Who are the current Medicare Administrative Contractors (MACs) for each Jurisdiction?
- To find the current MACs and their contact information visit the CMS.gov website at: ... (more)
- To find the current MACs and their contact information visit the CMS.gov website at: Who are the MACs.
How did Medicare Contracting Reform affect Medicare providers and Medicare beneficiaries?
- As a result of Medicare Contracting Reform, both providers and beneficiaries now have a single po... (more)
As a result of Medicare Contracting Reform, both providers and beneficiaries now have a single point-of-contact for all Medicare Fee-For-Service related businesses and needs.
For providers, in addition to processing claims, the MACs are able to assist providers and suppliers with obtaining information on behalf of patients about items or services received from another provider or supplier that could affect claims payment.
For beneficiaries, the first point of entry for resolution of questions about Medicare coverage is 1-800-MEDICARE, which takes them through a more advanced customer service network for meeting their information needs, including complex original Medicare plan inquiries, availability of prescription drug coverage and finding and comparing nursing homes.
What were the key changes implemented with Medicare Contracting Reform?
- As CMS implemented Medicare Contracting Reform, it ensured that changes were man... (more)
- As CMS implemented Medicare Contracting Reform, it ensured that changes were managed effectively and coordinated with other Program initiatives. CMS ensured that Medicare claims continued to be processed effectively, accurately and in a timely manner. Under Medicare Contracting Reform, contracts are now subject to the Federal Acquisition Regulation. Differences between the Title XVIII contracts (previous contracts) and the Federal Acquisition Regulation contracts (current contracts) are:
- Restrictions on who could receive contract award
- Generally were limited to cost reimbursement contracts
- Performance standards and criteria were published in the Federal Register
- Either party could terminate
- Submitted monthly expenditure reports, which did not have to be approved in advance in order to access funds
- Contracts/Agreements were renewed year to year.
- Full and open competition is required
- Several types of contracts are available
- Performance standards are contained in the contract
- Only Government may terminate for convenience or default
- Must submit a voucher in order to get paid, and payment is made after voucher is approved
- Section 509 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the maximum length of a MAC contract, inclusive of all option and renewal periods from five (5) to up to ten (10) years
Learn more about Medicare Contracting Reform on cms.gov at Archives.
What was the impact of Medicare Contracting Reform on the Medicare Fee-for-Service (FFS) program?
- Under Medicare Contracting Reform, CMS was able to improve and modernize Medicare FFS claims pr... (more)
- Under Medicare Contracting Reform, CMS was able to improve and modernize Medicare FFS claims processing operations. It provided the flexibility for CMS and the Medicare contractors to work together more effectively and better adapt to changes. Medicare Contracting Reform enabled the Medicare FFS program to benefit from economies of scale and competitive performance contracting.
When will CMS finish assigning all providers to their designated geographical A/B Medicare Administrative C...
- CMS has not set a timetable to move all out-of-jurisdiction providers to their designated geographic... (more)
- CMS has not set a timetable to move all out-of-jurisdiction providers to their designated geographical A/B MACs. Learn more about out-of-jurisdiction providers on the CMS.gov website at: Provider Assignment.
Will CMS finish the Medicare Administrative Contractor (MAC) Jurisdiction consolidation plan, combining Jur...
- Originally CMS planned to implement 15 A/B MACs across the country, but later changed its strategy t... (more)
- Originally CMS planned to implement 15 A/B MACs across the country, but later changed its strategy to consolidate these 15 Jurisdictions down to 10. In 2014, CMS postponed the final two consolidations and paused at 12 A/B MAC Jurisdictions. In 2016, after evaluating the impact of the consolidation of these remaining MAC jurisdictions, CMS concluded that further consolidation is not in the best interest of the MAC program. CMS will not be combining Jurisdiction 8 and 15 to form Jurisdiction I, nor will it combine Jurisdiction 5 and 6 to form Jurisdiction G.
What will be the impact of Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 on Medicare Fee-for...
- The Medicare Access and CHIP Reauthorization Act (MACRA) enacted on April 16, 2015, included languag... (more)
- The Medicare Access and CHIP Reauthorization Act (MACRA) enacted on April 16, 2015, included language in Section 509 that extends MAC contract terms from five to ten years. Also, it requires the Agency to publish performance information on each MAC, to the extent that such information does not interfere with contract procurements. CMS shares information on its strategy to implement this new legislation and includes publishing MAC performance information on the cms.gov website. To learn more visit: MACRA Section 509.