What does MAC stand for?

The effort requires each carrier and Medicare Administrative Contractor (MAC) to begin revalidation proceedings for each of the top 50 billers in each state for each of the following categories: Part B organizational suppliers, individual practitioner suppliers, SNFs, and the approximately 50 Slide Preparation Facilities (SPFs) currently enrolled in Medicare nationwide.

Fiscal intermediaries and carriers, which were responsible for physician and hospital claims processing, are being replaced with Medicare Administrative Contractors (MAC) that administer the Medicare program for both physicians and facilities.

The contract will help Centers for Medicare & Medicaid Services (CMS) fulfill the contracting requirements of the 2003 Medicare Modernization Act, which requires the agency to transition Medicare fee-for-service claims from fiscal intermediaries and carriers to the Medicare Administrative Contractors.

CNE questions In addition to the Recovery Audit Contractors, hospitals soon will be audited by Medicare Administrative Contractors, Comprehensive Error Rate Testing auditors, and Zoned Program Integrity Contractors as part of the CMS initiative to combat fraud and abuse.

CMS backed off the requirement to name the Medicare administrative contractor as a certificate holder.

The certification, called "EHR Integrated[TM]," validates that by using the Compliance 360 Claims Auditor, hospitals will be able to seamlessly send and receive denial appeals data and status updates, including data and updates relevant to all governmental auditing programs such as Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs), Zone Program Integrity Contractors (ZPICs), and Medicaid Integrity Contractors (MICs) to and from EHR.

RACs are private companies that will contract with CMS to conduct analyses and audits of claims beyond those conducted by the Medicare Administrative Contractors (MACs) (formerly, Carriers and Fiscal Intermediaries).

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