The Resource Center for Providers

Although Medicare is a Federal program, providers generally interact with the designated Medicare Administrative Contractor (MAC) for their jurisdiction. MACs act on behalf of the Center For Medicare and Medicaid Services (CMS) in many capacities in Part B Medicare. According to Medicare, " A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims for Medicare Fee-For-Service (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary operational contact between the Medicare FFS program and the health care providers enrolled in the program. MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. MACs perform many activities including:

  • Process Medicare FFS claims
  • Make and account for Medicare FFS payments
  • Enroll providers in the Medicare FFS program
  • Handle provider reimbursement services and audit institutional provider cost reports
  • Handle redetermination requests (1st stage appeals process)
  • Respond to provider inquiries
  • Educate providers about Medicare FFS billing requirements
  • Establish local coverage determinations (LCD’s)
  • Review medical records for selected claims
  • Coordinate with CMS and other FFS contractors"

What you will learn...

This module outlines the Provider-MAC relationship, the duties that the MAC performs for the provider, and how providers interact with this important payer, both on the national and local levels. The resources that are provided are very useful in your practice. Because your MAC processes your Medicare claims, it's critical to understand their role and how to interact with them.