Medicare administrative contractors (MACs)

Medicare administrative contractors (MACs)

CMS Announces Claims Hold

In anticipation of possible congressional action to suspend the two percent budget sequestration cut slated to take effect April 1, 2021, the Centers for Medicare and Medicaid Services (CMS) has instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow.  Further information from CMS will be posted here as it becomes available. Congress is expected to act on this issue in mid-April.

Photo of the capital building

AUDIOLOGY ADVOCATE | Academy Kicks Off 116th Congress with In-Person Congressional Visits

The 2018 mid-term elections left a reshaped Congress, with nearly 100 new representatives and senators coming to Washington, DC. This much turnover has led to great opportunities for the Academy’s government relations department to build relationships with new members of Congress, many of whom have not held elected office before. The new class is the most diverse and the most educated in congressional history.

Topic(s): Advocacy, Medicare Telehealth Parity Act (MTPA), Medicare administrative contractors (MACs)

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Publication Issue: Audiology Today May/June 2019

Abstract illustration of coding and reimbursement for audiology

CODING AND REIMBURSEMENT | New Medicare LCD Process—What You Need to Know

Local coverage determination (LCD) policies issued by Medicare administrative contractors (MACs) serve as the workhorse of Medicare coverage policy. About 90 percent of coverage determinations are made through LCDs. Coverage policies include a defined list of services the insurer will cover and specific exclusions. Medicare provides coverage of services that are determined to be “reasonable and necessary” for Medicare beneficiaries. If a specific item or service is not covered under an LCD, this does not mean it isn’t covered. Claims may be adjudicated on a case-by-case basis.

Topic(s): Coding, Reimbursement, Practice Management, Medicare, Medicaid, Local coverage determination (LCD), Medicare administrative contractors (MACs), Centers for Medicare and Medicaid Services (CMS)

Publication Issue: Audiology Today May/June 2019