Which contractors are responsible for reviewing and paying claims for Medicare?

Medicare claims are reviewed and paid by Medicare Administrative Contractors (MACs). MACs are private companies that have been contracted by the Centers for Medicare & Medicaid Services (CMS) to process claims, determine eligibility, and ensure the proper payment of medical services provided to Medicare beneficiaries. They play a crucial role in the administration of Medicare, facilitating transactions and ensuring compliance with regulations, thus enabling healthcare providers to receive timely and accurate reimbursements.

In contrast, the other organizations mentioned serve different functions within the healthcare compliance landscape. For instance, the Health Resources and Services Administration (HRSA) focuses on enhancing healthcare services and access, particularly for underserved populations. The Office of Inspector General (OIG) is primarily involved in overseeing and promoting efficiency, transparency, and accountability in federal healthcare programs but does not process claims. The Zone Program Integrity Contractors (ZPIC) are tasked with preventing and investigating fraud, waste, and abuse in Medicare and Medicaid, rather than processing claims. This delineation of responsibilities highlights why MACs are specifically designated for claim review and payment within the Medicare system.