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Having a single Medicare administrative contractor, or MAC, lets providers rely on one entity for coverage and reimbursement policies, claims processing issues, and general provider information.
The Medicare Modernization Act (MMA) of 2003 initiated the most significant changes to the administration of the Medicare program since its inception in 1965. The contracting reform provisions in the MMA required fundamental changes to the operational infrastructure of the Medicare fee-for-service program. For example, the reform requires the re-engineering of fee-for-service business processes, and provides incentives to encourage innovation, outstanding service, and customer satisfaction. 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. Providers will now rely on one entity, their MAC, for coverage and reimbursement policies, claims processing issues, and general provider information.
MACs are being awarded by the Centers for Medicare and Medicaid Services using a competitive acquisition process, which is outlined under the Federal Acquisition Regulations. Each MAC has a defined geographical jurisdiction that covers multiple states (Fig 1). Eight MAC contracts have now been awarded. Table 1 outlines each jurisdiction and the states within each jurisdiction, the company awarded the MAC contract, and the award date.
For additional information on Medicare Contracting Reform, MACs, as well as information on your state Carrier Advisory Committee (CAC) representative, visit www.asco.org/cac. You can also contact Laura Cathro, ASCO's Medicare Program Coordinator, at 571-483-1642 or email@example.com.
On July 15, 2008, the House of Representatives and the Senate both voted to override the President's veto of the Medicare Improvements for Patients and Providers Act of 2008, which averted the 10.6% cut in physician payments under the Medicare Physician Fee Schedule. Given that Congress over-rode the veto, the law will go into effect and provide a 0.5% increase for the remainder of 2008 (retroactive to July 1, 2008) and will provide a 1.1% increase for the year 2009.