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What Is a Medicare Administrator?

The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for Medicare regulation and oversight. Medicare administrative contractors process claims for beneficiaries enrolled in original fee-for-service Medicare.

  1. About CMS

    • CMS is an agency of the U.S. Department of Health and Human Services with headquarters in Woodlawn, Maryland. Its responsibilities include administering the Medicare and Medicaid programs and setting standards for accrediting or certifying health care providers such as laboratories, hospitals and nursing homes. CMS also plays a large role in the federal Children's Health Insurance Program (CHIP), medical privacy and insurance reform.

    CMS Administrator

    • The CMS administrator position is a political appointment, with a new administrator appointed after a president takes office. Acting administrators are usually career federal employees who temporarily take the agency helm when the administrator resigns.

    Regional Administrators

    • There are 10 CMS regional offices that represent the agency at the local level to ensure Medicare policies and guidance are consistently implemented. Each of these offices has a regional administrator.

    Medicare Administrative Contractors

    • Medicare contractors perform most day-to-day Medicare operations that are visible to beneficiaries. Upon completion of the Medicare contractor reform mandated by the 2003 Medicare Modernization Act, 15 Medicare administrative contractors will administer Part A and Part B claims processing.

    History

    • CMS, previously known as the Healthcare Financing Administration (HCFA), was created in 1977. Prior to then, Medicare was administered by the Social Security Administration.

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