely fashion may result in payment suspension.
Home Health Claims Processing Issues
NAHC has become aware of some home health claims processing problems last week and this week because of a Centers for Medicare & Medicaid (CMS) systems issue and some Medicare Administrative Contractor (MAC)-specific issues. NAHC quickly began addressing these issues when it was brought to our attention.
MACs to Send Direct Mailing to Hospices Regarding MA VBID Hospice Component Model
In January 2021, the Centers for Medicare & Medicaid Services (CMS) initiated a four-year demonstration model (the MA VBID Hospice Component) under which eligible Medicare Advantage (MA) plans are permitted to offer hospice services as part of the benefit packages.
MACs to Send Direct Mailing to Hospices Regarding MA VBID Hospice Component Model
In January 2021, the Centers for Medicare & Medicaid Services (CMS) initiated a four-year demonstration model (the MA VBID Hospice Component) under which eligible Medicare Advantage (MA) plans are permitted to offer hospice services as part of the benefit packages.
What is Medicare Administrative Contractor?
A Medicare Administrative Contractor (MAC) is a type of fiscal intermediary that works with the Medicare program. After the passing of the Medicare Prescription Drug Improvement and Modernization Act of 2003, the Centers for Medicare and Medicaid Services (CMS) replaced its Part A fiscal intermediaries and Part B carriers with MACs who perform all ...
Who are the Medicare intermediaries?
The federal government contracts with a selection of MACs, or Medicare intermediaries, to administer its Medicare program in districts across the country.
What is fiscal intermediary?
What is a fiscal intermediary, and what do they do? A fiscal intermediary is a business contracted by the federal government to administer a program and process its payments in a specific geographic location, such as a metro area or a state.
What are the functions of a health care provider?
They can perform several functions, including: Administering claims for government programs, including Medicare and Medicaid, and making payments to health providers. Informing people who perform subsidized services, such as health providers, about government programs and billing requirements.
Does Medicare Advantage cover prescription drugs?
Depending on where you live, you may have access to Medicare Advantage plans and Medicare Part D prescription drug coverage that meet many of your health care needs. To learn more about what types of plans, benefits, coverage and costs are available in your area, call today to speak with a licensed insurance agent.
Do Medicare beneficiaries have MACs?
Most Medicare beneficiaries don't have relationships with MACs, although a MAC may approve subsidies for your services without you ever knowing.