The process of submission and following up on medical claims to insurance companies for receiving payment for services rendered by a health care provider is medical billing. It is a common process that is required for both the private and public insurance claims. Medical billing always requires adherence to proper coding and other procedures so that the insurance medical claim process is simplified. In the medical billing process, medical coding is the first step.

So what is SADMERC? Well, it is an abbreviation and expands 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). CMS was previously known as the Health Care Financing Administration (HCFA). It is a federal agency within the United States Department of Health and Human Services (DHHS) and administers the Medicare program and also works in partnership with State governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards. SADMERC 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 CMS 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. Now, it is here that SADMERC has to providing suppliers and manufacturers with assistance in determining which HCPCS code should be used for billing Medicare. 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!

SADMERC also has the function of operating a HCPCS Coding Helpline to answer questions about and to provide appropriate codes upon request. It also responds to written inquiries requesting HCPCS coding assistance. HCPCS Coding Verification Applications can be accessed online.

The SADMERC toll free helpline is (877) 735-1326, and works 9 AM to 4 PM (EST).