What is the role of a Medicare Administrative Contractor (MAC)?

• A. A private sector organization that audits hospitals only.
• B. A government agency that writes Medicare policy.
• C. A private sector organization contracted by CMS to process claims, pay providers, and support program integrity for Medicare.
• D. An independent charity that funds Medicare research.

Answer: (C)

Medicare Administrative Contractors are private sector organizations contracted by CMS to run the program’s administrative tasks in specific regions. Their primary role is to process Medicare claims, pay providers, and support program integrity by identifying and preventing improper payments, fraud, and abuse. They also handle provider enrollment and eligibility, and respond to provider inquiries, all under CMS oversight. This differs from options that describe a government policy-writing body, an entity limited to auditing hospitals, or a charitable fund; those don’t match the operational, contractor-based nature of MACs.