You’re a Medicare provider. And you know that the Centers for Medicare and Medicaid Services (CMS) runs Medicare. But did you know that CMS is just the umbrella organization? The actual administration is done by a Medicare Administrative Contractor (MAC.)
What is a MAC?
A MAC is a private health care insurer that’s been awarded a geographic jurisdiction to process claims for Medicare Fee-For-Service beneficiaries.
CMS relies on the network of MACs to serve as the primary operational contact between the Medicare Fee-For-Services program and providers enrolled in the program. Some of the activities the MACs include:
One of the functions of each MAC is to establish local coverage determinations (LCD.) An LCD is a determination of whether a particular item or service is going to be covered on a contractor–wide basis.
Before an LCD can be put in place, there's a whole process:
There is an LCD reconsideration process. As a physician you can request a revision to an LCD—either in its entirety or any provision.
An LCD can definitely throw a wrench into your revenue cycle management if it takes you by surprise. It’s imperative that your billing folks keep you abreast of any new LCDs or changes to an existing one.
You want to
Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com
Join my FB group, The Private Medical Practice Academy.
Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.
Join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice. The course, How To Start Your Own Practice is included in the membership, as a bonus.
Rate, Review, & Follow on Apple Podcasts"I love Sandy Weitz and The Private Medical Practice Academy Podcast." <-- If that sounds like you, please consider rating and reviewing my show! This helps me support more people -- just like you -- move toward the practice they want . Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!
You’re a Medicare provider. And you know that the Centers for Medicare and Medicaid Services (CMS) runs Medicare. But did you know that CMS is just the umbrella organization? The actual administration is done by a Medicare Administrative Contractor (MAC.)
What is a MAC?
A MAC is a private health care insurer that’s been awarded a geographic jurisdiction to process claims for Medicare Fee-For-Service beneficiaries.
CMS relies on the network of MACs to serve as the primary operational contact between the Medicare Fee-For-Services program and providers enrolled in the program. Some of the activities the MACs include:
One of the functions of each MAC is to establish local coverage determinations (LCD.) An LCD is a determination of whether a particular item or service is going to be covered on a contractor–wide basis.
Before an LCD can be put in place, there's a whole process:
There is an LCD reconsideration process. As a physician you can request a revision to an LCD—either in its entirety or any provision.
An LCD can definitely throw a wrench into your revenue cycle management if it takes you by surprise. It’s imperative that your billing folks keep you abreast of any new LCDs or changes to an existing one.
You want to
Want to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com
Join my FB group, The Private Medical Practice Academy.
Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.
Join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice. The course, How To Start Your Own Practice is included in the membership, as a bonus.
Rate, Review, & Follow on Apple Podcasts"I love Sandy Weitz and The Private Medical Practice Academy Podcast." <-- If that sounds like you, please consider rating and reviewing my show! This helps me support more people -- just like you -- move toward the practice they want . Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!