Audio transcript: Properly understanding and following the DME payer sequence is crucial for accurate billing and reimbursement. The payer sequence determines who pays first, and ensures claims are submitted in the correct order to prevent denials and compliance issues. The DME payer sequence begins with the primary payer—the first insurance responsible for payment. This may be Medicare Part B if the patient qualifies, private insurance if the patient has commercial coverage, or workers' compensation for work-related injuries. Then comes the secondary payer, who pays after the primary payer has processed the claim. This may include Medicare as a secondary payer (MSP) if another insurance is primary, Medicaid if the patient is dual-eligible for Medicare and Medicaid, and supplemental or Medigap plans that cover patient out-of-pocket costs. Patient responsibility covers any remaining balance after insurance processing, including copayments, deductibles, or co-insurance amounts, as well as out-of-pocket expenses for non-covered items.
Following payer sequences is important because it prevents billing errors and claim denials. Ensuring compliance with Medicare and Private Ensure Guidelines helps patients maximize their benefits while reducing out-of-pocket costs. Understanding the correct payer order ensures timely and accurate reimbursements while keeping your DME business compliant.
