Dealing with the MAAC (maximum allowable actual charge) program.

Abstract

Effective January 1, 1987, Congress established restrictions on the amounts a nonparticipating physician may charge Medicare beneficiaries for medical services--Maximum Allowable Actual Charges (or MAACs). After tracing the history of fee restraints upon nonparticipating physicians, this article describes how MAACs are computed and compliance determined, and suggests how unfavorable MAAC calculations can be challenged. Finally, the author alerts physicians to two other provisions of the same 1986 Medicare statute that impose substantial burdens upon nonparticipating physicians.