Which entity processes Medicare claims and supports program integrity?

• A. Local hospital boards
• B. Medicare Administrative Contractors (MACs)
• C. Private insurers in the marketplace
• D. State health departments

Answer: (B)

The key idea is who handles Medicare claims processing and helps keep the program honest. Medicare Administrative Contractors are the CMS-approved entities that process most Medicare Part A and Part B claims, issuing payments and handling adjudication. They also play a central role in program integrity, conducting provider enrollment checks, reviews, and audits to detect and prevent improper payments and fraud. This combination of claims processing and integrity work is what ties MACs to Medicare’s administration.

Local hospital boards govern individual facilities and don’t run the nationwide claims system. Private insurers in the marketplace administer private plans, not Medicare. State health departments focus on public health issues and state programs, not the Medicare claims processing and integrity functions. Therefore, the entity that processes Medicare claims and supports program integrity is the Medicare Administrative Contractor.