Medicare Payment Resources

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.

While there is no substitute for receiving a legal opinion regarding the specific facts in a particular case from qualified counsel that practice in this specialized area of law, the Federal Regulations section of ASCA’s website provides a starting point for understanding the federal rules impacting ASCs. For questions or more information, contact Kara Newbury at
Reproduction in whole or in part without written permission from ASCA is prohibited.