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Sleep Technology

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MAC | Medicare Administrative Contractors

Medicare Administrative Contractors (MACs) Increase Focus on Polysomnography Compliance

By: Marietta B. Bibbs, BA, RPSGT, CCSH, FAAST
July 29th, 2021

In late 2020, free-standing and hospital-based sleep centers began receiving communications from Medicare Administrative Contractors (MACs) asking for attestations that they were in compliance with their local coverage determinations (LCDs) for polysomnography. LCDs are decisions made by a MAC whether to cover a particular item or service in their jurisdiction (region). MACs are contracted by Medicare to develop LCDs and process Medicare claims. The MAC’s decision is based on whether the service or item is considered reasonable and necessary. The Centers for Medicare & Medicaid Services (CMS) awards geographical jurisdictions to MACS (private health care insurers). National coverage determinations (NCDs) supersede LCDs, but LCDs provide expansion on coverage policies for each jurisdiction. Coverage policies vary among LCDs related to coding, credentialing, diagnostic testing and treatment. This means that Medicare coverage can also vary depending on the geographical location. LCD contractors must follow a specified procedure to issue an LCD, including holding public meetings to discuss a draft LCD, distributing it to medical groups, posting it on their website and offering a 45-day period for public comments (posted on their websites prior to finalizing the LCD).

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