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A fiscal Intermediary (FI) refers to an entity or a private company that has a contract with the center for medicare and medicaid services (CMS) to determine and to pay part A and some part B bills such as bills from hospitals, on a cost basis and to perform other related functions. They are also called an "intermediary". The decision made by an FI or a carrier under medicare part A or part B is called the local coverage determination (LCD).
An FI provides written guidance to MDs, DOs, and DPMs. They also contract with the health care financing administration (HCFA) to administer a major part of the medicare program. All FI must meet the requirements outlined in the medicare intermediary manual. Fiscal intermediary services organizations (FISOs) are regulated by the Office of Insurance Regulation.