Tag: Medicare Administrative Contractor (MAC)
CMS to MACs: Provide TPE results, common issues
October 12, 2026HME News Staff
WASHINGTON – The Centers for Medicare & Medicaid Services (CMS) will require the Medicare Administrative Contractors (MACs) to post Targeted Probe and Educate (TPE) results on their websites to keep the provider and supplier communities informed of issues and trends. “Each quarter, MACs shall post TPE results with, at a minimum, the three most common reasons per Targeted Probe and Educate prioritized problem on their websites in an effort to keep the supplier community informed of issues...
MACs withdraw new coverage policies for skin substitutes
December 29, 2025HME News Staff
WASHINGTON – The A/B Medicare Administrative Contractors (MACs) are withdrawing the local coverage determinations (LCDs) for skin substitute grafts/cellular and tissue-based products for the treatment of diabetic foot ulcers and venous leg ulcers that were scheduled to go into effect Jan. 1, 2026.
The Centers for Medicare & Medicaid Services (CMS) made the announcement on Dec. 24, only days after announcing that the MACs would release updated LCDs that...
MACs to issue final LCDs for skin substitute products effective Jan. 1, 2026
December 17, 2025HME News Staff
WASHINGTON – The seven A/B Medicare Administrative Contractors (MACs) will release updated final Local Coverage Determinations (LCDs) for skin substitute grafts and cellular/tissue-based products used to treat diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) that will be effective Jan. 1, 2026, according to a Dec. 15 Fact Sheet from the Centers for Medicare & Medicaid Services (CMS).
Key highlights of the LCDs
Expanded access: Medicare...
CMS to MACs: Lift claims hold
October 28, 2025HME News Staff
WASHINGTON – CMS has instructed all Medicare Administrative Contractors (MACs) to lift the claims hold and process claims with dates of service Oct. 1, 2025, and later for certain services impacted by select expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act of 2025.
This includes claims paid under the:
Medicare Physician Fee Schedule
Ground ambulance transport
Federally Qualified Health...
CMS tells MACs to continue holding claims
October 16, 2025HME News Staff
WASHINGTON – In anticipation of possible Congressional action, CMS has instructed all Medicare Administrative Contractors (MACs) to continue to temporarily hold claims with dates of service of Oct. 1, 2025, and later for services impacted by the expired Medicare legislative payment provisions passed under the Full-Year Continuing Appropriations and Extensions Act, 2025. This includes all claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and all Federally...
OIG: MACs miss mark on cost reports
March 20, 2025HME News Staff
WASHINGTON – Medicare Administrative Contractors did not consistently meet Medicare cost report oversight requirements, according to a new report from the Office of Inspector General.
For federal fiscal years 2019–2021, each of the 12 MAC jurisdictions failed to comply with the contract requirements for audit and reimbursement desk review and audit quality (AR-4) for at least one of the three years.
CMS identified 287 total audit issues among all MAC jurisdictions during...
CMS proposes MAC changes
September 9, 2024HME News Staff
WASHINGTON – CMS has posted a request for information to obtain public feedback on consolidating the Medicare Administrative Contractor (MAC) jurisdictions. The RFI also asks for feedback on awarding future MAC contracts with 10-year award periods of performance. The agency asks that those interested submit responses by email to MAC_Procurement@cms.hhs.gov within 30 days of the RFI publication date (Sept. 4). It says responses should be submitted as an email attachment in Microsoft Word and...
Senators introduce bill to change LCD process
October 5, 2016HME News Staff
WASHINGTON - Two senators recently introduced a bill that seeks to improve the transparency and accountability of the local coverage determination (LCD) process performed by the Medicare Administrative Contractors (MACs).
The Local Coverage Determination Clarification Act of 2016 would: require open and public meetings with the MACs that are on the record; require disclosure by the MACs of the rationale for an LCD and the evidence for that decision at the beginning of the process; provide stakeholders...
CMS limits scope of audits
September 1, 2015HME News Staff
WASHINGTON - For redeterminations and reconsiderations of claims denied following a post-payment review or audit, CMS has instructed the MACs and QICs to limit their scope to the reason the claim or line item was initially denied, according to a recent MLN Matters article.
In the past, the MACs and QICs have had the discretion to develop new issues and review all aspects of coverage and payment related to a claim or line item.
“In some cases, where the original denial reason is cured,...
In brief: MACs miss standards, health spending stays low
January 10, 2014HME News Staff
BALTIMORE - Medicare Administrative Contractors (MACs) failed to meet one-quarter of CMS's performance standards, according to a new report from the Office of Inspector General (OIG). “Given the billion of dollars awarded to Medicare Administrative Contractors and the critical role they play in administering the Medicare program, effective oversight of performance is important to ensure that they are adequately processing claims,” the OIG states. The OIG based its findings on a performance...