As you navigate the complex world of Medicare, you’ll more than likely encounter numerous acronyms and other confusing terminology. Two that you may have already stumbled across are DMERC and DME MAC. Although the two terms are often used interchangeably, they actually refer to two distinct reimbursement programs for durable medical equipment (DME).
Similar though they are, it’s important for any medical provider to understand the current terms in the industry. In this post, we’ll clarify the distinction between DMERC and DME MAC, explain what they are, and how they work today.
What Does DMERC Mean?
DMERC stands for Durable Medical Equipment Regional Carrier. The Centers for Medicare & Medicaid Services (CMS) implemented this program many years ago to handle reimbursement for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
Aside from the program itself, the term “DMERC” has also long been used to refer to the partnering contractors the program employed. Under this program, Medicare reimbursed providers for DMEPOS items according to a DMERC-established fee schedule.
The program split the United States into four DMERC regions, each with its own contractor responsible for administering the program in that region. The contractors handled the processing of all claims and appeals. Though the program saw decades of success for Medicare, DMERC was overhauled in favor of a newer system in December 2006.
What Does DME MAC Mean?
Durable Medical Equipment Medicare Administrative Contractor (DME MAC) is the program that replaced DMERC on the first of January, 2007. Similar to DMERC, DME MAC employs contractors to manage reimbursement for DMEPOS items. However, there are a few significant differences in how the current program operates.
As was the case with DMERC, the DME MAC program divides the country into regions with a designated MAC (Medicare Administrative Contractor) assigned to each. Here are some names you should expect to see:
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
To find out what region and DME MAC partner your state falls under, visit CMS.gov.
Are DMERCs and DME MACs the Same Thing?
Although the terms DMERC and DME MAC are frequently used interchangeably, they refer to two distinct programs with different operating standards. DMERCs were primarily concerned with processing claims and paying for DMEPOS items according to a fee schedule, while DME MACs are additionally responsible for conducting audits in addition to processing claims. Beyond this, today’s MACs provide education and outreach programs to medical suppliers and providers to help them understand Medicare requirements and avoid costly billing errors.
Understanding the World of DMERCs and DME MACs
The multi-faceted terminology surrounding Medicare and its reimbursement practices can be difficult to comprehend, especially when it comes to similar programs such as DMERC and DME MAC. While seemingly identical at first glance, there are significant differences that can have a substantial impact on reimbursement procedures. This makes it all the more important to understand the difference.
If you’re a supplier or provider looking for help with navigating the complex world of Medicare and DMERCs, reach out to Medbill today. Our team of experts can educate you not only in industry terminology but also in the best possible practices for Medicare billing. With Medbill, you can be confident you’re getting the reimbursement you deserve.
Contact Medbill today to discover a better understanding of medical billing.