Medicare Administrative Contractors (MACs) are private insurers that process Medicare Part A, Part B (A/B), and Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. They serve as the primary link between CMS and healthcare providers, ensuring accurate claims processing and compliance.
Key Responsibilities of MACs
1. Claims Processing & Adjudication
MACs evaluate and pay Medicare Part A and Part B claims from hospitals, physicians, and outpatient providers within their jurisdictions.
2. Provider Enrollment & Credentialing
They manage Medicare enrollment, ensuring only eligible providers can bill Medicare.
3. Medical Reviews & Audits
MACs verify claim accuracy, checking for medical necessity and compliance with Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs).
4. Provider Support & Education
- Answer billing and coding questions
- Offer training (webinars, guides) on Medicare rules
5. Fraud & Abuse Prevention
MACs detect and report suspicious billing patterns to prevent Medicare fraud.
MAC Jurisdictions & Specializations
- Part A/B MACs: Process hospital, physician, and outpatient claims.
- DME MACs: Handle durable medical equipment claims.
MACs operate in designated multi-state regions, ensuring efficient Medicare administration.
For practice managers and providers, understanding MAC functions helps streamline billing and avoid claim denials.
(Source: CMS.gov)