Importance of DMERC & DME MAC in Durable Equipment Billing

Navigating through the complex lanes of healthcare is a tough task. You will come across various acronyms and other confusing terms that are hard to understand. Two of the terms that you might have stumbled across are DMERC and DME MAC. These two terms are often used interchangeably, but they actually refer to two different reimbursement programs for durable medical equipment. Learning about these terms is very important to cross the DME billing hurdles that you might come across.

They are somewhat similar but if used incorrectly, it can cause huge damage to your revenue cycle. In this blog we will learn about the differences between these two and see how they work.

What Is DMERC?

DMERC stands for Durable Medical Equipment Regional Carrier. It was implemented by Medicare and Medicaid Services (CMS) many years ago to handle reimbursements for durable medical equipment, prosthetics, orthotics, and supplies.

Apart from the program, DMERC has been used for a very long time to refer to the partnering contractors for the program employed. Under this program, Medicare reimburse providers for DMEPOS items according to a DMERC-established fee schedule.

According to the program, the United States is divided into four DMERC regions, each having its own contractor responsible for handling the program in that region. The contractors handled the processing of all claims and appeals.

What Is DME MAC?

DME MAC stands for Durable Medical Equipment Medicare Administrative Contractor. It is a program that replaced DMERC on the first of January 2007. Similar to DMERC, DME MAC employs contractors to handle reimbursement for DMEPOS items. However, there are some significant differences in how the current program operates.

Just like DMERC, the DME MAC program also divides the country into several regions with a designated MAC (Medical Administrative Care) assigned to each region.

• Noridian Healthcare Solutions
• Palmetto GBA, LLC
• CGS Administrators
• National Government Services
• Wisconsin Physicians Service Government Health Administrators
• Novitas Solutions, Inc
• First Coast Service Options, Inc

These are some names you might see in the differentiated regions.

Are DMERCs & DME MACs the Same Thing?

DMERC and DME MAC are used interchangeably, but they are two different programs with totally different operating standards. DEMRCs are primarily concerned with processing claims and paying DMEPOS items according to a fee schedule. Whereas DME MACs are responsible for conducting audits in addition to processing claims.

Beyond this, today’s MACs provide education and outreach programs to medical suppliers and providers that help them understand Medicare requirements and avoid hefty billing errors.

Understanding the World of DMERCs & DME MACs

The multi sided terminology around Medicare and its reimbursement practices can be a bit difficult to comprehend. Especially when it comes to programs like DMERC and DME MAC. These two seem identical at first glance, but there are some significant differences that are of huge importance and cannot be ignored. If done incorrectly, it will strongly impact the reimbursement of healthcare practices. This makes understanding the difference more important.

In the world of healthcare, managing and focusing on every aspect of medical billing is not easy for every healthcare provider. This is where partnering with a DME billing company can be helpful for providers.

Conclusion

Having an efficient revenue cycle management is what every healthcare practice wants. This is what keeps them on track and lets them focus on patient care. Finding the right DME billing company is a bit time-consuming, but it is not that difficult.

Unify Healthcare Services is one such DME billing company that manages the billing of multiple small and big scale healthcare organizations. We have a team of experts who are well-trained in all the elements of medical billing and coding. We make sure that you are relieved of all the administrative burden so that you can focus solely on patient care. Finding us is very easy. Just search “Outsource Medical Billing Services Massachusetts” on Google and you will find us in the top results.

Our experts create accurate claims for you fostering a fast and healthy reimbursement cycle. If somehow a claim gets denied, we act proactively to rectify and resubmit the claim within the provided time frame.

Getting you reimbursed for every single treatment rendered is always a priority for us. We believe that you can provide better patient care with a peaceful and healthy mindset. Which is why we do not offer just medical billing services, we offer mental peace.