Carrier Advisory Committee
What is the CAC Network?
The Centers for Medicare and Medicaid Services (CMS) contracts with private insurance carriers to administer Medicare claims in each state. Medicare carriers administer Medicare Part B claims, while Fiscal Intermediaries administer Medicare Part A claims. Some national contractors (i.e. Noridian) administer Medicare in more than one state, creating a similar set of reimbursement policies across those states.
Each local Medicare carrier is required by CMS to have a physician Contractor Medical Director (CMD), who may serve more than one state, however, each state must have at least one CMD. CMDs oversee the development of local Medicare policies in their jurisdiction and often collaborate with other CMDs to share data and coordinate the development of Local Coverage Determinations (LCDs).
LCDs, formerly referred to as Local Medical Review Policies (LMRPs), are documents produced by CMDs, which outline medical necessity for a given procedure. They typically include a set of indications that support medical necessity and may or may not include a list of ICD-9 codes that support medical necessity.
To assist Medicare carriers in the development of LCDs, each state is required to have a Carrier Advisory Committee (CAC), comprised of physicians from various specialties who serve as resources to their local Medicare carriers. Radiology, radiation oncology and nuclear medicine each have seats on the CAC.
The ACR CAC Network was developed to encourage communication and coordination among all radiology CAC representatives. The ACR is committed to providing as much assistance as possible to each CAC representative. In September 1999, the ACR Council passed Resolution 42, which called for the development of a state model for coordination and communication of local CAC activities. In addition, Resolution 42 encouraged the development of local subspecialty advisory panels to further aid local CAC members in the review of local Medicare policies. Adoption of the ACR CAC Networks and the model by the state chapters created a better organized and more effective mechanism for dealing with local Medicare issues.
Cristopher Meyer, MD, FACR
William Pao, MD, FACR