Many physical therapists (PTs) and physical therapist assistants (PTAs) know the names Noridian Healthcare Solutions, Novitas Solutions, and Cahaba Government Benefit Administrators. They are 3 of the largest Medicare Administrative Contractors, or MACs—private health insurers that have been awarded contracts from the Centers for Medicare and Medicaid Services (CMS) to process claims for Medicare parts A and B services and for durable medical equipment (DME) for Medicare fee-for-service beneficiaries. MACs are granted jurisdiction over defined service areas, with 12 MAC jurisdictions for Medicare parts A and B processing and 4 MAC jurisdictions for DME.

In addition to processing claims, MACs provide services that include making and accounting for payments, enrolling providers in the Medicare program, handling redetermination requests, educating providers about billing requirements, reviewing medical records for selected claims, and coordinating with CMS and other contractors. In this column, however, let's take a closer look at MACs' role in making local coverage determinations (LCDs).