Medicare Administrative Contractors

By Author: Jaun Paul
Total Articles: 53
Comment this article

Medicare fraudsters quite often set up ‘dummy' storefront operations that have billing addresses, but no health care going on as such. The feds are on to this trick, and that's good news. But well-meaning providers and suppliers that have moved recently need to take steps to ensure they don't get caught in the trap.


Now that November 2 is over, be ready as your health care organization might be getting a house call from Medicare; the reason behind this is simply to make sure you're there.


According to CMS Transmittal 306, all providers and suppliers are subject to unannounced site visits before receiving Medicare billing privileges or after receiving
Medicare Billing privileges.


In some cases, CMS will instruct a MAC (Medicare Administrative Contractors) to make a visit to a medical provider or supplier to determine if it's operational ...
... at the address on the file. If the MAC representative cannot tell from an external check-up whether the place is in operation, the MAC rep shall conduct unobtrusive site verification by restricting its encounter with provider or supplier personnel or medical patients.


If the MAC rep happens to visit your office at a time when it's closed and it doesn't seem like the office is non-operational, it will come back at a later date to re-check.


And if the MAC finds out that the office is not operational at the address on file, the MAC will cancel the provider's billing privileges within a week, until and unless the provider has submitted a change of address to Medicare.


The transmittal intends to discourage fraud operations from setting up shop - those storefront buildings that set up Medicare billing privileges and submit sham claims but do not tend to patients.


Remember: In case you've shifted recently, see to it that your MAC has the right contact information on file for your practice.

We provide the latest developments in Healthcare Compliance and offers advanced Learning Opportunities about Medicare Administrative Contractors (MAC) for healthcare executives and physician billers.