by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Feb 10th, 2015 - Reviewed/Updated May 13th
The Centers for Medicare & Medicaid Services (CMS) uses a network of contractors called Medicare Administrative Contractors (MAC) 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. Even though Section 1861 of the Social Security Act (“the act”) defines the items and services for which Medicare may pay, in many cases, MACs may have more defined policies than what is included in Medicare's National Coverage Determinations (NCDs). MACs publish a Local Coverage Determination (LCD) for the jurisdiction(s) they serve to clarify policies.
Consolidation
CMS determined that contracted Medicare claims operations could increase in efficiency and effectiveness by consolidating some of the smaller Part A and Part B MAC workloads to form larger A/B MAC jurisdictions. In March 2014, this consolidation process was temporarily halted. Click here to read more about the consolidation halt.
Links:
- Medicare MAC information
- Part A/Part B MAC information
- Medicare Carriers Manual - Local Coverage Determinations
- Find Your MAC tool - helps you find your state's MAC information.
About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.
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