Which federal agency administers the Medicare program and Medicaid programs and oversees the MACs involved in processing and reviewing Medicare claims at the first and second level of appeals?

• A. Food and Drug Administration (FDA)
• B. Centers for Medicare and Medicaid Services (CMS)
• C. National Institutes of Health (NIH)
• D. Department of Health and Human Services (HHS)

Answer: (B)

The Centers for Medicare and Medicaid Services administer the Medicare and Medicaid programs and oversee the Medicare Administrative Contractors (MACs) that process Medicare claims and handle the early levels of appeal. CMS sets the rules, pays the bills, and manages the contractors who actually run the claims workflow and initial review processes. While the Department of Health and Human Services is the parent department that houses CMS, the agency responsible for day-to-day administration and MAC oversight is CMS itself. The other agencies have different missions: the FDA regulates foods, drugs, and medical devices; the NIH conducts medical research.