CHOW Considerations for Medicare Chain Providers: The Importance of Knowing Your MAC

All Medicare providers must update their enrollment information to reflect changes in ownership (CHOWs) within 30 days after the CHOW.1  Providers must report CHOWs to the applicable Medicare Administrative Contractor (MAC). Typically, a provider’s MAC is merely determined by the provider’s covered services and payment location.2  A/B MACs process Medicare Part A and Medicare Part B claims for a defined geographic area or jurisdiction.3  However, in certain circumstances, a provider’s MAC may not be the currently assigned contractor in their jurisdiction.

Medicare providers that are currently or were previously part of an approved chain of two or more providers under common ownership or control may be enrolled with and assigned to a MAC outside their jurisdiction.4  Chain providers may request and receive an exception to the traditional MAC assignment, and, upon CMS approval, may enroll with and bill on behalf of the eligible providers under its common ownership or common control to the MAC for the geographic locale in which the qualified chain provider’s home office is physically located.CMS also has authority to grant an exception to the traditional MAC assignments to eligible providers that are not under the common ownership or common control of a qualified chain provider, as well as ineligible providers, if CMS finds the exception will support the implementation of MACs or will serve some other compelling interest of the Medicare program.6

It is important for providers and investors to know their current MAC to prevent delays with reporting and processing CHOWs. Failure to timely report a CHOW, including changes in individuals or organizations with 5% or greater ownership or controlling interests, may result in termination of a provider’s Medicare provider agreement and revocation of Medicare billing privileges.7  In addition, delays in reporting CHOWs can result in the provider having to hold Medicare claims from the effective date of the CHOW until Medicare has processed and approved the CHOW.

[1] 42 C.F.R. § 424.516.

[2] 42 C.F.R. § 421.404(b).

[3] See CMS, Who are the MACs, https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.

[4] 42 C.F.R. § 421.404(a).

[5] 42 C.F.R. § 421.404(b).

[6] Id.

[7] 42 C.F.R. 424.516.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Arnall Golden Gregory LLP | Attorney Advertising

Written by:

Arnall Golden Gregory LLP
Contact
more
less

Arnall Golden Gregory LLP on:

Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
- hide
- hide

This website uses cookies to improve user experience, track anonymous site usage, store authorization tokens and permit sharing on social media networks. By continuing to browse this website you accept the use of cookies. Click here to read more about how we use cookies.