DME Billing

Payer IDs

Any of the following Payer IDs can be used. They are all directed to a single Clearinghouse.

• DMERC
• DMEAA
• DMERC
• DMECC
• DMEDD

CFI

The Claim Filing Indicator must be MB.

POS

The Place of Service is 12, and when used, the Patient's Address is populated on the claim instead of a practice address. If you have made a change to the Place of Service, check the line to make sure they have been updated as well.

Patient's Address

The Patient's Address must be the same as the Medicare database. On the Eligibility Report, you can view the Patient's Address that Medicare has on file. You may need to temporarily change the Patient's Address in the System, send the Claim to Medicare DME, and return to the Patient and change the Address back to the previous one if it is correct.

Add DME to an Active Insurance Profile

1. In the Active Policies panel, click the Insurance Management link on the Encounter or Patient Dashboard.

2. Click the Add New Insurance Profile button.

3. Deselect the Default checkbox.
4. Click the Add New link.

5. Select the DME Insurance.
6. Enter the Policy number.
7. Click Save [F2].

8. Using Add New or From Existing link, add Secondary and Tertiary, if applicable. Skip this step if none exists.
9. Click Save [F2]. (If this Save step is missed, the new profile will land in the Policies Not Part of an Insurance Profile panel.

Send Medicare or Medicaid DME To The Correct Payer

For Medicare and some Medicaid, DME claims must be sent to a different payer. The DME payer should be set up in the Insurance Library as a unique Insurance. You need to add the DME policy to an Active Insurance Profile for the patient.

1. From the Post or Modify Charge screens, choose the correct Insurance Profile from the  Insurances dropdown list.

If the Insurance does not exist, click Edit (next to the Patient information) to proceed to the Patient Dashboard. Click Insurance Management to add.

Example of a DME Charge

1. Choose the Insurance profile.
2. Use Facility that is set up with POS 12 - typically required by Medicare and other payers. 

DME Claim Rejections

• Was the claim sent to DMARC with the CFI, MB?
• Does the claim have POS, 12 (home)?

• When POS 12 is used, the Patient's address is automatically populated on the Claim for the Place of Service.
• If you have not chosen 12 for the POS, modify the Encounter POS making sure each line item updates to POS 12.

• Is the Patient address the same as the real time Eligibility check?

• In ERA Remit example below, the Patient address in the System is not the same as the one from the Medicare Eligibility response.

Resubmit the DME Claim

Resubmit the Claim with the Address Medicare has on file.

Example 1

• Temporarily change the address on the Demographics screen.
• Set the Claim to Ready for Submission/Resubmission.
• Submit the Claim.
• When it has been Clearinghouse accepted, change the address back to the original address.

Example 2

• If this is a person that lives at one address for several months and another address the rest of the time, you can create an additional Guarantor Statement address that is different from the address that is in the Demographics.
• Change the Demographic address to the Medicare address on the Eligibility Check.
• Add the Statement address to the Guarantor.