MEDICARE (MAC’S)

MEDICARE-MACS-2014
WHAT IS A MEDICARE ADMINISTRATIVE CONTRACTOR?
A Medicare Administrative Contractor (MAC) is the new contracting entity that is responsible for the receipt, processing and payment of Medicare fee-for-service claims. In addition to providing core claims processing operations for both Part A and Part B, the MAC will be the primary contact for physicians and perform functions related to: Appeals, Provider Outreach and Education, Financial Management, Provider Enrollment, Reimbursement, Payment Safeguards, and Information Systems Security.

MACs are not government entities, all MACs are private entities that hold the governments Medicare contracts throughout the United States. MACs are responsible for a majority of Medicare’s work nationwide.
The primary responsibilities of each MAC (Medicare Administrative Contractor) are the following:
• Claims processing
• Beneficiary and provider customer service
• Appeals (in-case of denials)
• Provider education
• Financial management
• Provider enrollment
• Reimbursement
• Payment safeguards
• Information systems security

FROM CMS WEBSITE: (LINK)

MAC Jurisdictions

The Centers for Medicare & Medicaid Services (CMS) uses a network of contractors called Medicare Administrative Contractors  to process Medicare claims, enroll health care providers in the Medicare program and educate providers on Medicare billing requirements. MACs also handle claims appeals and answer beneficiary and provider inquiries. Section 1861 of the Social Security Act (“the act”) defines the items and services for which Medicare may pay. It also defines the provider types recognized by the Medicare program.

Part A and Part B MACs

A/B MACs process Medicare Part A and Medicare Part B claims for a defined geographic area or “jurisdiction,” servicing institutional providers, physicians, practitioners, and suppliers.  In April 2006, CMS began to award Medicare claims processing contracts through competitive procedures.

Through the initial series of A/B MAC procurements, Medicare’s claims processing operations have realized significant operational savings from the consolidation of state workloads and the efficiencies gained through integrating Part A and Part B functionality.  CMS believes that the efficiency and effectiveness of its contracted Medicare claims operations can be further increased by consolidating some of the smaller A/B MAC workloads to form larger A/B MAC jurisdictions.  Additional details, Fact Sheet and Maps for the A/B MAC jurisdictions are available using the “Related Links” below.

Home Health and Hospice (HH+H)

In March 2007, CMS announced that the HH+H workloads would be consolidated into four of the A/B MAC contracts instead of being procured separately under Cycle Two.  CMS integrated the four home health and hospice jurisdictional claims workloads into the following four A/B MAC competitions:

  • Jurisdiction 6 included home health and hospice Jurisdiction D
  • Jurisdiction 11  included home health and hospice Jurisdiction C
  • Jurisdiction 14  included home health and hospice Jurisdiction A
  • Jurisdiction 15  included home health and hospice Jurisdiction B

Additional details, Fact Sheets and Maps of the HH+H jurisdictions are available using the “Related Links” below.

Durable Medical Equipment (DME) MACs

DME MACs process Medicare claims for durable medical equipment, prosthetics, orthotics, and suppliers under Part B of the Medicare Fee-for-Service program for a defined geographic area or “jurisdiction.”  The DME MACs will process claims based on a Medicare Beneficiary’s principal residence by state.  During the initial DME implementation phase (2005 – 2011) CMS awarded contracts to four regional DME MACs.  The four DME MACs processed claims for geographical areas or states that may be in more than one A/B MAC jurisdiction.  For example, Jurisdiction D processes claims for those states in both Jurisdictions E and F.  Additional details, Fact Sheets and Maps of the DME jurisdictions are available using the “Related Links” below.

Consolidation of the MACs

Originally, CMS proposed 15 regional A/B MAC jurisdictions to serve the nation as the foundation for CMS’s initial series of A/B procurements.  CMS is currently engaged in a MAC consolidation strategy, moving from 15 A/B MAC jurisdictions to 10 A/B MAC jurisdictions.  For more details about the consolidation plan use the Vision of Future FFS link on the left navigation bar. The Consolidated jurisdiction map can be accessed using the “Download” below.

Find Your MAC

MACs are assigned by State. The  Link below will take you to an interactive map where you may find all your MAC and other contractors assigned to your state.

    Interactive Map >>> Find Your MAC

 

2 thoughts on “MEDICARE (MAC’S)

  1. Pingback: Medicare Administrative Contractors (MACs) page Updated 4/22/2014 | HBOTechBlog.com

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