Not to submit claims to Medicare when service are related to DMERC, RHHI AND UMWA

Durable Medical Equipment Regional Carrier (DMERC) 

Physicians are required to submit most claims for durable medical equipment, prosthetics, orthotics, and supplies to one of the four Durable Medical Equipment Regional Carriers (DMERCs) that proc- ess DME claims. A listing of DMERCs is also available at on the Internet.

For a complete list of procedure codes billable to the DMERC, physicians may write to the local Medicare contractor or local DMERC.

Regional Home Health Intermediary (RHHI) 

RHHIs currently process Part A hospice and home healthcare claims. The beneficiary ’ s home state determines which RHHI is responsible for processing his or her claim. For the appropriate State in- termediary, physicians should contact their contractor. This information is also available at on the Internet.

United Mine Workers of America (UMWA) 

Some Medicare beneficiaries are members of the United Mine Workers of America (UMWA). The UMWA Health and Retirement Fund is a health benefit plan for retired UMWA coal miners, spouses, and dependents. The local Medicare contractor can provide information on where to send UMWA claims.

Medicare Managed Care Plan 

When a beneficiary is a member of a Medicare managed care plan, the plan is responsible for paying claims under the following conditions:

The physician is affiliated with the Medicare managed care plan
The physician provides emergency services, urgently needed services, or other covered services not reasonably available through the Medicare managed care plan

When a physician submits claims for a beneficiary enrolled in a Medicare managed care plan, the local Medicare Part B carrier will deny payment (except dialysis and related services provided in a dialysis facility).

No comments:

Medical Billing Popular Articles