Medicare is a federal program that pays for specific health related services for individuals 65 and over. Medicare programs are administered by designated organizations which are assigned specific geographical regions. Medicare is divided into four parts – Part A for inpatient services, Part B for outpatient services, Part C for Medicare HMO programs and Part D which covers prescription medications.
In the past more than one organization administered programs for one state. Currently, MACs or Medicare Administrative Contractors are being selected to function as carrier (previously the term for the administrator of Part B benefits) and fiscal intermediary (previously the term for the administrator of Part A benefits).
Organizations administering Medicare benefits must operate under certain NCD’s (national coverage determinations) created by CMS (Centers for Medicare and Medicaid Services) and by local guidelines or LCD’s (Local Coverage Determination) created by the specific organization for each state impacted.
