We have enhanced the intelligence of BFN (Bill From Note) for DMERC claims. There are a few scenarios in which I am going to explain how it works.
Scenario 1: Medicare only on patient chart
When a provider is using the Podiatric Care Macro formerly known as Routine Foot Care and creates a claim for lets say Ankle Sprain with a Pneumatic Walker Boot (L4360) which is a DME code, the provider will receive a pop up stating: "This claim must be billed to DMERC. However, this patient does not have a DMERC carrier on chart. You must add DMERC to the patient chart to process this claim."
At this point, if you were to pull up the patients chart and add DMERC and come back to SamNotes, click ok and then "Create Claim as Above" a second time and it will recognize that the patient has DMERC. There is a pop up making you aware of the change. The message box states: "This claim must be billed to DMERC. This patient has a DMERC carrier. As such, we have updated the primary insurance on this claim." Click ok and the claim will be created properly to DMERC.
Scenario 2: Medicare Primary and billing E&M with DMERC codes
When a provider is using the Podiatric Care Macro formerly known as Routine Foot Care and creates a claim for lets say Callus with debridement (11055), Ankle Lace Up Boot (L1902) which is a DME code and X-ray (73610), the provider will receive a pop up stating: "There is/are procedure code(s) that must be billed directly to DMERC and not Medicare Part B. This patient does not appear to have DMERC as either a secondary or tertiary carrier. As such, this claim will be denied if submitted to Medicare Part B."
The provider will need to remove the DMERC code (L1902) from this claim and then bill that out separately via the billing screen.
Scenario 3: Medicare Primary and DMERC Secondary or Tertiary
When a provider is using the Podiatric Care Macro formerly known as Routine Foot Care and creates a claim for lets say Ankle Sprain with a Pneumatic Walker Boot (L4360) which is a DME code and an Office VIsit (99213), the provider will receive a pop up stating: "This claim has both DMERC and non DMERC procedure codes. Please modify your note to reflect procedure codes for one carrier."
At this point, the provider needs to determine which carrier they would prefer to bill using BFN and then remove the codes that would need to be billed manually to the other carrier. If the provider were to remove the L4360 and bill the 99213, the claim would be created for Medicare. If the provider were to remove the 99213 and bill L4360 the claim would be created for DMERC.
Removed the L4360 and billed 99213
Scenario 4: DMERC Only on the chart
When a provider is using the Podiatric Care Macro formerly known as Routine Foot Care and creates a claim for lets say Ankle Sprain with a Pneumatic Walker Boot (L4360) which is a DME code and an Office visit (99212), the provider will receive a pop up stating: "You cannot bill E & M codes to DMERC. That has to be on a separate claim."
This is reading from the DMECodes.txt file which is located in the application path C:\SammyEHR, C:\SammyEHR1, etc...
Scenario 5: Commercial Insurance Primary and DMERC Secondary
When a provider is using the Podiatric Care Macro formerly known as Routine Foot Care and creates a claim for lets say Ankle Sprain with a Pneumatic Walker Boot (L4360) which is a DME code and an Office visit (99213) along with an X-ray (73610) and Unna Boot (29580) the claim is created properly to the commercial carrier.
***When the primary pays the claim, the non-dmerc codes are going to cause an issue when transmitted to DMERC as a secondary carrier and will reject via 277 report for HCPCS codes. At that point it is advisable to create a new claim with just the DMERC code, post the primary payment and then send to the secondary carrier.
Scenario 6: Commercial Insurance and DMERC Codes
When a provider is using the Podiatric Care Macro formerly known as Routine Foot Care and creates a claim for lets say Ankle Sprain with a Pneumatic Walker Boot (L4360) which is a DME code and an Office visit (99213) along with X-ray (73610) and Unna Boot (29580) the claim is created properly to the commercial carrier.