Collectively in FY2021, the MACs processed more than 1.1 billion Medicare FFS claims, comprised of approximately 221 million Part A claims and 956 million Part B claims, and paid out approximately $424 billion in Medicare FFS benefits.Ī/B MACs process Medicare Part A and Medicare Part B claims for a defined geographic area or “jurisdiction,” servicing institutional providers, physicians, practitioners, and suppliers. In Fiscal Year 2021 (FY2021), the MACs served more than 1.1 million health care providers who are enrolled in the Medicare FFS program.

Learn more about the strategy in the Archives.Ĭurrently there are 12 A/B MACs and 4 DME MACs in the program that process Medicare FFS claims for nearly 56% of the total Medicare beneficiary population, or 36 million Medicare FFS beneficiaries. Various elements of the Agency’s original strategy for implementing Section 911 of the MMA evolved over the years. CMS procures all MAC contracts according to the Federal Acquisition Regulation. Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003 directed CMS to replace the Part A Fiscal Intermediaries (FIs) and Part B carriers with MACs. Coordinate with CMS and other FFS contractors.Review medical records for selected claims.

Establish local coverage determinations (LCD’s).

Educate providers about Medicare FFS billing requirements.

Handle redetermination requests (1st stage appeals process).Handle provider reimbursement services and audit institutional provider cost reports.Enroll providers in the Medicare FFS program.Make and account for Medicare FFS payments.MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. 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. Relationships between MACs and Functional ContractorsĪ 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 or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.

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