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Medicare Administrative Contractor

In a latest move, the Centers for Medicare and Medicaid Services (CMS) have decided to seek opinions from public on improving Medicare Administrative Contractor (MAC) contracts. As part of the process, it issued an official Request For Information (RFI) in the Federal Register. The decision is said to help CMS in monitoring the MAC contracts.

RFI is designed to seek public comments on the CMS procedure to encourage legal authorities to administer a set of tasks, which include publishing performance information on each MAC, handing over rewards to best MAC performances and making changes in the MAC jurisdictions.

CMS adheres to standard Federal competitive procedures in giving out awards to MAC contracts. Often, it is done in line with the Federal Acquisition Regulation (FAR). CMS has been depending on a group of about 16 MACs for Medicare claims processing. Among them, 12 MACs would deal with both Part A and Part B claims. The remaining 4 MACs are responsible for processing Part B claims for Durable Medical Equipment (DMEPOS).

CMS reports that more than 1.5 million healthcare providers and suppliers in the country had registered in the Medicare Fee-For Service (FFS) program where MACs act as the primary operational contact for the suppliers and healthcare providers.

All the major tasks like processing Medicare claims, monitoring the enrolments in the Medicare programs, answering inquiries from healthcare providers and suppliers, educating healthcare providers and suppliers, etc. Reports indicate MACs handle more than 4.9 million Medicare claims on an average business day. Around $365 billion is disbursed as program payments by them each year.

MACRA Extends MAC Contract

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Processing Of Medicare Claims

The Medicare Access and CHIP Reauthorization Act (MACRA) passed in 2015 extended the duration of MAC contracts. Prior to the act, the maximum duration was 5 years. Now it is extended to 10 years. The extended contract length would cover all options and renewal periods.

CMS hopes that the RFI would enable it to identify the additional contracting mechanisms that can be introduced in future for improving MAC performance. It believes that there can be numerous MAC acquisition strategies that could improve the contracts. It is ready to make potential adjustments in the terms and conditions for MAC contracts for better results.

CMS is looking forward to hearing from the public about a number of issues. It wants to see what the public thinks about the award term plan and strategy, and suggest any changes or developments.

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