Medical billing always requires adherence to proper coding and other procedures so that the insurance medical claim process is simplified. So what is SADMERC? Well, it refers to The Statistical Analysis Durable Medical Equipment Regional Carrier. It is a national entity that provides services under contract to the CMS (Centers for Medicare & Medicaid Services). It’s Reports and Analysis Unit provides data analysis support to the Durable Medical Equipment (DME) and Program Safeguard Contractors (PSCs).
Thus, SADMERC is a liaison between medical suppliers, manufacturers, and the Centers for Medicare & Medicaid Services to determine which Level II HCPCS codes work best for Medicare-reimbursed DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies). CMS instructs the different manufacturers/suppliers to contact the SADMERC HCPCS units to get the proper codes and prices for items. SADMERC also performs a variety of national pricing functions for DMEPOS services besides assisting CMS with the DMEPOS Fee Schedules and analysis of DMEPOS fees/ issues.
How long does it take for the verification of a code? SADMERC indicates that a decision may be made 90 days after receipt of the supporting documentation and initiation of the review process. Users of a product contact the SADMERC to find out if a particular product is coded. Now can a SADMERC Coding Verification Review decision be appealed? Yes of course!
The SADMERC toll free helpline is (877) 735-1326, and works 9 AM to 4 PM (EST). Refer a more detailed FAQ at, http://gmassocinc.com/7-faq.htm
HCPCS Coding Verification Applications can be accessed HERE!