General Claims Processing Rules for DMEPOS

90.2.2 - General Claims Processing Rules for DMEPOS (Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06) The DME MACs may only be billed for surgical dressings, splints, casts and for prosthetics and orthotics by IHS suppliers, not by IHS providers. The Region D DME MAC shall accept all DMEPOS claims submitted by IHS suppliers and shall forward electronic media claims to the appropriate DME MAC for processing. IHS providers already bill the designated A/B MAC (A) for DME used in the home. The DME MACs shall identify the IHS, tribe and tribal organization facilities by specialty code. If an IHS or an Indian tribe or tribal organization facility (hospital-based or non-hospital- based) submits an unassigned claim with dates of service on or after July 5, 2005, to the DME MAC for these Medicare Part B services, the DME MAC shall process the claim as though the IHS or an Indian tribe or tribal organization had accepted assignment of the claim. The DME MACs shall identify DMEPOS claims submitted by IHS suppliers and waive coinsurance and deductible for these beneficiaries. The DME MACs shall apply all other edits, including Certificate of Medical Necessity (CMN) requirements. The MSN is suppressed. Deductible and coinsurance amounts are applied by Medicare, but are waived by the IHS.