A fiscal intermediary, sometimes called a Medicare Administrative Contractor, works with the federal government to help administer certain Medicare benefits and services. Learn more about how these companies work with federal programs like Medicare and Medicaid.
You may deal with a fiscal intermediary when accessing some government-subsidized services, such as health services like Medicare or Medicaid. If you're in this position, it's natural to wonder what a fiscal intermediary is and how these organizations work.
What is a fiscal intermediary, and what do they do?
A fiscal intermediary is a business contracted by the federal government to administer a program and process its payments in a specific geographic location, such as a metro area or a state. These businesses are usually private companies that work in the insurance industry.
The Office of Insurance Regulation regulates fiscal intermediaries and sets the requirements for registration. Once a fiscal intermediary is authorized, they can partner with government programs such as Medicare and Medicaid.
Fiscal intermediaries play an essential role in communicating and processing payments on behalf of the government and the people and businesses who use their programs. They can perform several functions, including:
Administering claims for government programs, including Medicare and Medicaid, and making payments to health providers
Advising people covered by government programs about subsidized services and any changes
Auditing providers and assessing their financial reports
Communicating with government employees on behalf of program beneficiaries and providers
Establishing the wages of people delivering government-subsidized services
Informing people who perform subsidized services, such as health providers, about government programs and billing requirements
Processing income tax and withholdings for people delivering government-subsidized services
Reviewing medical records and deciding if certain services are medically necessary
Supervising provider enrollments
Is a fiscal intermediary the same thing as a Medicare Administrative Contractor (MAC)?
A Medicare Administrative Contractor (MAC) is a type of fiscal intermediary that works with the Medicare program.
After the passing of the Medicare Prescription Drug Improvement and Modernization Act of 2003, the Centers for Medicare and Medicaid Services (CMS) replaced its Part A fiscal intermediaries and Part B carriers with MACs who perform all the duties of fiscal intermediaries.
These private health care insurance companies can process:
A network of MACs serves as the primary contact point between the Medicare FFS program and health care providers across the country. While fiscal intermediaries working with Medicare are now called MACs, those working with Medicaid are still called fiscal intermediaries, or FIs for short.
Who are the Medicare intermediaries?
The federal government contracts with a selection of MACs, or Medicare intermediaries, to administer its Medicare program in districts across the country.
MAC Jurisdiction DME A (Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont)
MAC Jurisdiction DME D (Alaska, Arizona, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, American Samoa, Guam, Northern Mariana Islands)
MAC Jurisdiction E (California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands)
MAC Jurisdiction F (Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming)
CGS Administrators, LLC
MAC Jurisdiction DME B (Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin)
MAC Jurisdiction DME C (Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico, U.S. Virgin Islands)
MAC Jurisdiction 15 (Kentucky, Ohio)
Wisconsin Physicians Service Government Health Administrators
MAC Jurisdiction 5 (Iowa, Kansas, Missouri, Nebraska)
MAC Jurisdiction 8 (Indiana, Michigan)
National Government Services, Inc.
MAC Jurisdiction 6 (Illinois, Minnesota, Wisconsin)
MAC Jurisdiction K (Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont)
Novitas Solutions, Inc.
MAC Jurisdiction H (Arkansas, Colorado, New Mexico, Oklahoma, Texas, Louisiana, Mississippi)
MAC Jurisdiction L (Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania. Includes Part B for counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia)
Palmetto GBA, LLC
MAC Jurisdiction J (Alabama, Georgia, Tennessee)
MAC Jurisdiction M (North Carolina, South Carolina, Virginia, West Virginia. Excludes Part B for the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia)
First Coast Service Options, Inc.
MAC Jurisdiction N (Florida, Puerto Rico, U.S. Virgin Islands)
Note that there is some overlap as MACs have jurisdiction over a set geographical area, which is often smaller than an entire state.
As of December 2020, the approved Medicare intermediaries for home health and hospice claims and the states and territories they work in are:
National Government Services, Inc.
Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, Northern Mariana Islands, Oregon, Puerto Rico, US Virgin Islands, Wisconsin, and Washington
CGS Administrators, LLC
Delaware, District of Columbia, Colorado, Iowa, Kansas, Maryland, Missouri, Montana, Nebraska, North Dakota, Pennsylvania, South Dakota, Utah, Virginia, West Virginia, and Wyoming
Palmetto GBA, LLC
Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont
Will I have a relationship with a fiscal intermediary?
You might have a relationship with a fiscal intermediary if you have a personal or home care assistant subsidized by Medicaid. You might also work with a fiscal intermediary if one of these assistants cares for your parents or other loved ones. Working with a fiscal intermediary can give you greater control over the care you or a relative receives.
Working with a fiscal intermediary allows you to do the following:
Choose the person administering care
Train them to satisfy your specific care needs
Dismiss the carer if things don't work out
Unlike fiscal intermediaries working with Medicaid, MACs usually communicate more with health care providers than members of the public. Most Medicare beneficiaries don't have relationships with MACs, although a MAC may approve subsidies for your services without you ever knowing.
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