“The documentation, history, and trends that result from a gap analysis process can be particularly valuable to new managers” (Healthcare Financial Management Association, 2008, para. 13). As an employee of a Medicare Administrative Contractor (MAC) for the Centers for Medicare & Medicaid Services (CMS), the author will conduct a gap analysis to better understand claims administration. The purpose of this document is to describe the process of interest and outline the plan for conducting a gap analysis. Determination of Medical Necessity Medicare benefits are delivered to eligible beneficiaries through a number of Medicare administrative contractors (MACs). Similar to the meaningful use requirements that health care providers must meet, MACs must adhere to federal CMS guidance defining the process for determining medical necessity. As stated in Review of Medical Necessity Decisions, "[The] primary expectation is based on evaluators' knowledge of Medicare coverage requirements... However, evaluators are expected to follow all applicable Medicare requirements, such as deadlines for evaluation, in the exercise of their functions. » (Medicare Program, 2011, p. 21496). The current medical examination process in an exclusive MAC (hereinafter referred to as “Well Health”); will be revised for the course project. At Well Health, incoming service requests from healthcare providers are received by fax and made available to nurse evaluators in electronic format using a computerized application. Once received by the examiner, the nurse must access numerous websites and programs to complete the medical necessity review process. Each of these applications closely resembles standard electronic health records (EHRs) used in many...... middle of paper...... September). A gap analysis methodology for the team's software process. In Quality of Information and Communications Technologies (QUATIC), 2010 Seventh International Conference on (pp. 424-429). Retrieved from Google Scholar database. Fater, K. H. (2013). Gap Analysis: A method for assessing the development of core competencies in the curriculum. Perspectives on Nursing Education, 34(2), 101-5. Retrieved from http://search.proquest.com/docview/1350295201?accountid=14872Healthcare Financial Management Association (HFMA). (2008). Gap analysis helps nurses become better leaders. Retrieved from http://www.hfma.org/Content.aspx?id=3398Medicare Program; Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs for Contract Year 2012 and Other Changes, 76 Fed. Reg. 21495 (April 15, 2011) (to be codified at 42 CFR pt. 422.562, 422.566, 423.562, & 423.566).