DMERC billing

[drxtine]

has anyone EVER billed for materials/glasses after cataract surgery to the same Medicare entity as the exams (not DMERC)?? Does anyone know if that was the case back in the day, years ago?? I inherited this practice where the original employees had left and i'm trying to pick up the pieces...but they said they would send all their claims to the same place and they would get some kind of reimbursement. doesn't make sense to me but it anyone has any info i'd really appreciate it. thank you

[harry888]

Probably ALL claims went to a billing service at the same address.

Harry

[drxtine]

They didn't use a billing service...they didn't even bill electronically! They mailed all the claims directly to Medicare. I'm stumped.

[sharonm516]

Well....first things first....did they get the waivers and paperwork signed at the time of dispensing? If not, you will have to write it off. DMERC wont pay without the modifiers for the waivers on them. :finger: Applying the modifier and sending it in without the waivers on file constitutes Medicare fraud. Been through a Medicare audit and its not pretty and you dont want one of them. :idea:
I just wrote off about $8,000 in DMERC because of that:angry:...so you and I are in the same boat...in picking up pieces of insurance. I started with $40,000 total in unpaid claims from all sorts of insurance companies...now Im down to $10,000. :hammer:
DMERC still has to be sent in by mail and depending on what region you are in will determine the mailnig address. Any other Medicare claims are to be done electronically, I think Medicare will charge you per paper claim to process.
Good Luck to you...its a dirty dirty job insurance is!!!

[fjpod]

It depends on your part of the country. Years ago, it was all billed to traditional medicare. Here in NYC, we now bill DMERC to a different company than traditional medicare. Do a Google search on DMERC in your area, call them and ask the procedure.

[bwoz]

Doctor, I realize this posting is a little older. Massachusetts is one of those states that currently use the same carrier (NHIC) for part B and DME billing. I believe your state of California now uses NHIC for your part B and Noridian Mutual for DME. I thought I saw in some of our NHIC publications that California recently switched over to them, so you may have had the same carrier in the past. Here's a link for carriers by state from cms http://www.cms.hhs.gov/ContractingGe...Cdirectory.pdf
Either way, I'd contact Noridian and verify they are your carrier and get your own updated manual and start from scratch. There are so many rules and regs, at least w/our carrier, that it'd probably be best for you to get it straight from them anyway! Hope this helped.
barb

[James Peterson]

Hi,
Yes, I do.
DMERC, DURABLE MEDICAL EQUIPMENT REGIONAL CARRIERS.
First, you should go to their web site.
Ultimately, you will need to set up your office with a NPI Number, as well as a P TAN Number code.
The web site, and customer service, , 1-866-419-9458, are helpful.
Here is how it generally works.
Patients are allowed $60.88 for a frame. The same, approx. for flat top 28 mm bifocals, a little less for S.V.
(ALL CR-39)
Anything over the designated amounts , called UPGRADES, The Patient is responsible for.
IE, Progressives, Poly, A/R, etc.
Set up your program on line, if you can.
Have DMERC send to your office the very critical ( v ) codes.
For example, V2200 represents the frame code.
Make sure your office has a supply of Value Eyewear type, inexpensive frames. IE Frames that you would retail for , say, $ 75.00.
If a patient says, " My friend told me that she received her Post CAt. glasses for free, that may be true if they were, for EX. CR-39, FT 28, With A Value Frame.
"Always ask patients for their primary Medical Coverage, as well as their Secondary carrier, because, Medicare, for example is only going to cover 80% of the basics, while their secondary may pick up the additional 20%
Let me know if I can help?
James Peterson, R.D.O.
:cheers:

[PAkev]

Contingent upon your jurisdiction the address varies. We send ours to the following address:

NHIC, Corp DME MAC Jurisdiction A
PO Box 9180
Hingham, MA 02043-9180