The Centers for Medicare & Medicaid Services (CMS) uses a network of contractors called Medicare Administrative Contractors (MACs) to process Medicare claims, enroll healthcare providers in the Medicare program and educate providers on Medicare billing requirements. MACs also handle claims appeals and answer beneficiary and provider inquiries. Find your MAC.
Medicare pays ASCs a prospectively determined rate for covered procedures. These rates are updated annually via a regular process. Each summer, Medicare proposes rates for the next year and then finalizes the rates in the fall.
CMS maintains a comprehensive resource document, the Medicare Claims Processing Manual that contains definitions, policies, and processes relating to submitting a claim for procedures performed in an ASC.