Medicare Compliance & Reimbursement

INDUSTRY NOTES:

Differentiate Traditional Medicare Carriers From the New MACs

Know where to go to find out how long payers in your state are allowed to wait before seeking refunds.

If you were confused about the differences between a Medicare administrative contractor (MAC) and an oldfashioned Part B carrier, it's time to get them straight.

Many practices received notices from their carriers over the last few months indicating that their claims for both Part A and Part B services should now go to the same place. If you thought this was a typo -- think again.

"This is the change from Medicare carriers to Medicare MACs," advises Barbara J. Cobuzzi, MBA,CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC with CRN Healthcare Solutions. "MACs process both Part A and Part B claims -- some have changed the company they go through from carrier to MAC and others just are going to see the consolidation of their carrier doing part A and part B to become the MAC and not change the company."

For example, Cobuzzi says, New York is staying with National Government Services (NGS), whereas New Jersey will leave NGS and switch to Highmark. "But both NGS and Highmark are now MACs, processing Part A and Part B; they are no longer carriers," she says.

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