Medicare Administrative Contractors: Who They Are and What They Do

Medicare Administrative Contractors, commonly known as MACs, are private companies contracted by the Centers for Medicare & Medicaid Services (CMS) to manage and administer specific aspects of the Medicare program. There are multiple MACs across different regions in the United States, each responsible for handling Medicare claims and services for healthcare providers and beneficiaries within their designated jurisdiction.

Currently there are 12 A/B MACs and 4 DME MACs in the program that process Medicare FFS claims for nearly 54% of the total Medicare beneficiary population, approximately 35 million Medicare FFS beneficiaries. (CMS.gov)

According to CMS, MACs perform many activities including the following:

• 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

See the full list of MACs by state HERE

Medicare Administrative Contractors (MACs) are vital components of the Medicare program, responsible for managing claims processing, provider enrollment, medical reviews, education, appeals, and policy implementation. Their efforts contribute to the effective and efficient functioning of the Medicare system, ensuring that beneficiaries receive the appropriate healthcare services and providers are reimbursed accurately and timely.